The recent SIIA Forum addressed many of the value-added benefits of the TPA. The role of the TPA is in essence, can be a solution to lower costs and improve the health status of its members. A better understanding of wellness programs, better stop-loss rates, more creative options for plan design to name a few are additional benefits.
The role of the TPA in supporting their clients can to be choosing providers, networks and can act in a fiduciary responsibility. There are caveats-in many instances the employer do not want control but want the ASO to make all decisions. This can create an environment with too much authority delegated. Other deficits of ASO’s are minimal reports such as analysis of employer data.
New opportunities for the TPA to be pro-active are analyzing data and applying predictive modeling applications. Wellness strategies are key to the employer for keeping rates down and to maintain key employee relationships. Older work forces, bigger employees (read BMI), smokers, and co-morbidities need to be managed through multiple strategies. But the employee and their family need to be engaged. Incentives-financial as well as accessibility to health clubs and other interventions are recommended.
When selecting a TPA these may be some good starting points in a due diligence process.
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