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Philhealth: Promoting Quality Care For Filipino Patients

Philhealth: Promoting Quality Care For Filipino Patients 768 487 Exist Software Labs

As the country’s largest health insurance provider and primary source of hospital funds, Philhealth can single-handedly affect healthcare policy changes unlike any other.  Even as the Dept of Health struggles with handling the COVID 19 pandemic – the accuracy of reporting, recruiting, and empowering medical personnel not to mention managing its public persona, Philhealth has continued to stealthily move powerful care institutions to do its bidding with less fanfare.

This is not to say that resistance is non-existent.  On the contrary, Philhealth is among the most difficult to please, for being quite unpredictable and dynamic as it responds to situations with its advisories via its circulars.  One must understand that it is responsible for a huge amount of money. Leaving hospitals huffing and puffing with sudden policy changes and updates to ensure proper disbursements, claims and billing departments can only breathe a sigh of relief if their counterpart team of doctors, nurses, and other care providers are as flexible as their IT personnel.

Beginning in 2018, Philhealth has made and remade its eClaims system not just as the primary payment system for medical services but a valuable cross-checking clinical tool.  It wouldn’t be surprising that as time passes, the eClaims will be requiring more and more supporting data in the form of clinical information that will be good enough to paint a picture of patient health statuses and clinical protocols for every medical condition.  

What may initially be just diagnoses, the data in eClaims submitted by hospitals for their patients include procedures, medications, and other forms of treatment received. By being digital, cross-referencing the case rates with allowable treatment is now possible. One could surmise that the eClaims will not just offer proof but more importantly, ensure that globally-accepted, evidence-based clinical protocols were followed to approve the reimbursements.

In this scenario, hospital information systems will play a vital role in streamlining the process of eClaims processing.  While doctors and care teams ensure that correct and minimally varied treatment protocol is followed in treating patients, they would also be looking to match these with case rates and requirements as well. With digital systems in place that store clinical data such as EMR, the eClaims reimbursement forms would then require minimal manual encoding and prevent literally, ‘costly’ errors.

If payment reimbursements are not enough reason to adopt better hospital IT systems and use of medical records instead of paper, then they will need to find other sources of revenue and prepare to suffer business consequences.  

Once all things fall into place, patients would also get to benefit the most.  With the requirements outlined in the eClaims, they get to receive the right treatment their condition requires and hopefully, the improved patient outcomes that healthcare institutions are primarily in existence for.

Check out our healthcare product, MEDCURIAL, and see how it helped some of the biggest hospitals in the country provide better patient outcomes.

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A Playbook To Improve Clinical Effectiveness and Reduce Variability in Care

A Playbook To Improve Clinical Effectiveness and Reduce Variability in Care 768 487 Exist Software Labs

Rules and payment models keep changing, revenues falling while demand for care quality is at an unprecedented scrutiny. To thrive, hospitals need to address clinical variability.

For years, our team at Exist has made it a priority to build technology capabilities that tear down the barriers of siloed systems particularly in healthcare.

From our clinic system which connects both users and clinics to our hospital system that integrates every available important service within the institution around the patient data and the care that they received, we believed that achieving significant and quality care outcomes required connecting dots via promoting effective care coordination.  After all, a superhero doctor approach – which traditionally has been the case, is unsustainable, if not constrictive.

While ‘interoperability in healthcare’ presents a tremendous gain, it is still not the end goal. What connecting through data unlocks is access to information that could lead to evidence-based care protocols and if taken to heart, reduce care variabilities.  

It is apparent that hospitals globally are under tremendous challenge, not only from containing diseases but operationally with slow revenue growth that results in a sustainability challenge.

This sustainability gap for healthcare providers is a result of multiple factors, not limited to:

    • Rules keep changing midgame
    • Shifting payment models
    • Regulatory changes
    • Rise of non-traditional competitors with tech advantages such as Google, Apple, and Amazon.

It is quite a challenge!  

Many hospitals will try to tighten their revenue cycle management — contain costs by streamlining operations and reducing staff and adding technology — but it would only be a short-term measure because it won’t be able to close this gap unless variability – source of inefficiencies, adverse events, increased lengths of stay, and higher mortality rates is addressed until consistency of care becomes the norm.

At the root, two critical factors emerge that need to be addressed: the decisions clinicians are making every day and the engagement and preferences of your patients. 

For institutions, however, addressing variability is an itch better left unscratched since it involves challenging traditional approaches and behavioral change for an overburdened care workforce, it can get pretty tricky.

Unless doctors and clinicians come across a common care playbook that could make the transition easier and by which they could all align with.

Healthcare is under siege and new approaches are needed. Learn more about evidence-based playbook to reduce clinical variability and address the sustainability gap.  Download the eBook Reducing Variability in Care: Drive Behavioral Changes That Improve Clinical Effectiveness to take a deeper look into proven approaches for improving your organization’s clinical effectiveness.  (Registration required).

Check out our healthcare product, MEDCURIAL, and see how it helped some of the biggest hospitals in the country provide better patient outcomes.