Introducing the new Open HIE community Health Financing

Introducing the new Open. HIE community: Health Financing towards UHC Alicia Spengler, GIZ Carl Leitner, Digital Square Caren Althauser, PATH (virtual)

Agenda 2030, SDG 3 • Goal: UHC • A viable way: Health Financing • Challenge: Administrative Burden • Solution: Health Data • Leverage knowledge: Open. HIE Subcommunity

Health financing toward Universal Health Coverage • Health financing is essential for countries on their way to Universal Health Coverage (UHC) • WHO defines health financing as the “function of a health system concerned with the mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system” • A health purchaser is any institution that buys health care goods, services, and interventions on behalf of a covered population. • schemes • Health purchasers need data to manage their health financing schemes.

Why we need Open. HIE • The provision of healthcare, documentation of health care delivery and subsequent data sharing is closely interwoven with health sector financing • Documentation and sharing of normalized health data of clients is critical for case-based as well as longitudinal care at health facilities; this data forms the information substrate for health financing and payment

Members • • • PATH CHAI GIZ Swiss. TPH WHO ec. Group Regenstrief Watsi CIEL/IMO Blue. Square Joint Learning Network

Joint Learning Network • The Joint Learning Network is a country-driven network of practitioners and policymakers designed to help bridge the gap between theory and practice for achieving UHC • Establishing a new JLN community of practice for Universal Health Coverage to support knowledgesharing related to health insurance/purchaser information systems.

Community identified goals • Serve as a collaborative workspace for sharing of best practices • Identify and prioritize foundational requirements needed to meet data elements and data exchange needs of health care financing • • • Identify and create alignment around standardized terminologies Identify solutions that meet these requirements Develop data sharing use cases Update Open. HIE workflows to incorporate health finance Represent the real world needs of countries as they implement health purchasing schemas • Collaborate with other stakeholder groups • Collaborate with developers and implementers working with health insurance/finance solutions, such as open. IMIS (open insurance management information system)

Community activities to date • Community calls monthly started January 2018 • Drafted mission statement and goals • Drafted a terminology comparison spreadsheet to research and compare code sets

Next steps • broaden community • Identify workflows • develop a community roadmap • What would you like to see this group do? • Where do we start? • Prioritization and workplan – what, how, when? Please provide input

Next step: Open. HIE Diagram Please provide input Open. HIE Business Component Layer Health Financing & Insurance Mobile Payment • • Open. HIE Metadata Component Layer Claims Review / Adjudication Payments / Reimbursements • Place of Service Store • • • Magic Enrollment Eligibility Verification Claim Submission

Next step: Module Transformation of open. IMIS • Develop a proof-of-concept claim submission, enrollment and/or enrollment verification module with a clinical point of service application using the relevant HL 7 FHIR Standards • Develop synchronization services with an Open. HIE-compliant Client Registry and Facility Registry. Notice C 1

Health Financing towards UHC • Join us: https: //wiki. ohie. org/pages/viewpage. action? page. Id=28841789 • Community mission statement: https: //docs. google. com/document/d/1 yiq_kx. B 7 Jo. FWSEZSv 8 WNg. Atyj z. Pqtp 5 D 7 flmuhcu. Aqc/edit? usp=sharing • Open. HIE Assessment of Code Sets for UHC http: //bit. ly/2 LXzp 6 C • Useful glossary of health finance and UHC related terminology: https: //www. hfgproject. org/ghana-uhc-workshop-glossary/

http: //ohie. org