By By Jacqueline Deelstra, Communications Associate, Digital Health, PATH
May 15, 2018
The Joint Learning Network for Universal Health Coverage (JLN), like the BID Learning Network (BLN), is a country-led effort to promote knowledge exchange among peers. Last month, the Information Technology initiative of the JLN convened to discuss a topic familiar to BID – the importance of data use for strong health information systems and improved health outcomes. The following post first appeared on the JLN blog.
Having high-quality health care and health insurance data readily available, and knowing how to use it for planning and decision-making, are key goals for countries working toward Universal Health Coverage (UHC). From April 4-6, 2018, 30 practitioners from 10 countries across Africa, Asia, and the Americas gathered in Seoul, South Korea, for the second Data Foundations Collaborative workshop. The Data Foundations Collaborative is part of the Information Technology (IT) Initiative of the Joint Learning Network for Universal Health Coverage (JLN).
This workshop allowed participants to engage in joint learning focused on best practices and challenges related to data governance and data use. The workshop was hosted by South Korea’s National Health Insurance Service (NHIS) and Health Insurance Review & Assessment Service (HIRA), and co-facilitated by PATH and Wipro. The workshop included visits to NHIS and HIRA headquarters in Wonju, allowing participants to visit the organizations’ data centers and hear presentations from health care data experts.
The Data Foundations collaborative team chose data use as the workshop focus since it is a key building block for improved health system performance and health outcomes. Data use refers to the process of turning data into information that allows for evidence-based action. (The pathway for achieving effective health care data use, and how it leads to improved population health outcomes, is further explained in PATH’s Data Use Partnership Theory of Change.)
The workshop centered around three specific health care data use topic areas: (1) health care financial management; (2) chronic disease management; and (3) health insurance claims data utilization. Experts from NHIS or HIRA provided an introductory presentation for each data use topic and shared their data systems and learnings supporting each area.
To gather additional key insights on best practices for data use in the three topic areas, workshop participants engaged in a series of one-on-one interviews with each other to learn about the data challenges and successes in the different countries represented. Working in small groups, the participants identified common themes from the interviews, which were reported back to the full group.
Some of the key insights summarized by the collaborative participants are discussed below.
Accurate data on the population and their usage of health care services, as well as the cost of health services, is critical for financial planning and expanding UHC. Government ministries use available data to determine the annual budget for national insurance programs, conduct real-time financial management, and manage financial risk. Our workshop uncovered that while all countries strive to have a “real-time” system to monitor health expenditures and ensure actual costs are in line with budget estimates, different countries have different definitions of real time. Based on the country, the current target for real-time data could be quarterly, monthly, or weekly updates on income and expenditures.
Chronic disease management
Chronic diseases, such as diabetes and hypertension, are a growing burden for health care systems around the world, especially as many countries simultaneously face intermittent or ongoing communicable disease challenges. Electronic data systems can help health workers manage this burden by tracking citizens who have obtained basic health screenings and their health indicators—such as blood pressure, weight, and cholesterol—and which people should be referred for additional services based on their health indicators. Electronic data systems also can easily identify citizens who have not received a preventive health screening and should be contacted for follow up. Data systems that are based on mobile devices, such as tablets, allow health workers in some countries to conduct health screenings through home visits and record collected health information. This rather time-intensive process of sending health workers door to door is seen as an important factor in countries such as Indonesia in reaching average citizens and spreading the word about the importance of receiving regular, preventive health screenings.
Health insurance claims data utilization
Electronic claims data systems provide numerous benefits for national health insurance agencies. The workshop revealed that country participants have a strong interest in how claims data can be used to detect potential fraudulent billing. HIRA discussed how their claims data software platform uses a variety of indicators to identify if a health care provider should be investigated for fraud. The platform, for example, flags health insurance claims that are submitted while a provider is scheduled to be on vacation, and claims that come from patients residing far from the provider’s office or that are submitted after regular office hours. Learning from South Korea’s advanced fraud detection system during the visit to HIRA headquarters provided inspiration and learnings for the other participants whose countries are in earlier stages of developing policies and processes for how to use claims data.
Workshop participants volunteered to join subgroups for the three data use topic areas. These groups will meet virtually in the coming months to review and finalize a short case study focused on their chosen topic area. These case studies will cover best practices and learnings from South Korea’s data systems and data use practices, and the practical insights from additional countries shared by our collaborative team members through the joint learning exercises at the workshop. These documents will be released publicly in fall 2018, along with a webinar to share and promote our learnings.