502.495.5040

Squeezing TPA’s for Profit and Other Myths….

Oct
07

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Squeezing TPAs for Profit and other Myths….Or it seems the more I cut my administration/claims medical management, the faster my over all claims costs go up!!!  I can’t begin to list the number of self-funded clients I have advised over the years that want to focus on squeezing the absolute last nickel from the 15%-20% administration budget.  All of this effort on the “overhead” component of the claims dollar while paying only lip service to ever escalating medical/pharmaceutical costs.

And what do you get when you take a sledgehammer to the administrative budget?

  1. Adjusters/case managers with too many files
  2. Rubber stamp UR
  3. Less effective provider networks
  4. Runaway drug costs

My advice is to pick the right vendors but pay them a fair fee to properly handle the claims and not just be a check processor.  Then, spend your energy and invest your loss control dollars on effective medical management of your claims.

These include:

  1. Aggressive/early intervention with nurse case managers
  2. Enhancing the UR function to improve patient accountability and optimize outcomes
  3. Address extent and duration of prescription usage, not just cost of pills purchased
  4. Secure the right specialty match physicians for peer to peer remediation with treating physicians
  5. Constantly monitoring your physician networks to ensure your providers have the best skill sets, not just the lowest price

At OMCA, we work with TPA’s, adjusters and self-funded employers to make sure medical costs are contained.

 

Call us, We can do better.

William Faris, JD
Chief Executive Officer
502-495-5040
william.faris@omca.biz
www.omca.biz

Posted in Medical Cost Containment, OMCA