Abdullah Syed Younus’ Post

In Saudi Arabia, the introduction of the Diagnosis-Related Group (DRG) and the Case Mix Index (CMI) has been essential to transforming healthcare administration and resource distribution. The CMI is a statistic that represents the average diagnosis and level of treatment intensity and is used to evaluate the complexity of patients receiving care in a medical facility. DRGs, on the other hand, group patients for billing purposes into homogeneous groups based on similar diagnoses and treatments. The implementation of CMI and DRGs in Saudi Arabia has been driven by the desire to improve healthcare affordability, quality, and efficiency. Hospitals can more accurately allocate resources and make staffing decisions by using CMI to better understand patient acuity levels. By enabling standardized billing and reimbursement based on patient groups, DRGs further simplify this process. Well organized workshop by Council Of Health Insurance Special Thanks to Racha M Naim, CHIP, RCMS and team for an amazing effort and looking forward for many such events in future to enhance our knowledge in this domain :) #KSAvision2030 #RCM #ARDRG #casemixindex #SBSv2 #SBS #CDI #Healthfinancemodel #Valuebasedcare

The Strategic Value of DRG Implementation in Saudi Healthcare The transition to Activity-Based Funding (ABF), powered by the Diagnosis-Related Groups (DRG) system, marks a significant milestone in enhancing healthcare efficiency and transparency in Saudi Arabia. This model aligns with the Council of Health Insurance’s guidelines to optimize cost and revenue management, ensuring quality-driven care. By categorizing patients into DRGs based on clinical conditions and resource utilization, this approach enables: • Accurate financial planning for providers. • Improved resource allocation across the care continuum. • Benchmarking healthcare quality to foster competitiveness. For healthcare professionals, understanding the pillars of DRG implementation—such as coding, data analysis, and cost mapping—is crucial for seamless integration into the evolving healthcare landscape. The recently announced Council Of Health Insurance guideline on DRGs is an excellent initiative to empower professionals with practical skills like data management and workflow optimization using DRG Groupers. 🚀 Let’s embrace DRG to drive innovation and financial sustainability in Saudi healthcare. #DRG #ActivityBasedFunding #HealthcareInnovation #RCM #SaudiHealthcare #PatientCentricCare #JHAH #KSAJOBS #NEOM #newchallenge #populationhealthmanagement #KSA

Exciting to know about Saudi Healthcare Key Players … Saudi Arabia is the most growing & organized market in the Middle East, in healthcare sector several key players are shaping the landscape to enhance services and accessibility. Here's a brief overview: 🔍 Ministry of Health (MoH): The regulatory authority overseeing all healthcare activities and services within the country. #MoH #HealthcareRegulation 💊 National Unified Company for Medical Supplies (NUPCO): Responsible for centralized government procurement of pharmaceuticals, medical equipment, and supplies for public healthcare facilities. #NUPCO #HealthcareProcurement 🛡️ Saudi Food and Drug Authority (SFDA): Monitors and controls imports and distribution of medical devices, pharmaceuticals, and food products to ensure safety and quality standards. #SFDA #HealthcareSafety 💼 Cooperative Council of Health Insurance (CCHI): Regulates the health insurance sector, ensuring fair practices and accessibility to healthcare services. #CCHI #HealthInsurance 🔐 National Center for Privatization (NCP): Facilitating the privatization of government assets and services, including in the healthcare sector, to improve efficiency and innovation. #NCP #Privatization 📚 Saudi Authority for Intellectual Property (SAIP): Enhancing and protecting the Kingdom’s intellectual property landscape to foster innovation in healthcare and beyond. #SAIP #IntellectualProperty 🤝 Health Holding Company (HHC): Taking over day-to-day administration of health services from MoH, focusing on digital health and virtual medical care through primary healthcare development programs. #HHC #DigitalHealthcare 💵 Center for National Health Insurance (CNHI): Providing payment for health services offered by HHC and its subsidiaries, ensuring financial accessibility for all. #CNHI #HealthcarePayment These entities are driving forward initiatives to improve healthcare delivery and accessibility for all citizens and residents of Saudi Arabia. Tell me if you are interested or need to know more about Saudi Market?

