YAKAP clinics get paid Php 1,700 per patient, but only if they meet PhilHealth's criteria.
And if you do not track this, your clinic can lose a lot of money.
The full Php 1,700 per patient is split into two payments:
- Payment 1 (monthly): 40% – first patient encounter consultation
- Payment 2 (yearly): 60% – performance based, based on clinic's Performance Factor
Source: PhilHealth Circular 2024-0013 Annex I
Payment 1: First Patient Encounter (40%)
Every time a clinic completes a First Patient Encounter with a patient, they are paid Php 680. This includes baseline screening with vitals, medical history, NCD risk.
Example: In March, a clinic sees 100 patients. So for that month, they receive Php 680 x 100 patients = Php 68,000.
Payment 2: Performance Based (60%)
At year-end, PhilHealth computes your Performance Factor — a score from 0% to 100% — and multiplies it by Php 1,020 x your total FPE count.
Example: If a clinic has 500 FPEs.
With 100% Performance Factor, they earn: Php 1,020 x 500 patients x 100% = Php 510,000
With 60% Performance Factor, they earn: Php 1,020 x 500 patients x 60% = Php 306,000
That means they lost Php 204,000 from the full amount — and this is where most clinics lose money without realizing it!
How Do You Calculate Performance Factor?
The Performance Factor has four parts:
- Consultation rate (30%, target: 100%) — % of FPE patients that had at least one consultation this year.
- Lab utilization (30%, target: 50%) — % of FPE patients that did at least one laboratory service.
- Antibiotics dispensing (10%, target: 15%) — % of your FPE patients that received indicated antibiotics for communicable diseases.
- NCD medication dispensing (30%, target: 20%) — % of your FPE patients that received indicated non-communicable disease medicines.
What Is the Target?
To receive full % for that component, you need to hit the target %. For example, to get the full 30% for lab utilization, at least 50% of your patients need to have a laboratory service.
If you do not hit the score, PhilHealth adjusts your score based on your performance.
Example: If only 25% of your patients have a lab service done, you only get 30% x (25% / 50%) = 15%
If you have 500 patients: - Achieved lab services target (50%): Php 1,020 x 500 x 30% x (50%/50%) = Php 153,000 - Missed lab services target (25%): Php 1,020 x 500 x 30% x (25%/50%) = Php 76,500
How RecordKo Helps You Achieve 100%
The #1 action to boost performance factor is to find the patients who have not received services yet (e.g. consultations, laboratory services, antibiotics, NCD meds) — and deliver the services.
RecordKo helps clinics find those patients: Our Finance & Performance dashboard computes your Performance Factor in real time from your consultation data.
For each indicator, we show you the patients who haven't received those services, so that the clinic staff can follow up with them. Each additional patient improves your score and your year-end payout.
But Wait, There's More
Our dashboard also tracks which patients are empaneled (i.e. assigned) to your clinic but have not had their FPE (Tranche 1 — 40% income), and what % of the barangay population has not registered, so you can increase your clinic's patient load.
If you're interested in seeing how RecordKo helps track your clinic's performance, book a demo with us today!