THE ROLE OF

INA CBG TECHNICAL TEAM

dr. Kalsum Komaryani, MPPM

Member of INA CBG Technical Team
Ministry of Health
Jakarta, October 23, 2015
 OUTLINE

1.The role of INA CBG Technical Team

2.Problems and challenges on INA CBG implementation
3.Roadmap on INA CBG development
4.Some figures from field visit

2
1.The role of INA CBG Technical Team

3
 PRESIDENTIAL DECREE # 12/2013 ON
NATIONAL HEALTH INSURANCE
Article 37

(1)Payment to health care provider decided by agreement

between BPJS Kesehatan and health care provider association
based on tariff which is set by MoH

Article 39

(4)Capitation and Ina CBG tariff reviewed at least every 2 years

conducted by MoH and should be coordinated with MoF.

4
WHO CARE OF INA CBG TARIFF?

5
INA-CBG TECHNICAL TEAM
AS A SUBTEAM OF JKN TARIFF TEAM
AT MINISTRY OF HEALTH
UNDER HEALTH MINISTRIAL DECREE
NUMBER 102/MENKES/SK/2014
THE STRUCTURE OF JKN TARIFF TEAM
 THE TASK OF INA CBG TECHNICAL TEAM

1.Setting tariff for secondary and tertiary health care

provider (INA CBG)
2.Providing socialization on INA CBG tariff
3.Conducting monitoring and evaluation of INA CBG
implementation
4.Updating INA CBG tariff routinely

8
1. INA CBG TARIFF SETTING

NCC TEAM INA CBG TECHNICAL TEAM

9
 2. SOCIALIZATION ON INA CBG
Socialization
conducted by

10
3. MONITORING AND EVALUATION INA CBG

Many ways to do monitoring and evaluation:

1. Data claim claim analysis

2. Information: by phone, sms, letter, email, report, etc
3. Field visit
4. Review/Evaluation meeting

Field visit

1. Based on data claim select hospital that will be visited

2. Using standardized monitoring tools
3. Conducted by a team INA CBG team, BPJS Kesehatan, IDI
4. Through field visit providing assistance for hospitals 11
FIELD VISIT MECHANISM
REGULATION ON INA CBG IMPLEMENTATION

1. MoH decree # 27 /2014 INA CBG guideline

2. MoH decree # 28/2014 JKN guideline

3. MoH decree # 59/2014 JKN tariff

4. MoH decree # 36/2015 Fraud prevention system

5. Secretary General MoH circular letters

13
 PENDING CLAIM AND SOLUTION
IN INA CBG IMPLEMENTATION
Dispute on INA CBG claim causes pending claim situation.

To cope this problem, INA CBG Technical team conduct a

several meetings with BPJS Kesehatan and doctor (specialist)
associations.

For coding problem, decision made by INA CBG team, but, for
clinical problem, decision made by doctor associations.

This guidance has been/will be disseminated through Secretary

General Circular Letter.

14
4. UPDATING INA CBG AT LEAST EVERY
2 YEARS

15
 SIMULATION ON PREMIUM VS TARIFF

SIMULATI FINALI
UP ZATION
ON
DATING OF
PREMIUM
TARIFF TARIFF
VS
TARIFF
2. Problems and challenges

17
 PROBLEMS AND CHALLENGES (1)

INA CBG has not been fully understood by stakeholders

Competency of coders

Poor medical record

Some hospitals have not implemented cost containment and quality control
 PROBLEMS AND CHALLENGES (2)
Medical fees/insentives distribution

The defect of grouper

Nominal in some groups is still not appropriate

 SOLUTION

Socialization
Certified and accredited training for coder
Compliance to medical guideline
Cost containment
Remuneration
INA CBG grouper refinement
Updating and refinement on INA CBG tariff

20
3. Roadmap on INA CBG development

21
ROADMAP ON INA CBG DEVELOPMENT
IN INDONESIA

2015 2016 2017 2018 2019

4. Some figures from field visit

23
TREND OF OUTPATIENT VISIT RATE AT
SELECTED HOSPITAL 2014
TREND OF INPATIENT VISIT RATE AT
SELECTED HOSPITAL 2014
 % OF CASES WITH 2 X VISIT

OUTPATIENT CARE
 % OF CASES WITH MORE THAN 2 X
VISIT
OUTPATIENT CARE
% OF CASES WITH 2 X ADMISSION
INPATIENT CARE
% OF CASES WITH MORE THAN 2 X
VISIT
INPATIENT CARE
TREND OF PROVIDER PAYMENT FOR
OUTPATIENT CARE
TREND OF PROVIDER PAYMENT FOR
INPATIENT CARE
THANK YOU