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Blog & News

What more do employer groups expect from their health plan or TPA?

In this busy selling season for TPAs and health plans, we wanted to share an updated eBook that outlines some of what the Advanced Plan for Health is hearing from our TPA, health plan and employer clients related to what employers are really looking for as they’re shopping for benefits.

Here’s an excerpt:

Providing your employer clients with the right mix of services and support boosts your chances of standing out and winning and retaining their business. Fortunately, most self-insured employers want the same thing: healthy employees, positive employee healthcare experiences and reduced costs. Sounds simple enough, but how can you be sure that you are offering the best solutions in today’s strained and ever-changing healthcare environment so that you can continue to differentiate yourself and show value?

When it comes time to select (or reselect) a health plan or TPA, the factors being considered by employer decision-makers are evolving. As the offerings from health plans and TPAs become more comprehensive, the employer is facing more pressure to select a partner who will truly support them in reducing healthcare costs. To remain competitive in this market, and meet growing client demands, health plans and TPAs must become trusted advisors – offering targeted recommendations about how to use data and analytics to create measurable programs aimed at specific high cost / high risk populations.

In order to win and retain more business, health plans and TPAs should ask themselves the following questions:

  • Am I looking out for health risks and costs to the best of my ability on behalf of my clients?
  • Am I making the best use of available client population health data?
  • Do I offer a full longitudinal view of data that delivers the insight needed to take meaningful action?
  • Am I offering the most effective disease and case management available? Am I making sure important cases aren’t slipping through the cracks?
  • Do I have the tools to help my clients look at cost trends and take action quickly?
  • Do I have predictive analytics capabilities to help clients proactively get ahead of coming events (admissions, re-admissions, heart attacks, strokes, chronic kidney disease and more)?
  • Are my health and wellness programs truly driving down costs? Can I prove it?

In order to answer these questions you need comprehensive and easy-to-use analytics that provide a high-level situational overview and also allow for deep dives to understand the unique trends impacting each of your clients and prospects. Analytics that deliver insight for reactive as well as proactive engagement, clinical and medical support.

Benefits managers have a lot of options being presented to them, but what they don’t have is a simple intelligent guide that shows them how to set the levers they have in order to achieve the desired outcomes. They’re not confident in their analytics. It’s time to think about what more analytics can do – and how you can best deliver those analytics to your clients.

APH helps health plans and TPAs better support their Employer Group clients to:

  • Decrease high cost claims and reduce risk
  • Close Gaps in Care
  • Deliver physician engagement tools
  • Support admission and readmission prevention
  • Reduce inappropriate ER utilization
  • Support medication adherence and reduce medication risk and cost (including opioids)
  • And more

Click here to download the full e-Book titled “What More are Employer Groups Expecting From You?”

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