micare 5-year strategic plan · 2008). about 98% of revenues are derived from the members’...
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MICARE 5-YEAR STRATEGIC PLAN
(2009-2014)
I. Introduction
This 5 year Strategic Plan is a comprehensive approach to systematically address many
challenges affecting the operation of MiCare Plan and its mandated purpose of providing
health insurance coverage to all its members.
Most of the strategies presented here are developed to guide the implementation of this
Strategic Plan derived from the FY07 Annual Report and the MiCare Audited Financial
Statements ending September 30, 2007.
The strategies and activities will specifically address those actions recommended by the
Report and the Audit Financial Statements found in page 24.
II. Current Performance of the MiCare Plan
Fiscal Year 2007 had shown a net profit of $771,793 compared to net lost of $113,764 in
FY2006 and a steeped net lose of $557,261 in FY2005. The Audit Reports recommended
certain actions reflecting the previous Management views: (1) To wipe out the remaining
deficit, and (2) Restore the capital reserve of MiCare. Certain specific actions are also
recommended and these recommendations become the implementations strategies for this
3-5 Strategic Plan.
The FY07 Audit Report recommended actions are summarized as follow:
1. Strict implementations on referrals policy and procedures
2. A better control policy on claims review and adjudication
3. Aggressive collections of premium contributions
4. Implementation of co-payment for every visit at the private clinics
5. Promote members awareness on their health care benefits
6. Work with Department of Health Services in promoting healthy lifestyle of the
members
7. Improve public relations to government officials to seek additional funding
Continue to implement cost containment programs to closely monitor and control
Operational costs to ensure expenses are effectively managed.
III. Mission Statement of MiCare Plan
The Plan’s vision is to ultimately extend medical health insurance coverage to more than
30% of FSM residents at a more comprehensive and affordable costs.
2
This 5-Year Strategic Plan is also guided by the mission statement and will strategize
approaches to increase memberships from the current 20% of the FSM residents to 50%
within the planning period. This effort may posts heavy challenges since unification of
health insurance program in the National has been in futile with partial participations from
Yap, Chuuk and Pohnpei... Nonetheless, systematic approach to repeat the effort may
bring equal benefits to wider spectrum of the health insurance users throughout the FSM. .
IV. MiCare Membership
At the end of fiscal year 2007, total enrollment was 20,545, decrease of 1,171 or 5%
compared to fiscal year 2006. Table below shows the type of enrollment and the changes
over the three year period and the projections for the ensuing years (FYs 2010-2013).
FY09 enrollment information is available in the MiCare Office but has yet to be officially
tabulated and analyzed. The average annual membership based on FYs 2005-2008
enrollment data was 20,496 members, less than 19% of the FSM residents and other
MiCare users living in other countries.
The activities during the 5 year period (FY2009-FY2013) are to increase MiCare
membership by 50% or more than 10,000 additional enrollees.
The recent passage of the Mandatory Enrollment Bills by Congress end of September,
2008 is a big step to increasing MiCare membership. However, the bill is pending review
and endorsement by the President.
Table 1: Enrollment by Year and
Type of Enrollment FY05 FY06 FY07 FY08 FY09
Basic 15,871
17,518 18,321 17,865 n/a
Supplemental 2,554
2,857 3,022 2,577 n/a
Supplement Non-Residents 354 383 373 293 n/a
Total !8,779
20,758 21,716 20,735 n/a
Table 1.a. Rate of Enrollment by Type Type of Enrollment FY05 FY06 FY07 FY08 FY09
Basic 85% 84% 84% 86% n/a
Supplemental 14%
14% 14% 12% n/a
Supplement Non-Residents 1% 2% 2% 2% n/a
Total !8,779
20,758 21,716 20,735 n/a
Source: Data Analysis Unit, Administration Division, MiCare Main Office
3
As shown in Table 1 and Table 1.a above, a four year average of 17, 400 (or 84%) of the
MiCare members selected to enroll in the Basic Health Option, and average of 2,750 (or
13.5%) enrolled in the Supplemental Health Option. A minimal number, or average of 350
(1.75%), is enrolled in the Supplemental Health Option for Non-Residents.
