Rising Healthcare Costs Lead to More Challenges for TPAs

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Creativity is Good for (Almost) Everyone

Employers and employees facing rising healthcare costs nationwide isn’t new. The days when a low deductible health plan was the only option available to employees — and the only one needed — have seemingly come and gone.

Companies that cover 100% of employees’ healthcare premiums are few and far between. Many are located in the country’s largest cities, which leaves many Americans out of luck. And those that do live in those urban centers face stiff competition for opportunities.

So what are people doing to curb rising healthcare costs? They’re getting creative.

Brokers and employers are finding more and more ways to ensure that plan participants’ medical needs are met despite rising healthcare costs through the plans in which they’re enrolled. On the surface, this seems like a good thing, right? Employers are saving money, and their employees are getting the coverage solutions they need.

Yes…and no.

Creativity Creates Complexity When It Comes to Rising Healthcare Costs

Let’s explore a scenario. A broker sells a low deductible benefits plan to a company. A year later, the company wants to save money and purchases a high-deductible health plan from the broker to address rising healthcare costs. Employees using the high-deductible plan will pay more, so to help them absorb this cost, the company provides them with an HRA.

A year later, the broker and employer meet again, and the employer reports that certain related services or expenses weren’t covered by the HRA. The broker then redesigns the plan to accommodate — inevitably adding layers to the plan and subsequently increasing its complexity.

Not only can that additional complexity confuse employees, but it can create difficulties for TPAs — difficulties that extend beyond day-to-day work and well into the financial and operational well-being of a TPA’s business.

As a TPA for this client, you would be responsible for administering this plan. Ideally, you would administer it through your system. However, with the variety of software on the market (both benefit administration software and HR software), that can be difficult to manage.

Your system might be unable to manage plans with this level of complexity. In some instances, TPAs have resorted to using Microsoft Excel as a workaround to manage the details of these plans. This results in business loss through time and technology wasted, andloss is not why any business does what it does.

The Solution Already Exists

We recently covered a variety of TPA best practices that enable TPAs to create and maintain long-lasting relationships with their brokers, employers, and plan participants. Ultimately, TPAs need to focus on providing a high level of customer service on all fronts. It’s just common sense for a long-lasting TPA–partner relationship.

To provide a high level of service, and to keep your workload manageable and business profitable, TPAs must invest in benefits administration technology that addresses this issue. More importantly, TPAs must invest in solutions that extend the abilities of their existing benefits administration platforms — whether they were purchased or built from scratch.

Why manage plans outside of your benefits administration system? Why burden yourself with solutions that only result in a loss for your business? Why do anything that distracts you from doing what your customers need to you do efficiently and quickly?

Tools are available now to help you cut out the paperwork and hassle. Take advantage of a platform that works alongside your existing software to get the most out of it and utilizes automation to drive efficiency for your business.

Discover how TPA Stream can make your business more efficient. Schedule a demo now.

Why TPA Stream

TPA Stream is a thriving, innovative insurance technology company committed to empowering better healthcare outcomes for employers and their employees.

Learn more about TPA Stream here.

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