Prashant Jhaveri, Head, Products, and Strategy, Medi Assist Healthcare Services recently wrote an article for the Business World magazine in which he discussed how TPAs are transforming from being just organizations that process claims, into partners who help organizations solve for all realms of healthcare. He also discussed how organizations can choose a TPA partner who delivers on all fronts of healthcare– cost, excellence, insights and customer experience.
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"In many ways, Third Party Administrators (TPAs) are slowly stepping out from the shadows into a healthcare industry that is at the cusp of transformation.
Responsible for processing claims of the insured on behalf of the insurer, TPAs have for long ensured that stakeholders in the healthcare industry concentrate on their core competencies – insurers on underwriting risks and product innovation; medical care providers on enabling high-quality of care; and corporate HR on elevating employee experience.
In recent years, TPAs have transformed into being much more than just an organization that manages claims; they are increasingly donning the role of a partner who helps organizations solve for all realms of healthcare and also makes health benefits actionable to their largely young and tech-savvy employee base.
If you are a corporate decision maker, choosing the right TPA can significantly impact the bouquet of services you offer to your people, the cost at which you make these available to them, and also the employee experience you enable for them.
While cost has traditionally been the most important parameter applied to evaluate a TPA, in today's day and age, your choice must be driven by many other aspects. Here is a contemporary guide to choosing a TPA partner who can help you deliver on all fronts – cost, excellence, customer experience, and insights.
Choose a TPA who understands and leverages the power of technology. Adopting a technology-first approach to claims management can go a long way in maximizing productivity and minimizing inefficiencies. Your TPA should be capable of empowering your employees with self-help tools to independently access their e-cards and policy details, raise and track claims online, and access benefits on-the-go using their mobile phones.
Technology-oriented innovations like eCashlessTM can today give employees the ability to "book" a cashless hospitalization using a mobile app and reduce wait time at the hospital during admission by as much as 95 per cent.
The customer experience enabled during cashless hospitalization is a true litmus test for a TPA. TPAs who are able to leverage technology to simplify the process of choosing an ideal network hospital and also systematically reduce the time taken to process a preauthorization request would pass the litmus test with flying colours.
Choose a TPA who appreciates the fact that the magic of the human connect is irreplaceable. From enabling access to predictable customer support and governance structure, to constantly engaging with your employees at various junctures of their healthcare lifecycle, TPAs must have the ability to truly touch every life they service.
At Medi Assist, we leverage two innovative consumer touch points at two opposite ends of the spectrum. With our CareRangers program, we check on the well-being of our members by their bedside at the hospital when the family in the throes of a medical emergency. On the other end of the spectrum is ChampCamp, our high-energy onsite event that has helped us create awareness about health benefits among more than 50,000 Gen Y professionals in less than one year.
Your TPA must demonstrate a deep understanding of their core operations – claims management – and also a willingness to constantly evolve with the rapidly changing world around them. Building robust systems that increase process accuracy and scalability, and adopting industry best practices such as paperless processing, digital receipt and storage of documents, real-time access, analytics, etc., can be significant differentiators for TPAs today.
Fraud and abuse control are a natural extension of strong operations. Your TPA must adopt the right blend of technology, to automatically flag suspicious activities, and people, whose timely intervention can safeguard the interests of all stakeholders in the ecosystem.
Couple these with the need to demonstrate full knowledge of regulatory norms, and compliance with statutory regulations and audit practices, and you have a TPA whom you can rely on to manage your health benefits conscientiously.
Partner with a TPA who empowers you to control and channelize your health spend effectively. TPAs have always been instrumental in reducing the overall cost of care by enabling cashless hospitalization at preferred tariffs. TPAs are also entrusted with the generation of MIS reports to evaluate adherence to SLAs.
Your TPA must go one step further to help you analyse your portfolio and give you actionable insights – top ailments where your benefits are being spent, demographical contribution, year-on-year movement of incurred claims ratio (ICR) and, importantly, predictive analysis that can help you design your benefits programs effectively in the coming years.
Clearly, the role of a TPA has morphed in recent years – and interestingly, this transformation is led by the growing needs of your growing organization and the demands of your savvy employees. Let's welcome this paradigm shift and prepare for a future where employee delight hinges as much on experience as it does on cost and other traditional parameters – with a TPA and an insurer partner who share your vision and can match your pace of growth".