New Generation of Advocacy
08/07/2011
by Scott Thompson
As we move into the health care reform era, we see a shift in how third-party administrators (TPA) services are delivered to customers, and more specifically, where they go to find these services. Specialized organizations are now available to provide outsourced solutions for the pain points within the traditional TPA/carrier model, including: disease management, wellness, nurse-line, and customer service.
The TPA/carrier model is centered on medical claims payment and benefit administration. In addition to these core services, the traditional TPA has also provided ancillary services to customers to create an integrated source for administration. The typical core and ancillary TPA services include:
CORE
- Claims Payment & Administration
- Network Access
- Utilization Management
- Case Management
- Customer Service
ANCILLARY
- Disease Management
- Wellness Services
- Nurse-line
While this bundling of services has created administrative efficiency for employers, over time it has limited the effectiveness of the member-focused services such as customer service and disease management. Employers will look to custom solutions that enhance member advocacy, provide targeted employee communication, and integrated disease management, wellness, and coaching. This advocacy approach will allow employers to:
- Provide a new level of concierge consumer service to members to empower consumerism
- Offer members a key resource for support with handling insurance claims and billing issues
- Partner with an organization that maximizes chronic care opportunities
- Target members with specific conditions and gaps in care with specific messaging
- Partner with an organization that addresses the needs of the most critical segment of our health care population, educating them on how to partner with health care providers in the management of care
To learn more about this solution, register for our Fresh Perspectives webcast at freshperspectives.eventbrite.com. You can also contact your Advisor, Account Executive, or Account Manager for more information.
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