Mganga.netIT solution in financial management of

primary Health Care

Powered by :

Topics

1. Introduction

2. Benefits

3. Use of POS terminals for identification and medical billing

4. Solution broad overview

5. Platform architecture

6. Billing system, financial reporting and accounting integration

7. Business model

Introduction

• The strategy of Performance Based Financing ( PBF) introduced by the government recommends an integrated management of all financial resources injected at health center level for a clear and transparent accounting system.

• Some of the challenges of the extensive utilization of ICT to improve services to the population are:

1. The constraints related to the cost of computer hardware

2. Ignorance of ICT in the countryside

3. The frequent electricity cuts

4. The problem of internet connection (price and quality).

• Challenges for Community based health insurance (CBHI) and Health Insurances:

1. Lack of a strong identification system of members at the point of service delivery: Growing fraud in medical services / distribution of pharmaceutical products

2. Long invoice reconciliation processes

Introduction

Mganga.net solution has been designed:

1. To help health care providers in the management of daily revenues and expenditures to:

– provide information timely and primarily to Community Based Health Insurances (CBHI) and other health insurances,

– monitor the use of health care services by their members / clients,

– assist in the management of pharmaceuticals,

– provide timely reports to MOH and other stakeholders like development partners, public administration etc.

2. To help Community Based Health Insurances (CBHI) and other health insurances to:

– Reduce control procedures for the reconciliation of invoices,

– enable real-time followed by consumption related to insurance policies for disease control limits consumption allowed,

– prevent fraudulent cases,

– avoid late receipt of invoices from suppliers,

– facilitate / simplify accounting by reducing the volumes of papers and enabling the automatic import of invoices in an accounting file (Sage, Win-Book, etc.).

3. To provide governments with:

- Access to data on a regular basis

- Monitor billing process whenever they want to at health provider level

Benefits from the solution

1. Health centers are able to comply with Health Management Information System on financial component with prompt data

2. Health centers are able to keep their stock of medicines up-to-date with exact information on consumption and date of expiry.

3. Community Based Health Insurance and private insurance are better informed on the using and monitoring of services by their own users on a regular basis.

4. Health Centers are able to bill health insurance without delay.5. Accessibility to medicines for all categories of people through

different authorized channels by the country is feasible.6. Governments which runs gratuity of health services are able to

check the correctness bills from health providers on a regular basis

7. It provides means to verify the respect of prices that have been agreed upon

The use of POS terminals

for identification and medical billing

The POS synchronizes regularly with the central database for having on it's memory the exact medical services price list of MOH and of different health insurance institutions, thereby the receipts are printed out with the exact prices, total amounts (copayment and Insurance contributions) are automatically calculated.

The stock of medicines is up-to-date with prices and date of expiry.

POS are also used to send informations related to financial statement of health center (receipts and expenses).

Smart cards (Chip Card and Magnetic Stripe Card) are used in order to identify users and patients

Integration of payment Solutions (Credit Cards, mobile money etc.) and Health card systems (hospitals and health insurance companies) is feasible.

Use of POS terminals

for identification and medical billing

The POS can provide secure access to healthcare services everywhere anytime

Biometric POS is a solution for health insurance member identification :

Member identity will be used by only one person (Finger print cannot be shared).

No need for change member cards: Finger prints don’t expire and cannot be destroyed (Changing cards is an expensive, even smart card can be shared).

Make it easy to identify forgotten cards.

Accurate verification and identification – No human errors (don’t rely on picture and cards verification).

The use of POS terminals

for medical billing

• For the first visit in the health institution, patient informations (name, ID number, birth date, gender, phone, …) are entered on the POS to generate the unique medical file number “Patient ID”.

• The same file number can be used by any health institution that uses Mganga.net to allow tracking of medical service and consumption history of the patient; an easy way to identify any fraud and abuse.

• For every new case, the medical file number and the health insurance used are entered in the POS with all the medical services prescribed. The POS generate a unique Invoice Number and calculates the total amount depending of the insurance plan and prints the invoice with details and the total amount to be paid by the patient (co-payment). The same invoice can be updated during the follow up.

