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CLIENTS ADVANTAGE

CLIENT ADVANTAGE

We personally manage each episode of care from end to end.

You maintain your branding.

As a payer, you can maintain and grow your brand identity in the U.S. while accessing WMMS’ provider network and healthcare savings. We white label, using your brand front and center with every healthcare entity to whom we direct your insureds for care. This brand continuity is uncommon among U.S. TPA’s.

WMMS’ Urgent Care Clinics and House Call Doctors delight patients and lower the cost of care.

World Medical Care’s house call network and emergency care clinics provide hassle-free solutions for patients who are able to avoid emergency room visits and unnecessary hospitalizations in 95 – 97% of episodes of care. Your insureds are seen by board certified doctors at their convenience in the setting of their choice. This personalized approach to care is a huge driver of patient satisfaction.

We personally manage each episode of care from end to end.

We manage each case holistically to maximize outcomes and minimize cost.

  • Prevention. Our first priority is to prevent simple cases from escalating by leveraging our network of urgent care clinics and board certified house call doctors.
  • Adherence to care protocols. When further treatment is required, we recommend in-network providers and ensure that care adheres to InterQual guidelines to avoid overutilization.
  • Second Medical Opinions. Before any invasive procedure, we coordinate second medical opinions.
  • Real-time reporting. During the course of treatment, we expedite the release of medical reporting so that you can make treatment decisions proactively, not reactively. (Normal hospital records release could involve wait times of as long as 60 – 90 days).
  • We benchmark Medicare rates on clean claims. When claims are received, they are cleaned before they are repriced. Regardless of claim date, we negotiate repricing with Medicare rates as our benchmark.

We expedite emergency care.

When hospitalization is required, we will get your insureds admitted right away. If they went to a hospital on their own, they might have to wait for hours.  

Real time medical reporting enables YOU to make faster and better case decisions.

We are not only a licensed TPA, we are also US healthcare providers. We know how to navigate thru the US healthcare system, whether it’s working with hospital administrators or directly with healthcare providers to get you the test results and prognosis with supporting documentation in a fraction of the time that you could get them on your own. (You could wait at least 60-90 days to get reporting directly from a U.S. hospital).

Transparent financial reporting.

We provide our clients with a monthly score card, reporting the overall percentage of hard savings by episode of care. These reports include the original charge, the negotiated charge, our access fee, the savings, and the net savings. We are flexible, so should you need a different reporting format, we can accommodate you.

The ultimate patient experience.

WMMS delivers the five “C’s” of quality care to your insureds. Our patient satisfaction research tells us that these factors drive patients satisfaction with their payer during an episode of care in the U.S.:

  • Care quality. We identify and direct patients to Centers of Excellence based on outcomes for the condition being treated.
  • We arrange for patients to get prescribed medications, often providing delivery right to their doors.
  • We provide patients with provider choice. Each patient may choose from a minimum of three highly qualified physicians and/or in-network care facilities. Suggested facilities are based on outcomes (e.g. the highest survivor rates and the lowest infection and mortality rates) and cost, ensuring the best possible patient treatment at a fair price.
  • Care Coordination. We coordinate patient appointments. We minimize and often avoid out-of-pocket payments.
  • Communication. During the episode of care, we communicate with a patient-authorized loved one to keep family members apprised of the patient’s status. We provide translation in English, Spanish, Portuguese, Haitian, French and Russian.