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ضمان مجلس الضمان الصحي Council of Health Insurance INTRODUCING PATIENT CLASSIFICATION SYSTEMS IN SAUDI HEALTH INSURANCE MARKET White Paper on Diagnoses Related Groups Classification System in CHI Husein Reka, Abdullah Almaghrabi, Susan Young Council of Health Insurance, Policy Department October 2022 Published by The Council of Health Insurance King Fahd Rd 11564 Al Malqa, Riyadh © The Council of Health Insurance # Executive Summary Casemix and patient classification systems are important building blocks for contemporary health systems and crucial transparency enablers. One of the most important tools, and what is known as one of the most successful health care financing systems, Diagnosis Related Groups (DRGs), have been present in Saudi Arabia since 2009. However, the most considerable progress in their implementation has been achieved in the past five years as a result of Vision 2030 transformation efforts. Being part of Vision 2030, the health insurance sector in Saudi Arabia is spearheading the implementation of new and innovative ways toward more transparency in healthcare financing and provision such as National Platform for Health Information Exchange Services (NPHIES) Saudi Billing System (SBS), and Minimum Data Set (MDS). The implementation of AR-DRG is one of the most important projects as part of CHI's 2020-2024 strategy and through this white paper CHI will explain the concepts of casemix, patient classification and plans for AR-DRG implementation in the Saudi health insurance market. AR-DRG has already been implemented through Article 11 and is part of the already up and running NPHIES. However, in order to scale up DRG usage and implementation, significant market preparedness and readiness is required. As part of these requirements, CHI plans a series of educational and knowledge-sharing sessions for the market, followed up by pilot implementation plans and support. CHI's implementation framework has a comprehensive approach to introducing casemix, by tackling all areas deemed as prerequisite for AR-DRG implementation (clinical coding, clinical documentation, episode grouping, technology, and financial impact). As per CHI's implementation plan, AR-DRG will be implemented in three phases: 1. Phase 1: Market preparedness 2. Phase 2: Testing and implementation with selected payers and providers 3. Phase 3: First AR-DRG reporting and billing activities These phases will enable subsequent scaling up of AR-DRG as a reporting and reimbursement tool for the market in 2025 and are more explained further in this document. This will require significant communication efforts and change management in the market. The successful planning and implementation of AR-DRG in CHI will enable seamless utilization of this system via NPHIES and pave the way to more transparency and value-based health care in the market.  # Diagnoses Related Groups Classification System in CHI 2 # Contents * Executive 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