Mentor Health Assurance: Preventive Care Beyond Financial Coverage

Mentor Health Assurance - Click here to Watch the Video

If you are a decision-maker in your organization and any of the following questions resonate with you, then this article is for you!

1. Are your health expenditures or insurance premiums increasing every year?
2. Does your employee health benefit structure cover employee well-being?
3. Approximately 12% of your employees end up using all your health expenditure. What are the other 88% receiving, aside from a useless card in their pocket?
4. What if we commit to increasing your employee well-being by 10% and reducing your health expenditure by up to 20%, or covering the cost if we don't?

Witnessing a broken healthcare system – reactive care failing to effectively address employee needs – we at Mentor Health knew there had to be a better way. So, we built a proactive revolution. "Mentor Health Assurance" offers a comprehensive solution, bridging the gap between financial coverage and preventive care. We prioritize prevention, empower employees, and ensure financial coverage, fostering a healthier, more productive workforce. It's a win-win for a healthier workforce and a stronger bottom line.

The Changing Landscape of Corporate Healthcare in Pakistan: A Call for Proactive Solutions

Is Your Investment in Employee Health Delivering Measurable Results?

Billions are poured into traditional health insurance plans and employer-funded healthcare reimbursements in Pakistan, yet a concerning reality persists: chronic diseases are on the rise. Statistics paint a grim picture – 1 in 5 adults battles diabetes, hypertension affects nearly a quarter of the population, and mental health disorders cast a shadow over 19% of Pakistanis.

These figures highlight a critical flaw – a healthcare system focused on reacting to illness, rather than preventing it. The consequence? Rising healthcare costs, an unhealthy workforce, and a missed opportunity to invest in employee well-being.

Why Traditional Health Insurance and Employer-Funded Reimbursements Isn't Enough

While traditional health insurance and employer-funded healthcare reimbursements have become commonplace in Pakistan's corporate landscape, offering a sense of security, they often fall short of addressing the evolving needs of employee health. Here's why these traditional approaches have limitations:

1. Reimbursement-Focused Model: Both traditional health insurance and self-funded plans with employer reimbursements primarily focus on reacting to illness by reimbursing medical expenses after they occur. This reactive approach fails to prevent health issues from arising in the first place. Companies remain vulnerable to unexpected healthcare costs and potential employee absenteeism due to illness.

2. Limited Emphasis on Preventive Care: Traditional plans and even some self-funded models often lack a strong focus on preventive care. Regular checkups, screenings, and healthy lifestyle programs are often limited or not emphasized, leading to missed opportunities for early intervention and disease management. This can translate to higher healthcare costs down the line for both companies and employees.

3. Doesn't Address Chronic Disease Burden: As chronic diseases like diabetes and hypertension become more prevalent, traditional health insurance/re-imbursement models struggle to keep pace. They may not provide the necessary support for proactive management of these conditions, potentially leading to increased healthcare needs and higher costs in the long run.

4. Focus Health Equality, not Health Equity: One Plan Doesn't Fit All

A traditional health plan might treat everyone the same, but that doesn't mean it addresses everyone's needs.

A 50-year-old employee with a pre-existing heart condition might need inpatient hospitalization (IPD) coverage. While a 22-year-old Gen Z employee might need accidental coverage, they would likely benefit more from mental health consultation or stress management sessions than a generic coverage card.

Similarly, a 35-year-old female who is a mother of three might not need IPD coverage as much as frequent outpatient department (OPD) coverage for her children.

Likewise, a 25-year-old employee with an elderly father might require home care and facilitation services or phone-based patient counseling along with IPD coverage

4. Limited Cost Management Strategies: Traditional plans and self-funded models often lack robust strategies for cost management. This can leave companies with limited control over rising healthcare expenditures.

This reactive approach simply isn't sustainable. There has to be a better way. The current landscape demands a proactive approach to corporate healthcare, one that prioritizes prevention, empowers employees to take charge of their health, and ultimately fosters a healthier and more productive workforce.

