In order to fully implement the spirit of the 20th National Congress of the Communist Party of China and continue to focus on the concerns of the masses in the field of medical insurance management, the medical insurance agency in Jilin City, Jilin Province has accelerated the transformation of its functions, further promoted the reform of "decentralization, decentralization and service" in the field of medical security, and comprehensively created a new joint service model of "medical insurance + bank + hospital + pharmacy" through the establishment of a cross-industry and cross-field collaborative working mechanism, and strived to extend the tentacles of medical insurance services to the "first-line window" around the masses, and the sinking work of the city's medical insurance handling service system has been solidly promoted.
1. Plan scientifically, clarify responsibilities, and formulate and complete the localization implementation plan
Jilin City attaches great importance to the construction of the medical insurance service system and promotes the sinking of services, and lists it as a key task to promote it during the year, and instructs the agency to take the lead in implementation. After the issuance of the Provincial Bureau's "Sinking Work Plan" and the "List of the First Batch of Sinking Matters", Jilin City's medical insurance did not wait or rely on it, and took immediate action, actively reported the relevant requirements of the superiors to the leaders in charge of the city, and scientifically judged its own advantages and work directions. With the all-round support of the Municipal Party Committee and the Municipal Government, the "Implementation Plan for Strengthening the Sinking of the Medical Security Service System in Jilin City" was formulated. At the same time, it has continuously strengthened communication and cooperation with functional departments such as politics, civil affairs, finance, and health, and clarified the core content of the objectives, tasks, work content, and construction goals of each functional department in the service sinking work, and widely issued them in the whole region in a joint form. We have built a work pattern of "leading the promotion and coordinated implementation of departments".
2. Extensive screening and strict measures to cultivate tree services and sink provincial pilots
After careful study, Jilin City identified Changyi District as a provincial pilot for the construction of a medical insurance service system. There are 469 designated medical institutions (117 medical institutions and 352 pharmacies) in the jurisdiction, and more than 20 outlets of Bank of Jilin, which have good conditions for pilot creation and potential for reform and innovation. After the pilot was determined, we established a long-term communication mechanism with the district as soon as possible, and took the initiative to carry out 7 full-process approval system tests with functional departments such as politics and taxation to ensure the smooth implementation of the first batch of 4 sinking service items stipulated by the provincial bureau, and strive to achieve the comprehensive window service goal of "preliminary review is final review". At the same time, we have also established and implemented a collaborative supervision mechanism, actively sought 860,000 yuan of financial matching funds, and extended the whole-process approval system to district, township (street) and community (village) level service places.
3. Innovate ideas, take multiple measures at the same time, and actively explore new paths for service sinking
In recent years, Jilin medical insurance people have deeply felt that only by effectively extending the service tentacles can more people enjoy the policy of benefiting the people in a timely and convenient manner. To this end, on the basis of the existing medical insurance grassroots service platform and the whole process approval system, the Jilin Medical Insurance Office has independently expanded the service functions and extension scope of the WeChat public platform and the 12393 consulting platform, and took the lead in the industry in the province to create a Jilin medical insurance characteristic service system with medical insurance as the main line and "hospital, pharmacy and bank" as the branch line. The first is to conduct extensive research and accurately cast the net. We went to the city's first and some secondary medical institutions, large chain pharmacies in the region and Huitong Branch of Bank of Jilin to carry out on-site research and discussions. Combined with the characteristics that most of the problems of mass payment are concentrated in the bank window and the reimbursement and settlement problems are mainly concentrated in the settlement link of hospital pharmacies, the "Jilin Social Medical Insurance Administration" Medical Insurance Handling Service into the Hospital "Activity Plan" and "Jiyin + Medical Insurance" Activity Plan have been formulated to provide a solid guarantee for the specific implementation. The second is to vigorously practice and do a good job in training. After the investigation, the staff of banks, hospitals and pharmacies were immediately organized to carry out a number of medical insurance business trainings, and each service station implemented a two-person AB rotation system, that is, one person participated in the training and one person sat in the window. Through the establishment of a training normalization mechanism, to ensure that the trainees can solve high-frequency service matters, know how to operate, and understand coordination. It is clear that the construction is carried out in accordance with the "eight standards" of special windows, special personnel, logos, signs, equipment, systems, systems and lists. The third is to take a long-term view and implement it step by step. By setting up medical insurance service points in ** hospitals, the masses can consult and handle a number of high-frequency medical insurance businesses at the window. The medical insurance service is accurately connected with the needs of patients, so that patients can enjoy the "one-stop" intimate service close to them in addition to medical treatment, and vigorously promote the medical insurance business to be "multi-point, nearby and convenient". The establishment of medical insurance handling service points in the bank gives full play to the advantages of Bank of Jilin's "multi-line, long-term and wide-ranging, integrated urban and rural development", and sets up medical insurance handling service points in pharmacies, highlighting the advantages of sporadic, scattered and convenient, and providing medical insurance services for the insured in a timely manner. It has laid a good foundation for the next step to realize the medical insurance service into the community and the countryside, and also provides a strong fulcrum for building a "15-minute medical insurance service circle".
