MODULE 1 • Integrated delivery systems (IDS)

✓ Is a single organization or group affiliated

• Exclusive Provider Organization (EPO)
organization that provide a wide spectrum of
▪ Its up to me to avail ang hospital or ndi
ambulatory, tertiary care services.
▪ Not required nga kinahanglan dapat
✓ Care must also be provided across various
• Health Maintenance Organization (HMO) settings of a healthcare continuum
▪ Ex. Member ka sa HMO company then ✓ Example:
example mabayad ka 30k tapos gaan ka 1. Highmark health
nila sang blue card sa card ng ani e swipe 2. UPMC (University of Pittsburgh Medical
mo sya either laboratory, analysis, CT- Center)
scan etc. 3. Mayo Clinic
▪ Dri ka lang dapat ma avail sang service its 4. Cleveland clinic
exclusive for them • Mayo Clinic & Cleveland Clinic
▪ Requires primary care physician and
▪ healthcare providers in America.
referrals to see a specialist leading to more
▪ Provide integrated delivery system
integrated care
• Preferred Provider Organization (PPO)
▪ Example:
✓ Programs in which contract are established
1. Maxicare
with providers of mental care
2. Avega
✓ Providers under PPO contract referred to as
3. Intellicare
“preferred providers”
4. Caritas
✓ Usually, the benefit contract provides
5. Health shield
significantly better benefits of services receive
6. Benlife
by preferred providers does emerging
▪ is an organize system for healthcare and
members to use this provider
geographical area.
✓ Covered persons are generally allowed
▪ Kung mag pa check up ka sa ila:
benefits towards non-formulating provider
services usually on ambiguity, bases,
o 1st: Adto danay sa primary
significant and hoppiness
care physician nila (wala na
✓ Example High Insurance Company:
sya specialization if need mo
1. AXA
further evaluation and
2. BSP (Bangko Sentral ng Pilipinas)
assessment ga specialist sila
3. PAGCOR (Philippine Amusement and
man dapat ang ma referndi ka
Gaming Corporation)
pwede kapangita sang iban
4. STAYWELL
nga specialist, you don’t have
5. TRICARE
freedom to look other doctor,
✓ Pwede ka kapili kon diin kaman nga hospital
or providers of healthcare.
ndi kapa kapili provided nga ensured ka by this
Kung member ka nila sila lang
companies.
ma decide kon diin mo e avail
✓ Pwede ka kapili pero sila ang mabayad
ang imong service)
✓ PPO is expensive
▪ HMO is most affordable than PPO
✓ Life insurance: Sunlife, Manulife, etc.
▪ Advantage: example: If regular ka nga
• Point-of-Service-Plan (POS)
employee sa UI automatic HMO ka
✓ Example: PhilHealth (e automatic nya deduct
• Voluntary Enrolled Group of people
sa imong sweldo)
✓ So kung nagkuha ka sang maxicare
nagkuha ka sa mga ing-ani nga mga
4 Types of HMO Model
insurance sila lang dapat ang may
1. Group Model
authority kon ndi mo sila e take, dapat
2. IPA (Independent Practitioner Association)
imong doctor is affiliated sa HMO para ma
3. Network
carry imong insurance.
4. Staff
 1. Group Model- contracts with a single multi-specialty ✓ Intermediate healthcare worker sya ma refer sa
medical group to provide care to the HMO’s first line sila ma storya sa emergency nurse,
membership proctor, pharmacist and other personnel
Ex. Cancer clinic (special group oncology)
Patients
2. IPA (Independent Practitioner Association)-
contracts with individual fee for service physicians to ✓ Is any recipient of healthcare service, once they
provide services to HMO members at the physician’s receive healthcare service called them patients
private offices ✓ In community tawag sa ila patients; kon ga pa
3. Network- contracts with more than one independent check up tawag sa ila client
physician group to provide health services. The
providers may see patients who are not members of Routine health facility reporting system
the HMO • Function of Health Information Management
4. Staff- type of closed panel HMO, meaning patients ✓ The health information management shall
can receive services only through certain physicians, be responsible for the processing,
such as those who are employee of the HMO maintaining and safekeeping of all medical
records created in the hospital in the course
• Preferred Provider Organization (PPO) of giving patient care.
✓ If the patient uses a provider that is not part of the
network, they will have larger financial 1. Maintain all health records in accordance with the
responsibility (If ndi sila part sa PPO dako ilang principles and practices of efficient and effective
balayran). health record management.
• Philippine healthcare delivery 2. Maintain comprehensive indexes and registers.
✓ Governing healthcare agency in Philippines: 3. Review records for completeness and accuracy,
DOH coding of diseases and operations.
Note: Tanan health programs and policies dapat si DOH ang 4. Maintain a comprehensive and up-to-date record
mag mandate for healthcare facility patients.
5. Collate and compile data and procedures, statistical
• The Level III (Tertiary Level of Health Care reports required by the DOH and respective
Facilities) healthcare facility management.
✓ May mga specialist ana dri ga lagaw-lagaw may 6. Provide information of patient’s health record for
cardio, gastro, use in approved research program.
✓ Hospitals: 7. Respond to all subpoenas and medico legal cases
1. PGH (Philippine General Hospital) under in directed to the healthcare facility.
University of Manila 8. Maintain and safeguard confidentiality of the health
2. East Avenue Medical Center record
3. Lung Center of the Philippines 9. Provide health record, upon request, for a patient’s
4. Philippine Heart Center request, for a patient’s attendance to OPD and
5. Kidney Institute of the Philippines wards.
10. Ensure that all reports and results are promptly and
Note: Causative agent of leptospirosis is Leptospira
accurately filed in the corresponding patient’s
interrogans (kung may leptospirosis naapektuhan imo
record.
kidney so dal-on ka sa Kidney Institute of the Philippines.
11. Participate in research activities and studies.
Healthcare Workers 12. Prepare periodic reports and morbidity, birth and
deaths, utilization of hospital beds, rate of bed
✓ Employed in healthcare facility but they provide occupancy, out-patient service rendered, as well as
healthcare services with their patients. compilation of statistical reports on type of surgery
✓ Are your barangay healthcare workers performed, typed of disease treated or cases
The intermediate level of healthcare workers receiving special form of therapy and other related
data.
✓ Are frontline health workers 13. Search and log patient to Hospital Operation
✓ They supervise train supply Management and Information System (HOMIS)
At the Out Patient Department and Emergency Room.
Routine health facility reporting system
✓ Health information management sa hospital ni sya
wala pa sa community kung sa botika ka nga may
POS for example dapat nakaa log na dra tanan imo
bulong kaso may breach sa data privacy expensive
sya need sang DOH mag invest sang dako