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Digital Technology Initiatives in the Regulatory Environment

Explore the impact of the Fourth Industrial Revolution on healthcare delivery and the role of regulators in aligning IT capabilities to remain effective. Learn about digital technology initiatives and the Central Beneficiary Registry for coordinated service delivery.

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Digital Technology Initiatives in the Regulatory Environment

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  1. DIGITAL TECHNOLOGY INITIATIVES IN THE REGULATORY ENVIRONMENT CMS CIO: Jaap Kügel

  2. Fourth Industrial Revolution • The Fourth Industrial Revolution represents entirely new ways in which technology becomes embedded within societies and even our human bodies. • The fourth industrial revolution will impact fundamentally in the way in which healthcare is delivered and paid for. • Regulators will have to align and leverage IT capabilities in order to remain relevant and effective and in doing so, “put the member first”.

  3. Digital Technology Initiatives Perspectives

  4. Presidential Health Compact 2019 Pillar 9: Develop an Information System that will guide the health system policies, strategies and investments

  5. Presidential Health Compact 2019 Pillar 9: Monitoring by DPME • Integrated Health Information System

  6. Presidential Health Compact 2019 Pillar 9: Monitoring by DPME

  7. Presidential Health Compact 2019 Pillar 9: Monitoring by DPME

  8. Presidential Health Compact 2019 Pillar 9: Monitoring by DPME

  9. Presidential Health Compact 2019 Pillar 9: Monitoring by DPME

  10. CMS Digital Transformation

  11. Simplified Admin with Reduced Friction Points Digital Technology Initiatives 2020-2025 Realtime Processes and Responses Coordinated Service Delivery • XML/XBRL based Returns Platform for: • Annual and Quarterly Financial Returns • Auditor Approvals • Managed Care Returns • Utilisation Returns • Electronic Rule Submissions • Demarcation Returns • Accreditation based inspections END MARCH 2021

  12. Simplified Admin with Reduced Friction Points Digital Technology Initiatives 2020-2025 Coordinated Service Delivery • CRM & ECM Platform for: • Improving customer relation management • Improving case management • Improving complaints management • Assisting with compliance interventions END MARCH 2022

  13. Digital Technology Initiatives 2020-2025 Coordinated Service Delivery • Central Beneficiary Registry for: Single contact point and improved collaboration Caring & Empathic Service Delivery END MARCH 2020

  14. Information Technology Advisory Group (ITAG) Workstreams

  15. Central Beneficiary Registry Interoperability Government Administrators/Schemes Write Read Read Reporting and regulatory purposes Uploads data files and collects validation reports BR for funded patients Read Read Verifiers Health Patient Registration System API for interfacing hospital management systems with the BR

  16. Central Beneficiary Registry Update • Finalized configuration of: • A secure FTP site for uploading of data in a format specified by ITAG. • Added capability to upload BR information on the DDDR platform. • Established an encrypted SQL based database for storing the data. • Reached agreement on participation by BHF – BHF Conference 2017. • Signed a MOU and NDA with GEMS to participate in a pilot program - 2018. • GEMS pilot data uploads commenced in December 2018 via the CMS FTP site. Submission of a standardized pilot data set (10 000 lines) underway. Valuable lessons learnt during the process. • Established a Central Beneficiary Registry IT Governance Committee (CBRITGC) consisting of the Health Funders Association, BHF, National Department of Health and the CMS as an oversight committee. • Invited Medical Schemes to participate in the pilot programme on a voluntary basis by means of Circular 52 of 2019. Extended the deadline for participation by means of Circular 67 of 2019. • In the process of addressing outstanding cyber security concerns raised by some of the CBRITGC members through the Central Beneficiary Registry Technical Task Team on Security and Confidentiality.

  17. Central Beneficiary Registry Way Forward • Addressing confidentiality and cyber security concerns raised at the CBRITGC at task team level. • Ongoing collaboration with ITAG members to refine the system and identify issues as well as additional features which may benefit the industry. • To date, participation has been encouraged on a voluntary basis. • Going forward, the CMS intends drafting and promulgating Regulations under Section 67(1)(q) of the Medical Schemes Act, 1998 (Act 131 of 1998), with a view to avoid any possible contention that the CMS lacks the necessary power to create and maintain the Beneficiary Registry and avoid any contention that the CMS is in breach of the Constitution or the Protection of Personal Information Act 4 of 2013 (POPI). • This will be deemed an interim measure until the promulgation of the Medical Schemes Amendment Act. • Practical issues experienced with submission of data dumps and contributions towards improving the process.

  18. THE END

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