Watsi - Due Diligence Policies v1
Watsi’s Mission = fund healthcare by connecting people
Watsi’s Vision = healthcare for everyone
Purpose of Due-Diligence = efficiently verify the who, what, where, when, why, how of healthcare delivery to support Watsi’s mission
Medical Partnership Due-Diligence Values
- Communication based on trust, growth, mutual respect
- Regular, pro-active communication at all levels
- A mutual understanding that fraud and unintentional mistakes will happen… but ideally not more than once
- A mutual urgency to find solutions that scale
- Willingness to test, evaluate, and invest in new approaches together
- Definition: Solicitation of funds for a patient that did not exist or did not receive the reported healthcare.
- Response: Watsi will pursue a full refund for all affected cases, Watsi will conduct and document a risk assessment and decide on the partner state (full speed ahead, probation, end partnership).
- Systematic reporting errors
- Definition: Repeated and systematic reporting errors of case details.
- Response: Watsi will conduct and document a risk assessment and decide on the partner state (full speed ahead, probation, end partnership).
- Definition: One-off or infrequent reporting errors of case details.
- Response: Case details will be corrected but no other action will be taken in an effort to promote proactive communication.
- Note: we reserve the right to make individual calls in all cases.
- Full submissions and funds transfer activity
- Customized plan to work out operational and partnership issues after a freeze. Generally very limited submissions, increased auditing and communication for a period of time.
- Watsi and partner will communicate with affected donors about the situation
- When suspicion of a serious problem arises. Funds transfers and submissions are suspended. Partner is notified and communications and investigations begin to learn more.
- If there is no longer a sustainable program fit the remaining cases in the Watsi pipeline will be resolved and the partnership will be inactivated
Examples of fraud, systematic reporting errors, and mistakes
- The patient’s identity was misrepresented or the patient does not exist
- The type and/or cost of care was misrepresented or care did not occur
- The care did not occur at the reported location
- The care and reporting did not occur in the proper sequence
- The rationale for care was misrepresented or the care was unnecessary
- The delivery of care was misrepresented or occurred in a negligent manner
Overview of Watsi Due-Diligence
- Proactively identifying and correcting potential sources of future fraud
- Enabling early detection of fraud
- Protocols for responding to fraud
- Educate about and support best practices
- Up-front and ongoing Risk Assessment
- Map the flow of payments, patients, and reporting structure through care-centers
- Provide suggestions to simplify workflows / handoffs, address cultural impediments, and streamline communication channels within and between organizations
- Re-assess after reasonable amount of time to evaluate the changes made by the partner
- A risk assessment happens at least once within 3 months after onboarding and as needed as the partner scales
- Up-front Data Collection / Operational Support
- TODO [robust workflow, convenient best practices, incentivizing good practice, standardization of operational processes, aligning incentives ]
- We value proactive communication when problems arise and collaboration when seeking out solutions
- Cultivate trust through regular calls / communication with Watsi representatives and executive staff
- Augmented decision making
- Easier structured and unstructured data capture
- Closing the loop with hospitals, healthcare workers, patients, fellows
- Random audits of ongoing and completed cases at the partner and patient level
- Regular, rotating on-the-ground presence in order to allow for efficient auditing, operational support, special projects
- #1 = Decision to Freeze or Not
- #2 = Preliminary Data Collection / Documentation
- #3 = Preliminary Assessment and Plan
- #4 = Creating Plan and Beginning Communication with Actors / Stakeholders
- Medical Partner, Watsi, Funders, Board
- Open Cases
- #5 = Conduct Investigation
- Both in-person and technological vetting
- #6 = Make necessary changes to deterrence policies, monitoring tools / procedures
- #7 = Decide on next Medical Partner State
- Full speed ahead
- Probation / Ramp-Up
- End partnership
- #8 = Final Communications Actors / Stakeholders
Last Updated: 06/02/16