The average enrollment per year for FY04-FY08 was 20,497 combining all Health Options.
This serves as baseline for the MiCare effort’s to increase membership by 50% in FY2013
or additional 10,248 new members, approximately 2,000 new members per year.
The Chart below shows projected enrollment for FY2009 to FY2013 under a rigorous
membership enrollment campaign.
Table 1.b: Enrollment Projections with MiCare 5-Year Campaign
FY08 FY09 FY10 FY11 FY12 FY13
Baseline Projection Projection Projection Projection Projection
17393.75 19133.13 21046.44 23151.08 25466.19 28012.81
2,753 3027.75 3330.525
3663.578
4029.935
4432.929
350.75 385.825 424.4075 466.8483 513.5331 564.8864
20497 22546.7 24801.37 27281.51 30009.66 33010.62
Chart One: Enrollment Projections for FY2009 to FY2013
0
5000
10000
15000
20000
25000
30000
35000
Basic
Supplemental
Supplement Non-Residents
Basic 17394 19133 21046 23151 25466 28013
Supplemental 351 386 424 467 514 565
Supplement Non-
Residents
351 386 424 467 514 565
20497 22547 24801 27282 30010 33011
FY08 FY09 FY10 FY11 FY12 FY13
4
The total enrollment goal for FY2013 is about 33,000 or additional 12,000 new enrollees
within the next five years.
Table 2: Enrollment and Projections by Agencies
Subscriber
Type
FY05 FY06 FY07 FY08 4-
Year 4 Year Rank FY09 FY010 FY11 FY12 FY13
Total Average Proj Proj Proj Proj Proj
National 2913 2944 2965 2730 11552 2888 3 3177 3494 3844 4228 4651
Pohnpei 4257 5076 5834 5785 20952 5238 1 5762 6338 6972 7669 8436
Chuuk 1073 959 1032 703 3767 942 6 1036 1140 1253 1379 1517
Kosrae 2488 2710 2863 2424 10485 2621 4 2883 3172 3489 3838 4222
Yap 550 619 728 713 2610 653 8 718 790 868 955 1051
COM-FSM 1282 1462 1615 1544 5903 1476 5 1623 1786 1964 2161 2377
FSM Tel 637 670 715 700 2722 681 7 749 823 906 996 1096
FSM SS 105 105 114 129 453 113 11 125 137 151 166 182
FSMDB 172 167 188 174 701 175 10 193 212 233 257 282
BOFSM 183 217 210 231 841 210 9 231 254 280 308 339
MLSC 114 106 113 89 422 106 12 116 128 140 154 170
Private Bus 0 5723 5339 5511 16573 4143 2 4558 5013 5515 6066 6673
TOTAL 18779 20758 21716 20735 81988 20497 22547 24801 27282 30010 33011
Source: Data Analysis Unit, Administration Division, MiCare Main Office
Based on the enrollment statistics from FY2004 to FY2008, the largest agency subscribing
to MiCare Plan is Pohnpei State with an average enrollment of 5,238 (or 26% of the total
enrollees) per year. Private Sector is second largest sponsor and has enrolled a yearly
average of 4,143 (or 20%). Other top agencies are National Government (2,888, or 14%),
Kosrae State Government (2,621, or 13%) and the COM-FSM (1,476, or 7%).
V. Revenue Collections
The table 3 shows the sources of revenues collected during four (4) fiscal years (2004-
2008). About 98% of revenues are derived from the members’ premiums. The Plan has a
potential premium collection of $5.3 millions per year.
Income from investment reached a top level of $55,536 in FY2007, and slanted in FY2007
($43,790) and again in FY2008 (projected $33,000). The level of investment as of
FY2008 is approximately $700,000 and it generated a 5% come during the same year.
It is one of the main Strategic Goal of the 5-Year Strategic Plan is to increase capital
investment by 50% by fiscal year 2013, or additional amount of about $350,000. The
projected total capital investment during the target year is about $1.0 million. Table 3.a.
shows annual investment and projected investment income during the five years period
(2009-2013).