At present, the medical insurance service point in Jilin City has officially entered the operation stage. The city's medical insurance service points can provide the masses with medical insurance handling services such as the change of basic information of insured persons, flexible employment personnel and urban and rural residents' payment guidance, and the handling of medical treatment errors. At present, the medical insurance service points serve more than 600 people per day, and the public's satisfaction with the medical insurance service is also constantly improving.
Fourth, coordinate and linkage, improve the mechanism, and implement the overall management of 12393+ manual customer service in the region
As early as 2020, Jilin City completed the construction of a first-class medical insurance consulting service platform in the province, and took the lead in upgrading it to the domestic 12393 medical insurance unified consultation**. In order to give full play to the convenience advantages of first-class services and boost the quality and efficiency of services, at the end of July, we carried out centralized integration of the 12393 and WeChat manual customer service management systems in the whole region and implemented overall management at the municipal level. The first is to integrate the team and carry out training. In order to facilitate normal and long-term management, we require each county and city to designate 2 to 3 people to engage in full-time call services, and all employees implement the record management of call employee numbers. A two-week business and practical training was organized to standardize and improve the caliber of responses, policy interpretation, service attitude, and standardized language, and the quality of the cadre team was effectively improved. The second is to standardize business and unify the caliber. In order to ensure the unified and standardized medical insurance service process in the whole region, the medical insurance agency of Jilin City organized medical insurance agencies at all levels in the region to jointly compile the "Jilin Medical Insurance Handling Business Knowledge Base", which was incorporated into the Jilin Smart Medical Insurance Service Platform, strictly implemented the daily zero reporting system, and achieved dynamic updates, truly realizing the "authoritative and accurate, standard system".
1. Real-time updates, co-construction and sharing". The third is to sort out the difficulties and transfer them in a centralized manner. In the daily answering process, in case of problems that cannot be dealt with in a timely manner or cannot be clearly answered, the operator will record the call time, call appeal, and request the time limit for reply in detail, and fill in and submit the transfer document online through the Jilin Smart Medical Insurance Platform, and transfer it to the counterpart business department. After receiving the transfer case, the responsible department shall immediately deal with the transfer problem and reply to the caller within 24 hours until the masses are satisfied with the processing results, and then confirm the completion of the processing on the Jilin Smart Medical Insurance Service Platform. Fourth, establish a system to enhance reputation. After the implementation of the city-level overall management of the consulting platform in Jilin City, all counties and cities have uniformly implemented the three characteristic systems of busy line callback, service satisfaction return visit and delayed service in accordance with the requirements of the city. For unsuccessfully connected work orders, 4 times a day are called back regularly, so that the connection rate during working hours reaches 100%, and the callback rate of the line is 100%. Conduct a random return visit to the service satisfaction of the completed work orders to understand whether the people's medical insurance problems have been solved, whether they are satisfied with the service of the customer service personnel, understand the opinions or suggestions on the medical insurance service, realize the closed loop of service, take the initiative to provide the people with appeals and complaint entrances, and solve problems in a timely manner. In addition, 12393 staff at all levels in the city have implemented the working mode of lunch break on weekdays and extended service on holidays.
In the future, Jilin medical insurance agencies will continue to promote the construction of "smart medical insurance" by constantly changing service ideas, and continue to build a good medical insurance service model of "small front desk and big rear" by using information technology, so as to effectively provide more intimate and warm medical insurance services for the masses.
Original title: Extending the tentacles of medical insurance management and creating a linkage service brand - the highlight of the work of Jilin Social Medical Insurance Administration to "do practical things for the people".
Author |Jilin Social Medical Insurance Administration.
* |China Medical Insurance.
Edit |Fu Meiru buys Xiaofei.
Hot Article
The medical insurance cloud "leverages the "big improvement" of handling services
"Internet + medical insurance" has changed "mass errands" to "data runs", and the medical insurance cloud has leveraged the "great improvement" of handling services