In March 2020, the National Supplementary Health Agency (ANS) presented the Normative Resolution 452, known as RN 452. The new parameters came to replace the Normative Resolution 277, an old document that served as the basis for the operators’ actions.

The objective of the new guidelines is to assist in the qualification of the service that is offered to beneficiaries, including a set of actions that range from the management area to the health care team, and which are analyzed in the Operator Accreditation Program.

Therefore, the main objective of the change is to induce the use of a new service and monitoring system that is capable of satisfying everyone involved.

It is worth mentioning that the new Normative Resolution has been under discussion since 2016, evaluating numerous points of change. After some changes, it came into effect in 2020, being used as a guide for health plan operators.

Want to know more about the subject? So take the opportunity to check all the information and understand the main changes caused by RN 452.

What is RN 452?

RN 452 becomes valid as an evaluation standard for all health plan operators operating in the country and opting for accreditation, including various aspects that are part of everyday life, from the organizational management system to patient care.

Although voluntary, accreditation is very important for operators who wish to invest in their own reputation through the excellence of the services provided.

The new document sets out four chapters of standards and rules that must be applied in the day-to-day activities of institutions, covering topics such as the characteristics and composition of the score for accreditation and even regulatory incentives.

Normative Resolution 452 is the basis for participation in the Operator Accreditation Program.

To be successful you must meet the following requirements:

• Have an active registration as an operator with the ANS;
• Not included in the following groups:
  • assistance recovery plan;
  • economic-financial adequacy plan;
  • special technical management regime;
  • special fiscal management regime;
  • extrajudicial liquidation process;
  • supervisory intervention.
• Have been positioned in band three of service guarantee monitoring twice consecutively in the 12 months prior to the assessment;
• Have a Supplementary Health Performance Index (IDSS) and its dimensions, equal to or greater than 0.6 (six tenths);
• Not having an Independent Audit of the financial statements with an adverse opinion or with a disclaimer of opinion for the last available year.

 

With RN 452, the assessment is now determined according to the proportion of verification items and their compliance, with scores that can vary between 0 and 100. It is essential to achieve the conformity in all the main items of a question. Otherwise, it is possible to reset the entire item to zero.

Depending on the grades achieved in each of the criteria, the accreditation level can vary between Bronze (score between 70 and 79), Silver (score between 80 and 89) or Gold (score between 90 and 100).

It is important to emphasize that the accreditation process involves the analysis of four dimensions: Organizational Management, Provider Network Management, Health Management and Beneficiary Experience. In total, they are:

• 21 requirements and 168 items for operators in the Medical-Hospital segment;
• 19 requirements and 134 items for operators in the Exclusively Dental segment and;
• 21 requirements and 166 items for operators in the Self-Management segment.

Check the list of main requirements according to dimension:

1. Related to organizational management

• Strategic Planning and Management
• Corporate Governance System
• People management and leadership development policy
• Information Technology
• Information security and privacy policy
• Corporate Risk Management
• Operator Sustainability
• Quality Improvement Program – PMQ

2. Related to health management

• Beneficiary access to the health service provider network
• Structure of the Provider Network based on Primary Health Care – PHC
• Relationship and Contractualization with the Service Provider Network
• Regulation Mechanisms

 

3. Related to provider network management 

• Health Care Quality and Patient Safety Policy
• Coordination and Integration of Care
• Chronic Health Conditions Care Management Program
• Pharmaceutical care
• Value-Based Compensation Models

 

4. Relating to the beneficiary’s experience

• Provision of Information to Society
• Communication Channels with Beneficiaries – response to demands (REACTIVE)
• Communication Channels with Beneficiaries – provision of information (PROACTIVE)
• Beneficiary Satisfaction Survey

 

Items

As for items, construction is based on graduation, from the minimum necessary to the level of excellence. See the characteristics of each one below:

Core items

Essential items are essential for scoring a requirement as a whole. The operator who does not fulfill 1 essential item resets the entire requirement, that is, to score the requirement, the health operator must have at least all the essential items.

Complementary items

Defines the recommended good practices to be followed by the healthcare provider. These items increase the requirement score if met.

Excellent items

These are practices that are little used in the sector and are more difficult to implement. Compliance with 80% of excellence items is one of the requirements for the operator to achieve level I Accreditation.

The items of excellence are practices that are not widespread in the sector and are more difficult to achieve.

Compliance with 80% of excellence items is one of the requirements for the operator to achieve level I Accreditation.

 

How does RN 452 impact health plan operators?

As it is a change that has been under analysis since 2016, RN 452 presents numerous advances in the way we see operators' actions.

The Operator Accreditation Program presents new techniques based on national and international experiences and studies. The aim is to reduce the differences between the information sent to the ANS, in addition to contributing to the improvement of health practices.

One of the main changes is the manual that explains to professionals how all the items that must be observed during the search for accreditation are interpreted.

This is an important step, since before RN 452 each operator used their own manual to understand the requirements of the ANS. This way, it is possible to standardize the process and avoid different interpretations.

By following and adhering to new practices, it will be possible to notice some significant changes, such as:

• agility for scheduling exams and consultations;
• workflow optimization;
• cost reduction and reduction in inconsistencies that can lead to fines.

 

RN 452 and IDSS: what is the relationship?

It is possible to see that Normative Resolution 452 will be a valuable instrument for health plan operators who want a good result, including with regard to the Supplementary Health Performance Index (IDSS).

This is because the new resolution includes aspects that affect regulatory incentives, contributing to the bonuses that can be achieved in the IDSS, depending on the level of accreditation achieved.

It should also be noted that a good result in the IDSS is one of the prerequisites for achieving the long-awaited accreditation, which can make a difference for the operator. In other words, the minimum score for each of the four dimensions that make up the Index must be above 0.6 and, for the maximum level of accreditation, the final score must be above 0.8.

By knowing the standards and requirements that are evaluated in the Operator Accreditation Program, it will be possible to carry out an analysis to find out in which aspects and areas the institution can improve to offer an excellent service, identifying problems and thinking about improvements.

When planning new solutions, feedback from the beneficiaries themselves will be noticeable, who will praise the changes and the new service being offered.

 

How technology helps with accreditation 

Part of the adjustments required by ANS for minimum accreditation concerns technology infrastructure, implementation of health management systems and modernization as a whole in favor of improving the beneficiary's experience.

This is because one of the great benefits of using technology is agility, the potential for quick and easy sharing of information, process management and so on.

The systems of medical audit They are true strategic assets and support strategic decision-making. Therefore, choosing the ideal System increases the operator's value proposition, adding more efficiency, transparency and cost reduction.

Among the advantages of using ideal technology, we highlight:

• Help the institution to score the items in RN 452, proving the evidence;
• Empower the organization and decision making in real time;
• Significantly reduce costs;
• Exponentially increase operational capacity;
• Reduce Operational Cost of Processing Authorizations, OPME, Concurrent Audit and Audit of Medical and Hospital Accounts and Disallowance Resources;
• Automatic and complete recording of the entire audit trail;
• Compliance with deadlines in accordance with RN 363 articles
• Check out other advantages!

 

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