5
Table 3: Revenue Sources, FY-05-FY08
Table 3: Revenue Sources, FY04-FY08
Sources of Revenue FY 2004 FY 2005 FY 2006 FY 2007 FY 2008
Members Premium 4,132,265 5,506,315 5,529,637 5,676,543 5,540,000
Investment Income 8,349 22,887 55,536 43,790 33,000
Other Income 4,965 5,272 9,295 11,266 7,000
FSM Contribution 300,000
Total 4,145,579 5,534,474 5,594,468 6,031,599 5,580,000
The revenue projection is based on annual 10% increase in membership, and 10% increase
in capital investment per year. Thus, the projected revenue from all sources is projected to
reach $9.0 millions by fiscal year 2013, or 60% from the FY2008 level. .
The projection is quite ambitious, but it is the determination of the 5-Year Plan and the
MiCare workforce to exert extra efforts towards realization of this goal.
Table 3.a: Projected Income by Sources, FYs2009-2013
Sources of Revenue FY 2008 FY09 FY10 FY11 FY12 FY13
Members Premium 5,540,000 6,094,000 6,703,400 7,373,740 8,111,114 8,922,225
Investment Income 33,000 36,300 39,930 43,923 48,315 53,147
Other Income 7,000 8,470 9,317 10,249 11,274 12,401
FSM Contribution 0 0 0 0 0
Total 5,580,000 6,138,770 6,752,647 7,427,912 8,170,703 8,987,773
Some strategies and activities that are outlined under the Planning Matrix section are as
follows:
1. Financial Supports to augment non-employed who are interested to enroll in
MiCare Plan;
2. Rigorous enrollment campaigns;
3. Improve Working relationships with the States, especially Yap States
4. Diversify funding sources to support MiCare;
5. Reduce medical referral costs;
6. Increase capital investments;
7. Support diagnostic equipment improvements and training to the four main
Hospitals;
8. 5-Year Healthy Members Incentive Program (Those who have not used their
insurance benefits for five or more years); and
9. Others.
6
Chart 2: Levels of Revenues, FYs 2004-2008
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
Series1 4,145,579 5,534,474 5,594,468 6,031,599 5,580,000
FY 2004 FY 2005 FY 2006 FY 2007 FY 2008
The Chart 2 above shows a collection norm at $5.5 millions since FY2005. The slight
increase in FY2007 to over $6.0 millions was due to infusion of $300,000 from FSM
Congress appropriations to help bail out the deficit spending during the previous years,
most particularly the FY 2006 net deficit amount of $1,554,304.
The recent passage of the Mandatory Enrollment Bills by Congress, if signed into law, will
increase revenue collections from currently non-covered FSM Government employees and
students enrolling at the COM-FSM. As of now, it is premature to project the revenue
collections as result of this legislation.
However, the unqualified estimate for per new enrollee coverage per year is $250.00 based
on the current enrollment and revenue collections. With the projected 10% membership
increase per year the total projected revenue during FY2013 will surpass $8.0 million.
7
Chart 2.a: Projected Revenues, Fiscal Years 2009-2013
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
8,000,000
9,000,000
10,000,000
Series1 5,580,000 6,138,770 6,752,647 7,427,912 8,170,703 8,987,773
FY 2008 FY09 FY10 FY11 FY12 FY13
VI Medical Expenditures
In FY08 alone, the projected expenditures for Medical Referrals were leveled at $2.6
millions which is about 53% of the total projected expenditure of $4.8 millions. On-Island
Private Providers had a significant share of the payment made by MiCare in the amount of
$1.8 millions or about 36%, while the four main Hospitals in FSM receive a bare amount of
$.5 million or 11%.
Medical Referral expenditures include Off-Island Tertiary Care Institutions, Patient
Airfare, and Patient Stipends.
