Clinical costing for provider organisations

PwC has developed a structured approach to Patient Level Information and Costing System (PLICS) that leverages deep regional and international healthcare and technical experience required to assess, design, and implement sustainable costing programmes. Our key service offering is the development and implementation of a PLIC framework.

We have insight into funding policy and regulatory changes in the region around coding, classification systems, and funding. We also understand healthcare provider operations, how hospitals operate, and patient and provider behaviour in the region.

We have access to internationally renowned subject matter experts who have implemented costing around the world.

We assess, design, and implement your costing framework in line international best practice costing standards which have been co-authored by our SME’s in Australia and the UK. Our approach is flexible and is customized to suit your business requirements and the specificities of the market you operate in. Our view is objective and independent of any particular vendor solution. It focuses on your business requirements and designs the costing methodology and framework with the future in mind so that it evolves as the core PLIC components are developed and improved.

Clinical costing should be viewed as an ongoing programme that is driven by the organisation's strategic and operational requirements.

The end goal is to develop and implement a robust and sustainable PLIC framework.

Key phases and tasks under our approach

Assess

In the Assessment phase, we conduct an assessment of your current (and planned) costing and coding practices, financial recording including the General Ledger’s structure and suitability for costing, HIT and data infrastructure, and core operational processes against mandated standards or best practice costing requirements.

Design

In the Design phase, first we design the costing methodology and framework. Secondly, we develop the requirements (RFP) for the coding, grouper, and costing software (if not yet completed) and assist you with the vendor selection process.

Implementation

In the Implementation phase, we support you in conducting or quality assuring the costing study; this includes:

Data preparation
Conducting the costing study using a software of our choice or quality assuring the costing process conducted through your chosen costing software
Adjusting the results to final outcomes including conducting clinical panels and simulating the impact of funding policies such as the outlier policy

Governance & development

Part of every engagement is the Government and Development component. We conduct organisation-wide awareness sessions on PLIC, conduct coding training on through certified coders, and conduct costing training. We also support with setting up the governance structure for running the programme.