Health Systems Transformation Platform (HSTP) provides technical support to the state government for the implementation of the State Health Insurance scheme - Biju Swasthya Kalyan Yojana (BSKY) in Odisha. HSTP works closely with the implementation agency - State Health Assurance Society (SHAS) building personnel capacities, improving business & clinical processes, and targeting better stakeholder engagement and beneficiary experience that contributes to better financial risk protection and good health outcomes.

The workshop conducted on  Strengthening BSKY Operations: Pre-authorization & Claims Processing is a capacity building exercise by HSTP to enhance the capacities of practitioners and functionaries at the state-level health programs. SHAS is transitioning to implementing BSKY directly without the support of third-party administrators (TPA).

This workshop provided an opportunity to provide re-orientation training to the scheme functionaries, especially the doctors who play a key role in this transition and to build their skills in reviewing the pre-authorization and claims processes. This was executed in collaboration with the State Health Assurance Society Odisha and the Department of Medical Education & Training (DMET), Odisha.

The workshop provided a learning opportunity to about 20 doctors working for SHAS, TPAs & DMET to improve the implementation of the Biju Swasthya Kalyan Yojana in the state.

The learning was facilitated by Dr Devadasan (HSTP), Sudha Chandrasekhar (HSTP), Dr. Bisoyi (SHAS), Dr. Sambit Behra (SHAS), and Ms. Shalini Pandit, IAS - CEO, BSKY. 

This policy paper attempted to present resource allocation, utilization, and absorption across four Indian states. It highlights key issues and provides recommendations to improve the health financing process that facilitates greater flexibility and efficiency in financing the programs. The experiences of policymakers who have successfully handled systemic issues developed best practices, and ensured results for the state have been included as a part of the learnings.

Further, in terms of continued center-state engagement in implementing health schemes, the current financial transfers for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) have been included as a case example.