Table 4: Medical Expenses in FYs 2004-2008
Cost Centers FY 2004 FY 2005 FY 2006 FY 2007 FY 2008
Off-island Providers 2,810,983 2,970,896 2,509,568 2,464,380 2,271,965 On-island Private Providers 1,222,043 1,703,611 1,915,921 1,571,598 1,732,640
State Hospitals 395,289 390,248 487,316 483,582 519,813
Patients Airfare 461,021 585,805 395,284 309,820 304,082
Patients Stipends 32,038 12,210 7,220 4,540 1,500
Total 4,921,374 5,662,770 5,315,309 4,833,920 4,830,000
The MiCare 5-Year Strategic Plan is to reduce cost of medical referral services down by
25% in FY2013, while increasing funding assistance to the 4 main Hospitals by 25%
8
during the same period. Based on FY2008 as baseline year, Table 4.a projected
decreases/increases for beginning FY2009 to FY2013.
Cost Centers FY 2008 FY 2009 FY 2010 FY 2011 FY 2012 FY2013
Off-island Providers 2605558 2475280 2351516 2233941 2122244
2016131
On-island Private Providers 1629163 1732640 1732640 1732640 1732640 1732640
State Hospitals 455250 478012.1 501912.7 527008.3 553359 581026.7
Patients Airfare 411202 390642.3 371110.2 352554.7 334927 318180.6
Patients Stipends 11502 1500 1500 1500 1500 1500
Total 5112675 5078075 4958679 4847644 4744669
4649479
Chart 3: Expenditures by Cost Center, FY08
On-island
Private
Providers,
1732640,
36%
Off-island
Providers,
2271965,
47%
State
Hospitals,
519813,
11%
Patients
Airfare,
304082, 6%
Patients
Stipends,
1500, 0%
9
Chart 3.a: Projected Revenue by cost center in FY2013.
1758003 39%
1732640 38%
837164 18%
211546 5% 1500 0%
Off-island
ProvidersOn-island Private
ProvidersState Hospitals
Patients Airfare
Patients Stipends
Table 4.a. Yearly Medical Expenditure by Cost Centers
Cost Centers FY 2004 FY 2005 FY 2006 FY 2007 FY 2008 5-Yr Total Yrly Ave
Off-island Providers 2810983 2970896 2509568 2464380 2271965 13027792 2605558
On-island Private Providers 1222043 1703611 1915921 1571598 1732640 8145813 1629163
State Hospitals 395289 390248 487316 483582 519813 2276248 455250
Patients Airfare 461021 585805 395284 309820 304082 2056012 411202
Patients Stipends 32038 12210 7220 4540 1500 57508 11502
Total 4921374 5662770 5315309 4833920 4830000 25563373 5112675
10
Chart 2: Type of Expenses
Four-Year Average Medical Expenses
(FY2004-FY2007)
$0
$1,000,000
$2,000,000
$3,000,000
Series1
Series1 $2,688,957 $1,603,293 $416,102 $504,431
Off-Islands
Providers
On-Island Private
ProvidersState Hospitals Patients Airfare
Chart 3: Summary of Projected Revenue, Expenditure and Variance
11
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
8,000,000
9,000,000
10,000,000
Projected Revenue 5,580,000 6,138,770 6,752,647 7,427,912 8,170,703 8,987,773
Projected Expenditures 5112675 5078075 4958679 4847644 4744669 4649479
Porjected Variance 467,325 1,060,695 1,793,968 2,580,268 3,426,034 4,338,294
FY 2008 FY09 FY10 FY11 FY12 FY13
Planning Matrices
Based on the foregoing background, MiCare is embarking on implementing beneficial
changes during the next five years. The strategic goals to direct these desirable changes are
listed below:
1. STRATEGIC GOAL 1: Eliminate current deficit of $782,511 by end of FY20109
2. STRATEGIC GOAL 2: Restore and Increase MiCare Capital Investment by 50%
in FY2012
3. STRATEGIC GOAL 3: Increase membership of MiCare subscribers by 25% in
FY2012 from FY08 baseline.
