Medical Management Solutions

Transcription

1 Medical Management Solutions Global Corporate Solutions

2 INTERNATIONAL TPA TRAVEL FOR TREATMENT Medical Management Solutions COST CONTAINMENT As a leading international third party administrator (TPA) and health management company, our medical management solutions including International TPA, Travel for Treatment and Cost Containment services are constantly evolving to ensure our international and domestic clients have a complete set of world-class solutions to manage the three universal fundamentals of healthcare: Access, Quality and Cost. With over 5 decades of experience, we are committed to assisting our clients, along with their insured members and employees to confidently navigate the increasingly complex global healthcare systems and leveraging the economic advantages of our unmatched global healthcare provider network with ease. Our unparalleled North American and international proprietary network, medical case management, strong claims processing systems, customized services and technology are all seamlessly interwoven to ensure that patients receive the best-possible medical care, while reducing and controlling our clients risks and costs. We are your most experienced and trusted partner for unrivaled access to the best medical care in the world 2 Global Corporate Solutions ITPA Medical Management Solutions

3 Our Services Backed by strong systems and processes, highly experienced management and skilled staff, our medical management solutions deliver important value to our clients, along with their insured members and employees on a daily basis, no matter where they are located around the globe. OUR WORLD-CLASS MEDICAL MANAGEMENT SERVICES INTERNATIONAL TPA Recognized as the service leader for borderless healthcare management and cost containment TRAVEL FOR TREATMENT COST CONTAINMENT Worldwide Medical Networks U.S. Cost Containment Large Claim Review & Audit 24/7 Medical Case Management & Emergency Assistance Claims Management & Repricing Online Web Portal Services Reporting Capabilities & Statistics 3

4 Worldwide Medical Networks Member experience is consistent globally We continually work to enhance and expand our Corporate Medical Network (CMN ). New contracts are signed on a daily basis and the network includes industry leading hospitals, doctors, specialists, dentists and other medical providers in over 130 countries. We know that members need more than just hospitals for their daily healthcare needs. The main contributing factor to any successful healthcare plan is to have access to a broad range of healthcare services and providers. The CMN covers a comprehensive range of healthcare specialties and fields including specialized diagnostics testing, labs, neo-natal care, cardiac care, serious trauma injuries or burns, oncology, orthopedic, general to specialized surgery, organ transplants and occupational medicine. More important than the size of the network, is the quality of the providers selected. Our team of dedicated Provider Relations Network Specialists is actively contracting with healthcare providers around the globe. In order to ensure we are consistently working with the best providers at the best price, we regularly review and evaluate our contractual relationships with all our providers while building relationships with the best providers in the region. A key point to understanding how our network is growing is through our active Provider Nomination Process. Members, plan administrators and providers themselves can be nominated to become part of the CMN TM. This is the best way for us to contract with the providers that members want to use. We currently run at a success rate of over 95% on every nomination within 60 days. This ability to turn requests into reality is unique within the industry and one of the key success factors. A Worldwide Presence by Europ Assistance Over 600,000 physicians across 130 countries 10,000 acute care facilities Over 5,000 international facilities with cashless service 4 Global Corporate Solutions ITPA Medical Management Solutions

5 U.S. Cost Containment We are the industry leader and experts when it comes to U.S. Cost Containment. Our long history of bringing people to the U.S. to access healthcare has allowed us to build an unparalleled direct contract provider network with industry leading discounts. By combining our direct network, along with access to best-inclass HMO and PPO networks, refined cost-based negotiations, and other cost containment tools like Utilization Review and Medical Case Management, we have been able to significantly reduce our clients U.S. healthcare costs. Our capabilities and performance in the U.S. market include: Over $650 million worth of U.S. medical bills and over 475,000 claims processed every year Largest international U.S. Cost Containment company Highest net savings in the industry Contracts in all 50 states and Puerto Rico Best in class discounts with key Centers of Excellence Unparalleled direct contract provider network with industry leading discounts 5

6 Large Claim Review & Audit Unique to the market, our large claim review and audits result in a signed agreement with the billing provider, ensuring that the settlement is never disputed. 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. Our review and audit services include: Review of medical necessity Unbundling of charges Utilization review Anesthesia services review Supplies, materials and durable medical equipment (DME) review Determining the room & board reimbursement rate Comparison of charges against the hospital documentation Signed agreement with the billing provider, ensuring that the settlement is never disputed 6 Global Corporate Solutions ITPA Medical Management Solutions

7 24/7 Medical Case Management & Emergency Assistance We Know the Deal. Our highly trained and experienced medical management team works together to manage all aspects of a case: from initial contact to completion of medical treatment. Our goal is to provide empathetic patient advocacy, while effectively monitoring and managing our clients costs. We provide 24/7, 365-days-a-year access to: Dedicated multilingual case management and assistance teams 27 nurses and 5 physicians who provide medical management and oversight Support in accessing emergency, routine and planned tertiary care Pre-authorizations/pre-certifications Steerage of patients to cost effective providers while maximizing available benefits, coordination of admissions, monitoring of treatment, as well as constant patient support Coordination of air ambulance and commercial evacuation Assistance with direct billing with the provider should a member find themselves referred to a non-network provider Cashless billing coordination Bed find specialists Direct toll free numbers or assisted toll free numbers to allow members easy access to reach the assistance centre 24/7 Our goal is to provide empathetic patient advocacy, while effectively monitoring and managing our clients costs 7

