“Framing the Context: ICT- enabled Health Systems – a Luxury, an Option, or a Necessity? ” Partnerships for Enabling UHC Kate Wilson Director, Digital Health Solutions, PATH December 2, 11:00-13:00

What is the Joint Learning Network’s approach? Contextualize common knowledge to country-specific needs. Offer new learning to share across countries. Adapt Knowledge: Engage directly with countries Create a community of policymakers and practitioners. Share Knowledge: Conduct topic-specific cross-country learning activities Synthesize country experience into knowledge products. Make existing information more accessible and useful. Build Knowledge: Document and share global experience

What is the IT Track’s approach? Shared Common Architecture Requirements Standards Guidelines etc. Country Specific Architecture Requirements Standards Guidelines etc. Shared Common Solutions Software Hardware Services etc. Country Specific Solutions Software Hardware Services etc.

Why Partnerships Matter for ICT? Plan Manage & Improve Operationalize Design National policy regarding target population set by country Scheme policy Benefit package Formulary Provider rates Eligibility requirements Provider policy setting Premium setting Fundamental system Beneficiary management Provider management Premium collection Claims management Accounting Analyzing performance Care management Utilization management Provider quality management Fiduciary fund management Actuarial management Medical loss Audit/fraud Rules Data & feedback Change management Data provides policy guidance Source: Joint Learning Network

Why National Partnerships Are Complex? Indonesia’s Presidential Decree 24 states that an entity called BPJS Kesehatan will be established by Jan. 1, 2014 and health insurance will be managed under one umbrella for all citizens of the country. Jamkesmas (insurance for poor and nearly poor) (76.4M) Jamsostek (insurance for formal sector)(4.4M) AASBRI (insurance for active military) (16.6M) Jamkesdas (many schemes provided at provincial/local level Myriad private insurers (Inhealth, etc) (7.5M) By 2014 – First Phase of Integration After 2014 MOH is in charge of regulations but PT Askes is tasked with integration of BPJS 9 Ministries involved with the reform

6/12/ *Please note that system needs and complexity varies greatly dependent on provider payment model. This is a simplified model but functional components are relevant whether capitated or fee for service model. Difference is generally around “timing” and rules vs. data needs National ID Database ID, Birth and Death Registry managed by other Ministry eGovernment Systems Interoperability Layer National Health Insurance System – Basic * Client Registry Indicator Registry Provider Registry Facility Registry Inventory National Health Systems Shared Health Record Other systems Logistics Management Lab Pharmacy Eligible Member Database Accredited Provider Database Key Processes: Enrollment, Eligibility Check, Claims Processing Reimbursements, Support Financial (Pricing & Billing) Member Encounter/ Support Claims Engine Reporting Engine Rules Engine Vital Registration Database Privacy & Security Rules Set diagnostic coding standardsManages national statistics Users: Why National Partnerships Are Complex? Patients ProvidersPolicymakers Payors

How Cross Geography Partnerships Help?

1 st Country 2 nd 345 Multi-Country Solution Collaborative Cost Time Multi-Country Requirements & Standards Collaborative 1 st Country 2 nd 345

What Common Tools Have Partners Produced? information- technology/resourcescontent/tools

If you want to go fast, go alone. If you want to go far, go together. African Proverb