4. STRATEGIC GOAL 4: Reduce costs of claims and operational expenditures by
25% in FY2012
5. STRATEGIC GOAL 5: By 2010 gradually increase financial supports to Hospitals
in FSMN to improve diagnostic and treatment services to reduce referrals.
6. STRATEGIC GOAL 6: By 2012, Construct MiCare Office Building
7. STRATEGIC GOAL 7: BY FY2009, Develop and Implement a Human Resources
Development Plan
Strategic Goals and Activities
Strategic Goal Activities
SG I: Eliminate Deficit I.A.1.a: Recruit a qualified Utilization Manager with strong med background
Spending by end of I.A.2.a: Train one Utilization staff per fiscal year on medical terms and procedures
12
FY2009 (Same as VII.A.1.a)
I.A.3.a: Request and justify the needs in FY10 of new recruits with medical background
SGII: Increase Capital II.A.1.a: Increase Investment portfolio by 10% each year based on FY07 baseline.
Investment by 50% in FY2012
SGIII: Increase MiCare III.A.1.a: Launch an rigorous enrollment campaign to attain at least 800 member/year
Membership by 25% in FY12
III.A.1.b: Amend existing regulations to allow any dependent, including parents, to
participate in MiCare program even they are not staying in the same household.
III.A.1.c: Seek funding to supplement premiums of non-employed.
III.A.1.d: Work with Yap State to participate in the program.
III.A.1.e: Institute 5-Year Healthy Members Award to payback 50% of paid premiums
SG IV: Decrease Medical IV.A.1.a Modify the Medical Coordination functions in various Hospitals in Manila
Expenses and claims IV.A.1.b: Recruit a full-time Medical Coordinator in Manila with full authority to
by 25% in FY12 monitor and direct patient cares to members
IV.A.1.c: Recruit a full-time Utilization Manager to focus in on Provide Provider claims
(Same positions in I.A.1.a above)
IV.A.1.d: Train local utilization personnel to attain medical procedures and claims
(Same as VII.A.1.a)
IV.A.1.e: Work closely with private providers to eliminate unnecessary claims by
Instituting a Claim Accreditation Facility.
IV.A.1.f: Institute a Doctor Referral Accreditation Program to improve diagnosis of
Referred patients.
IV.A.1.h: Institute a Most Efficient Provider Awards to provider(s) who strictly follow
claim and referral requirements of MiCare.
SG V: By 2010 gradually V.A.1.b: Conduct a Medical Equipment Needs to reduce number of referrals.
increase funding V.A.1.c: Collaborate with other Donor Agencies to support diagnostic and medical
supports to Hospitals equipment and trainings to local providers.
VI: By 2012, Construct VI.A.1.a: Secure a land parcel with the State
MiCare Office Building VI.A.1.b: Design a concept Floor layout
VI.A.1.c: Final Engineering Design and Material Listings
VI.A.1.d: Construction
SGVII: Human Resources VIII. A.1.a: At least one staff per year for short term trainings (6-12 months duration)
Development Plan VII.A.1:b: At least one staff for formal trainings (AA/AS,BA/BS, etc.)
VII.A.1.c: At least 3 personnel to attend 1 week trainings.
FUNDING OF 5-YEAR MiCARE PLAN
Funding
Activities FY09 FY10 FY11 FY12 FY13 Sources
I.A.1.a: Recruit a qualified Utilization
Manager with medical background $ 29,000 $ 29,000
$ 29,000
$ 29,000
$ 29,000 MiCare
13
I.A.2.a: Train one Utilization staff per fiscal year $ 12,000 $ 24,000
$ 36,000
$ 36,000 MiCare
II.A.1.a: Increase Investment portfolio by 10%
each year based on FY07 baseline. $ $ 75,000 $ 75,000
$ 75,000
$ 75,000 MiCare
III.A.1.a: Launch a rigorous enrollment campaign to attain at least 800 new members.
$ 5,000 $ 10,000
$ 20,000
$ 20,000
$ 20,000 MiCare
III.A.1.b: Amend existing regulations to allow dependent parents to enroll regardless of residency.
