Comparison of beneficiary management related to functionalities of CORE-MIS and openIMIS.
This wikipage presents the comparison between the beneficiary management related to the functionalities of CORE-MIS and openIMIS. It has for aim to highlight the main similarities, differences between both softwares.
openIMIS and CORE-MIS are IT tools that were implemented to support health financing programs, social protection schemes. (See table 1)
Table 1: Definition of CORE-MIS and openIMIS.
CORE-MIS | openIMIS |
“Free and robust web-based application designed to support a wide range of social protection programs” | “Versatile open source software which supports the administration of health financing and social protection schemes.
|
Source: Author with information found on openIMIS wiki and https://core-mis.org/
Nevertheless, openIMIS is more focused on health insurance schemes while COREMIS covers more cash transfers related operations. The common schemes covered by both IT tools are unconditional cash transfers. As a result, additional modules will be needed to take into account the other social protection schemes covered by CORE-MIS during the integration of it in openIMIS. (See table 2)
Table 2: Schemes covered by CORE-MIS and openIMIS.
CORE-MIS | openIMIS |
-Cash transfers (conditional and unconditional) -Public work programs -Training programs -Saving groups -Communication campaigns -Grievance redress mechanism -Targeting
|
-Voucher schemes -Employment injury insurance -Unconditional cash transfer |
Source: Author with information found on DCI (2022) workshop presentation Workshop - open-source solution providers - Presentation - Digital Convergence Initiative (spdci.org)
Furthermore, both IT tools operate in different countries (see table 3 below). The needs of the countries will be taken into account to implement the adequate version.
Table 3: Countries where openIMIS and CORE-MIS were present in 2022.
CORE-MIS | openIMIS |
Guinea, Mozambique, Sierra Leone, Togo, Zambia. | Cameroon, Chad, DRC, Mauritania, Nepal, Tanzania, The Gambia. |
Source: Author with information found on DCI (2022) workshop presentation Workshop - open-source solution providers - Presentation - Digital Convergence Initiative (spdci.org)
Concerning the workflow of the two IT tools, some similarities exist between them notably for the enrollment step, the service delivery/provision of services.(see figure 1 below).
In the workflow of CORE-MIS, the enrollment module is situated in the 4th and 5th step while in openIMIS it is directly the first step. This difference can be explained by the importance given to the assessment step in CORE-MIS that comprises the targeting of beneficiaries. Furthermore, in openIMIS, the beneficiaries are covered if they have contributed a certain amount-premium while in CORE-MIS, benefits are noncontributory.
Figure 1: Workflows of openIMIS and CORE-MIS.
Source: Workflows and Functionalities - openIMIS Knowledge Base - openIMIS Wiki (atlassian.net) and World Bank (2020)
The beneficiary management of openIMIS is constituted of the three following elements:
beneficiary registration; employer registration; contribution management.
Concerning CORE-MIS, the beneficiary management is constituted of more disaggregated elements that are : eligibility assessment; enrollment decision; eligibility assessment; beneficiary registry; Payment administration; payments provision; services provision; conditionalities monitoring; Grievance redress mechanism; data analytics.
The similarities worth emphasizing are enrollment; registration of beneficiaries and the main differences are the eligibility assessment, the existence of a Grievance Redress Mechanism (GRM) in CORE-MIS. A GRM is a tool “giving people the capacity to provide feedback to program administrators”. (World Bank, 2020). It can be used by beneficiaries in case of “unclear program guidelines, lack of program awareness, unsatisfactory package of benefits and services, mistreatment by frontline workers, GRM it self”. (World Bank Group, 2020).
Figure 2: Beneficiary managements of openIMIS and CORE-MIS.
Source: Workflows and Functionalities - openIMIS Knowledge Base - openIMIS Wiki (atlassian.net)
and World Bank (2020).
The following table gives more details about the similarities and differences between the beneficiary management of the two IT tools.
Table 4: Beneficiary managements in details of CORE-MIS and openIMIS.
CORE-MIS | openIMIS |
|---|---|
Eligibility assessment-Enrollment decision- Beneficiary registry: Inputs: Registrant profiles, eligibility criteria, program budget Outputs: Applicants enrolled, wait listed or notified as ineligible, benefit levels approved and services assigned or referred, individualized plans established; beneficiaries onboarded. | Enroll beneficiary: Inputs: Demographics, financial information, geographic information, qualifying criteria, proof of identity, medical history, current medical condition Outputs: Time based eligibility determination, beneficiary identifier, benefits class, benefits plan detail, proof of coverage, feed into data repository. |
Payment administration, Payments provision, Services provision Inputs: Payroll updated/established with information on accounts and provision points (for each cycle) Outputs: Beneficiaries receive services, provision verified. | Assign beneficiary to PCP (Primary Care Provider) or a primary care unit Inputs: Beneficiary identifier, provider identifier, census, benefit class, benefit plan, physical proximity, list of available providers, family relationships, maximum of beneficiaries to which a provider can attend Outputs: Provider capitalization list Provider roster Notification of primary provider |
Conditionalities monitoring-Grievance redress mechanism Inputs :Information updates and corrections; GRM cases; compliance information; individualized action plans Outputs: Updated beneficiary registry and benefit service package; progress towards service plans monitored. | Eligibility inquiry by provider: Inputs: Beneficiary identifier, Provider identifier, Benefits class, Benefit plan, Encounter date, Beneficiary accumulator, Demographic criteria, Clinical criteria Outputs: Time-based eligibility status, Benefit capitalization, Pre- authorization, Beneficiary accumulators |
Data analytics | Eligibility inquiry by beneficiary Inputs: Beneficiary identifier, Provider identifier, Benefit class, Encounter date, Beneficiary accumulation, Demographic criteria, Clinical criteria Outputs: Time based eligibility status, benefit capitalization, pre-authorization, beneficiary accumulation |
| Pre-authorization Inputs: Beneficiary identifier, Provider identifier, Benefits class, Benefit plan, Clinical information, Supporting documents, Treatment plan, Fee schedule, Diagnosis. Outputs: Approval with cost, service or unit boundaries or rejection, Approval/ provisional approval (services can proceed but services may not be covered) disapproval, Approval percentage (percentage of requests that are approved), Analysis of which services are being rejected (what provider, what services) |
Source: Author with information from Background - Joint Learning Network for UHC - openIMIS - openIMIS Wiki (atlassian.net)
and World Bank (2020).
