PCEO EMMANUEL R. LEDESMA, JR.
3rd PHA THELMA CLEMENTE MEMORIAL LECTURE
Bridging Gaps and Building Futures:
Towards the Digital Revolution in Philippine Healthcare
31st NATIONAL HOSPITAL WEEK
with the PHILIPPINE HOSPITAL ASSOCIATION
The Manila Hotel
August 6, 2024
09:00 H
Distinguished colleagues of the Philippine Hospital Association, good morning. Dear friends, I am truly honored to be invited today to speak to you and represent the Philippine Health Insurance Corporation. My appreciation goes out to PHA President Dr. Jose Santiago, the PHA Board of Directors, hospital-members, and all health advocates present today.
PhilHealth is proud and thankful for your association’s support and collaboration to the National Health Insurance Program, more so, in the implementation of the Universal Health Care (UHC). Your close to 2,000 hospital-members have indeed greatly contributed to this administration’s health agenda. The same health care providers also act as avenues and instruments for PhilHealth benefits to be distributed and maximized by all the Filipinos we both serve.
We have been celebrating National Hospital Week since 1993 to highlight the role of hospitals as partners in health and wellness. This is a testament to the indispensable role hospitals play in our healthcare system. Even before our National Health Insurance began in 1995, and long before Universal Health Care became policy, hospitals had always been at the forefront of healthcare. In fact, the Philippine Hospital Association, now 70 years strong, predates both UHC policy and PhilHealth. This just shows how critical a robust hospital network is in maintaining public health. It is vital for implementing any national health policy, including of course, our National Health Insurance Program.
At PhilHealth, we recognize this inherently symbiotic relationship we have with hospitals, and with the PHA in particular. Our mission is to institutionalize affordable and accessible healthcare for our 108 and a half million members, but the achievement of this vision is heavily reliant on close collaboration with our accredited hospitals.
One of my primary objectives since I have taken the lead at Philhealth is to be conscious of the various issues that hospitals have with Philhealth as the national insurance service. I take a serious look at anything that might pose any impediment to the growth and development of our hospital networks. Because it is not just lip service for me to say, ‘I advocate for the advancement of our hospitals’. This is an actual need, and an urgent one, if I am to see the fulfillment of universal health care under my watch. This means addressing two concerns: first, our accreditation process, and second, claims management. I want to assure you all that at PhilHealth, we are receptive to your feedback. We are conscious that these are key areas we need to work on from our side of things.
On our accreditation process, let me say that we are working hard on refining our systems and rolling out initiatives to improve our somewhat lengthy and complex accreditation process. We are cognizant that our requirements are stringent, and involve multiple layers of documentation. We have put these systems in place primarily to maintain the integrity and value of our accreditation, and prevent fraud and abuse of the system. But we know these can be difficult for hospitals to navigate, particularly for smaller or remote ones. We hear you. We are working closely with our regional offices to get rid of inconsistencies in the interpretation and enforcement of standards. Our aim is to drastically reduce the administrative burden on hospitals due to accreditation because they just divert resources away from patient care.
We have in mind an accreditation process that is simple, standardized, and transparent. We are also open to your inputs as to how we might make the process easier to get through, which steps are particularly difficult, or that we might consolidate for redundance. Perhaps we could take the first step together and develop training modules to help hospitals understand our accreditation process better and be more efficient in the preparation and filing of the necessary documentation. We are willing to work with you to address these as well as other concerns.
As for our claims management, we are also aware of the top issues. Like our claims processing time, the complexity of our reimbursement scheme, and the rate of denied or return-to-hospital claims. On this particular point, open and constructive communication between hospitals and Philhealth is crucial.
Philhealth has been constrained to deny a considerable number of the claims made to us in the last few years, the main reasons for which were deficiencies in the submissions, mainly having to do with missing or just plain incorrect documents, non-compliance with standard of care protocols, or for being filed out of time.