The Need for Mentor Health Assurance: A Proactive, AI-Powered Approach to Employee Well-being

Mentor Health Assurance (Preventive care beyond Financial Coverage) offers a revolutionary approach to corporate healthcare in Pakistan. It represents a significant shift towards proactive healthcare management, leveraging technology and artificial intelligence (AI) to prioritize prevention, early intervention, and empower employees to take charge of their health.

Empowering Employee Well-being Through Financial Security and Preventive Care

Mentor Health Assurance goes beyond traditional healthcare models, offering a comprehensive solution that addresses both financial security and proactive health management for your employees. With our flexible plans, you can customize a program that aligns perfectly with your company's needs and budget.

1. Financial Coverage (IPD + OPD) Tailored to Your Needs:

• Health Insurance Partnerships: We partner with a network of reputable insurance providers to co-create customized health insurance plans at competitive rates, covering both IPD and OPD.
• Self-Funded Health Administration: For companies that self-fund employee reimbursements, we offer a streamlined tech solution in collaboration with our sister concern, Mentor TPA (a licensed Third-Party Administrator from SECP). This solution connects you with a vast network of over 300 hospitals, 15,000 doctors, hundreds of pharmacies, and laboratories. We facilitate cashless transactions, negotiate rates, and manage the entire employee hospitalization journey, from appointments to bill payment a. Group Pool Option: Establish a collective pool for employee healthcare spending, ideal for companies with predictable health costs. b. Individual Pool Management: Manage personalized spending limits assigned by your organization for greater cost control.
• Health Facilitation Service: Provide access to discounted medical care for employees who don't have medical allowances. We leverage our provider network to negotiate significant savings on medical bills.

2. Proactive Health Management:

Mentor Health Assurance goes beyond simply covering medical expenses. We focus on preventing health issues and promoting long-term well-being through a suite of innovative programs:

• Telemedicine and Virtual Triage as Gateway Services: Offer employees convenient access to doctors for consultations and preliminary assessments through secure online platforms. This streamlined approach saves time and money while ensuring they receive appropriate care
• Personalized Health Risk Assessments: Identify potential health issues early on, allowing for preventive action and improved health outcomes.
• Engaging Wellness Programs: Motivate employees to adopt healthy lifestyles through interactive programs and valuable resources.
• Easy Access to Screenings and Checkups: Make preventive care a priority with readily available screenings and regular checkups.
• Vaccinations Readily Available: Maintain employee health with a comprehensive vaccination program.
• Customized Care Plans: Develop personalized plans for individual employees, addressing their unique needs and recommending lifestyle modifications or medications.
• Empowering Awareness Programs: Educate your workforce on important health topics, equipping them to make informed choices about their well-being.

What sets Mentor Health Assurance apart?

1. A Comprehensive Spectrum of AI-Driven Healthcare Services:

Unlike traditional plans, Health Assurance goes beyond financial coverage. It offers a comprehensive range of services, seamlessly delivered through a user-friendly tech platform that utilizes AI-powered data analysis:

• Promotive: Empowering employees with the tools and knowledge they need to make healthy choices. Health Assurance goes beyond basic resources. The AI analyzes user data to deliver personalized wellness programs, coaching tips, and educational content that address individual needs.
• Preventive: Prioritizing preventive care by doing Health Risk Assessement surveys, making regular checkups, screenings, and vaccinations readily available (potentially covered within the plan). Health Assurance utilizes appointment scheduling tools and reminders, but goes further by leveraging AI to analyze health data and recommend preventive measures based on individual risk factors.
• Curative: Providing coverage for treatment (similar to traditional health insurance) with facilitation services. The tech platform can help employees locate in-network providers, manage appointments, pre-authorizations, claim submission and potentially access discounts on medical bills. AI can further assist by analyzing treatment options and potential outcomes.
• Rehabilitative: Offering support services like physical or occupational therapy after illness or injury. Health Assurance may utilize telehealth consultations or mobile apps to deliver these services conveniently. AI can personalize rehabilitation plans based on individual progress and recovery data.
• Palliative: Recognizing the need for comfort care in some cases, Health Assurance may offer resources or guidance for palliative care.

