Advantages for our clients
White Label TPA Services
As a payer, you can maintain and grow your brand identity while leaning on the 24/7 operational plateau, the worldwide providers network and the cost containment programs of WMMS. We white label, using your brand front and center with every healthcare entity to whom we direct your insureds for care. We will process calls, bot chats, what’s app chats, and emails under your brand, as well as using your brand in all our communications with the providers network. In this way, you benefit from brand recognition through the entire medical case handling process.
The most comprehensive outpatient network in the world.
The use of Hospital healthcare services, which represent the higher portion of payers’ loss ratio, can be avoided in up to 97 % of the medical instances.
We have therefore designed an international network of outpatient providers ranging from house call doctors, imaging and lab centers to emergency care clinics, that will reduce the use of hospitals, while ensuring that patients are provided a hassle-free and medically efficient solution. Outpatient services are personalized, faster, and non-invasive. Maximizing outpatient approach to medical care, not only impacts positively in your loss ratio, but is also a huge driver of patient satisfaction.
We manage each case holistically to maximize outcomes and minimize cost.
- 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. In any Hospital in the world. If a patient self-steers to a healthcare facility, he/she might have to wait for hours and get involved in a cumbersome administrative process.
Real time medical reporting enables YOU to make faster and better case decisions.
We are not only a licensed TPA, but we are also a US outpatient healthcare provider. 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 most relevant information of every case handled, including resolution lead time, diagnosis, medications prescribed, an accurate estimation of costs and 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 emphasizes in observing all the drivers that deliver 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 every country around the world:
- 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.
- 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 out-of-pocket payments.
Communication. During the episode of care, we communicate with the family member appointed as the point person, to keep family members apprised of the patient’s status. We provide translation in English, Spanish, Portuguese, Haitian, French and Russian.