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© 2006 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice Using new technology for Information.

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Presentation on theme: "© 2006 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice Using new technology for Information."— Presentation transcript:

1 © 2006 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice Using new technology for Information share between HI, Patient and other entities Martin ŠEBEK Sofia, February 7-th 2007

2 2February 7-th, 2007 Topics to be addressed  Starting point  Expectation and Goal  Solution

3 1.Starting point

4 4February 7-th, 2007 Where we start with information claims for hospital care ID of insured p. diagnosis procedures length of stay ID of provider claims for ambulant care ID of insured p. diagnosis procedures ID of provider registration prescriptions ID of insured p. drug code drug price ID of provider ID of pharmacy Lamb-sum Per Capita / services Cost Services specialists ID of insured p. diagnosis procedures ID of provider registration

5 5February 7-th, 2007 Where we start with information insured person change of HIC eligibility for state subsidy state administration unemployed pers. retired persons social service recip. people relocation birth & death employers address account number list of employees total payment amount

6 6February 7-th, 2007 Scope Insured people~ 7 M Health care providers> > Premium payers> Government entities~ 10

7 2. Expectation and Goal

8 8February 7-th, 2007 Goal Check Health Insurance eligibility CZ + EU Check validity of contract Insured person access to data reported by Health care providers Yearly statement -> on-line ? Exchange data between HI and other external entities Government Premium payers Health care providers

9 3. Solution

10 10February 7-th, 2007 Architecture Premium collection Different types of premium contributors Premium collection check Financial operation general ledger Bank Pair invoice & claims Claim management Different types of HC claims & funding Claim check Price calculation Register management Insured people Health care providers Premium contributors Financial management Cash flow Planning & simulation controlling Health Care management HC network mngmt. Insured person info HC information Information exchange hub Operational level Strategy and management level External Communication Paper, file on disk, Portal, B2B

11 11February 7-th, 2007 Functionality Portal - Extranet On-line access to EHIC card validation B to B connection −Services oriented architecture −Adaptation of SW on both sides −Limitation of mistake & increase of speed −Quality of data

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13 13February 7-th, 2007 Health Insurance solution - components Claim management −types of claim according funding scheme (per capita, fee for service, contracted amount of health care/funds, DRG, …) −checking against contract, catalogues, registers −checking against history −payment calculation Financial operation −all legal accounting requirements, general ledger, bank −pair invoices with claims, process financial differences Premium collection −collect premium from all types of contributors (individual people, companies, government, self employed, …) −build and keep list of “Health care eligible/insured people”

14 14February 7-th, 2007 Health Insurance solution - components Information exchange hub −ensure information and message transfer between different solution components / applications −ensure data availability and integrity −integrate all operational sites and strategy/management site

15 15February 7-th, 2007 Health Insurance solution - components Register management −health care providers, health services insured/eligible people, premium payers −links between registers (per capita, contribution payment, …) −serving all operation sites −link to other institutions in the country Financial management −Cash-flow across country −Financial planning on the base of trends and history experience Health care management −unified view on the insured/eligible person (across all services) −unified view on the health care provider (direct, indirect cost, quality, efficiency, …) −source for planning −source for claim and behavior checking


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