Scheme Monitoring System

Universal health coverage (UHC) defined as ‘ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship’, is a goal of national healthcare systems globally. UHC is eminently desirable not only from a human rights perspective, but also because it is expected to improve health and productivity of individuals and population, prevent people from being driven into poverty in paying for needed health services at the point of care and also to reduce social inequality. The goal may seem utopian, but is reachable as is evident from the progress achieved in low- and middle-income countries such as Rwanda, Kyrgyz Republic and Thailand.

Developing nations across Africa and Asia, face similar problems in implementation of health programs and are still struggling to achieve major milestones on the Sustainable Development Goals. Inability of health care delivery system to reach the remotest corners of society, increasing incidence of non-communicable diseases that demands high cost treatment , a growing uninsured population, political or economic instability, increasing budget deficits and increasing pressure to reduce healthcare costs are issues that are plaguing governments the world over. This makes scheme monitoring and evaluation a critical need for sound strategic planning and proper implementation.

Salient Features of the Scheme Monitoring System include:

• Beneficiary Registration: Authentication of beneficiaries, Generation of Unique ID, Evaluating Eligibility as per Scheme, Digitization of Medical Records
• Hospital Registration: Infrastructure Mapping of hospitals, Empanelment of hospitals as per infrastructure readiness & healthcare demand in catchment area
• Treatment Packages: Creation of custom treatment packages based on diagnosis of patient medical records
• Claim Processing: Online applications for claims, automated workflows for sanction, online disbursement
• Grievance Management: Ticketing and auto escalation of grievances raised by citizens
• Decision Support System: Advanced analytics and reports on performance of hospitals & insurance providers, fund deployment & utilization under scheme (district, block & ward level)

CSM with its Scheme Monitoring System, offers the necessary IT intervention to facilitate an integrated approach to state healthcare schemes. Our solution normalizes, authenticates, and validates arrays of data through enhanced programs of data mining and warehousing, thus ensuring benefits of healthcare schemes reach targeted beneficiaries. . The state of Himachal Pradesh is one of the first in India to successfully leverage technology for smooth implementation of a universal health protection scheme and our solution has been instrumental in facilitating this remarkable move towards creating an egalitarian healthcare system.