8 Claims Management & Repricing Our medical claims experience covers all facets of the claims process and is backed by a system that allows for customized support and tracking of each client s specific processes and needs. Our detailed reporting and consultative analysis further enhances these partnerships. We work with our clients to create a specific claims management process that works for their needs. Our commitment to managing our clients claims includes the following services: EDI or customized file exchange Complete TPA outsourced solution Adjudication on our system or our clients system Robust client portal HOW WE IMPROVE SERVICE The following chart illustrates how our claims team has significantly improved the claims turnaround time for one of our clients after taking over the business from one of our competitors. CLAIMS TURN AROUND TIME - PERCENTAGE OF CLAIMS PAID WITHIN 5 DAYS Offering our clients added savings without sacrificing service to members 8 Global Corporate Solutions ITPA Medical Management Solutions

9 Online Web Portal Services We are committed to developing and providing access to web-based solutions that provide a higher level of service to our clients, along with their members and employees. In order to provide access to a broader array and wealth of on-demand information, reports, resources and tools, we provide each of our clients with access to a dedicated web-based portal. Our web-based portal is available in real time 24/7, 365-days-a-year and connects our clients, along with their members and employees to us through a fully secure web service. Realizing that each of our clients has their own unique needs, we are committed to working with our clients to customize the information available through their dedicated web portal based on the medical management solution and services we provide. Web-based solutions that provide a higher level of service 9

10 Reporting Capabilities & Statistics We understand the importance of keeping our clients informed and providing them with access to a robust suite of detailed reports that provide insight into key measures such as performance, customer service, claims, and program utilization by their members or employees. In order to meet the unique reporting needs of our clients, we offer a great deal of flexibility and customization based on the medical management solution and services we provide. We are committed to working with our clients to develop a customized reporting package that best meets their needs on a monthly, quarterly, annual and ad hoc basis. We also offer our clients the ability to access reports and information 24/7 via a designated web-based, real time Web Portal. Depending on the medical management solution and services provided, there is an array of Ready reports available to clients for quick summaries and certain snap shots of how their business is performing. We understand the importance of keeping our clients informed 10 Global Corporate Solutions ITPA Medical Management Solutions

11 About us A pioneer in assistance with more than 50 years experience behind it, Europ Assistance gives shape to its Care Services every day. Europ Assistance watches out for more than 300 million people around the world. More than 8,200 employees within 44 local companies are available 24/7 to respond to assistance requests from our clients. They are supported by a close-knit network of 425,000 partners to provide an instant answer adapted to each situation and to the client s need. The development of Care Services by the Europ Assistance Group - the union of health, innovation and proximity - embodies the meaning behind our business lines. This involves a strong sense of being there, acting effectively when needed for our customers in everyday life and exceptional circumstances alike. Europ Assistance - Global Corporate Solutions (GCS) is the division dedicated to International Corporations, Institutions and Global Organizations, Insurers and Health Carriers. GCS is able to provide worldwide Remote Medical & Security Services, Business Travel Risk Management and International TPA & Cost Containment Services. WHY GCS IS THE BEST SOLUTION FOR CLIENTS? Worldwide comprehensive Health Management Organization Truly global capabilities Transparency of process and pricing Cost containment driven and solutions oriented Client and patient centric WHY OUR CLIENTS ARE HAPPY TO WORK WITH GCS? Quality of service delivery Available and flexible Professional and accountable Responsive Activity monitored through KPIs and reports KEY FIGURES (2013) ORGANIZATION & RESOURCES 500 employees (8,200 within the Group) GROUP ASSETS 35 assistance centers in the Group 3 dedicated interconnected 24/7 Contact Centers (Washington, Paris, Singapore) 115 agents 1 central Network & Claims Center (Toronto) 10,000 acute care facilities 5,000 cashless access facilities MARKET 5,000 corporate accounts 425,000 providers OPERATIONAL CAPABILITIES 6,000 air ambulance hours 25,800 air tickets issued per year 1 intervention every 2 seconds 5M covered members 11

12 Contact details of your nearest GCS office EUROPE FRANCE PARIS (Headquarters) Tel GERMANY BERLIN Tel AFRICA SOUTH AFRICA JOHANNESBURG Tel ASIA PACIFIC SINGAPORE SINGAPORE Tel NORTH AMERICA CANADA TORONTO, ON Tel USA SUNRISE, FL Tel LATIN AMERICA, ANGOLA & MOZAMBIQUE PORTUGAL LISBON Tel SSL