The elements highlighted in this table are extracted respectively from the Joint Learning Network (2012) and the sourcebook of the World Bank Group (2020). The workflow of CORE-MIS is based on the social protection delivery chain of the World Bank Group. Hence, the elements of the beneficiary management of CORE-MIS were grouped according to the different steps of the social protection delivery chain:
> Eligibility assessment; Enrolment decision; Eligibility assessment; Beneficiary registry: Enrollment
> Payment administration; Payments provision; Services provision: Payment of benefits and provision of services.
> Conditionalities monitoring; Grievance redress mechanism: Monitoring and GRMs.
>Data analytics.
The steps of the social protection delivery chain comprised inputs and outputs elements as the beneficiary management of openIMS extracted from the JLN hence it seemed relevant to proceed to a comparison this way.
It is worth noticing that the registrant profiles in CORE-MIS can be associated to the demographics-financial information-geographic information in openIMIS.
There are also some elements of the assign beneficiary to PCP (Primary Care Provider) or a primary care unit, eligibility inquiry by provider, eligibility inquiry by beneficiary, pre-authorization that present similarities also with the first block of the beneficiary management of CORE-MIS.
One main difference that can be highlighted is the medical information such as clinical information, treatment plan, diagnosis, clinical criteria that are not mentioned in CORE-MIS.
In the beneficiary management of openIMIS described by JLN, there is no module about payment contrary to CORE-MIS and there is not neither a GRM module nor data reporting that could be associated to data analytics.
The demo servers of the two IT tools enable a better understanding of the similarities and differences between the beneficiary management related to the functionalities of both. The demo server has a targeting module, which is in line with the remarks made above on the place given in CORE-MIS to this module.
Table 5 : Modules in demo servers of CORE-MIS and openIMIS related to their beneficiary management.
CORE-MIS | openIMIS |
|---|---|
Targeting Targeting details Targeting listing Targeting submissions Targeting approval Targeting results Beneficiary Beneficiary list Potential beneficiaries Active Graduated Suspended Beneficiary file uploads Beneficiary settings Households Beneficiary changes Update requests Request approvals Update history(id, beneficiary UIID, file name, programmer number Full name, year of birth, gender, rural, able bodied, disability, processed status). | Insurees and policies Add Family/Group Families/Groups Insurees Policies Contribution Payments Policy holder |
Grievances Reports | Claims Health facility claims Reviews Batch runs Tools Registers Extracts Reports |
Geolocation Timesheet Payment Savings Training Bulk messaging: SMS campaign Campaign approval Message delivery ADMIN: Sub projects Tasks Kobo view Report Mangement | Administration Products Health facilities Medical services price lists Medical items Medical services Medical items Users Locations Roles Management Payers Policy Holder Users Contribution plans Contribution plans bundles |
Source: Author with information found on the demo servers of openIMIS and coreMIS.
The beneficiary module of CORE-MIS can be associated to the insurees and policies module of openIMIS though some elements are not the same.
It is worth noticing that in the beneficiary module, there is classification of beneficiaries according to them being active, graduated, suspended.
In CORE-MIS as in openIMIS, there can be updates about information of beneficiaries.
Another difference between both IT tools is the existence of grievances in CORE-MIS as already mentioned earlier. In openIMIS, the claims module represents a specificity related to the functioning of a health insurance scheme: Health facilities provide services to health insurance beneficiaries and then they have to submit claims to the health insurance institutions to be reimbursed.
Both IT tools have administration modules but in openIMIS some components are more related to medical elements and locations, which is a module apart in CORE-MIS, is part of the administration module in openIMIS.CORE-MIS has also a module not present at all in openIMSI-the bulk messaging module.
In summary, both IT tools are not completely different in terms of the beneficiary management. Some similarities exist which can facilitate the integration of CORE-MIS in openIMIS. However, there is likely a need to customize openIMIS to take into account modules that are only present in CORE-MIS.
References:
CORE-MIS,CORE-MIS.CORE-MIS. Viewed May 2023.
CORE-MIS, demo server. CORE-MIS. Viewed May 2023.
Digital Convergence initiative (2022), Workshop on open source solution providers. Workshop - open-source solution providers - Presentation - Digital Convergence Initiative (spdci.org) Viewed May 2023.
openIMIS, Background - Joint Learning Network for UHC. Background - Joint Learning Network for UHC - openIMIS - openIMIS Wiki (atlassian.net).Viewed May 2023.
openIMIS, demo server.https://demo.openimis.org/ . Viewed May 2023.
openIMIS, What is openIMIS? FAQ - What is openIMIS? - openIMIS Knowledge Base - openIMIS Wiki (atlassian.net) viewed May 2023.
openIMIS, Workflows and Functionalities. Workflows and Functionalities - openIMIS Knowledge Base - openIMIS Wiki (atlassian.net).Viewed May 2023.
openIMIS, workflows of openIMIS. https://openimis.org/health-insurance .Viewed May 2023.
World Bank Group (2020), Sourcebook on the Foundations of Social Protection Delivery Systems.
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