Utilize our experience and technology – and gain the competitive edge to control the healthcare dollars in your local community.
Always seeking a better way, AmWINS Group Benefits has developed the Communitas Program to empower local healthcare providers and employer coalitions, who want to drive the management of the premium dollars within their own communities.
While large traditional managed care players are focused on selling greater provider discounts and using new lives to further reduce provider reimbursement, we assist local providers in understanding their own community’s employer needs, as well as the need for insular accountability to ensure the most efficient use of the system as a whole. Utilizing a multi-faceted outsourcing program and proprietary technology platform, Communitas offers a comprehensive suite of health plan administrative solutions to meet the needs of healthcare organizations. These include provider-sponsored health plans, insurance companies, HMOs, TPAs, networks and utilization management entities.
Community Issues:
• Fewer insurance carriers
• Increased leverage of carriers to further reduce provider reimbursement
• Little carrier competition
• No data sharing between carriers and providers
• Local providers not involved in delivery strategies to control costs
• Little or no accountability
• Carrier profitability leaves the community
Strategy:
• Capture and distribute comprehensive market data
• Competitively price proprietary provider network
• Cultivate local provider infrastructure
• Move related health plans to controlled network and TPA
• Transition additional self-funded lives to controlled products
• Expand products to include insured products
• Ensure accountability of care & finances
The Communitas Advantage:
• Unmatched service delivery
• Management experience
• Timely, meaningful data capture and reporting
• Integrated cost-containment services
• Negotiated third-party products (reduced costs)
• Proprietary technology for enhanced services
Services:
• Contract administration
• Benefit administration
• Referral/authorization management
• Claims adjudication
• Capitation administration
• Member services
• Network repricing