1. Network adequacy
To provide members with care, either in the US or internationally, travel insurers must verify that a cost containment partner’s network will give members access to vetted providers throughout the contracted territory. That network should include providers both within and outside of capital cities and large metropolitan areas, and specifically in regions where the insurer’s membership lives or travels. Network adequacy is a key element of fulfilling benefits under the terms of your insurance contract, and giving members reasonable and quality access to a sufficient number of affordable suppliers is essential.
2. Medical bill reviews
At GMMI, we believe that a medical bill review goes beyond applying network discounts. A cost containment partner’s due diligence is to verify the accuracy of the bill in its entirety. The thorough review of diagnostic codes and medical bill charges, and comparing those codes and charges against medical records and applicable protocols in the region where care was delivered, is what powers and drives a strategic and proactive approach to cost containment.
How an insurer receives and views information from a cost containment partner is essential and understanding this makes transparency one of our core values. We provide our insurance clients with real-time, easy-to-access and easy-to-read patient medical notes, bills, bill audit records, accident reports and other relevant information needed to review and pay claims. To further fulfill obligations to provide insurers with access to available data and maintain a level of clarity, cost containers must ensure delivery of data transparency via a secure online portal.
4. Medically centered cost containment
A strategic approach to cost containment, with a driving focus on medical case management, is essential. Medical case management means having experienced, licensed nurse case managers who coordinate and manage the medical care received by members. Our in-house medical case management team is made up of 24 nurses and three US certified doctors. Working with a medical case management team means that utilisation review services are available to both members and the insurer, such as pre-certification reviews before the medical care is provided, concurrent reviews while the insured is in the hospital or during ongoing medical care, and retrospective reviews to verify the need for the medical services provided. More importantly, a medical case management team provides the insurer and its members with access to caring, professional, in-house team members who are ready to assist and provide support in times of distress.
5. Around the clock access
Getting sick or needing medical care while away from home is difficult enough. Having a cost containment partner poised with a robust assistance center available to service members when they need it, wherever they need it, is yet another key element of an insurer/cost containment company partnership. To deliver the most personalised and attentive service to our members, we have invested in building a diverse, culturally sensitive assistance team that is available around the clock. This team connects with each member that we assist as an individual. Speaking with members in their native language, our assistance staff possess the language skills and cultural awareness to approach every interaction with empathy and understanding.
6. A data-driven strategy
Data is a driver of decisionmaking and a cost containment partner should be prepared to identify high-cost medical providers while leveraging information impacting claims costs and payments. We use data to benchmark bill audits, bill negotiations and contractual pricing, and we share this knowledge and the resulting efficiencies and economic benefits with our insurance partners.
7. Customer-centric products and services
As customers become more involved in choosing and paying for their healthcare products and services, having a synergistic relationship with a cost containment partner can help deliver a better customer experience, improve satisfaction and build loyalty. Providing easy, timely patient reimbursement processes is a simple example of the various ways a customer-centric cost containment partner can improve the member experience. It’s important that you understand the end-to-end patient journey and the way it reflects on both brands. A cost containment partner that prioritises positive interactions with members and insurers, providing both with the right tools, resources and services, can have a significant impact on the insurer’s ability to achieve the shared goal of delivering clear, reliable and affordable care.
8. Security and redundancy
Data protection and privacy is a fundamental element of the travel and health insurance industries. A cost containment partner should utilise a secure framework that protects insurer and member data through certifications such as GMMI’s ISO 27001:2013 certification and other information security standards. To support data protection and overall security efforts, a cost containment partner must also be able to sustain and provide assistance 24 hours a day, 365 days a year. As a result, complete system and infrastructure redundancy is another important component of the insurer and cost-containment provider partnership.
9. A people-first approach
We operate a ‘we care’ company philosophy and culture at GMMI. The CARE acronym stands for Caring, Available, Reliable and Easy to work with, and these principles shape who we are and guide every interaction that we have with clients, members and partners. Whether we are communicating via phone, email, chat or virtual meetings, CARE culture means enhancing and protecting people’s lives. We accomplish this goal by understanding the intricacies of urgent and complex medical situations with not only industry expertise, but also with compassion and a human touch.
10. A true partner
Probably the most apparent, yet the most important characteristic of a successful cost containment provider encompasses all of the above qualities. A true partnership means fostering genuine understanding between the insurer and cost containment provider, working towards the same goal, improving and innovating together and proving that trust, empathy and integrity are vital to any business relationship, but especially when attending to the physical health and financial wellbeing of your members and employees