Ayushman Bharat Gyan Sangam 30 th September Parallel

Ayushman Bharat Gyan Sangam 30 th September – Parallel Session 1 New Delhi Presented by - Department of Health, Medical Education & Family Planning Jharkhand

Index 1. Background of State Health Systems 2. Implementation mode for ABPMJAY 3. Major Challenges 4. Key steps taken 5. Learnings & Innovations

Health Systems - Jharkhand To cater the Need Demography ü As per Census 2011, Jharkhand population was 3. 29 crores with 51. 32% as Male and 48. 68% Female ü Urban population is 1/4 th of Population ü 66. 41% is Literacy Ratio ü Total 38. 29% of population, SC/ST ü District Hospitals - 24 ü Additional Primary health Centres – 313 ü Community Health Centres – 171 ü Sub Divisional Hospital- 13 ü Referral Hospital -25 ü Medical Colleges – 6 ü Approx. no of private hospitals - 600

Jharkhand Statistics Hospital Empanelled Golden Card Issued • Public : 220 • Private: 434 • 72. 86 Lac Hospital Empanelment 434 220 500 400 300 200 100 0 Public • Cases: 2, 83, 756 Hospitalisation • Amount: 279 Crore Private Hospitalisation & Claim 283756 258546 300000 Claim Raised • Cases: 2, 58, 546 • Amount: 257 Crore 208981 250000 200000 150000 100000 Claim Paid to EHCPs • Cases: 2, 08, 981 • Amount: 206 Crore 50000 0 Hospitalisation Claim Raised Slaim Paid

e-Card & Hospitalisation Status in Jharkhand >90% villages covered with atleast 1 ecard 65% villages have atleast 1 hospitalisation

Implementation Mode – ABPMJAY Jharkhand ü Jharkhand has selected “Hybrid Model” for the implementation of ABPMJAY Jharkhand ü 1 Lacs initial Sum through Insurance Mode and remaining 4 Lacs through Assurance Mode Why Hybrid Model State experience with RSBY Utilization - 3. 1% Households Claim % - 88% State conceptualised similar scheme in 2017 ie. “Mukhyamantri Swasthya Bima Yojana” covering NFSA population ü Price for insurance was derived through Tender process. ü After announcement of Ayushman Bharat, MSBY scheme was kept on hold ü ü

Implementation Mode – ABPMJAY Jharkhand Why Hybrid Model ü ü Preparedness State was prepared with the selection of Insurance Company Insurance co. had already setup a Project Office at Ranchi with requisite manpower and engagement of TPA IT infrastructure at the project office was already in place Insurance co. agreed to abide by the guidelines of ABPMJAY with same premium as earlier quoted Administrative Reasons ü Administrative cost is minimal in this set -up. TPAs are also providing services in processing of claims which is beyond insurance threshold ü Requirement of lesser manpower ü RSBY history, data analysis, low use of high end packages ü Focussed monitoring and evaluation ü Multiple layer of monitoring & control ü expertise in fraud detection

Challenges & Benefits – Hybrid Mode ü The Wallet bifurcation in Hybrid Mode. ü The NTMS Hybrid mode reviewed and calculated individually and manually ü Payment integration in Hybrid (Insurer liability) Mode ü Technical issues while deducting amount in hybrid mode cases. ü Un-able to upload UTR details in system for Hybrid cases , till both UTRs (of IC / SHA) available. ü Limited cost liability ü The Trust Claim % only 3. 5%. ü Quote for Rs 5 Lakh insurance-@ Rs 1060, Vs. @ 900 for 1 lakh ü Decision for hybrid mode with 100000 : 400000 , to save on the premium part. ü With this decision the SHA has saved approx. Rs 82 crores till now. ü Better reach amongst target group ü Requirement of lesser workforce. ü Three layer checking for Checks and Balances

Challenges – ABPMJAY Jharkhand ü Preventive Health Care Infrastructure and Resources ü Infrastructure for Tertiary Care treatments ü Limited facilities at Public hospitals in terms of infrastructure, staff, equipment & supplies ü Limited number of Private hospitals with requisite infrastructure as per the guidelines of ABPMJAY ü internet connectivity in remote districts. ü Manpower at SHA ü Non-resolution of IT issues in TMS ü Automation of Fraud Detection techniques ü Manual Payment processing leading to increase in TAT

Key Steps – ABPMJAY Jharkhand ü Constitution of state and district level – SEC, DEC, SAFU ü Weekly monitoring and review ü Physical infrastructure audit of EHCPs at the regular intervals ü Regular workshops of CS, ANM, Ayushman Mitras ü feedback mechanism at the state-level ü IEC- newspapers, radio, Television, Videos and success story clippings on mobile LED Vans and LED Screens at prominent places, etc. ü Interaction with beneficiaries ü Special drive for issuance of Golden Cards (free of cost , CSC) ü Beneficiary Compensation

Practices adopted by SHA – Audit Process Claim Triggers based on Data Analytics 1591 Based on Grievances received 733 Routine Physical EHCP Audit 759 Complaints received through District Public EHCP/Other sources 35 On-Site EHCP Audits are conducted by ü SAFU ü NAFU ü IC 83 34 759 Based on the findings from these 3 audits, SHA takes further corrective action 67 Show-Cause Notices 36 Suspension Notices 02 De-Empanelment Notices 02 FIR

Learnings & Innovations – ABPMJAY Jharkhand Learnings Innovations ü Availability of EHCP infrastructure is the key to success ü Proper IEC is the key to mobilisation of beneficiaries to avail the benefits under the scheme ü Technology is the most important pillar to make it a performing & sustainable scheme ü Proper Training & Motivation of all stakeholders like Treating Doctors, ANM, Sahiyas, Asha Workers etc ü Data Analytics ü RINPAS is the first hospital empanelled for treatment of Psychiatric patients in India ü Partnerships with corporate hospitals – Tata Group established 30 bedded hospital only for AB PMJAY beneficiaries , ü Promoting NABH Accreditation of EHCPs ü Partnership with Common Service Centres to distribute BIS e-cards to all beneficiaries without any cost. ü Incentivisation for Public EHCP treating medicos & staff , facility for hiring doctors from outside. ü Incentivisation of Sahiyaas for motivating the beneficiaries for hospitalisation in public EHCP.

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