Medical Management Advisory Program

In 1984, some medical reinsurers began providing advisory programs to their clients—partnering with them in the management of chronic and catastrophic medical claims. These programs assure clients that they are receiving quality care at the best possible cost, and they’ve saved clients like you hundreds of millions of dollars.

It’s a nice service to have, but it can tie you to the providing reinsurer. Now consider the fact that Re-Solutions has on staff individuals who pioneered the first such program, and can bring this advantage to you independently. Now you can negotiate renewal of your reinsurance program without the worry of losing the additional services that are valuable to you.

The services provided as part of our normal intermediary compensation include:

Consultative review of a client’s internal medical management program and assistance in developing such programs.
Assistance in reviewing chronic and catastrophic cases for appropriateness of case management.
Assistance in identifying expert external specialty case managers and/or physicians who help clients manage or obtain clinical consults in difficult cases.
Access to Transplant Centers of Excellence Networks.
Assistance in researching the use of internal/external disease, event or population management programs.
Specific topic onsite educational training relating to medical case management.
Access to research on current best practice trends for rare disorders, diseases and clinical trials.
Periodic and timely updates on new healthcare management trends relating to chronic and catastrophic medical cases.
Access to independent price and contract negotiators, subrogation services and re-pricing networks.
Assistance in projecting total claims costs, as well as analysis of the cost benefit of managing specific medical cases.

Impact of Catastrophic Events

From Hurricane Katrina, to the Asian Tsunami to the events of September 11th, we have our finger on the pulse of catastrophe management and know what the impact of such losses will be on the reinsurance market, and on you, our client. You might not suffer a direct loss as a result of any of these types of event, but the world is now a small place and the reinsurance market is a global one. Have you thought about the impact on you of a bird flu pandemic, or a chemical or biological terrorist attack? We have, and we can help you identify a strategy to prepare for the unexpected, the unthinkable and the unknowable.

Assistance in Claims Submissions to Expedite Reinsurance Recoveries

Identifying critical documentation and presenting it to the reinsurer in the most effective and acceptable manner can be time-consuming and difficult. But that’s where we come in. To expedite the fastest possible recovery of reinsurance claims dollars, we’ll work with your claims and financial departments to make sure the process flows quickly and smoothly.

PBM Analysis

Prescription drug charges represent the fastest growing cost for health insurers, and finding your way through all of the various vendors and management tools can be like navigating a minefield. The right program can provide your clients with the best possible coverage and can save you significant dollars, which can drop to your bottom line. We are constantly looking at what is out there and who is on the leading edge, and we bring you the tools to make informed decisions.