$ - $ -
$ -
$ -
$ -
III.A.1.c: Seek funding to supplement interested non-employees $ $ 50,000
$ 50,000
$ 50,000
$ 50,000 FSM
III.A.1.d: Institute 5-Year Healthy Members Award $ 50,000 $ 50,000 $ 50,000 $ 50,000 MiCare IV.A.1.a Modify the Medical Coordination functions in various Hospitals in Manila
$ - $ -
$ -
$ -
$ -
IV.A.1.b: Recruit a full-time Medical Coordinator in Manila $ $ 25,000
$ 25,000
$ 25,000
$ 25,000 MiCare
IV.A.1.c: Recruit a full-time Utilization (Same as position in I.A.1.a)
$ - $ -
$ -
$ -
$ -
IV.A.1.d: Train local utilization personnel to (Same as VII.A.1.a)
$ - $ -
$ -
$ -
$ -
IV.A.1.e: Work closely with private providers to eliminate unnecessary claims by
$ 5,000 $ 5,000
$ 5,000
$ 5,000
$ 5,000 MiCare
IV.A.1.f: Institute a Doctor Referral Accreditation Program to improve diagnosis of Referred patients.
$ 5,000 $ 5,000
$ 5,000
$ 5,000
$ 5,000 MiCare
IV.A.1.h: Institute a Most Efficient Provider Awards to provider(s) who strictly follow referral policies $ 50,000
$ $50,000 $ 50,000 $ 50,000 MiCare
V.A.1.a: Conduct a Diagnostic Equipment Need $ 30,000 $ - $ - $ - MiCare V.A.1.c: Collaborate with other Donor Agencies to support diagnostic and medical $ 200,000
$ 200,000
$ 200,000
$ 200,000
PRC, AusAide, etc.
equipment and trainings to local providers. Others
VI.A.1.a: Secure a land parcel with the State $ 30,000 $ - $ - $ - MiCare
VI.A.1.b: Design a concept Floor layout $ $ $ $ $ MiCare VI.A.1.c: Final Engineering Design and Material Listings $ 2,000
$ -
$ -
$ - MiCare
VI.A.1.d: Construction $ 250,000
$ 250,000 PRC, Others
VIII. A.1.a: At least one staff per year for short term trainings (6-12 months duration)
$ 7,000 $ 7,000
$ 7,000
$ 7,000
$ 7,000 MiCare
VII.A.1:b: At least one staff for formal trainings (AA/AS,BA/BS, etc.) $ 20,000
$ 40,000
$ 40,000
$ 40,000 FSM,AusAide
VII.A.1.c: At least 3 personnel to attend 1 week trainings.
$ 8,000 $ 8,000
$ 8,000
$ 8,000
$ 8,000 MiCare
Yearly Total $109,000 $608,000
$ 588,000 $ 850,000 $ 850,000
5-Year Total $3,005,000
Round-Off $3.0 million
Funded by MiCare Funded by Other Sources
Table Funding Needed to Implement the 5-Year Activities
14
Projected Sources of Funding
0
100,000
200,000
300,000
400,000
500,000
600,000
MiCare
Others
MiCare 59,000 338,000 298,000 310,000 310,000
Others 50,000 270,000 290,000 540,000 540,000
2009 2010 2011 2012 2013
POSSIBLE SOURCES OF FUNDING Sources Program 2009 2010 2011 2012 2013 TOTAL
MiCare Utilization Manager $29,000 $29,000 $29,000 $29,000 $29,000 $145,000
New recruits Medical Background
0
$12,000
$24,000
$36,000
$36,000
$108,000
Investment 0 $75,000 $75,000 $75,000 $75,000 $300,000
Enrollment Campaign
$5,000
10,000
$20,000
$20,000
$20,000
$75,000
Amend regulations to
include parents dependents
regardless of residency
0
0
0
0
0
0
Healthy Members Awards
$50,000
$50,000
$50,000
$50,000
$200,000
Centralization of Medical
Coordination in Manila
$25,000
$25,000
$25,000
$25,000
$100,000
Eliminate unnecessary
claims by Providers
5,000
5,000
5,000
5,000
5.000
$25,000
Institute Accreditations for
Hospital and Doctors
$5,000
$5,000
$5,000
$5,000
$5,000
$25,000