2. Data-Driven Insights and Personalized Health Guidance:

Health Assurance leverages a powerful combination of user data and AI analysis to provide highly personalized recommendations for individual employees. This targeted approach empowers them to take proactive steps towards better health, potentially lowering their risk of developing chronic diseases and fostering a culture of well-being within the organization.

3. Potential to Reduce Healthcare Costs and Improve Employee Health Outcomes:

By prioritizing prevention and early intervention through a tech-enabled approach with AI-powered data analysis, Mentor Health Assurance has the potential to reduce healthcare costs for companies in the long run. This translates into a healthier and more productive workforce for your organization.

Benefits of Mentor Health Assurance - How Mentor Health Assurance Harmonizes Well-being and ROI

Mentor Health Assurance offers a comprehensive solution that benefits employers, employees, and HR professionals alike. Here's a breakdown of the advantages for each group:

Employee Benefits:

• Holistic Healthcare Coverage: Mentor Health Assurance provides comprehensive coverage, encompassing both Inpatient Department (IPD) and Outpatient Department (OPD) expenses: preventive care like health risk assessment surveys, wellness programs, telemedicine, regular checkups, screenings, and discounts on pharmacy, labs, and homecare This ensures you have access to the care you need, from preventive checkups and consultations to hospitalization and specialized treatments.
• Enhanced Well-being: Convenient access to healthcare through telemedicine, virtual triage, and secure gateway services empowers you to manage your health proactively. Preventive care, personalized plans based on data-driven insights, and expert guidance promote long-term health and address potential concerns before they escalate.
• Reduced Financial Stress: Flexible options like traditional health insurance, health administration services, and facilitation services provide financial security. Streamlined claim processing and utilization management ensure funds are used efficiently.
• Mental Health Support: Recognizing the importance of mental well-being, Mentor Health Assurance offers mental health coverage plans tailored to your needs. This ensures you have access to qualified mental health professionals and resources to address any concerns and maintain emotional well-being.

Employer Benefits:

Reduced Costs Through Preventive Care:

• Mentor Health Assurance prioritizes preventive care with regular checkups, screenings, and vaccinations (potentially covered within the plan). Early detection and intervention can prevent costly complications down the line, leading to significant healthcare cost savings in the long run.
• Reduced absenteeism due to a healthier workforce translates to a more productive and efficient team.

Reduced Costs Through Smart Management:

• Reduced Premium Costs: We partner with a network of reputable insurance providers to co-create customized health insurance plans at competitive rates.
• For companies that self-fund employee reimbursements: We offer a streamlined tech solution in collaboration with our sister concern, Mentor TPA (a licensed Third-Party Administrator from SECP). This solution connects you with a vast network of over 300 hospitals, 15,000 doctors, hundreds of pharmacies, and laboratories. We facilitate cashless transactions, negotiate rates with these providers, and manage the entire employee hospitalization journey, from appointments to bill payment. This comprehensive approach helps negotiate better rates on medical bills, potentially leading to significant cost savings.
• Medical Audit Prevents Overbilling: We implement robust medical audit procedures to ensure proper utilization of healthcare funds within your plan. This helps identify and prevent potential overbilling from hospitals and other healthcare providers.

HR Benefits:

• Simplified Benefits Management: Mentor Health Assurance offers a comprehensive solution, reducing the complexity of managing various health benefit programs. This frees up HR professionals' time to focus on strategic initiatives.
• Employee Satisfaction: A happy and healthy workforce leads to higher employee satisfaction and retention, reducing HR burdens associated with recruitment and turnover.
• Demonstration of Employer Value: HR can showcase the company's commitment to employee well-being through Mentor Health Assurance, attracting top talent and fostering a positive employer brand.
• Reduced Absenteeism: By managing health proactively, Mentor Health Assurance potentially reduces employee absenteeism, simplifying HR workload

Medical Billing Transparency: How Mentor Health Reduces Your Healthcare Costs

Mentor Health helps you reduce healthcare costs through following methods:

1. Preventive Care:

We conduct health risk assessments to identify high-risk patients and those with chronic diseases.

