Consultant on rapid review of the Telehealth existing reimbursement and funding mechanisms (remotely, Bucharest/ Romania)

Contract

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UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. To save their lives. To defend their rights. To help them fulfill their potential.

Across 190 countries and territories, we work for every child, everywhere, every day, to build a better world for everyone.

And we never give up.

For every child, opportunities.

How can you make a difference?

Objectives and results

The COVID-19 pandemic is pushing against many of the structural barriers that had previously slowed health system investment in integrated digital health, including funding mechanisms, consumer adoption, and provider adoption.

Health systems have introduced regulatory flexibilities and incentives to encourage adoption and implementation, with coordination from providers and technology companies. Cost-effectiveness and sustainability will require systems-level approaches to building digital online care pathways that link opportunities in digital health for reimbursement mechanism lie along the entire patient pathways.

The ultimate aim of developing and adopting a telehealth reimbursement policy is to increase health access, improve provider availability, and reduce healthcare costs for both patients as well as for the health system. Telehealth can increase access to necessary care in areas with shortages, such as behavioral health, improve the patient experience, and improve health outcomes.

In order to build the capabilities and incentives of the provider workforce to support virtual care (for example, workflow design, centralized scheduling, and continuing education), the process should provide comprehensive information on the existent financing and reimbursement mechanisms and how could align the benefit structure to drive adoption in line with health system and/or physician practice economics. Optimize provider networks and accelerate value-based contracting to incentivize telehealth.

Define approaches (beyond the immediate COVID-19 response measures) to reimbursement and covered services, embed in contracting, and optimize networks and value-based models to include virtual health. Align incentives for using telehealth, particularly for chronic patients, with the shift to risk-based payment models.

Payers may need to offer reimbursement, and solutions that need to enable integrated access between, for example, primary care physicians, care managers, and at-home caregivers. These services could also require the deployment of supportive patient engagement tools (for example, digital coaching, care plan navigation tools), tailored to patients’ needs and integrated with communication channels to providers, care managers, and others involved in their care.

The focus of the consultancy will be on:

• Document existing principles of reimbursement mechanisms of digital health products and solutions principles.
• Assess the regulatory flexibility, scope of services and criteria of reimbursement by national/local health authorities across different countries.
• Identify and review funding reimbursement mechanisms for digital health services in other 6-8 countries.
• Document (sub)national health authorities reimbursement models and mechanism for public client to provider outpatient telemedicine services and Provider-to-provider.
• Financial enablers, including payment and reimbursement models
• Identify national/international guidelines for relevant and fit-for-purpose evidence generation for digital health products and solutions reimbursement mechanisms
• Assess types of primary care, community care digital health products and solutions reimbursement mechanism that benefit from either EU or national funds within innovation investment funds and/or public funding.
• Propose guiding principles for reimbursement of eHealth and mHealth, digital Health Products and Solutions, to inform national health public financing policies.
• Identify recommendations that address the special nature of digital health technologies and their difficulty in entering funding and reimbursement pathways in other countries (eg. Netherlands, Singapore, UK, Estonia, Germany, Sweden, UAE)
• Assess how telemedicine financing models fit into the larger context of digital health strategies and implementation plans in countries such as Estonia, Sweden, Netherlands, Germany, Switzerland.
• In close communication with all involved partners to provide support to National Health Insurance House, Ministry of Health and UNICEF in the organization of at least two meetings a) sharing the findings outlined in the analysis and b) providing an opportunity to agencies to present and discuss the approaches of their respective telemedicine services plans.

Methodology

The Consultant (team of consultants) could rely on the below considerations:

• Desk review of data, programme reports and analysis of digital health related financing models and telemedicine reimbursement mechanisms, digital health services financing models provided by National Health Insurance Houses, Ministries of Health and/or Digital, UNICEF/WHO, including studies, research and evaluations.
• Secondary data analysis, provided through National Health Bodies, Health Services Purchasers, Ministries of Health, EU reports.
• Provide an analysis of the financial enablers, including payment and reimbursement models for digital health.
• Key informants’ interviews with different governing bodies that regulate and finance telemedicine and digital health services and/or
• Focus Group Discussions with all the above.
• The analysis must fully consider, and articulate types of telemedicine services financing and reimbursement models on the following health focused areas: primary care, community care, mother and child care.
• Assess incentives of the provider workforce to support digital health /virtual care (for example, workflow design, continuing education and graduate medical education) and provide examples of align benefit structure which drives adoption in line with health system and/or physician practice economics.

