Almost every industry has been touched by digital transformation, and the healthcare benefits sector is no exception.
Third-party administrators (TPAs) are being tasked with riding oncoming waves of an ever-evolving industry landscape characterized by a strong current of digital-forward solutions. As a result, their role in the healthcare industry has also shifted.
TPAs have always been a part of the insurance system, but digital technologies and other factors are accelerating their transformation. Let’s take a look at how TPAs have changed over time, and how MagnaCare is using digital transformation to better serve clients in this evolving landscape.
The traditional TPA model
A TPA is an organization that handles the claims, processing, and reporting components of a self-funded employer’s health benefits plan. TPAs have extensive knowledge and expertise in the healthcare industry, regulatory requirements, adjudicating claims, account management, and member needs, making them a strong asset for any self-funded employer’s team.
Traditionally TPAs have handled the administrative and operational services for certain employee benefits, focusing primarily on an organization’s health plan. This work includes collecting premiums, reviewing healthcare utilization, and overseeing the entire claims process. But with the steady advancement of the digital age, the role of TPAs is rapidly changing — and so is the scope of their capabilities.
How is the role of the TPA evolving?
Ultimately, TPAs are embracing change to provide more comprehensive and integrated solutions to their clients. Gone are the days of handling only claims processing and administrative tasks: Forward-thinking TPAs are harnessing digital tools and responding quickly to regulatory shifts to provide clients with the best possible service.
Here are some recent developments:
TPAs are well known for their responsiveness and personalized service to client plans and participants. Highly attentive service is crucial to maintain effective and positive client interactions. Claims are usually processed and finalized in shorter periods of time, questions are handled promptly, and plans can be adapted as the client’s workforce changes.
As a result, TPAs are investing in user-friendly online portals, mobile apps, and self-service options to empower individuals to access information, submit claims, and track their benefits easily. Personalization and proactive communication are also being emphasized to improve member satisfaction and engagement.
Digital capabilities and technology adoption:
Innovative TPAs are arming themselves with digital capabilities to harness the power of data to support business outcomes. Automation and digitization are significant in tasks like claims adjudication, document management, and customer service. TPAs are also adopting advanced analytics and data-driven tools to gain insights, identify trends, and improve decision-making.
Legislative and regulatory changes:
TPAs have to stay on top of changes in the legislative landscape to best serve their clients. It’s up to them to adjust to the hundreds of legislative and regulatory changes and federally mandated benefits yearly. Normally an insurance company makes one decision for all policyholders on how new rules and regulations will be implemented, but TPAs assess each plan individually to maximize efficiency.
MagnaCare: Serving today’s clients with future-forward innovation
At MagnaCare, we don’t consider innovation an extra add-on; we consider it essential. Our primary goal is to ensure our clients receive the support they need to provide personalized health benefits to employees. And as the role of TPAs has shifted over the years, we’ve made great strides in meeting the demands of changing times.
It all starts with our approach to technology. We proudly leverage our award-winning Create® Technology platform, which simplifies healthcare and benefits for everyone, providing users with an experience that goes beyond simplifying administrative tasks (although the platform does that, too!).
Create® Technology puts members at the center, offering a user-friendly interface and self-service tools. Members can access their benefits information, search for providers, view their claims history, and communicate with customer support. It empowers members to take control of their healthcare journey, ultimately improving engagement and satisfaction.
The platform offers powerful analytics and reporting capabilities, providing valuable insights to TPAs and employers for informed decision-making. It enables stakeholders to analyze utilization patterns and identify cost drivers. These data-driven insights help optimize benefit designs, track program performance, and initiate cost-containment strategies.
Moreover, MagnaCare’s Create® Technology platform is designed to adapt to the unique needs of different organizations. It offers customization options, allowing TPAs and employers to tailor the platform to their specific requirements. This flexibility ensures that the platform aligns with their branding, workflows, and business processes.
By leveraging the MagnaCare Create® Technology platform, organizations can simplify healthcare administration, empower members, optimize costs, and improve overall healthcare outcomes. With its robust features, seamless integration, and user-centric approach, the platform offers a comprehensive solution for managing healthcare benefits effectively and efficiently.
It’s safe to say that MagnaCare has evolved past the traditional model for TPA services. The role of TPAs is evolving from traditional claims administration to a more strategic and comprehensive service provider. TPAs like MagnaCare are adapting to industry changes, embracing technology, and focusing on cost containment and customer satisfaction to deliver value-added services to their clients.