Atividade reuniu operadoras e prestadores das regiões Centro-Oeste e Norte; em dois dias, foram realizados cerca de 150 atendimentos
A Agência Nacional de Saúde Suplementar (ANS) realizou, entre os dias 24 e 26 de junho, mais uma edição do Encontro ANS, desta vez em Campo Grande, no Mato Grosso do Sul. O evento reuniu cerca de 250 pessoas em cada dia do evento, entre representantes de operadoras e prestadores de serviços de saúde das regiões Centro-Oeste e Norte do país, para discutir temas relacionados à regulação do mercado de planos de saúde.
Na abertura, Paulo Rebello, diretor de Normas e Habilitação das Operadoras, falou da importância do evento para a ANS, e dos esclarecimentos prestados pelos técnicos da Agência aos participantes. “Os atendimentos individualizados realizados no Encontro ampliam a interação da Agência com o setor regulado”. “O que levamos daqui contribui para o aprimoramento da regulação da saúde suplementar”, acrescentou o diretor de Desenvolvimento Setorial, Rodrigo Aguiar.
A diretora da Fiscalização, Simone Freire, ressaltou o serviço prestado pela reguladora durante o evento: “As mesas de atendimento são ótimas oportunidades para o setor ter contato direto com o técnico da Agência”. Rogério Scarabel, diretor de Normas e Habilitação dos Produtos, afirmou que as portas da Agência continuam abertas para além do evento: “Esse alinhamento é muito interessante e importante para os processos da ANS”. O diretor-presidente, Leandro Fonseca, encerrou a abertura frisando que a troca realizada é válida para os dois lados: “O Encontro ANS representa uma grande oportunidade de aprendizado também para nós da Agência”.
Diretores da ANS na abertura do Encontro: Rogério Scarabel, Leandro Fonseca, Simone Freire, Rodrigo Aguiar e Paulo Rebello
Primeiro dia de palestras
No primeiro dia de palestras e atendimentos do Encontro ANS, o diretor Paulo Rebello abriu o painel inicial com o diretor-adjunto da Diretoria de Normas e Habilitação das Operadoras, César Serra, o gerente de Acompanhamento das Operadoras, Robson Cruz, e o gerente de Habilitação e Estudos de Mercado, Washington Alves.
César Serra reforçou que as normas econômico-financeiras objetivam que “as operadoras não operem além de suas capacidades financeiras, de modo que o mercado possa alcançar maior sustentabilidade”. Washington Alves palestrou sobre o Programa de Escala Adequada e a movimentação de ativos garantidores, e ainda sobre as regras de conduta do mercado. Robson Cruz falou sobre as principais alterações das normas contábeis e salientou os problemas que a falta de qualidade nos dados repassados para a ANS podem gerar. Em seguida, os três esclareceram dúvidas do auditório sobre os temas trazidos no painel.
No painel seguinte, Daniel Schtruk, coordenador de Procedimentos de Adequação Econômico-Financeira, destacou pontos relevantes dos programas voltados para esse fim. Roberto Araújo, coordenador de Direção Fiscal, explicou como funciona o trabalho de um diretor fiscal nomeado pela ANS no acompanhamento realizado junto às operadoras. Ele destacou que mesmo quando sai do regime de Direção Fiscal, a operadora continua sendo acompanhada de perto pela coordenação para haja verificação de que todas as diretrizes dadas pelo diretor fiscal estão sendo tomadas.
No painel da tarde, o gerente-geral de Estrutura dos Produtos, Rafael Vinhas, palestrou sobre os aprimoramentos que estão sendo propostos pela Diretoria de Normas e Habilitação dos Produtos, como as novas regras para alteração de rede hospitalar – que hoje possui um sistema totalmente automatizado, que diminuiu o tempo de resposta da Agência para 24 horas. “De fevereiro de 2018 até junho de 2019 já foram feitas 33.916 alterações de maneira eletrônica”, informou o gerente-geral, que também explicou a nova metodologia de cálculo de reajuste anual dos planos individuais, ressaltando a transparência que o mercado ganha com o novo cálculo. Após a palestra, a equipe da diretoria tirou dúvidas dos participantes sobre temas como aplicação de reajuste retroativo, portabilidade de carências, declaração de saúde e CPT, descredenciamento de prestadores hospitalares e a nova metodologia de reajuste dos planos individuais ou familiares.
