Activity Documentation Report PhilHealth Konsulta Training
Activity Documentation Report PhilHealth Konsulta Training
Department of Education
SOCCSKSARGEN REGION
Contents
This session will enable them to study and be oriented with the PhilHealth
Konsulta Package and Professional Accreditation in order to make informed
decisions about availing these benefits. Furthermore, it will outline the critical
factors and necessary preparations the department must consider if decided to
proceed with accreditation. Two (2) subject matter experts from Philippine
Health Insurance Corporation RO XII and Department of Health RO XII – Center
for Health and Development were invited to provide an orientation with Konsulta
Package accreditation and implementation.
A. Preliminary Activities
Module/Session Specifications
Orientation on PhilHealth Konsulta Package by Dr. Leana Clare Filipinas
Omnibus Guidelines on During the discussion, Dr. Leana outlined the core objective of
the Accreditation of the PhilHealth Konsulta Package: to expand access to and
Health Facilities (HFs) to reduce the cost of primary and outpatient care services. She
the National Health further explained that the capitation for Konsulta is set at PHP
Insurance Program 1,700 per patient annually. Regarding the ideal patient load,
she mentioned a catchment population ratio of 1 doctor to
every 20,000 patients. Additionally, Dr. Leana clarified the
payment structure, stating that the first tranche, amounting to
60% or PHP 680.00 of the total capitation, will be paid upon the
patient's initial encounter.
Registration to a As discussed by Doc Leana, members have several options for
PhilHealth Konsulta enrollment. One method is Member-initiated, where
Package Provider (KPP) individuals can directly register through the My PhilHealth
online portal. Alternatively, assistance is available via
PhilHealth-Assisted processes, implying direct support from
PhilHealth personnel. Furthermore, registration can also be
facilitated by Third-party partners, who collaborate with
PhilHealth to provide these services.
PhilHealth Konsulta The PhilHealth Konsulta Package encompasses comprehensive
Benefit Package health screening and primary care consultations, with
diagnostic services and medicines to be availed based on the
physician's health screening and assessment. Dr. Leana
elaborated on the specific Health Services covered, which
include 15 diagnostic tests such as CBC with platelet count,
urinalysis, fecalysis, Sputum Microscopy, Fecal Occult Blood,
Pap smear/VIA, Lipid Profile, FBS, Oral Glucose Tolerance Test,
ECG, Chest X-Ray, CREATININE, HbA1C, Ultrasound, and
Mammogram. Furthermore, the package also provides
coverage for 21 types of medications.
Benefit Availment Process Dr. Leana presented an illustration of the EKAS and/or EPRESS,
C. Open Discussion
Responsible
Issues/Concern Recommendations/ Agreements Person/Offic
e
The Medical Officer III of the PhilHealth responded that while FPE can DepEd
Schools Division Office (SDO) be conducted in the field, a
Koronadal inquired whether the significant challenge arises: the
First Patient Encounter (FPE) inability to verify in real-time if the patient
must be conducted exclusively is already registered with another
within a facility or if it is Konsulta Provider Package (KPP).
permissible in the field. Conversely, if the FPE is performed within
the facility and the patient's name is
entered into the system, "the system will
automatically prompt if they are already a
beneficiary of another KPP."
The Medical Officer III of SDO PhilHealth responded that there is DepEd
Kidapawan requested clarification currently no official MOA template.
on the specific items and However, PhilHealth will provide guidance
provisions to look for in the on the technicalities of crafting the MOA
Memorandum of Agreement once an application is submitted.
(MOA) concerning partnered
Key provisions to include in the MOA are:
laboratories and pharmacies.
A clear statement that patients
referred to partnered laboratories
or pharmacies will not be charged
for services (No Balance Billing
Policy).
An internal arrangement detailing
how the Konsulta Provider Package
(KPP) will remunerate their allied
agencies.
The Medical Officer III of SDO PhilHealth advised to clarify with their PhilHealth
The Medical Officer III of SDO PhilHealth confirmed that, yes, profiling DepEd
Kidapawan inquired whether can be done during the accreditation
profiling can commence while the period. As of now, PhilHealth permits a
accreditation process is still child to have a different provider than
ongoing. their parents. For instance, a parent might
be registered at a Rural Health Unit (RHU)
while their child is enrolled at a school or
SDO Clinic. However, PhilHealth reiterated
a crucial challenge: it is currently not
possible to cross-check if a student is
already registered with another Konsulta
Provider Package (KPP) in real-time.
The Medical Officer III of SDO PhilHealth responded by stating that DepEd
Kidapawan raised a concern Konsulta has its own system, known
regarding the Functional as ECON. It was suggested that each
Health Information System, Konsulta Provider Package (KPP)
specifically the inability to assign must have an encoder whose role is to
an individual for back-end perform data entry on this system.
processes or claims due to a lack
of additional manpower in School
Health. The MO III inquired, "Can
The Medical Officer III of SDO PhilHealth responded positively, stating PhilHealth
Tacurong confirmed they had they will provide technical assistance Insurance
already consulted with the once SDO Tacurong begins preparing for Corporation
Schools Division Superintendent accreditation. RO XII
(SDS) regarding the accreditation
process. They then formally
requested assistance throughout
the entire process,
acknowledging its novelty for
them.
