Subject: FW: UHCP GEO: Mission (June 26-28) Summary
From: Mariana Mkurnali <[email-masked]>
To: Tamar Gabunia <[email-masked]>, "[email-masked]" <[email-masked]>, "tengiz abazadze ([email-masked])" <[email-masked]>, "[email-masked]" <[email-masked]>, Mariam Darakhvelidze <[email-masked]>, Ketevan Goginashvili <[email-masked]>, Ekaterine Adamia <[email-masked]>, "[email-masked]" <[email-masked]>, "[email-masked]" <[email-masked]>, "[email-masked]" <[email-masked]>, "[email-masked]" <[email-masked]>, "
Date: Tue, 02 Jul 2019 11:49:31 +0000

მოგესალმებით,

გთხოვთ, იხილოთ სტრატეგიული შესყიდვების მისიის შემდგომი, ჯანმოს ექსპერტთა მიერ გადმოგზავნილი მეილი (გასათვალისწინებელი რეკომენდაციები/წინადადებები) და დანართი.

დამატებითი შეკითხვების, დაზუსტებების ან სკაიპ ქოლის ჩანიშვნის შემთხვევაში, გთხოვთ მომწეროთ.

პატივისცემით,

მარიანა მკურნალი

საერთაშორისო ურთიერთობებისა და აპარატის საქმისწარმოების სამმართველოს უფროსი

ანალიტიკის, ადამიანური რესურსების მართვისა და საერთაშორისო ურთიერთობების დეპარტამენტი

საქართველოს ოკუპირებული ტერიტორიებიდან დევნილთა, შრომის, ჯანმრთელობისა და სოციალური დაცვის სამინისტრო

აკ. წერეთლის გამზირი 144,  თბილისი, საქართველო,  0159

მობ:  +995 599 490942

Dear Mariana,

Our main focus this time was on SSA’s branch office health related functions and based on our visit to the Rustavi office we developed the new structure for the branch office. You can find it from the attached file after head quarter organogram. Below is a brief summary of it.

First, we recommend to simplify the SSA’s head quarter structure a bit (new organogram in the attached file). We discussed in Rustavi the claims management process and their feedback was that it is difficult to make a clear distinction between those who inspect the claims and those who are doing on-site monitoring. Generally speaking, these two functions have same objective and can replace each other. Thus, our recommendation is to merge these two structural units – claims management and on-site monitoring. This is also in line with the future direction to move more to the digital analytical controls and to reduce the amount of case level “inspection”. Competences needed for both functions are same and merging two units would allow more flexibility among staff, e.g. one person can focus half a time on digital inspection and remaining time on on-site monitoring.

Second, we suggest that the new branch office structure follows the head quarter structure which means overcoming fragmentation between vertical and UHC programs. Not all functions are presented at the branch office level according to the new organisational structure. For example, two head quarter departments under the strategic planning and organizational support stream do not have branch office level functions. At the same time, two departments under the provider relations stream – contracting and claims management – have important functions also at the branch office level. Contracting function is currently not existing in the SSA’s branch offices. In the future it would be important to move to active contracting which also includes selective contracting elements. This would require clear division of the roles between the head quarter and branch offices. It is advisable to have a strong central coordinating role but at the same time to actively involve branch offices to get their knowledge about actual situation and to make them responsible for regular communication with providers. Similarly the claims management (including on-site monitoring) functions will be divided between the head quarter and branch offices. Branch offices role in claims management is much bigger compared to the contracting and head quarter role is only to develop the procedures and to supervise branch offices work.

New head quarter and branch office functions are elaborated keeping these principles in mind (see attached file).

Please let us know if you have any questions for clarification or if it would be useful to have a skype call in coming weeks.

Have a nice weekend

Triin