Consultant (team of consultants) are required to propose a more precise methodology and research instruments within the application package.

Time frame

The contractor will further define the methodology and conduct existing data analysis.

An intermediary (draft) report, covering partially the requests covered in section 3. Objectives and results should be provided for comments and review by 20st August 2021, with the final, revised versions in September 2021. All deliverables will be produced in English.

Within UNICEF, the contractor will report to the Health Specialist and will work in close collaboration with Advocacy Team; it will provide the reviewed methodology to the Technical Assistance and Knowledge Management team for clearance.

To qualify as an advocate for every child you will have…

• Advanced university degree in health economics or university degree in health information systems, public policy with advance knowledge and experience in digital health and telemedicine budgeting and public financing;
• Knowledge in Public Finance Management, covering budget preparation and budgetary processes, prioritization and costing and closer linkages between budget and policy, costing and standard costs for social services, etc.;
• Understanding of health systems designs and reforms;
• Strong analytical and conceptual thinking and proven experience in report writing
• Good speaking and writing skills in English;
• Previous collaboration with the UNICEF, the UN, including World Bank is considered an advantage
• Availability for work within the proposed time frame.

For every Child, you demonstrate…

UNICEF's values of Care, Respect, Integrity, Trust, and Accountability (CRITA) and core competencies in Communication, Working with People and Drive for Results.

To view our competency framework, please visit here.

Click here to learn more about UNICEF’s values and competencies.

UNICEF is committed to diversity and inclusion within its workforce, and encourages all candidates, irrespective of gender, nationality, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of the organization.

UNICEF has a zero-tolerance policy on conduct that is incompatible with the aims and objectives of the United Nations and UNICEF, including sexual exploitation and abuse, sexual harassment, abuse of authority and discrimination. UNICEF also adheres to strict child safeguarding principles. All selected candidates will be expected to adhere to these standards and principles and will therefore undergo rigorous reference and background checks. Background checks will include the verification of academic credential(s) and employment history. Selected candidates may be required to provide additional information to conduct a background check.

General conditions

Reporting: the consultant will be reporting to the Health Specialist and will work closely with other UNICEF programme staff and with experts from the National Health Insurance House and MoH.

Ownership: UNICEF will have sole ownership of all final deliverables; no parts of the deliverables will be reproduced without the permission of UNICEF.

Payment and calendar: This contract include no other benefits. Considering the tasks and timeframe mentioned above, the fee will be paid after submission of report, based on the number of actually worked days, and corresponding deliverables, upon approval by supervisor. The consultant is expected to work from home. No official travel is planned

Note: consultant will sign health statement prior to taking the assignment and the designation form will be completed. The Consultant will be responsible for paying income taxes and any other due taxes as per applicable national legislation.

Application procedure:

The application will be made in the dedicated UNICEF platform and it must include:

1. an updated CV focused on the skills and experience requested by the current consultancy;

2. a cover letter underlining the motivation for applying for the position and how the candidate’s experience, skills and experience match the requirements of the position;

3. a financial offer, specifying the requested Gross daily fee in USD as per the template Fin template_Ind cons_per day in USD.docx

Selection procedure:

Only shortlisted candidates will be contacted. Applications which do not include the financial offer will not be considered.

The contract will be awarded based on the best combination of expertise and fee.

Remarks:

Mobility is a condition of international professional employment with UNICEF and an underlying premise of the international civil service.

Only shortlisted candidates will be contacted and advance to the next stage of the selection process.

Individuals engaged under a consultancy or individual contract will not be considered “staff members” under the Staff Regulations and Rules of the United Nations and UNICEF’s policies and procedures, and will not be entitled to benefits provided therein (such as leave entitlements and medical insurance coverage). Their conditions of service will be governed by their contract and the General Conditions of Contracts for the Services of Consultants and Individual Contractors. Consultants and individual contractors are responsible for determining their tax liabilities and for the payment of any taxes and/or duties, in accordance with local or other applicable laws.