Most Efficient Providers
Award
$50,000
$50,000
$50,000
$50,000
$200,000
Diagnostic Equipment
Needs Assessment in the Hospitals
$30,000
$30,000
Land parcels for MiCare
Bldg
$30,000
$30,000
Engineering Design for
MiCare Bldg
$2,000
$2,000
Short Term Trainings $7,000 $7,000 $7,000 $7,000 $7,000 $35,000
Staff to Attend workshops
and Conferences
$8,000
$8,000
$8,000
$8,000
$8,000
$40,000
TOTAL MiCare $59,000 $338,000 $298,000 $310,000 $310,000 $1,.315,000
15
OTHER
S
FSM Congress
Non-Employees Supplement Funds
$50,000
$50,000
$50,000
$50,000
$50,000
$250,000
US
Japan
Hospital Diagnostic
Equipment Improvement
$200,000
$200,000
$200,000
$200,000
$800,000
PRC
MiCare Bldge Construction $250,000
$250,000
$500,000
Scholarships $20,000 $40,000 $40,000 $40,000 $140,000
TOTAL Others $50,000 $270,000 $290,000 $540,000 $540,000 $1,690,000
Summary of Sources of Funds
2009 2010 2011 2012 2013 Total
MiCare 59,000 338,000 298,000 310,000 310,000 1,315,000
Others 50,000 270,000 290,000 540,000 540,000 1,690,000
Total 109,000 608,000 588,000 850000 850,000 3.005,000
SCHEDULE OF ACTIVITIES
An Annual Implementation Plan will be developed to guide implementations of activities
for each fiscal year. The table below shows the yearly allocations of activities under each
Strategic Goal
Activity FY09 FY10 FY11 FY12 FY13
I.A.1.a: Recruit a qualified Utilization Manager with medical
background
I.A.2.a: Train one Utilization staff per fiscal year (Same as
VII.A.1.a.)
I.A.3.a: Request and justify the needs in FY10 for med background
recruits.
II.A.1.a: Increase Investment portfolio by 10% each year
III.A.1.a: Launch an rigorous enrollment campaign III.A.1.b: Amend existing regulations to allow dependent parent regardless of residency
III.A.1.c: Lobby for passage of the mandatory enrollment III.A.1.d: Seek funding to supplement premiums of non-employed
III.A.1.f: Institute 5-Year Healthy Members Award
IV.A.1.a Centralize Medical Coordination functions in Manila
IV.A.1.b: Recruit a full-time Medical Coordinator in Manila
IV.A.1.c: Recruit a full-time Utilization Manager (I.A.1.a)
IV.A.1.d: Train local utilization personnel (VII.A.1.a) IV.A.1.e: Institute a Claim Accreditation to cut unnecessary costs
IV.A.1.f: Institute a Doctor Referral Accreditation Program
To improve referrals of patients to off-island Hospitals.
IV.A.1.g: Institute a Provider Referral Accreditation/Incentive
Program to improve referral review of patients.
X
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
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IV.A.1.h: Institute a Most Efficient Provider Incentives Program
V.A.1.a: Conduct a Diagnostic Equipment Need Assessment
V.A.1.b: Funding to support Diagnostic and Med Equipment in Hospitals
VI.A.1.a: Secure a land parcel with the State
VI.A.1.b: Design a concept Floor layout
VI.A.1.c: Final Engineering Design and Material Listings
VI.A.1.d: Constructions
VIII. A.1.a: At least one staff per year for short term trainings
(6-12 months duration)
VII.A.1:b: At least one staff for formal trainings
(AA/AS,BA/BS,etc.)
VII.A.1.c: At least 3 personnel to attend 1 week trainings.
