Broker to broker: A real-world TPA checklist for benefits advisors

Consider this a real-world checklist to help benefits advisors choose a TPA partner to ensure client success.

By Brandon Kress | October 25, 2022 at 07:39 AM

Trust takes time to build, but maintaining it is just as valuable. Three years ago, I was searching for a third-party administrator (TPA) that would exemplify the following qualities: accessible, accountable, and proactive. These three traits were hard to find within the mainstream insurance carriers and large TPAs that primarily just process claims.

I was looking for someone to check all the boxes. As any advisor will tell you, the test is not the sales pitch. What really matters are those first crucial months when they start working with the client.

Consider this a real-world checklist for choosing a TPA partner to ensure client success:

Change smarter, not harder: Of the TPAs in the ring, it was WellNet that was hired by one of my groups – a mid-size automotive dealer with over 600 employees. They had two very key needs: find ways to save money and have a better experience. We delivered both – with a very specific strategy as the source of success.

Using a PPO network my client knew well, we had a directive to achieve $1M in savings the first year, which we exceeded. Even better, additional savings were found in the years that followed. Building change around familiarity allowed for continued, positive member feedback.

Make it a no-brainer: A second group decided to offer two totally different kinds of plans at the same time: a PPO chassis and a reference-based pricing (RBP) platform. Now we needed a design strategy.

While we mirrored the former PPO plan design that the group used with their previous carrier, our RBP platform allowed members to use any willing providers and simultaneously incentivized members to use high-value (high quality/fair price) providers.

With side-by-side options, members could see if they wanted to use certain high-value providers (without obligation).

Why it matters: The next move was to implement a comprehensive strategy that would assist all the first-time RBP plan enrollees. RBP plans are not for the faint of heart and require a lot of handholding and patience with members.

Knowing this, I needed a TPA partner who really understood how to do this – and how to do it well. As a broker, this is instrumental for a successful rollout.

The impact: I recently won a new broker of record (an independent school with over 400 employees) using the same TPAs Crawl, Walk, Run approach. This CWR solution meets customers where they are and allows them to evolve their plan at a pace that works for them.

Using a strategy to manage the health plan proactively resonated with a C-suite and HR team. This company had a 10-year relationship with their former broker, but now they have an opportunity to run a plan on their own terms. Shopping carriers on a spreadsheet no longer works.

Another reason to work with the right TPA is the ability to scale a strategy. Much like the groups above, we implemented the same PPO network they knew – and trusted – along with incentive management.

Then, we sealed the deal by making it personal to them. With a detailed, retrospective analysis, we showed the company leadership specific, achievable savings opportunities. Now, it’s real. They don’t have to change administrators to hope it will work – they know it works.

Bottom line: Many ask, what makes a smarter self-funded solution? To me, it’s controlling the cost of the claim before it gets paid. I love working with an independent TPA because, from the top down, they care about the details of each claim and meeting each member’s unique needs. It’s about ongoing education, proactive advocacy, and aligned incentives.

Broker to broker, you know we’re constantly solving complex issues. From helping a member find a highly specialized doctor, to managing a potentially plan altering transplant situation, your TPA partner must be in front of these ever-evolving issues.

Find that independent ride-or-die TPA to identify, prepare, control, and improve the outcome.

ONE BIG THING: If you leave with any takeaway, let it be this. Above all else, working with an independent TPA has allowed me to stay in front of my customers, maintain that broker of record, and change the conversation with prospects.

Brandon Kress is a partner at All Atlantic Benefits a South Florida employee benefits agency.

Read his article on the BenefitsPRO site here