Even before I joined the healthcare sector in the KSA, I kept a watchful eye on its development. I knew that it stood to be one of the most ambitious and revolutionary healthcare sectors in the world – and time and time again, it’s surpassed even my most optimistic expectations. I’d like to highlight just a few of my predictions that the KSA has surpassed: 🔹 More than fifty new hospitals or clinics have been built in under eight years. 🔹 More than a million people have been served by telehealth consultations in the last four years. 🔹 Health insurance has grown by more than 50% in the last five years. 🔹 Pharmaceutical production has been significantly insourced since COVID. Agreeable economic and social indicators have certainly played a role here, but I think the unique interplay of technological advancement and leadership that’s willing to take calculated risks on technology are the significant factors here. To truly lead, one needs vision and an appetite for risk, and that’s paying off for the Kingdom. #Healthcare #HealthTech #KSA #DigitalTransformation

𝐓𝐡𝐞 𝐒𝐚𝐮𝐝𝐢 𝐡𝐞𝐚𝐥𝐭𝐡𝐜𝐚𝐫𝐞 𝐬𝐞𝐜𝐭𝐨𝐫 𝐢𝐬 𝐛𝐨𝐨𝐦𝐢𝐧𝐠, and staying ahead of the curve is critical. But with a rapidly evolving market, it can be tough to grasp the competitive landscape. That's where VALUWIT's Saudi Healthcare Competitiveness Report 2021 comes in: While the figures in the report are from 2021, the market state and analysis are still current and relevant. The report delves into the healthcare insurance industry, specifically market concentration threats and recommendations. The report explores three parameters that are influencing local competition: 𝐇𝐞𝐚𝐥𝐭𝐡 𝐈𝐧𝐬𝐮𝐫𝐚𝐧𝐜𝐞 𝐌𝐚𝐫𝐤𝐞𝐭 𝐂𝐨𝐧𝐜𝐞𝐧𝐭𝐫𝐚𝐭𝐢𝐨𝐧 𝐌𝐨𝐧𝐨𝐩𝐬𝐨𝐧𝐲 𝐏𝐨𝐰𝐞𝐫 📌How to Calculate Market Concentration 📌Insurance Companies in the Saudi Market 𝐀𝐧𝐭𝐢-𝐂𝐨𝐦𝐩𝐞𝐭𝐢𝐭𝐢𝐯𝐞𝐧𝐞𝐬𝐬 𝐏𝐫𝐚𝐜𝐭𝐢𝐜𝐞𝐬 📌Vertical and Horizontal Restraints 📌Price Subsidies and Discrimination 𝐁𝐞𝐧𝐜𝐡𝐦𝐚𝐫𝐤𝐢𝐧𝐠 𝐰𝐢𝐭𝐡 𝐔𝐒 𝐈𝐧𝐬𝐮𝐫𝐚𝐧𝐜𝐞 𝐌𝐚𝐫𝐤𝐞𝐭 𝐖𝐡𝐲 𝐚𝐫𝐞 𝐰𝐞 𝐬𝐡𝐚𝐫𝐢𝐧𝐠 𝐚 𝐫𝐞𝐩𝐨𝐫𝐭 𝐟𝐫𝐨𝐦 𝟐𝟎𝟐𝟏? This report from 2021 is an example of the initial phase of a larger consultancy project. It serves as an illustrative example of VALUWIT’s data-building process and analytical capabilities. To download the report please fill out this form: https://lnkd.in/g5m66F4Q #VALUWIT #Healthcare #Saudi #KSA #Competitiveness #SaudiHealthcare

*Webinar Tuesday* – Don’t miss out on the opportunity to join our experts on June 11 to discuss the significant restructuring of Saudi Arabia’s healthcare sector, and the impact on healthcare MNCs. The webinar will cover the key evolving issues and expectations for Saudi Arabia’s health-sector reform plans: 👉 The implementation of national health insurance is leading to an increased focus on cost containment, while the launch of healthcare clusters raises questions about the future role of NUPCO. 👉 Firms are also grappling with how to engage with the Health Holding Company, as well as seeking more clarity on the implementation of health technology assessment. 👉 Localization pressures are adding further complexity, with the Economic Participation Policy requiring firms to make additional investments in the Kingdom. Don’t miss out on this opportunity to stay ahead of the curve! Register your place now: https://lnkd.in/ecXrsU5Y Violet Tinnion Mansour El-Zahab #saudiarabia #saudihealthcare #NUPCO #healthcareMNCs

The healthcare sector will remain a priority for Vision 2030 objectives. In 2024, the sector's budget allocation ranks third, trailing only military and general items, underscoring the government's ongoing prioritization. The budget statement outlined projects aligned with Vision 2030 goals, focusing on workforce capabilities and system capacity. This is expected to boost health expenditure, prompting a revision of the 2022-2027 CAGR forecast to 5.9% (previously 4.3%). With faster economic growth driven by high oil prices and a strong non-oil sector, diversification and healthcare goals are set to advance. Saudi Arabia has announced several healthcare projects for 2024 that will aim to improve service quality, increase system capacity and strengthen preventative measures. Initiatives aligning with Vision 2030 and the Health Sector Transformation Programme include launching the National Health Emergency Operation Center in 2024. This project targets workforce development through training, research, and partnerships. The kingdom plans to increase bed capacity by building multiple hospitals, aiming for 1,100 beds. Additionally, new legislation and the World Health Organization Collaborating Centre for Nutrition and Food aim to improve public health through preventive measures. Recent healthcare advances support ongoing progress towards Vision 2030 objectives. Saudi Arabia initiated its national electronic health record system in 2023 under the NPHIES, enabling patient data exchange. With 14.7 million beneficiaries linked, this boosts healthcare efficiency and informs decisions. State-funded insurance for all by 2026 enhances access and aligns with Vision 2030, stressing accessible healthcare and digital integration. The private sector's healthcare contribution is increasing due to government efforts to enhance spending efficiency and involve the private sector more. Private health expenditure is expected to exceed public spending, driven by the growing private sector's role and demand for private healthcare. This aligns with Vision 2030 objectives and presents growth opportunities for private healthcare companies, especially with a projected five-fold increase in private health insurance. #saudihealthcare2030 #budgetpriorities #vision2030 #healthcareprojects2024 #healthcaretechnology #preventivemeasures #publichealth #electronichealthrecords #insurancecoverage #privatehealthcaregrowth https://lnkd.in/dzE6DPpK

