PMCare

OUTSOURCING THE MANAGEMENT AND ADMINISTRATION OF HEALTHCARE PROGRAMME

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rivatisation has been actively pursued by the Malaysian government since the 1980’s where a number of the government bodies or agencies were transferred to the private sectors to be managed and administered by them as profit centres instead of cost centres.

The idea of privatisation or outsourcing is not something new, especially to the developed nations. The practice of outsourcing is common amongst the private sectors and this enabled them to focus on their core business, which will generate income for the organisation.

 

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anagement and administration of various healthcare programmes are PMCare’s forte. The services that PMCare have established stem around the basic idea of the need to outsource the management and administration of the delivery of medical benefit programme extended to the employees by their employers. On the same note, insurance companies would also benefit by outsourcing the management and administration of the medical policies that they have issued in favour of their policyholders, be it individual policyholders or corporate policyholders.

 

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    entral management tracking system is essential to PMCare’s efficient data management. Our Medicare Integrated Information Exchange or MiX is the backbone to PMCare’s operations. The MiX is now in the 10th generation since we first designed and developed it in 1996.

The healthcare programmes managed and administered by PMCare are no longer fragmented but instead integrated from the primary care right through to tertiary care.

 
 

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s the same medical providers who are providing medical services are engaged by PMCare, quality of healthcare would not be affected and should be of the same quality, if not better.

 

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esearch and analysis are also carried out by PMCare’s Utilisation Review Committee with the objective of advising our corporate clients and the insurers of their healthcare programmes as compared to the market practice.

 

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volution is something that none of us can avoid from. Healthcare delivery, which used to be fragmented, has now evolved into an integrated delivery system which is efficiently managed and administered by PMCare through MiX.

 

Profile of PMCare

 

PMCare Sdn Bhd (“PMCare”) is a BPO provider specialising in management and administration of the corporate clients’ medical benefits extended to their employees and eligible dependents. PMCare was incorporated on 28 February 1998 under the original name of HMO Pacific (1998) Sdn Bhd as a private limited company under the Companies Act, 1965 to take over the business of HMO Pacific Sdn Bhd (“HMOP”). HMOP was the pioneer to bring the concept of managed care into Malaysia in 1995. Pursuant to a corporate restructuring exercise, we changed our name to Pantai Medicare Sdn Bhd which was subsequently renamed as PMCare on 16 January 2004. The Company’s authorized and paid-up share capital as at today stands at RM5.0 million and RM1.0 million respectively.

In 1996, we designed and developed our own application software based on our own specifications. It took us about one and half years to write and test the software application. Between July 1997 and January 2003, several upgrades and improvements were done and the system, previously called Central Management System was subsequently renamed as “MiX” in short for Medicare Integrated Information Exchange.

Because of the flexibility and robustness of our MiX, we are able to manage and administer various combinations and permutations of benefit entitlements or healthcare programmes. The healthcare programmes can either be self-insured, where the actual medical expenses are being borne by the clients themselves or on the other hand, if the clients wish, can be fully insured by appointed licensed insurer. Alternatively, the insurers themselves can appoint us as their Third Party Claims Administrator to manage and administer their medical policies portfolio.

In order for us to process the medical claims from the medical providers, we need to capture the data. Capturing of data can be done in two ways such as manual data entry and on-line through the Internet. Mediline™ is a web based application system to facilitate or assist the panel medical providers to verify and validate members, on-line claims submission and generate claims summary report which can be used as a statement of accounts.

Medifile™ is a business intelligence system that collates and manages information given to the company, and produces reports for analysis by the relevant member organization. Its web-based feature allows it to be accessed from anywhere in the world, 24 hours a day. The reports are confined to the data of therespective corporate clients only and are provided for now into 2 tiers:-

Tier 1 is the KPI type of reports which are useful to the heads of organization with colour coded to signify the status of the data. For example, green is for normal, yellow is for alert, and red is for urgent actions need to be taken.

Tier 2 is the detailed reports which are useful to the middle management. These reports can be further drilled down to the smallest denominator which is the employee such as amount incurred, number of visits, name of medical providers visited, etc.

It serves like a personal ledger of the member. Other reports can also be generated such as on the medical utilisation by months, the trend of diseases, total amount of treatment costs, average cost per treatment, type of medication used and average cost for medication, etc.

PMCare's strength is in our personnel and our efficient systems namely MiX, Mediline™ and Medifile™ which provide the Company with the right tool for collating data, managing information and producing report in order to make informed decision. About 80% of our staff are in the Medical Department, Claims Department and Operations Department, which we believe are the most important divisions of any managed care organizations (“MCO”).

We are confident that with our proven track record and experience, and being the first and only MCO in Malaysia to be certified ISO 9001:2000 by Certification International (UK) Ltd, United Kingdom,  we can position ourselves to be the leader in the management and administration of the delivery of healthcare in Malaysia.