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Cost Containment

World Medical Care is constantly evolving to ensure that our international clients have a complete set of leading solutions to manage the three universal fundamentals of healthcare: Access, Quality and Cost. We have structured our services to meet the needs of members with international coverage and to assist insurers to contain costs. For this matter we have a number of services aimed at treating the insured comprehensively and avoiding whenever possible (statistically in 95% of cases) for them to be referred to a hospital or ER, and thus generate substantial savings.

Our highly experienced management and skilled staff audit medical claims in conjunction with medical advisors delivering important value to our clients and their insured members on a daily basis.

We provide THE FOLLOWING main level of services for Cost Containment

  • Cost Containment: World Medical Care provides true cost containment for payers basing on our medical claims pricing on the actual cost of appropriate care, not a percentage reduction off of an inflated retail price. Our negotiations with providers are based on a clear understanding of their costs, by type and size of facility, type of treatment and by actual share of unfunded or underfunded care that requires them to cost shift. This knowledge empowers us and our clients, with a unique advantage in negotiating fair reimbursement for quality care
    World Medical Care has effected major changes in provision of cost containment in the industry and has had a significant impact in influencing a more controlled claims environment in the tourist and domestic markets.
  • House Calls: World Medical Care offers the highest quality, professional and personal medical attention to our insureds whenever they need it. Our commitment to serving patients in a timely and cost effective manner is what differentiates our services from others’ services. We can offer patients excellent medical services quickly while saving our clients time and money.
    We have developed an extensive network of at home doctors covering the most relevant metropolitan areas for international members.
  • Referral Coordination: Our long history and extensive knowledge in healthcare has allowed us to build a direct contract network of more than 2.000 providers nationwide (urgent cares and specialists) that allow us to coordinate any assistance in any corner of the United States.

World Medical Care’s team will work closely with our client and patient to coordinate an efficient referral to the best specialist. Our team will also keep informed of your patient’s progress and treatment plan and send the patient’s records when they return home to ensure continuity of care

When it is necessary to coordinate assistance in any facility that is not part of our network, we have the ability to pay up-front for the visit avoiding in all cases for the insured to pay out of pocket
Through both, , our network of house call providers plus our ability to coordinate in any urgent care in the US, we manage to successfully prevent unnecessary admissions into Hospitals and ERs and help reduce our client’s healthcare costs, enhance profitability while maintaining effective collaboration with medical providers.

  • World Medical Care Urgent Care and Family Medicine: Our clinic with 4,000 square foot state-of-the-art, located in North Miami Beach, Florida was designed with the objective of maintaining, in the first instance and whenever possible, the policyholders outside Hospital and ERs of south Florida
    It is the first of its kind to offer personalized services for all types of non-emergent medical treatments, open 7 days a week.
  • National Pharmacy Discount Program: our network reaches more than 65,000 locations with discounts of up to 85% on drugs approved by the FDA.
  • Medical Case Management: In order to control medical costs and promote proper care, our case management department coordinates medical care for pre-planned procedures, suggests treatment options and monitors ongoing medical treatment while directing patients toward high-quality providers with in-network discounts. We evaluate each case using evidence-based medicine and best practice guidelines ensuring that patients are receiving the right care, in the right setting, at the right time. Our case managers are experts at working with an entire episode of care to foresee billing and care delivery situations that require active monitoring and advocacy on behalf of both the payer and the patient. Our highly effective medical case management solution reduces billing errors, facilitates prompt payment to providers, maximizes opportunities for savings and ensures that patients are receiving the appropriate care.

Our Services Include:

  1. Concurrent monitoring of patient treatment plans
  2. Directing patients to cost-effective providers and facilities
  3. Coordination of hospital admissions and appointments
  4. Post-discharge planning and care coordination
  5. Effective communication between all parties
  6. Pre-authorizations of medical treatment
  7. Coordination of referrals
  8. Coordination of air ambulance/commercial airline evacuation

Advantages

  1. Case managers provide an accurate evidence-based review of treatment plans
  2. Early identification of costly cases allows time for cost saving solutions
  3. We focus on the quality of care provided while ensuring timely and cost effective treatment based on medical necessity.
  4. Steering of patients to cost-effective facilities

Negotiation and management of Individual Cases: our staff has over 20 years of experience in negotiating catastrophic cases allowing them to develop relationships with major medical centers (discounts can reach 60% of bill charges). This is the last level for cost containment and it is meant to generate substantial savings when membership end up at a Hospital facility. In addition, we offer our case management services by which we control and gather medical records and itemized bills
Our “case management” extends from the beginning until the closing of the episode of care. This enables us on the one hand to control the quality of service at all stages and on the other to contain the costs (our coordination team keeps contact at all the time with the client – insurance or assistance company – in order to report the evolution of the case and seek permission for any costs that may arise – we never proceed without the authorization from our client)

• Bill Review
Our large claim review and audit services provide clients with a full claims audit that includes line-by-line reviews of billed charges to identify and exclude any technical and coding accuracy errors. This results in claims charges being reduced before the application of the discount or reimbursement. In addition, this service can be applied to claims that are in or out-of-network.

Services include:

  1. Review of medical necessity
  2. Unbundling of charges
  3. Utilization review
  4. Anesthesia services review
  5. Supplies, materials and durable medical equipment (DME) review
  6. Determining the room & board reimbursement rate
  7. Comparison of charges against the hospital documentation