A New Monitoring Toolkit Empowers Countries to Track Provider Payment Systems Apr 20, 2017

A New Monitoring Toolkit Empowers Countries to Track Provider Payment Systems

Achieving universal health coverage—ensuring access to basic health services for an entire population without risk of financial hardship or impoverishment—is a challenge confronting many countries. To sustain progress toward universal health coverage (UHC), governments must generate resources for expanding coverage, distribute the resources equitably, and use them efficiently to achieve the most benefit in terms of meeting health care needs, ensuring quality of care, and protecting users from financial hardship due to out-of-pocket payments – functions that all get affected by the efficacy of provider payment systems.   

A new data analytics toolkit, released by the Joint Learning Network for Universal Health Coverage (JLN), is aiming to arm the countries with meaningful monitoring of health provider payment systems, even when the data availability is not perfect. 

“Using Data analytics to Monitor Health Provider Payment Systems: A Toolkit for Countries Working Toward Universal Health Coverage” is being launched at the 2nd Annual Universal Health Coverage Financing Forum, held April 20-21 in Washington DC, where over 300 participants have gathered from over 40 countries to discuss the challenges and learn about practical pathways to improving the efficiency of health financing.  

An effective provider payment system is a critical stepping stone to achieving UHC. Provider payment systems consist of one or more provider payment methods and all supporting systems, such as contracting and reporting mechanisms, information systems, and financial management systems. Nearly every country that is working toward UHC is developing or improving strategic provider payment systems.

It is important to collect information about the implementation and maintenance of provider payment systems, to track how providers are responding, whether objectives for service delivery and other goals are being achieved, and to watch for any unintended consequences, such as overuse of expensive services, excessive referrals, or skimping on necessary care. 

Development of the Toolkit

The JLN, a community of policy-makers and practitioners from around the world, convened representatives from 13 countries in 2015 and 2016 to share experiences, expertise, and challenges related to monitoring health provider payment systems. With support from technical facilitators from Results for Development (R4D), PATH, and PharmAccess Foundation, the participating countries – Ghana, India, Indonesia, Kazakhstan, Kenya, Malaysia, Mali, Moldova, Mongolia, Nigeria, the Philippines, and Vietnam – collaboratively applied practical knowledge to develop the toolkit – a step-by-step guidance on using data analytics to monitor health provider payment systems, identify trends, track whether payment systems are supporting health system objectives, and get timely information on any unintended consequences.

Claims data and other routine administrative data that are generated by the implementation of provider payment systems should be the main sources of this strategic information. However, many countries do not use these routine data to their fullest potential, particularly to determine whether provider payment systems are achieving their objectives or leading to unintended consequences. These data are often underutilized because of a lack of capacity within the purchasing agency, weak or underdeveloped data systems, or fragmentation in information sources.  This toolkit seeks to address the gap in data utilization by providing guidance and tools based on practical experience to help countries implement provider payment monitoring systems that use claims and/or other routine administrative data.

The Toolkit

The toolkit is organized around a framework or “cycle” for building and implementing a provider payment monitoring system (see Figure below.) The framework is based on a generic “data for decision-making” process with seven steps, divided into three parts. The parts are organized such that each one includes similar activities, actors and stakeholders.  

Part 1 – Identify the questions that the system should routinely answer and identify indicators that can help answer those questions.  These indicators alone cannot answer all of the questions, but they can show general trends and point to services, providers, or other areas that warrant deeper analysis.

Part 2 – Collect and analyse the data.  The activities involved in producing the indicators include agreeing on precise definitions for the indicators (including what data elements are required and how the indicators will be calculated), identifying data sources, creating a process to assess and act on data quality issues, and determining a meaningful way to report and visualize the data.

Part 3- Use the data to inform decision-making.  The ultimate goal of creating a provider payment monitoring system is to make better informed policy decisions, finetune provider payment systems to ensure that objectives are met and unintended consequences are minimized, and identify issues that call for deeper analysis or operations. 

Who Can Benefit from the Toolkit?

The Data Analytics Toolkit provides concrete tools for countries to work through each step by providing a summary of the common challenges faced by participating countries, along with the solutions that they found; a tool (or tools) that can facilitate the step, developed or validated by country participants based on practical experience; examples of country experiences; and links to additional resources.

A carefully developed provider payment system can be a powerful instrument for making progress toward UHC. Countries can draw on the collective experience presented in this toolkit to create an effective provider payment monitoring system that generates information on an ongoing basis to keep a tab on whether objectives are being met and any emerging unintended consequences.

The development of the toolkit was supported by the Rockefeller Foundation and with contributions from the Bill & Melinda Gates Foundation.