Our Solutions
What is a TPA?
Third-Party Administrators (TPAs) serve as essential administrative support for self-funded companies. Typically, TPAs collaborate with brokers, consultants, and a company's HR team to develop and implement healthcare benefits plans. Key administrative responsibilities include:
Claims Processing
Managing the adjudication and payment of claims for members and providers with speed and accuracy.
Plan Design & Implementation
Working with HR teams to create the most suitable benefit plan for employees and assisting in its execution.
Compliance Management
Ensuring that self-funded health plans adhere to local regulatory authorities and remain up to date.
Member Services
Directly engaging with members to address plan-related needs, handling inquiries, and assisting high-risk members in accessing appropriate care.
Network Administration
Negotiating contracts and pricing with healthcare providers and networks to maximize coverage value.
Reporting & Analytics
Providing comprehensive, data-driven reports on plan utilization, expenses, and the overall health status of the employee population.
Third-party administrators (TPAs) serve as an extension of an employer's HR Department, assisting HR leaders in maximizing the effectiveness of their employee benefits plan. By delegating administrative tasks and claims management to a TPA, HR can concentrate on key areas such as employee retention, talent acquisition, organizational culture, and other C-Suite priorities.
TPAs work closely with their clients to create tailored solutions that meet their specific requirements from scratch. Following the implementation phase, TPAs oversee the health plan and fine-tune it to meet financial objectives through cost-effective strategies. To accomplish these objectives, TPAs rely on data analytics and insights obtained from utilization reports and clinical care management initiatives to direct employees to the most suitable healthcare services.
How do TPAs Save Time and Money?
TPAs' specialized knowledge enables us to handle tasks more effectively, cutting down on administrative expenses. Through network flexibility, fund optimization, compliance, and superior technology, TPAs deliver measurable cost savings.
Offering Network Flexibility
TPAs collaborate with payers like Etiqa, Liberty, and Takaful to provide top-notch networks along with their own Member Services, Technology, and Analytics. TPAs can facilitate direct contracts between employers and local healthcare providers, effectively addressing out-of-network challenges.
Optimising Allocation of Funds
A TPA partner uses analytics to pinpoint wasted funds from underutilized programs. TPAs recommend boosting engagement with specific programs or optimizing the plan for the next year by introducing more effective alternatives.
Remaining Compliant
TPAs excel at navigating the intricate realm of healthcare regulations. Their proficiency aids employers in mitigating the risk of incurring expensive fines and penalties by staying compliant with the most recent state and federal regulations.
Enabling Unbundling & Carve-out
TPAs offer employers the flexibility to choose a provider network independently from a bundled Pharmacy Benefit Manager (PBM), cutting costs while enhancing access to healthcare services.
Providing Superior Technology
A contemporary TPA provides technological solutions to enhance backend efficiency, streamline enrollment, and maintain a positive member experience. Features like consolidated billing and customized reporting reduce administrative workload.
Clinical Care Management
TPAs reduce costs through pre-admission counseling and care coordination. eBen Assist uses data analysis to identify risks and find cost-effective solutions, offering innovative health plans like reference-based pricing.
How Do TPAs Improve Employee Health?
Working with a TPA can improve employee well-being through customized health programs like maternal health initiatives, behavioral health, chronic condition management, and wellness programs. TPAs analyze plan data to identify gaps and offer preventive solutions.
Positive Collaboration
Through implementing a thorough healthcare program, we boost staff morale and educate them to prevent unnecessary costs from providers.
Sense of Value
Companies engaging a TPA can effortlessly conduct wellness and chronic disease management sessions, providing real value and establishing a reputation as a Good Employer.
Loyal Workforce
Companies often struggle to retain skilled employees. Engaging with a TPA can help your company become a Preferred Employer through enhanced benefit offerings.
Making Tough Decisions
When employees face tough healthcare decisions such as surgeries or procedures, there is always someone available to support them throughout the entire process.
