Medical Audits Collaborative: Phase III Meeting in Seoul and Wonju, South Korea

The Medical Audits Collaborative held its third in person meeting in South Korea from December 6 to 9, 2016. The meeting was the third in a series that brought together participants from Colombia, Ghana, India, Indonesia, Kenya, Malaysia, Nigeria, and Philippines toward the development of a medical audits systems toolkit. The toolkit will synthesize country experiences, challenges, solutions, and collective recommendations on the development and implementation of medical audit systems. The Health Insurance Review and Assessment Service in South Korea hosted the meeting and provided technical support, as it has done since the very beginning of the collaborative.

The focus of the Phase III meeting was to finalize the toolkit outline and content. As the technical coordinators of the collaborative, ACCESS Health International synthesized and developed content for the toolkit based on case studies, country examples, and critical insights shared by participants. Virtual engagement via email exchanges, webinars, calls, and social networking chat groups created sustained momentum among participants of the collaborative.

During the four day meeting, separate sessions were allocated for in depth analysis of each section of the toolkit. During each session, participants reviewed draft content and split into smaller groups to compile detailed feedback and suggest summary points.

As part of the session on functional requirements of a medical audit system, Caren Althauser, Program Officer, Health Management Information Systems at PATH, made a presentation on Common Requirements Development Methodology. The presentation oriented the group on business process analysis and redesign, definition of requirements, and the use of methodology under Joint Learning Network IT initiative. Members made suggestions based on examples from their countries. A common framework for medical audit systems was finalized based on these discussions (see Figure 1).

Some of the important recommendations that emerged out of the Phase III meeting included:

Solutions or recommendation should be accompanied by rationale

Governance and administration should cover cases from multi payer systems

Training on medical audits should be accredited and be part of the course curriculum in academic institutions

Performance of medical audit team should be monitored

Indicators, rules, and triggers should include examples from countries that rely primarily on manual data

Site investigations should include service overuse, underuse, and misuse; immediate and long term actions should be defined separately from one another

Since cost containment and quality improvement are the main goals of medical audits, these should be identified within each section of the toolkit

A Review Committee consisting of international technical experts will be set up to examine and validate the toolkit. The aim is to make it a robust and relevant knowledge product on the global platform. Over the next three months, ACCESS Health will work with the Health Insurance and Review and Assessment Service and member countries to incorporate feedback received during the Phase III meeting and gather additional information. The goal is to officially launch the Medical Audits Toolkit in April 2017.

The Phase III meeting overlapped with the meeting of the Joint Learning Network Technical Working Group for Strategic Planning also held in Seoul, South Korea. Participants from the Medical Audits Collaborative attended the two day event and presented their journey and experience to the larger gathering. The group also attended the Health Insurance Review and Assessment Service International Symposium on Effective Management of Medical Supplies and Drugs. Sofi Bergkvist, Executive Director, ACCESS Health International and one of the founding members of the Joint Learning Network, presented the keynote address for the event. She highlighted the network’s history, objectives, and achievements in supporting exchange of knowledge and good practices among countries.

Participants in the collaborative and the meetings in South Korea said that the experiences over the past year have created a multiplier effect on country capacities on medical audits. The group recognized the importance of linking the medical audit work with ongoing activities of the other technical initiatives under the Joint Learning Network. The collaborative is strongly committed to finalizing the toolkit, launching the new tool, and ensuring its broad use by other member countries.

This item was cross posted on the Joint Learning Network.