slide 1 strengthening family planning voucher service provision in bluestar social franchise network...
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SLIDE 1Strengthening Family Planning voucher service provision in BlueStar Social Franchise Network using Claims Processing Data Management System (CPDMS)
Strengthening FP voucher service provision in BlueStar
SF Network using Claims Processing Data
Management System (CPDMS)
Authors: Kanakulya Richard1, William Nnyombi1, Kelsi Kritimaa1
Affiliation:
1 Marie Stopes Uganda
SLIDE 2Strengthening Family Planning voucher service provision in BlueStar Social Franchise Network using Claims Processing Data Management System (CPDMS)
Introduction
MarieStopes Uganda (MSU) is implementing a five year program for provision of long acting and permanent methods (LAPM) of FP services.
75% of the targeted services are voucher based (targeting the poor populations), and 25% of services are targeting Cash clients
The program works through 400 accredited Bluestar clinics across the country, where MSU reimburses the franchisees for voucher service provided.
As MSU needed a system to help effectively monitor the voucher scheme implementation and be able to process claims on a timely basis, the ‘Claims Processing Data Management System’ (CPDMS) was developed
SLIDE 3Strengthening Family Planning voucher service provision in BlueStar Social Franchise Network using Claims Processing Data Management System (CPDMS)
Contract MgtProject
Supervision & M&E
Contract MgtMonitor service
Quality &
CME
Design, distribution of
Vouchers &
BCC activities
Voucher distributors Voucher Service providers
MSU Voucher Management Mechanism
Voucher recipients
Accreditation, contracting
and training VSPs
Claims Processing
& Reimbursement
to Providers
External relations & Advocacy
SLIDE 4Strengthening Family Planning voucher service provision in BlueStar Social Franchise Network using Claims Processing Data Management System (CPDMS)
Background
Reimbursement and payment reports to providers were recorded using paper based records and Excel spreadsheet.
The above systems were compounded by several challenges including;– Poor and slow programme monitoring and delayed reimbursements to
providers.
– None detailed program reports that can help management in strategic operations of the scheme
SLIDE 5Strengthening Family Planning voucher service provision in BlueStar Social Franchise Network using Claims Processing Data Management System (CPDMS)
Program Intervention
MSU implemented the CPDMS, an SQL database to capture information that is used to focus resources and increase efficiency of FP-service provision (program monitor and timely reimbursements to providers)
Implemented in February 2011, the CPDMS captures:a) FP clients’ bio data and geographic information and the information on the PGT
b) Medical & Reproductive history and FP method taken
c) Complications reasons and treatment given
d) Reason for FP removal and FP charges in each module
The CPDMS currently provides: Timely information used for generating service numbers, performance reports & reimbursement
reports.
Used to Quarantine claims, reject claims & fraud control
SLIDE 6Strengthening Family Planning voucher service provision in BlueStar Social Franchise Network using Claims Processing Data Management System (CPDMS)
System operation
Claims submitted to MSU offices by VSP
Claims submitted to MSU offices by VSP
Claims received is recorded by Admin
Assist
Claims received is recorded by Admin
Assist
Claims are entered in the system
Claims are entered in the system
Reimbursement report are generated by finance teamReimbursement report are generated by finance team
System checks adherence to CP systemSystem checks adherence to CP system
Medical Advisors vetting claims
Medical Advisors vetting claims
Payment processed and VSP paid
Payment processed and VSP paid
VSP provides serviceVSP provides service
STOP
START
The beneficiaries of the CPDMS are BlueStar managers, Research Monitoring & Evaluation department, Finance department and other stakeholders
Voucher distribution to clients
Voucher distribution to clients
SLIDE 7Strengthening Family Planning voucher service provision in BlueStar Social Franchise Network using Claims Processing Data Management System (CPDMS)
Program Intervention
With Integration of the SMS platform (MarieTXT) in CPDMS;
The system has an interactive platform to continuously share information between Voucher management agency (MSU) & service provider (VSP) and the community based distributors of vouchers(CBDs).
The SMS platform has been linked to the Hotline for more interaction with the clients, VSPs & CBDs.
Coupon for provision of service
Coupon for management of complication/side effects
Coupon for removal of method
SLIDE 8Strengthening Family Planning voucher service provision in BlueStar Social Franchise Network using Claims Processing Data Management System (CPDMS)
Key findings
The CPDMS has made FP claims processing faster and more efficient than the initial systems with;
– Fast and improved data validation to check fraud and other inconsistencies from the voucher scheme and service delivery.
– Improved FP data management for decision making through routine tracking of voucher services and generating detailed reports both programmatic and financial.
– Enhanced security and access authentication at different modules and levels with over 100 users able to be logged on at the same time
SLIDE 9Strengthening Family Planning voucher service provision in BlueStar Social Franchise Network using Claims Processing Data Management System (CPDMS)
Program Implications/Lessons
Due to the efficiency of the CPDMS in processing FP data, BlueStar management has been able to process FP claims for providers efficiently and has been able to make evidence based decisions through reviews and routine monitoring and evaluation.
SLIDE 10Strengthening Family Planning voucher service provision in BlueStar Social Franchise Network using Claims Processing Data Management System (CPDMS)
MarieStopes Uganda staff processing FP Claims
SLIDE 11Strengthening Family Planning voucher service provision in BlueStar Social Franchise Network using Claims Processing Data Management System (CPDMS)
Contact information for MSU: http://www.mariestope.or.og
Thank you for your attention!