New chief Edwin Mercado vows to find 鈥榗ure鈥� for PhilHealth 鈥榠lls鈥�
Dr. Edwin Mercado, the new PhilHealth president and CEO —Photo from the Presidential Communications Office
MANILA, Philippines — Dr. Edwin Mercado, the new president and chief executive officer of the Philippine Health Insurance Corp. (PhilHealth), vows to “find the cure” for the “ills” that the state health insurer has been facing since the previous administration.
In a Palace briefing on Wednesday, Mercado acknowledged that leading PhilHealth would be a major challenge for him.
“As a doctor, I see PhilHealth as a patient with an illness, and I am working to find the cure,” he said in Filipino.
According to Mercado, his priority is to assess and reform processes to ensure continuous service delivery and expanded benefits.
“So my first task is to carefully study the processes that need to be changed to fulfill the president’s directive of ensuring uninterrupted service and expanding benefits,” he said.
Article continues after this advertisementMercado identified benefit management and financial reporting as the agency’s two major “ills” that require immediate action.
Article continues after this advertisement“Our objective is to expand benefits without deterring or affecting our service delivery,” he said.
He emphasized the need for standardized processes to improve financial reporting.
“First, we need to clean up and standardize financial reporting, which should be manageable since it mainly involves defining a chart of accounts,” Mercado said.
“Once we have the data, we will use it as a reference point — we’re moving forward apples to apples,” he added.
To enhance transparency within the agency, Mercado added that financial reporting must also follow standardized accounting definitions.
“One process, for example, is financial report recording. We will standardize this so that when don’t keep changing the financial reports we come out with regularly,” he said.
On benefit management, Mercado said the agency would build on the reforms initiated by the former PhilHealth president, Emmanuel Ledesma Jr. — particularly the 50 percent increase in benefits implemented in January.
“We can discuss with hospitals how the 50 percent increase can be deducted from with existing the PF [professional fees] and hospital [fees], which are usually subject to deductions,” he said.
READ: PhilHealth approves 50% hike in most benefit packages
Computerization, efficiency as long-term solutions
Mercado also highlighted computerization and efficiency as key priorities for PhilHealth under his term.
“First, we will review processes to improve efficiency because there are still leaks and wastage that we can flag,” he said.
PhilHealth is also procuring tools to enhance membership tracking and claims adjudication, Mercado revealed.
“Another priority is the computerization of our system. Once we can implement digitization, we can flag excessive or questionable claims,” he said.
Doctor’s perspective
Being a doctor, Mercado said he understood the difficulties healthcare providers faced when dealing with PhilHealth.
“I’m a doctor. So my approach comes from my experience on the other side of the fence dealing with PhilHealth. We have identified the pain points, and those are what we will address first,” he said.
He also stressed the importance of reducing catastrophic healthcare expenses for PhilHealth members.
(The number one concern is what we call support value. We will analyze which illnesses most commonly lead to catastrophic health-care expenses,” he said.
The goal, he said, is to ensure an evidence-based standard of care in medical procedures, which will serve as a guideline for benefit adjustments.
“The standard of care is based on evidence-based data that specifies the necessary lab tests and procedures for each disease,” he said.
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Hence, as part of a whole-of-nation approach, Mercado said PhilHealth would work with health-care providers to align their services with these standards.
“We will engage health-care providers to follow the standard of care as part of a whole-of-nation approach. Since we are expediting the payment cycle, I also want to incentivize those who comply with these standards,” he said.