There is a time for everything, the adage goes. Hospital or citizen, we all lose rights that we do not assert in the correct manner and at the proper time. Nevertheless, we treat this matter seriously and are cognizant of the impact our denied claims can have on the cashflow of hospitals, and overall sustainability of operations. I believe that the surest way to address this right now is to continue to foster our relationship through constant and open dialogue, and even closer collaboration. Breaking up this trend is of paramount importance to us. I therefore appeal to you: join forces with us on this. We are doing our utmost to clarify our guidelines and regulations and resolve disputes and appeals over these denied claims.
On this note, I would like to pause and steer my message for this 3rd Thelma Clemente Memorial Lecture towards more encouraging matters. Dr. Clemente, the founder of the Capitol Medical Center and the PHA’s first lady president, was a renowned visionary and problem-solver, with a sensational track record as CEO of Capitol Med. Now I want to speak about concrete plans to execute the healthcare system of our dreams, just as I imagine visionaries like her would have done.
Digital transformation offers a powerful solution to all these mentioned challenges.
We are facing significant pressure to not just improve, but to revolutionize our healthcare system, driven by our growing and aging population. Our expanding middle class and rising incomes have significantly increased demand for quality healthcare. Despite our constant efforts to improve our services over the years, access to quality, affordable healthcare remains elusive for many, especially in rural and remote areas. The lack of a fully rationalized and integrated health care network exacerbates issues of accessibility, quality, and efficiency of services.
Despite these, the current administration is committed to strengthening health programs, like the First Lady Marcos’ “Lab4All,” and expanding facilities in remote areas. However, the need is still great—at least 40,000-45,000 additional hospital beds. And we need more healthcare professionals to meet the needs of our population of over 100 million. To begin with, we need to foster the growth and expansion of our hospital network.
Just last month, we launched ePhilHealth, and celebrated our integration onto the eGovPh app. With just a swipe or two, members can now access their account information, that is, all their data registered with PhilHealth, including their dependents. They can now easily track their premium contributions in-app. With ePhilHealth, we have taken the first bold step into a digital revolution, with our national health insurance program fully leveraging technology to make healthcare more accessible, efficient, and equitable.
Philhealth’s digitalization project is the beginning of solving those two critical problem areas earlier mentioned. We are a long way away yet. But the whole of PhilHealth is strongly committed to strengthening health programs with innovative solutions.
For claims management, digitalization is aimed at the Automation of Claims Processing and the Rationalization of Documentary Requirements. Our objective is to implement automated systems for claims submission and processing that will significantly reduce the time we spend reviewing and approving claims. Automation should eliminate, or at the very least, minimize human errors or any subjectivity that lead to claim denials. We want a system that ensures that hospitals receive payments promptly, and limit returned claims to the bare minimum.
But PhilHealth cannot do these plans alone. Nor do we plan to. The future of digital healthcare in the Philippines is multidisciplinary and inclusive. The cooperation and mutual support of hospitals, both public and private, as well as that of the national and local governments will be crucial in achieving the promise of universally accessible digital health solutions.
I urge hospitals to join us in this effort, and follow the pioneers that have already begun their transformative journeys.
The Philippines must catch up with global advancements in healthcare technology. Our eHealth Strategic Framework Plan for 2014 to 2020, along with reports like the Philippines Hospitals Market Outlook, highlight the trends of telemedicine and the potential of AI now being enjoyed by our more advanced neighbors in Korea and Japan.
This road will be long and our struggle will be considerable. But I also believe that with the right team—Philhealth and hospitals together, and the right out-of-box mindset that is just daring enough, we can take our healthcare systems through a digital revolution in no time at all.
On this 31st Hospital Week, I offer my abiding thanks and deep admiration to you, the Philippine Hospital Association, for your unwavering commitment to health care. The future of healthcare is digital, but it will be built on the strong foundation of our hospitals: you ensure that all our Filipino member-beneficiaries have access to the quality of care they deserve. The revolution in healthcare is the future, and the future is now. I hope I can count on your steadfast resolve to meet it.
It is my fervent hope as well that we will continue to support each other, and foster our strong relationship, as we move towards our common goal of providing quality, accessible and affordable healthcare services for all Filipinos.
Thank you, and a very pleasant day to all! ###