"Mercado's Prescription A Path to Cure PhilHealth's Ills

Title Mercado's Prescription A Path to Cure PhilHealth's Ills

As the newly appointed president and CEO of the Philippine Health Insurance Corp. (PhilHealth), Edwin Mercado has set out to tackle the organization's long-standing challenges. As a physician-turned-executive, he brings a unique perspective to the role, with a focus on diagnosing and treating the root causes of PhilHealth's ills.

The Doctor's Diagnosis

Upon taking office, Mercado identified several key areas that require attention to ensure a healthy and prosperous future for PhilHealth. These include

Financial Leakages Standardizing financial reporting to eliminate discrepancies and improve transparency.
Wastage Streamlining processes and reducing waste by standardizing financial reporting, enabling the agency to track its financial health apples to apples.
Claims Processing Implementing digitization to prevent fraud and improve efficiency, allowing for adjudication of claims and determination of actual funds needed for benefit distribution.

The Prescription

To cure PhilHealth's ills, Mercado has outlined a comprehensive plan that includes

1. Digitization Enhancing membership tracking, claims adjudication, and preventing fraud through the implementation of digital tools.
2. Process Reforms Reviewing and refining processes to ensure efficiency, eliminate financial leaks, and improve transparency.
3. Benefit Management Building on previous reforms, PhilHealth will continue to increase benefits and explore ways to deduct from existing professional fees and hospital charges.

Prioritizing the Patient's Needs

As a doctor-turned-executive, Mercado understands the challenges faced by healthcare providers when dealing with PhilHealth. He is committed to reducing catastrophic healthcare expenses for members by

1. Analyzing Illnesses Identifying common illnesses that lead to catastrophic health care expenses and developing evidence-based standards of care.
2. Aligning Services Collaborating with healthcare providers to align their services with these standards, ensuring an evidence-based approach to medical procedures.

A Unified Approach

Mercado emphasizes a collaborative approach, engaging healthcare providers to follow the standard of care and incentivizing compliance. This whole-of-nation effort will promote a unified approach towards improving healthcare for PhilHealth members.

Respecting the Court's Ruling

PhilHealth will respect the Supreme Court's ruling on the transfer of excess funds to the National Treasury, prioritizing transparency and accountability.

Conclusion

Edwin Mercado's prescription for PhilHealth is a comprehensive plan to address the organization's ills and prioritize the needs of its members. By standardizing financial reporting, streamlining processes, and digitizing claims processing, Mercado aims to create a healthier and more efficient PhilHealth. As a doctor-turned-executive, he brings a unique perspective to the role, ensuring that the patient's needs are always at the forefront.

Keywords PhilHealth, reforms, digitization, financial leakages, wastage, claims processing, benefit management, catastrophic healthcare expenses, standard of care.

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.