We then work with these individuals on preventive measures, promoting awareness and lifestyle modifications through screenings and early medical checkups. This helps prevent them from requiring expensive inpatient hospitalization (IPD), saving significant costs.

2. Health Insurance/Expenditure Management:

a. For those with health insurance: We leverage our comprehensive health data to negotiate with insurance providers, ensuring you receive fair premiums based on your actual needs.

b. For self-funded plans: There are no upfront charges for our services.

3. Hospital Admission Management:

a. Medical Audits: When your employees require hospitalization, our doctors collaborate with the attending physicians to conduct a thorough medical audit. This audit identifies unnecessary treatments, medications, or lab tests. Additionally, we can identify potential cases of overstaying or overcharging.

b. Negotiation: We then negotiate the pricing of each service utilized, including medicines, room charges, surgery fees, nursing care, and lab tests.

4. Fraud Prevention and Resource Optimization:

a. Virtual Triage: We act as a virtual triage system, analyzing cases to determine if they can be handled through telemedicine. This avoids unnecessary visits to specialists, saving time, effort, and money.

b. Efficient Care: We guide patients to the right specialists when needed, ensuring an efficient path to diagnosis.

c. Discounts: We negotiate discounts with pharmacies and labs and review prescriptions for unnecessary medications, potentially influenced by pharmaceutical companies.

d. Cashless Service: Our cashless service prevents fraudulent billing and misuse of benefits. We can identify discrepancies, such as diabetic medications prescribed to someone without a history of diabetes.

5. HR Efficiency:

Reduced Workload: By handling claim management and other healthcare-related tasks, Mentor Health frees up your HR team's time.

This allows them to focus on core HR functions, reducing administrative burdens and costs.

Case Example:

Imagine a patient facing a medical bill of PKR 300,000 for hospitalization. With Mentor Health's intervention, we can potentially achieve the following:

a. Medical Audit and Overcharge Protection: Our medical audit can identify unnecessary charges, (extra stay for a day or two, unnecessary lab & diagnosis, using extra medication) potentially saving 15-20% (PKR 45,000 - PKR 60,000) on the initial bill, bringing it down to PKR 240,000. (300,000 - 60,000)

b. Additional Mentor Discounts: Depending on your plan, you might be eligible for further reductions through corporate discounts offered by Mentor Health. For example, a 20% discount on the audited amount (PKR 240,000) could bring the cost down to PKR 192,000. (240,000 - 48,000(20%)=192,000)

c. Mentor Health Fee: Our service fee is typically a percentage of the final discounted bill. Let's assume a 10% fee on PKR 192,000, which would be PKR 19,200. Customer Final bill would be 211,200 (192,000+19,200)

Total Savings:

By combining medical audit savings, potential corporate discounts, and considering the Mentor Health fee, the overall savings in this scenario would be:

a. Apparent Saving from Medical Audit: PKR 45,000 - PKR 60,000

b. Total Saving Compared to Retail Bill: PKR 88,800 - 30% Saving

(PKR 300,000 initial bill - PKR 211,200 ---- final bill with Mentor Health fee)

Key Takeaway:

While Mentor Health charges a fee for its services, the potential cost savings from medical audit, negotiation, and access to discounted rates can significantly outweigh those fees. Mentor Health prioritizes transparency throughout the process. We ensure you're fully informed of potential savings, our service fee structure, and the final bill breakdown. Additionally, all details are available digitally on your secure corporate portal for your easy access and analysis

Ready to Take Control of Your Healthcare Costs: Improve Employee Wellbeing with Mentor Health

Contact Mentor Health today for a free consultation. Our team will discuss your specific needs and goals, and show you how Mentor Health can help you achieve significant cost savings while prioritizing employee well-being

Mentor Health Assurance - Click here to Watch the Video