It is not clear what necessitated his departure and where he is headed next, but he has told close associates that he wants to “pursue other career opportunities.”

The NHIA was a major subject of discussion during the just ended election, with the two major political parties at variance on the status of what has become Ghana’s biggest social protection programme, the NHIS.

[contextly_sidebar id=”qLVHTKnJsaqwe1ercjjcverMA2l8rtAA”]Despite these differences, the NHIS serves many Ghanaians and its effectiveness is of interest to many.

Insiders say he broke the news of his departure to his management staff last Monday, after their bi-monthly meeting.

The Scheme’s achievements under Mr. Otoo

Mr. Otoo leaves behind a Scheme with a membership of over 11 million members and a utilization of 31 million.

Mr. Otoo, a lawyer by training, joined the NHIA in 2006 from the Social Security and National Insurance Trust (SSNIT) as the first Director of Administration and General Counsel of the Authority, and helped establish many of the units and departments of the fledgling health insurance scheme.

He was instrumental in the revision of the NHIS law, Act 650 to Act 852, and has been involved in a wide range of the institution’s decision-making.
In 2013, he was promoted to the position of Deputy Chief Executive of the NHIA in charge of Operations, where he supervised five key directorates including Management Information Systems, Quality Assurance, Research and Development, Private Health Insurance, and Provider Payments.

In 2015, he was appointed to act as Chief Executive upon the exit of Mr. Sylvester Mensah. He was later confirmed by the Public Services Commission as substantive Chief Executive Officer of the NHIA.

Employees of the Authority generally describe him as a calm-headed and analytical person, who upon assuming leadership of the Authority purposed to make the NHIA a knowledge-based organization and a leader in technological innovations to solve problems in the public sector.

In this regard, he oversaw the introduction of the NAVIS member authentication application, a software developed in-house and sold to local banks to assist in their verification of customers who present the NHIS card as a form of identification.

The NHIA makes close to a million Cedis annually from this innovation. Under his tenure, the NHIA began the paperless registration of members which saves the Scheme about 6 million Cedis annually just by cutting out the use of paper in the NHIS enrolment process.

Mr. Otoo also oversaw the development of the electronic premium banking and e-receipting at NHIA district offices, where premiums are electronically receipted and collected by banks as a measure to block loopholes. This system has been reviewed by the Controller and Accountant General and found efficient.
In November 2016, a flagship program to enable NHIS card holders register or renew their membership by choice for two to four years was introduced. The system known as the ‘Multi-year Renewal’ is being expanded to other areas of the country. This is hoped to bring convenience to members and also assist the NHIA make some savings.

Other initiatives under Mr. Otoo’s tenure

As a champion of Universal Health Coverage, Mr. Otoo will be remembered as the one under whom the NHIA partnered with the Africa Health Market for Equity program and the Social Protection Ministry to devise an electronic identification system to assess eligibility of the poor and vulnerable for enrolment onto the NHIS. Hitherto, the identification of the poor and vulnerable onto the scheme was arbitrary.

As a way of exacting performance from his staff, he introduced a performance tracking model named the ‘Point Assessment System’ which rated the output of the district and regional offices on key deliverables in an objective mode and rewarded best performers.

In December 2016, Mr. Otoo launched one of his pet projects for the NHIS, the claim-it application. This is an application for use by health providers to generate and submit claims to the NHIA. It implements and enforces all the necessary claims generation rules and protocols of the NHIS. Hence, all claims submitted for reimbursement are validated by the application. The app ensures due diligence prior to claims submission.

NHIS’ funding challenges

Mr. Otoo worked assiduously to reduce the funding gap of the NHIS with significant success, registering a reversal of the deficit in 2015.
Until his resignation, he was overseeing the development of Mobile Claims Check Code technical requirements and the introduction of a unique provider identification system.

Mr. Otoo is quite prominent and respected in the health insurance and UHC fraternity around the world, and though he is holding his next moves close to his chest, sources at the NHIA say he has pledged not to withhold his knowledge and experience from the Authority should he be required at any time to do so.

Under his tenure as Chief Executive, the NHIA was reviewed for the first time by a committee set up by the then president.

Mr. Otoo was a member of the committee chaired by eminent health economist, Dr Chris Atim. The committee’s report was submitted to the Presidency late last year.

Mr. Otoo leaves a scheme which still has significant challenges, and it is hoped that the new path proposed to be chartered by the new Government will attempt to resolve these.
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By: Ebenezer Afanyi Dadzie/citifmonline.com/Ghana

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The move comes at a time when the scheme is being challenged by threats of boycott by some service providers over delays in payment of their claims.

Speaking at a ceremony to inaugurate the software on Tuesday, the Chief Executive of the NHIA, Nathaniel Otoo said the software will revolutionize the payment system and improve service delivery at health facilities.

“This new application that we are doing takes into account the context of the country so it’s not going to be an only system, online is part of it but we have other means, you can bring the claims on a pen drive. We have very flexible ways in which the claims will be submitted.”

“The benefits of a Claim IT system will be a reduction in the financial cost of claims generation and submission, Reduction in claim errors, improve claims processing turnaround time and reduction in terms of claims storage.”

He said the NHIA had volumes of documents and other information it kept, that require proper storage for subsequent use and reference.

The Director-General of the Ghana Health Service, Dr Ebenezer Appiah Denkyira who was also at the ceremony described the introduction of the software as a big leap forward in the operations of the scheme in the country.

He expressed optimism the software will help reduce the incident of rejection of NHIS claims from service providers for errors on them.

He said he was confident the new software will tackle the incident of fraud within National Health Insurance system.

“This software will solve a lot of problems. For us it will reduce the number of rejections that come in, which means that form now people will be particular that if you see a patient, you ensure that you submit the right type of claims; not beyond or below and also to ensure that at the level of care you prescribe what is demanded of you. It will always ensure that that gatekeeper system works.”

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By: Jonas Nyabor/citifmonline.com/Ghana
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The post NHIA launches claims payment software   appeared first on Citi 97.3 FM - Relevant Radio. Always.

It said the service which would be introduced in November, would help address the delay challenges associated with the submission of claims by service providers.

Mr Nathaniel Otoo, Acting Chief Executive Officer (CEO) of the NHIA, said this during the 14th Annual General Conference of the Ghana Physician Assistants Association (GPAA) in Wa.

The theme for the conference is: “Sustainability of the Gate Keeper System in Healthcare Delivery; Challenges and the Way Forward”.

He said the NHIA owed facilities but part of the challenge to its indebtedness had to do with the speed with which claims were processed especially in the Upper West, Upper East and the Northern Regions.

Mr Otoo expressed the hope that the initiative which has been successfully piloted would be able to address the claims delay challenge and reduce the scheme’s indebtedness to health facilities in the region and improve healthcare delivery.

Chief Alhaji Imoro Bandanaa II, National President of the GPAA, said whereas capitation seeks to assign clients to provider facilities of their choice, the gate keeper system was an inbuilt mechanism that kept the system in check against abuse and impropriety.

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Source: GNA

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