Squeezing TPA’s for Profit and other Myths…
Apr
02
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?
- Adjusters/case managers with too many files,
- Rubber stamp UR
- Less effective provider networks
- 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:
- Aggressive/early intervention with nurse case managers
- Enhancing the UR function to improve patient accountability and optimize outcomes,
- Address extent and duration of prescription usage, not just cost of pills purchased,
- Secure the right specialty match physicians for peer to peer remediation with treating physicians.
- 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 V. Faris, CEO, President
502-495-5040
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