• All the data entered on POS are sent to the server during the day.

Solution broad overview (the workflow)

10

Solution broad overview

(Network)

•Updating of costs of medical services•Provide MOH reports

Datacenter

•Helpdesk•Maintenance

Health Center

•Generate medical file numbers•Medical billing

HDP

INHILLS / SPS - TRACOM

INTERNET

MTN - TIGO - AIRTEL

Health center - Accounting

Pharmacy•Tracking / Monitoring

•Update the stock of medicines•Medical billing

CBHI / Health insurance

•Invoicing

POS APPLICATION

Client

Medical File Medical Act

New case

Follow-Up

Pharmacy Enquiries

Staff

Duplicate receipt

Batch Upload

Settlement

FTP Download

Daily Expenses

Receipts

Stock Manager

Reports

Administrator

Terminal details

Password manager

TMS

Solution broad overview (POS Application Menu and Menu Hierarchy)

The mobile terminals are provided by Ingenico, the worldwide leader in terminals and solutions specific to health card systems.Ingenico is the leading provider of payment solutions also used by banks such as Bank of Kigali (BK), Kenya Commercial Bank (KCB) and Equity for secure payments.

The secured architecture

GPRS

SOAP

Mganga.net

ISO

8583

Mess

ages

VPN

GPRSISO 8583Message format

VPN

Database Server

Gateway

Database Mirroring

BSC Cloud

POS

• The data servers are hosted in a secure datacenter which provides important safeguards for data protection and 24 hrs/ 7days a week.

• Backups are done automatically everyday.

The secured architecture

GatewayGPRS Web Application

VPN VPN

DatabaseMirroring

ISO8583

message

VPN

• The platform is built with ISO certified technologies used internationally.• The POS’s data are transferred to the central database via Internet GPRS by using encrypted message

of ISO 8583 to Virtual Private Network (VPN). Users and devices are authenticated• The TMS server is used for distributing new software updates and configuration settings. From the

central server, POS's are updated automatically to all the Users; who are unable to decline, or alter that update, and it applies immediately to everyone on the channel.

Billing system, financial reporting

and accounting integrationThe Mganga.net solution offers powerful modules for sales, reports and publications.• The sales module allows to visualize POS's sales information and to generate

detailed medical invoices for insurance company related.• The report module offers a built-in reporting tool that generates formatted result

of database queries with requested data of a healthcare institution and for a any period:– Receipts from clients (co-payment of insured and uncovered patients)– Expenditures– Insurance invoices (CBHI, RSSB, MMI, SORAS, CORAR, RADIANT,...)– Status of invoices (Pending Receipts)– Financial Statement for healthcare institution and pharmacy

• The publication module allows to manage contacts of health institutions in order to send them a mailing or emailing. So, invoices are timely sent to insurance companies and financial reports to health institutions.

• Mganga.net provides a tool for synchronizing with the accounting system (ex: Sage). The tool can be used for regular synchronization between the Mganga.net database and other external database.

Screenshots

Business model

It’s proposed a Software as a Service (SaaS) to allow Health Provider to benefit from professional IT solutions and without making high investment in infrastructure such as hardware (computers, printers,…), software, and IT support, by paying an affordable subscription of USD 100 monthly fee for one POS terminal usage. The monthly subscription fee includes the full maintenance of the application and of the device.

Insurance Provider will benefit and use real time or on demand medical care and billing information collected from Health Centers for a monthly subscription fee of USD 1,500.

Continuous efforts for the development of applications and strategic partnerships to allow health care providers to maximize revenues using mobile services by distributing consumer vouchers and other e-business integrated into POS such as:• Top Up Cash power (electricity) • Invoice collector (water)• Top Up Airtime• Event ticketing (Cinema, concert, sport stadium, Trade shows …)• Car Parking, lottery, etc.

Mobile paymentTop-UpTicketing LotoMobile Money

THANK YOU!