The Medical Officer III of SDO PhilHealth clarified that a Konsulta DepEd
South Cotabato raised a question Provider Package (KPP) applicant is
regarding the Memorandum of indeed allowed to have MOAs with
Agreement (MOA) with more than one laboratory and
laboratories and pharmacies. multiple pharmacies. This is permissible
Specifically, they inquired if a provided they possess a Certificate of
single MOA would suffice, even Service Delivery signed by the Schools
when dealing with patients from Division Superintendent (SDS). The
Prime Regional Government Center, Brgy. Carpenter Hill, City of Koronadal
Telephone Nos.: (083) 2288825/ (083) 2281893
Email Address: [email protected]
Website: depedroxii.org
Republic of the Philippines
Department of Education
SOCCSKSARGEN REGION
rural areas distant from the city. guideline suggests establishing one
laboratory/pharmacy per municipality, as
long as these facilities stock the required
21 medications.
The Medical Officer III of SDO PhilHealth responded that once DepEd, COA,
Kidapawan inquired about the accredited, an orientation will be and PhilHealth
process of establishing a special conducted that will include the
fund for Konsulta. This included process of filling out forms for
asking about a potential opening a bank account where the
Memorandum of Agreement Konsulta funds will be transferred.
(MOA) between DepEd and This account would be under the name of
PhilHealth that would outline how the school or division clinic. PhilHealth
to create a special account also advised the MO III to consult with
approved by the Department of their respective Commission on Audit
Budget and Management (DBM). (COA) and to inquire with other divisions
that are already Konsulta Provider
Packages (KPPs) for further guidance.
The Medical Officer IV inquired Dr. Rex responded by explaining their DepEd
about the current percentage of current capacity: with a ratio of one
the population profiled relative to doctor per 20,000 patients, and having
PhilHealth's coverage. two doctors (DTTD), their potential
coverage extends to 40,000 individuals.
However, as of today, they have only
profiled approximately 14,000
individuals. This represents about 35%
of their potential coverage (14,000 divided
by 40,000). He also noted that
PhilHealth's first payment will cover
this initial 14,000 profiled population.
The Medical Officer IV posed a Dr. Rex acknowledged this as one of his PhilHealth
The Medical Officer III of SDO Dr. Rex clarified that the payment PhilHealth
Kidapawan directed a question to distribution depends on each Local Insurance
Dr. Rex, inquiring about the Government Unit. He provided Corporation
method of payment distribution examples: in North Cotabato, the split is RO XII
for Konsulta services, who the 50% for the facility and 50% for
recipients would be, and the incentives. In Sultan Kudarat, the split is
specific distribution amounts. 60% for the facility and 40% for
incentives.
Dr. Rex posed a question to The Medical Officer IV (MO IV) responded DepEd
PhilHealth regarding DepEd's that she had already inquired with the
eventual integration into health Central Office of DepEd regarding the
provider networks and the healthcare provider network but had not
associated fund-pooling from the yet received feedback, expecting answers
province. He asked if, should at the next meeting. However, she also
DepEd establish its own Konsulta, consulted the DOH-CHD Regional Office
they would also be enjoined in XII, as the Healthcare Provider Network
this provincial fund-pooling or if (HCPN) is already operational in South
they would remain separate. Cotabato.
The Medical Officer IV raised a Dr. Rex responded by asserting that he is DOH-CHD
concerning issue: some Rural "pretty sure that he is not one of that
Health Unit doctors are doctors because he caters all." He further
reportedly refusing to cater to stated that he "can't provide a sentiment
DepEd students and teachers, because it's not usually talked about in
citing that they are already the meeting." He expressed hope that
covered by PhilHealth Konsulta. "soon, they could have a dialogue
The MO IV asked for Dr. Rex's addressing that certain kind of issue."
stand on this matter.
Dr. Rex raised an issue The Medical Officer IV, Dr. Jamila, DepEd
concerning teacher leave committed to raise this concern with Regional
forms, particularly for those the top management. Medical
nearing retirement. He noted that Officer IV
even though these teachers have
access to Medical Officers within
their respective Schools Division
Offices, they still opt to consult
with Rural Health Unit doctors for
their medical certificates.
The Medical Officer IV inquired PhilHealth confirmed that yes, 40 hours DepEd
about the requirement for a per week (8 AM-5 PM) is required,
Konsulta Provider to render 40 given that DepEd facilities operate during
hours of consultation per weekdays.
week, asking if it is indeed
mandatory and what strategies
Dr. Rex could recommend Dr. Rex added that for Rural Health Units,
fulfilling this. the 40 hours per week is
automatically met as their clinics are
operational from Mondays to Sundays.
D. Synthesis
During the open discussion, several issues and concerns were raised by
Medical Officers from various SDOs, along with recommendations and
agreements. Topics included the permissibility of First Patient Encounter (FPE) in
the field, the lack of an official MOA template for partnered laboratories and
pharmacies, clarifying health facility ownership for performance commitment,
and the ability to conduct profiling during accreditation. Questions also arose
regarding professional accreditation requirements for KPP personnel, the
feasibility of outsourcing back-end processes for the Functional Health
Information System, and concerns about redundancy in student registrations.
Discussions also covered establishing special funds for Konsulta, the percentage
of population profiled versus PhilHealth coverage, steps to acquire special health
funds, the rate split between doctors and providers, payment distribution, and
DepEd's potential integration into Healthcare Provider Networks. Additionally,
concerns were raised about RHU doctors not catering to DepEd students and
teachers, and teachers going to RHU doctors for leave forms despite having SDO
MOs. PhilHealth confirmed the 40-hour weekly consultation requirement for
Konsulta Providers. The orientation concluded with an awarding ceremony for
resource speakers and a photo opportunity.
E. Closing Activities
Photo Documentation
Prepared by:
Noted by: