Applying Learnings Back Home: Medical Audits Collaborative
This post was authored by Gilda “Gitchi” Diaz, OIC-Vice President, Quality Assurance Group, PhilHealth, Philippines. It appeared originally on the Joint Learning Network website.
The Philippine Health Insurance Corporation, PhilHealth, had developed a healthcare provider performance assessment system (HCPPAS) at around the same time that the Joint Learning Network’s (JLN’s) Medical Audits learning collaborative was launched.
The new PhilHealth system was designed to enforce performance standards among healthcare providers across regions of the country. Many of its goals were aligned with the objectives of the Medical Audits collaborative, such as cost containment and quality improvement. Participation in the collaborative thus turned out to be a key asset to the team at PhilHealth.
The objectives of the Medical Audits collaborative were also closely linked to the work of JLN’s Data Analytics learning collaborative. The Data Analytics collaborative’s focus on collecting indicators for provider payment mechanisms gelled with the work of the Medical Audits collaborative because we were looking at the process of developing triggers to action for audits. The Medical Audits collaborative was truly a collaborative in the true sense of the term. It was an opportunity for us to share what works well in Philippines and learn from other participating members. All participants took ownership in developing the final product. Participants maintained regular interactions through webinars, social media platforms and meeting one another at other events and technical collaboratives. Since South Korea’s healthcare system boasted advanced provider performance and medical audit systems, they were an apt choice as the host country for the collaborative.
Knowledge exchange from the collaborative was shared with colleagues here in the Philippines through seminars organized by the International Local Engagement Department at PhilHealth. The audience at these events took a deep interest in the collaborative and is already looking forward to the final product, a medical audit toolkit. Once launched, the toolkit will be used as an additional guide for monitoring activities in the Philippines.
Participation in the collaborative helped PhilHealth build the capacity of its staff and instill in them the importance of data quality. It also raised awareness around the need for standardization and use of indices and the need to ensure that changes introduced in the system should be determined by the use of thresholds. PhilHealth is working with a consultancy firm to determine thresholds for triggers for fraud identification. Thanks to the Medical Audits collaborative, the team in the Philippines was able to progress more quickly and answer key questions when developing their own system.
The participation of the Philippines in the JLN as a full member country allowed us to access the Joint Learning Fund – a pool of fund allocated to support member countries participate in learning collaboratives. The Fund allows us to build our capacity on topics that would strengthen ground level progress toward universal health coverage (UHC). While learning exchanges may occur as webinars, the face-to-face meetings are invaluable as they allow for effective discussion of problems and solutions.
Linking joint learning across collaboratives that draw on each other, such as Medical Audits collaborative with the Data Analytics collaborative, will ensure that the learning is in sync and well-aligned and not duplicating efforts.
The JLN’s focus on topics that are identified by member countries for joint learning ensures topics are relevant and increase the impact of the network as a problem-solving platform. More and more, countries should engage with and within the network sending representatives to network events and meetings who are experts on the area of focus and who are able to share and apply their experience upon their return home. This will bring us all closer to our ultimate goal of achieving universal health coverage.