Slow Productivity
Workers with chronic conditions often struggle to fully recover due to non-compliance with medication or unhealthy lifestyle choices. TPAs intervene early to address these barriers.
Exclusivity
The company needs someone to address daily employee issues and ensure that their well-being is taken care of — maintaining productivity while reducing absenteeism.
Clinical care management is an essential administrative program that oversees the medical aspect of healthcare. TPAs help guide members through clinical care paths to identify the most effective and cost-efficient options.
Employers can utilize TPAs' clinical care management to lower costs in emergency room visits, maternal health, radiology, and inpatient services. Given that healthcare spending exceeds RM30,000 per insured member annually, understanding service choices and expenses is vital.
Better Partnering with a TPA
Engaging with a TPA comes with numerous benefits for benefit plans and HR departments. Understanding your company's needs and expectations is crucial. A successful TPA collaboration should encompass:
- Providing employers the ability to comprehend their health plan options effectively.
- Offering high-quality, flexible, and customized solutions to meet current requirements.
- Partnering with an adaptable entity that delivers detailed, precise, insightful, and supportive reports.
After onboarding a TPA partner, cost savings and enhanced employee satisfaction should start to materialize. While outcomes are not immediate, over the course of a few years the advantages of transitioning to a self-funded, TPA-managed plan will become evident.
When to Consider a Self-funded Health Plan
Healthcare remains a substantial expense for employers, with costs anticipated to increase further. To manage expenses effectively, employers are looking into self-funded plan alternatives. When considering a self-funded strategy, it is recommended to work with a TPA or consultant to ensure the transition timing is right.
Why Self-fund?
Healthcare costs are a significant expense for employers, leading many to adopt self-funded plans to contain costs. Working with a TPA or consultant is advised to determine the right time for the switch.
Analysis
Analyze claims data to determine total expenditure and the payment status of both current and past claims.
Age Based Coverage
Consider employee age range and health. Offer wellness programs tailored to different needs — encouraging health check-ups, work-life balance, and mental health support for overall well-being.
Cost Efficiency
Examine the benefits utilized most and least. Employers might find opportunities to cut underused benefits, explore cost-effective alternatives, or enhance high-usage areas.
Use these annual self-assessment questions to gauge the impact of your TPA partnership:
Question 1
- Have I noticed a significant impact on healthcare spending or an improvement in the trend of my healthcare expenses?
- Does my TPA have a practical strategy in place to aid in cost reduction?
Question 2
- Do I have access to real-time data for optimizing my plan before open enrollment?
- Are my employees receiving payments or reimbursements promptly?
Question 3
- Is the care management at my current TPA effectively guiding employees to the most advantageous care settings, aiding in cost reduction, and increasing chances of improving health outcomes?
- How satisfied are my employees with their overall experience?
Preventive Care
We believe in preventive care rather than curative. Our specially customized program allows our clients to become award-winning organizations in staff welfare. We cater to those with strict authority requirements in screening prior to work — acknowledged by industries like Shipping, Pilots, Oil & Gas, and Occupational Health and Safety (DOSH).
Why Screening?
It is important to have the baseline assessment performed before commencing work to protect employers from being queried by authorities like SOCSO, DOSH, or the Labour Office.
Rehabilitation
Rehabilitation reduces MCs and increases productivity. Our experience shows close to 90% return-to-work program effectiveness once this program commences.
Age Based Coverage
Offer wellness programs tailored to different employee age ranges and needs — encouraging health check-ups, work-life balance, and mental health support for overall well-being and productivity.
Cost Efficiency
Clients who have conducted such a regime experienced a 50% cost saving due to availability of group rates and cashless facilities made available for employees.
Retention Tool
Preventive care is a proven retention tool. Organisations have experienced up to 80% reduction in attrition year by year — because employees who feel their health is managed and valued are more satisfied and committed to their employer.