​Medical expenses are driven by two simple factors: unit cost and utilization.  However, insurance carriers have made it extremely difficult to evaluate the most effective networks. Network discounts were long considered the standard evaluator for a self funded employer.  Choose the greatest discounts and achieve the strongest network.  While important, networks must also be able to manage a myriad of other areas.  To further complicate the process, administrators layer in additional profit measures such as shared savings expenses for out of network procedures and  capitation expenses, which were once reserved exclusively for HMO's.  The full impact of these are not typically transparent until after the employer transitions and is billed. They can be well over 10% of an employer's medical claims and can eliminate any expected savings.

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Every year 1 out of 20 adult patients experiences a misdiagnosis with almost one-third being life threatening or life altering.  You likely know someone or have experienced this unfortunate impact personally. So why aren't we more focused on quality and outcomes?  High performing network providers achieve improved outcomes and decrease medical costs and unneeded procedures.

 

Care management programs also present a major opportunity for cost control.  These programs effectively engage and assist patients with chronic conditions. Left unmanaged, your third party administrator has little incentive to engage members.

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While the full scope of a Third Party Administrator evaluation is complex, we simplify the process for our clients and provide concrete data and recommendations. We hold your partners accountable to deliver on their commitments through stringent performance guarantees tied to outcomes and compensation at risk.  Performance measurement isn't a one-time exercise during a request for proposal.  It is consistently measured and demands the highest results throughout the year.