Saudi Arabia Expands Universal Health Coverage to All Citizens As part of its ambitious Vision 2030 plan, the Kingdom of Saudi Arabia has made significant strides in expanding universal health coverage (UHC) for all its citizens. This landmark healthcare reform is a major step forward in ensuring equitable access to quality medical services across the country. Under the new UHC system, all Saudi nationals are now eligible for comprehensive health insurance coverage, which includes access to a wide range of preventive, curative, and rehabilitative services. This includes everything from routine check-ups and screening tests to advanced surgical procedures and specialized treatment. The government has invested heavily in modernizing the country's healthcare infrastructure, building new hospitals and clinics, upgrading medical equipment, and training additional healthcare professionals. This has helped to address longstanding gaps in service delivery, especially in remote and underserved regions. Importantly, the UHC program also focuses on preventive care and health promotion, with a strong emphasis on tackling non-communicable diseases, improving maternal and child health, and fostering healthier lifestyles among the population. This holistic approach is aimed at not just treating illness, but also preventing it in the first place. The benefits of this universal coverage model are already being felt by Saudi citizens. Families no longer have to worry about the financial burden of unexpected medical expenses, and more people are accessing vital healthcare services that were previously out of reach. This is a major step towards achieving the Kingdom's goal of ensuring the health and wellbeing of all its people. As Saudi Arabia continues to implement its UHC program, it serves as an inspiring example for other countries in the region and around the world that are striving to make quality healthcare a fundamental right for all. This is a remarkable achievement that will undoubtedly improve lives and strengthen the nation's social fabric for generations to come. #UniversalHealthCoverage #HealthcareTransformation #SaudiArabia #Vision2030 #HealthForAll #PreventiveCare #PublicHealthInitiatives

*** Mastering Mapping: A Guide to Aligning Provider Service Lists with Standard Code Sets *** As an RCM professional in the Saudi healthcare industry, understanding the importance of mapping provider service lists to standard code sets is crucial for ensuring accurate billing, efficient claims processing, and improved healthcare outcomes. The Council of Cooperative Health Insurance (CHI) has established comprehensive guidelines to facilitate this process. By aligning your organization's services with standard coding systems, you can: Standardize service descriptions: Create a unified language across healthcare providers, enhancing data consistency and comparability. Facilitate information exchange: Seamlessly share data for reimbursement claims, outcome reporting, and research. Support Value-Based Healthcare (VBHC) initiatives: Accurately measure and report on the quality and efficiency of care delivered. Improve transparency and sustainability: Enhance accountability and foster a more sustainable healthcare system. Are you familiar with the CHI's guidelines for mapping provider service lists? Share your experiences and insights in the comments below! #RCM #Healthcare #SaudiArabia #CHI #Mapping #StandardCodeSets #VBHC #HealthcareIT #HealthTech #KSA #NEOM #JHAH #newchallenge

As someone deeply invested in #healthcarereform, I recently came across an insightful study that investigates the evolving landscape of #SaudiArabia's healthcare system. The study offers perspectives from ten leaders across the private, public, executive, consulting, and regulatory sectors, providing a comprehensive view of the ongoing transformation. Key Findings: The study revealed four major themes shaping the future of healthcare in KSA: 1) #healthcaresystem reform 2) Impact of #corporatization/#privatization on healthcare providers 3) Impact of corporatization/privatization on #healthinsurance 4) Impact of corporatization/privatization on the #workforce The transition toward privatization in the public sector offers critical strengths that are crucial in driving transformation. The findings highlight the importance of enhancing sector capabilities, such as creating specialized units and bringing in the right talent, to overcome obstacles and accelerate progress. The study also emphasizes the need for further research to understand and address the barriers hindering transformation. These insights are a stepping stone toward understanding the complexities of healthcare reform and finding ways to contribute to the growth and sustainability of our healthcare system. #hbr #decisionmaking #leadership #strategy #lifelonglearner #digitaltransformation #innovations