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!