We provide service in different areas

We offer 24/7 assistance, patient guidance and medical care

Our health and safety services are specialized in five main areas, complementary to each other in order to achieve a complete and satisfactory user experience.

Customer Service

Personalized assistance and guidance

Customer support

The team of representatives provides guidance regarding the benefits your health plan offers. Total satisfaction is taken into consideration, channeling concerns, or complaints you may have, related to provider networks, medical equipment, and pre-authorizations, among other situations.

Pharmacy

Users of this service receive guidance about their benefits under their pharmacy coverage. Pharmacies have the support needed to receive the precise information required to process prescriptions and the protocol to send pre-authorizations, corroborate if a medication is excluded from the approved medications list and review the status of claims.

Outreach

Program designed to maximize reach and increase customer retention. It allows us to be proactive in evaluating trends. It uses multiple communication strategies such as text messaging, chatbot, text to speech, outbound dialing, voice broadcasting, emails and, if necessary, home visits.

Health Services

Wellness programs focused on a healthy lifestyle

Diabetes Prevention

Program of the Center for Disease Control and Prevention (CDC) that aims to reduce the risk of developing type 2 diabetes, a condition that has remained in recent years as the third leading cause of death in Puerto Rico. We currently hold CDC Preliminary Recognition as a Diabetes Prevention Program.

Smoking cessation

Program created to help people quit smoking. Designed to influence groups of smokers at the employer and community level, it uses a behavior and habit management approaches to cessation or decrease of tobacco use and reduction of exposure to secondhand smoke.

In control

Weight management program where medical nutritional therapy is offered to people identified as overweight or obese and who have additional health risk factors such as diabetes and hypertension, among other conditions.

Risk profile assessment

This assessment program includes questions that seek to identify health practices, habits, barriers, and trends, collecting information from the person's past and current situations. Based on the responses the program assists you in categorizing the individual's health risk levels. It has the capacity to identify social determinants within each population.

Prenatal

Program created to help remove barriers, raise awareness of existing conditions, nutrition guidance, breastfeeding, and care plans for conditions that may impact the outcome of pregnancy. It is complementary to obstetric care and promotes a healthy pregnancy.

Wellness Program

It includes sections and workshops of physical activity, orientation services and assistance for the development of environmental initiatives and implementation of programs according to the needs of the client, among which are: Prenatal, Smoking Cessation, In Healthy Body and In Control.

Clinical Management

Medical care in various disciplines

Planning services

Coordination and management of hospital discharges (Discharge Planning) and transportation coordination

TeleHealth

TeleHealth programs in its different modalities: nursing guidance line- Triage MD, virtual consultations- e-Health with multiple professionals and Telemedicine teams (stations, cameras and other peripherals).

Condition handling

Implementation of services: health navigators- Care 360®, e-Health with professionals from different specialties, home monitoring and telephone coaching.

Pharmacy Services

Audit, guidance and medication management programs

PharmaMedik

Retrospective audit program where a cross-relationship is made between the purchase of a prescription through the pharmacy coverage and its diagnostic codes billed to the medical plan, which allows analyses for fraud and abuse, optimization of the pharmacy benefit and evaluation of clinical measures.

Adherence

Program in which the patient's behavior is oriented and directed, encouraging the increase of their abilities to correctly handle their treatment, as indicated by their physician, changing their lifestyle in favor of compliance with therapeutic instructions, thus avoiding health relapses.

MTMP

The Medication Therapy Management Program (MTMP) is designed to improve medication use, reduce the risk of adverse events, and improve medication adherence.

Emergency Management

24/7 assistance in social, personal and health emergencies

Social problems

Assistance service in emergencies of a social nature. Our specialized staff manages the situation following protocols, in coordination with the appropriate assistance entity, to respond to situations of domestic violence, family preservation and support, protection of minors, help to the elderly, and assistance for adults with disabilities.

Health Alerts

Health emergency response, guidance, and management service. TeleMedik's clinical staff services the user virtually, following up until resolution of the situation. In case of extreme conditions, we refer and coordinate assistance with 9-1-1. This service can be complemented with the biomonitoring program, through the use of peripheral devices to measure health indicators such as heart rate, blood pressure, diabetes control, etc.

Assistance remote management

Emergency assistance service backed by software for sending and receiving SOS alerts with remote management. Allows direct connection with the user through a mobile device with access to vital information for rapid assistance; personal and health data of the user, location of the emergency, real-time monitoring, audio recording and live video, among others. This service can be used for personal emergencies and/or as a complement to emergency services derived from social problems and health alerts. It provides the user with the opportunity to connect with their caregiver.

Our services integrate

Omnichannel technology

Request a proposal or more information

We advise you with a plan adapted to the needs of your business