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5 Tips for Choosing the Right TPA

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While many risk managers have had excellent experience with their third party administrators (TPAs), others have been disappointed. Unfortunately, when the match isn’t right, the risk manager may be left with poor claim outcomes, higher claims and insurance costs, and difficulty identifying issues and making corrections.

The key to successful relationships often hinges on the risk manager’s ability to set  priorities and evaluate prospective TPAs and other claim service providers accordingly, based on objective, outcome-based metrics. Here are five tips for choosing TPA and claim service providers that are best suited to meet your needs:

  1. Look beyond household names. Too often, risk managers narrow their options based on name recognition.
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    While this might appear to be a safe choice, it may not yield the best fit. And that can lead to higher costs, poor outcomes, and ineffective relationships. Even with name-brand providers, mismatches might exist between the risk professional’s priorities and the service provider’s capabilities and operating cultures of the two organizations, available industry expertise, and resources such as risk management information systems.

  2. Articulate your needs and priorities. An effective relationship starts with knowing the specific requirements of your enterprise and setting relevant priorities. Are you in an industry with unique risks? Do you have a backlog of complex and legacy claims? Is your geographic footprint local, regional or national? Do you have significant operations in states with challenging regulatory frameworks? Do you need a provider with a strong reputation for closing difficult claims or managing litigation? How valuable are the TPA’s data management resources or risk management information system to your program? What’s your claims volume? Conduct a careful assessment of your needs, establish priorities, and create a request for proposal and related scorecard for evaluating candidates.
  3. Check how closely the TPA’s capabilities and resources match your needs. Areas you might examine include: staffing and account management, geographic locations, adjuster case load, pricing structure, reserving practices, quality assurance and training, MMSEA (Medicare, Medicaid and SCHIP Extension Act of 2007) reporting, litigation and subrogation management, managed care, data handling and reporting capabilities, and transition planning.
  4. As practical, insist on outcome-based metrics and use them to compare candidates. When you break it down, the fees charged by claim service providers represent only a small percentage of claim costs. Whenever possible, try to obtain metrics on actual claim outcomes rather than process. Analyze time and cost of various types of claim closures and percentages over time that might apply to your organization, check average claim duration and costs, and examine these results by state, your industry sector and other relevant breakouts.
  5. Know which adjusters will be assigned to your program. They’re the gatekeepers who will make a big difference in your results. So, be sure you know who the adjusters will be on your account. If your largest claims typically demand experienced adjusters with proven track records make sure that’s what you’ll be getting. Find out about their adjuster turnover rates. While some attrition might be expected, you want to avoid situations where you’re constantly re-educating adjusters to get up to speed—especially on complex and legacy claims. Try to ascertain whether their adjusters fit your culture, claims handling approach and priorities.
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Once you make your TPA selection, evaluate their performance on a regular basis. Track the TPA’s results against what you anticipated based on the metrics they provided in response to your request for proposal (RFP).

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By adhering to an objective selection process, including making sure the TPA’s team and capabilities are aligned with your priorities, you’ll be in the best position to get the results you want.

Purchasing a Risk Management Information System

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It’s bound to happen. At some point, nearly every risk manager is faced with the need to purchase or replace a risk management information system (RMIS).

The decision may be driven by the obsolescence of an existing RMIS, a need for different or more robust capabilities, organizational changes and general systems upgrades that facilitate wider application of data analytics.

The good news is that RMIS long ago transcended their traditional roles in claims tracking, analytics and benchmarking, and they continue to evolve. Today RMIS offer an array of sophisticated capabilities, including applications to support enterprise risk management and global strategic risk management initiatives.

To get the RMIS that best meets your current and emerging needs, thoughtful consideration is called for. In light of exciting RMIS developments, here are a few ideas that might help.

Rethink your RFP. A rigid RFP process with a defined set of parameters and limited detail might leave you with insufficient information and result in a choice that is less than optimal. With many risk managers now required to address more complex exposures, provide sophisticated analytics, and drive down costs, contemporary RMIS platforms offer the versatility to support a spectrum of risk management needs. So starting out with a broader conversation about needs analysis versus capabilities can equip RMIS buyers to make better decisions.

Remember, people are key. Sure, new technology is exciting. However, as highlighted in the 2014 Advisen/Bickmore RMIS Review, client service is a top reason for organizations to switch RMIS providers. Do the people on the other end of the phone have the experience to understand your complex business and needs? Can they advise or make the changes within your system? Do they have authority to do so without submitting tickets or routing your problem to another department?

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While it is reasonable to assume any RMIS vendor will need to get up-to-speed on the specific needs and priorities of your organization and department, you don’t want to be training a less experienced RMIS vendor or employees at your expense.

Usability: How quickly can your team get up to speed? Unlike a decade earlier–or even just a few years ago–virtually all RMIS users are quite familiar with general website navigation based on their Internet use. Ideally, the RMIS you select will have a simple user experience with navigation that’s fairly intuitive and functions and unique features that are for the most part self-explanatory. Historically, RMIS systems were “siloed” in terms of how their capabilities were developed, so information had to be searched for and located. Today, the workflow of a RMIS should coincide with the user’s organic thought process–and not the other way around.

Scalability: What happens as needs evolve? Today, virtually every RMIS provider claims its system is scalable to handle growing organizations. While that may be true, the question for the buyer to ask is: “At what expense?” When interviewing potential RMIS providers, be sure to ask plenty of “what if” questions so you come away with a clear understanding of what might be involved in scaling, changing, or even reconfiguring a RMIS system.

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Does each and every change come with a price tag, or is the system’s architecture built to accommodate on-the-fly configuration changes?

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There is no doubt these are challenging times for risk professionals and their organizations. In this environment, choosing the RMIS that is right for you can go a long way toward making your job a lot easier and your team more successful. Happy shopping!