Na sequência, Carla Soares, gerente-geral de Regulação Assistencial, abriu o painel reforçando que todos os temas da ANS são interligados, uma vez que “não há como falar de rede assistencial sem falar sobre Promoção de Saúde e Prevenção de Doenças, que coloca o beneficiário no centro do mercado regulado”. Katia Audi, gerente de Monitoramento Assistencial, iniciou sua palestra falando sobre a necessidade de avançar na assistência ao beneficiário para que este receba um cuidado coordenado. Segundo a gerente, por trás de problemas como alto custo, alta sinistralidade e envelhecimento populacional estão a ausência de coordenação de cuidados e de gestão dos dados, desconhecimento do perfil da carteira e pouco investimento em prevenção. Ainda no painel assistencial, o gerente de Direção Técnica, Wilson Júnior, falou sobre o regime que visa monitorar graves anormalidades administrativas de natureza assistencial.
A última palestra do dia foi com a gerente de Tecnologia da Informação, Luciene Capra, que abordou a transformação digital pela qual a ANS vem passando. “O foco é o ente regulado, sempre pensamos em como é possível otimizar o processo de trabalho, o envio de dados”, explicou. Em seguida, Luciene e Hegmann Lima, coordenador-substituto de Sistemas, responderam a perguntas sobre o envio de dados à ANS.
Durante os dois dias de palestras, participantes puderam tirar dúvidas com técnicos da ANS
Segundo dia
Na abertura do segundo dia de painéis do Encontro ANS, o diretor de Desenvolvimento Setorial, Rodrigo Aguiar, falou sobre os principais temas da área, como o estímulo a novos modelos de assistência e de remuneração de prestadores. Em seguida, Ana Paula Cavalcante, gerente de Estímulo à Inovação, falou sobre os dados demográficos do país, que atualmente passa por uma transição e que, até 2040, os idosos irão passar de 20% da população. “Com essas perspectivas, precisam ser alteradas também as dimensões do cuidado em saúde, que não podem ser as mesmas de antes. É preciso oferecer um cuidado coordenado, colocando o paciente no centro da atenção”, explicou Ana Paula, destacando que foi com esse objetivo que a ANS criou o Programa de Certificação em Boas Práticas, que concederá um selo às operadoras que voluntariamente aderirem à iniciativa e demonstrarem que praticam um cuidado coordenado.
No segundo painel, Gustavo Macieira, gerente de Assessoramento Normativo e Contratualização, falou sobre a negociação entre prestadores e operadoras, explicando as discussões realizadas na Câmara Técnica que discute o assunto (CATEC), como remuneração de materiais e medicamentos de uso hospitalar, remuneração por pacotes de consultas em oftalmologia e dificuldades na negociação contratual. “Nosso principal foco é a transparência. Não vamos determinar valores de pagamento para a prestação de serviços, mas vamos exigir que os valores cobrados sejam divulgados”, afirmou Macieira. O gerente explicou ainda sobre o Procedimento de Reclamação dos Prestadores (PRP), um sistema automatizado que começa a funcionar, ainda como piloto, e consiste no encaminhamento da reclamação do prestador para a operadora, que terá oportunidade de se manifestar antes mesmo da análise da ANS.
A Diretoria de Fiscalização ocupou a tarde do último dia do encontro. Erica Schiavon, gerente de Atendimento, Mediação e Análise Fiscalizatória, falou sobre o fluxo da Notificação Intermediação Preliminar (NIP) e as principais alterações trazidas pela RN nº 444. Após espaço de perguntas, Frederico Cortez, gerente-geral de Operações Fiscalizatórias, falou sobre o Programa de Intervenção Fiscalizatória. Cortez detalhou os critérios de seleção para a intervenção e mostrou como é feito o cálculo do indicador de fiscalização, que identifica quais operadoras ficaram nas faixas mais baixas e por isso deverão sofrer a medida.
Durante os dois dias de evento, foram realizados 151 atendimentos individualizados às operadoras pelos técnicos da Agência, sendo que 240 pessoas participaram no primeiro dia e 220 no segundo dia do encontro.
No encerramento, os diretores Leandro Fonseca, Rogério Scarabel e Paulo Rebello reforçaram a acessibilidade da agência e ratificaram a intenção de continuar realizando os Encontros ANS.
Visita à operadora
Plateia do Encontro ANS
O Encontro ANS também oportunizou a visita do diretor Rogério Scarabel ao Centro de Prevenção em Saúde e ao hospital da operadora Cassems. Junto com técnicos da diretoria de Normas e Habilitação dos Produtos, foi possível conhecer como a operadora investe no cuidado integral à saúde com programas como prevenção de doenças crônicas e odontologia para bebês entre outros.
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