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Our Services

MediMerge Health believes that new thinking is required to bring about radical change - stabilizing self-funded employers' risk and reducing their plan cost without shifting the burden to employees. The MediMerge model combines Identification of at-risk individuals, Intervention through proactive risk prevention and health advocacy programs, and an emphasis on Evidence Based Integrative Medicine Protocols. The model drives improvements in the aggregate member population's health and, in turn, drives reductions in total medical claims and stabilizes risk.

MediMerge offers significant benefits to our target markets:

We improve baseline data for plan sponsors and improve risk selection for reinsurers through analysis of claims data to create an Integrative Risk Profile, detailing disease and treatment categories likely to respond to a MediMerge Integrative Medicine initiative.

We improve health outcomes, reduce medical claims, and limit risk, through early identification of at-risk members, rapid intervention by a MediMerge Certified Health Advocate, treatment modification through proprietary, evidence-based Integrative Medicine Guideways, expert oversight through Integrated Concurrent Peer Review, and active promotion of e-health tools to engage healthy members and keep them in the wellness zone.

We improve claim control through early identification and reporting of developing problem areas, at both the group and individual level, through superior data capture and mining, and through the close integration of claims administration, Health Advocate, and peer review.

We improve the annual renewal process for Plan Sponsors, TPA's, and reinsurers through detailed reporting based on a proprietary database model that provides peer-reviewed evidence-based outcomes and analysis of developing trends.

We offer plan sponsors, TPA's and reinsurers turnkey access to Integrative Medicine, improving employee and client retention, at low risk.

Assembled into a seamlessly integrated package, MediMerge offers the following services:

For Self-Insured Organizations:

  • Health Advocacy Program
  • Claims Administration
    • COBRA / HIPPA
    • On-Line Eligibility Maintenance
    • Member Services
    • Online Claim Information Reporting
  • Utilization management Program
    • pre-certification
    • pre-authorization
    • large case management
    • referral care management
    • transplant care management
  • Integrated Wellness Plans
  • Nationally & Regional Provider Networks
  • Prescription Network and Mail Order
  • Dental & Vision
  • Stop loss insurance for self-insured companies

Direct to Consumer Services

Through our personalized wellness and health benefit programs, MediMerge provides health and wellness products and services:

  • Patient Health Care Advocate
  • Health Assessment and Monitoring Tool
  • Individual wellness and preventive maintenance plans that encourage individuals to proactively participate in their health and wellness management
  • Benefit plan selection
  • Complete e-commerce and fulfillment services for both providers and consumers

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The integration of MediMerge services through Web-based technology enables MediMerge to deliver its Integrated Healthcare model in the most efficient and effective manner to the customers we serve. The benefits and expected outcomes of our integrated package include:

  • Lower risk for self-insured plan sponsors
  • Improved health care outcomes
  • Improved wellness & productivity of plan member

MediMerge's Integrated model provides a solution to the
VICIOUS CIRCLE OF RISING COSTS AND CARE LIMITATION THAT THREATENS THE VIABILITY OF THE CURRENT HEALTH INSURANCE INDUSTRY

     


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