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FYO9 ACTIVITIES
Among 26 programs and activities to be implemented to attain the 6 Strategic Goals for the
next five years, 13 will be initiated in FY09. Nine (9) of these 13 will be attained in FY09
and 4 will continue into the FY10.
Those programs and activities to be completed in FY09 are in bold face.
ACTIVITY PERSON
RESPONSIBLE
Target Date STATUS REMARK
I.A.1.a: Recruit a qualified
Utilization Manager with
medical background
Utilization
Division
Administrator
Supervisors
MiCare Board
November 1,
2008
Position approved by Board 9/17/08.
Examination Announcement with FSM
Personnel Office
Recruitment is
expected 1st
November,
2008
III.A.1.b: Amend existing regulations to allow dependent parent regardless of residency
Administrator
Legal Counsel
MiCare Board
Draft: 10/08
Legal Review:
11/08
Board: 12/08
Amendment being drafted by the
Administrator
Part 1.6.j,s are
to be amended
III.A.1.d: Seek funding to supplement premiums of interested non-employed
Administrator
Congress
President’s Office
Proposal: 1/09
Effect: FY10
No activity as of date MiCare proposes
$50,000/FY
III.A.1.f 5-Year Healthy Members Award
Administrator
MiCare Board
Proposal:2/09
Effect:FY10
No activity as of date MiCare proposes
$50,000/FY
IV.A.1.a Centralize Medical Coordination functions in Manila
Administrator
Manila Office
Proposal: 11/08
Contract:12/08
Effect: 01/09
Ongoing discussions with Manila Office
and trials are ongoing
MiCare
proposes Dela
Santo Hosp &
Dr. Ocampo
IV.A.1.b: Recruit a full-time Medical Coordinator in Manila
Manila Office Admin Services
Manager
Administrator MiCare Board
FSM Personnel
Office
PD: 02-6/09 Board: 9/09
EA: 9/09
Salary:FY10
Manila Office is working to clear other activities with other Hospital prior to
setting up of the Centralized Medical
Coordination there.
Trial run during FY09, and
recruitment in
FY10 if approved by the
Board.
IV.A.1.h: Institute a Most Efficient Provider Incentives Program
Administrator Board of Directors
Draft: Jan 09 Approval: 3/09
Effect: FY10
No activity as of date MiCare proposes $50,000/FY
V.A.1.a: Conduct a Health Services Study: 3/09 Discussions with Secretary of Health and MiCare will use
17
Diagnostic Equipment Need Assessment
MiCare Report:5/09 Chairman HESA Committee on
supports to Hospitals.
$5,000 of its
travel funds in
FY09
VI.A.1.a: Secure a land parcel with the State
IT Specialist
Administrator
Land
Management
Governor’s Office
Designation:
1/09
Negotiations ongoing with State Land
Management and Governor’s Office.
MiCare
proposes
$30,000 for
FY10 in case
purchase is
required
VI.A.1.b: Design a concept Floor layout
IT Specialist
Administrator
Engineer
Layout: 10/08
PreDesign:
11/08
Final: 02/09
Draft Floor Concept is being reviewed
by appropriate staff
Construction is
projected for
FY11&FY12
VII.A.1:a Short term trainings:
Division
Supervisors
Administrator
Needs: 10/08
Information share with Office staff
during Staff Meeting Sept 23
Memo is issued to remind Supervisor
about the short term training needs
$15,000 is
budgeted for
this activity in
FY09.
VII.A.1.b. Long-term
formal training
Division
Supervisor
Administrator
Health Services
Candidates:
10/08
Funding: 2/19
Information share with Office staff
during Staff Meeting Sept 23
Memo was sent out to the Supervisor
asking for possible candidates
Letter was sent to Secretary, DHSS Oct
1requesting training assistance from
WHO and other sources
MiCare
Proposes 1 staff
to enroll each
year for the
next 4-6 years.
VII.A.1.c: At least 3 personnel to attend 1 week trainings.
Division
Supervisor
Administrator
Workshop:
10/08
Attendees:
10/08
Memo will be sent out reminding the
Supervisors
Same $15,000
in VII.A.1.a
above applies t