Management Information System (MIS)

Management Information System (MIS) as output or reports of digital system.

• Coverage Indicators

Service Provision Indicator

Assessment of Empanelment Criteria

 

Empaneled Service Providers

• Service Utilization Indicators

Analytical Indicators

Cost of Treatment and Claims related Indicators

Utilization of Revenue generated through health insurance by public sector Service Providers

Marketing/Product Promotion Indicators

Organizational Development (OD)

Organizational development encompasses measures undertaken to improve delivery and quality of service, capacity building of health care providers, administrative and finance staff, provision of equipment (medical/surgical, IT), and devising systems necessary for health insurance.

Above indicators and flow charts of operational processes may be modified and improved according to prevailing circumstances of the country.

Quarterly Progress Reports

• Project Overview
• Project at a Glance: A summary of the project, its objectives, geographical coverage, expected outcome.
• Project Update: A brief description of key progress made so far means major milestones only.
• Financial Summary
• Total Project Budget: _________
• Total Project expenditure incurred to date: _________
• Project expenditure during reporting quarter: _________
• Project Funds allocated for next quarter: _________
• Progress and Achievements
• Population Coverage: The coverage of the eligible population, numbers, and percentage as per linked with taxpayers, utility payers whatever the policy is, and also the number of households from the general population.
• Empanelment of Health Facilities: Described the process involved in impaneling of health facilities, key features of empanelment criteria (the detailed criteria may be annexed to the report), and the number of service providers (public and private separately) they were impaneled up to date and during the quarter.
• Service Delivery: Detail of services availed by insured patients (total admission, segregation by cause of admission, gender and age group of patients, type of health facility (public and private).
• Claims processing: Number of claims received/reported, processed, settled, contested, rejected (segregated by public and private) service providers up to date and during the reporting quarter, the amount claimed by service providers and disburse to service provider. The average time it takes in processing a claim.
• Complaint Management: Mechanism of complaint management. Total complaints lodged, addressed, resolved, feedback from complainants, and most commonly raised complaints.
• Organizational Development: Details of activities undertaken for organizational development such as building up an insurance infrastructure including a range of interventions for improving quality of service, system strengthening, smooth delivery of services.
• Health Promotion: Details of media campaigns and effectiveness of these activities.
• Success Stories
• Include success stories with images and videos if any.
• Key Challenges and Constraints
• Highlight important challenges and problems faced during the reporting quarter and remedial action taken.
• Lessons Learned and Recommendations
• Lessons learned and recommendations during the reporting quarter.
• Planned Activities for next quarter
• Increasing Population Coverage
• Activity Description
• Location
• Tentative Completion Date
• Organizational Development
• Training Title and Description
• Location
• Tentative Completion Date
• Health Promotion
• Media Campaigns
• Location
• Tentative Completion Date
• Other UHC Related Activities
• Activity Description
• Location
• Tentative Completion Date

Empanelment

• Check List

• Primary Healthcare.
• Secondary Healthcare.
• Tertiary Healthcare.
• Rehabilitation Center.
• Palliative Care.
• Registration from Health Care Authority.
• Tax Payer.
• Bank Account with the name of service provider/hospital.
• Multiple health facilities minimum of 3 departments including medical, general surgery, and gynecology/obstetrics.
• Ten or more beds.
• Less than ten beds.
• Provide 24/7 services including emergency services.
• Adequate number of medical officers including women medical officers.
• Willing to provide health services at pre-negotiated rates.
• Agree on payment mechanisms with the insurance company.
• Allocate a focal person for complaint resolution.
• Have a dedicated team to manage claims.