How-To Guide Mercado vows reforms to cure PhilHealth 'ills'

As a professional in the healthcare industry, you understand the importance of providing quality services to patients while also ensuring the financial health of your organization. In this guide, we will walk you through the key steps outlined by Dr. Edwin Mercado, the newly appointed president and CEO of the Philippine Health Insurance Corp (PhilHealth), as he vows to reform the organization.

Step 1 Conduct a Thorough Analysis of Current Processes

To kickstart the reform process, it's essential to carefully study your current processes and identify areas where changes can be made to improve efficiency. Start by analyzing financial reports, identifying discrepancies, and standardizing financial reporting. For instance, define a chart of accounts to ensure consistent and transparent financial records.

Step 2 Streamline Processes for Efficiency

Streamlining processes is crucial to eliminate financial leaks and improve overall efficiency. Review current workflows, identify bottlenecks, and streamline processes to reduce waste. Implementing digital claims processing systems can also help adjudicate claims efficiently.

Step 3 Standardize Financial Reporting

Transparency in financial reporting is vital to ensure consistency and transparency. Define a chart of accounts, implement standard accounting practices, and maintain accurate records. Utilize digital tools to track financial data and identify areas for improvement.

Step 4 Leverage Technology for Efficient Claims Processing

Digitization can be a game-changer in adjudicating claims efficiently and determining actual funds needed for benefit distribution. Develop a comprehensive IT strategy, integrate digital tools with existing systems, and provide training to staff. For instance, utilize artificial intelligence (AI) to flag excessive or questionable claims.

Step 5 Enhance Membership Tracking and Claims Adjudication

Implementing tools to enhance membership tracking and claims adjudication can significantly improve the overall experience for members. Develop a comprehensive membership database, implement digital claim submission systems, and provide real-time updates to members. Mobile apps can also be used for member engagement and benefits tracking.

Step 6 Review and Refine Benefit Management

Building on reforms initiated by former PhilHealth president Emmanuel Ledesma Jr., it's essential to review and refine benefit management processes. Develop a comprehensive benefit management strategy, implement digital claims processing systems, and provide real-time updates to members. Data analytics can be used to identify areas for improvement in benefit distribution.

Step 7 Comply with Supreme Court Rulings

Respect for the rule of law is crucial in any organization. Comply with Supreme Court rulings on the transfer of excess funds to the National Treasury, stay informed about court proceedings, and maintain transparent financial records. Utilize digital tools to track financial data and identify areas for improvement.

Conclusion
In this guide, we have outlined the key steps outlined by Dr. Edwin Mercado, the newly appointed president and CEO of PhilHealth, as he vows to reform the organization. By following these steps, you can ensure a smooth transition and improve the overall efficiency of your organization. Remember to prioritize transparency, consistency, and compliance with court rulings.

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How-To Guide

Step 1 Conduct a Thorough Analysis of Current Processes

Edward Lance Arellano Lorilla

CEO / Co-Founder

Enjoy the little things in life. For one day, you may look back and realize they were the big things. Many of life's failures are people who did not realize how close they were to success when they gave up.