The contractual relationship between the insurance company, the PMGs, and the primary care providers (the “Model”) is frequently established as to encourage a high quality in the services provided and a cost-effective use of resources. Their relationship varies considerably depending on the terms and conditions imposed by the Government (or any agency), the terms that they contractually agree to, the capabilities of each party, how much risk will be borne to each one, among others. This realm of possibilities makes technology fundamental. Having the tools that allow for the configuration of an infinite number of business rules, as well as the flexibility necessary to adapt to all possible scenarios that can result thereof, can make the difference between the success or failure of a Model.
The goal of R-Management is to aid the Providers, PMGs and Plans in successfully adapting to any Model. We do this, being involved from the beginning in the conceptualization of the Model; modeling different alternatives to make the best decision; assisting in establishing business rules; implementing the necessary software configurations for these settings; analyzing, segmenting, validating, reconciling, summarizing, and displaying the entire budget and claims information provided by the Plan; serving as an intermediary (for information purposes) between Providers, PMGs, and Plans among many other functions. This will cause to adequately adapt quickly and easily, and use resources efficiently.
R-Management consists of several health technology solutions composed by R-Provider, R-Members, R-Reports, R-Capitation, R-Secure Message, and R-Box.