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The cost of health care has become a major concern for both employers and employees. In fact, according to the Kaiser Family Foundation, the cost of employer-sponsored health plans is now rising seven times faster than wages. Add this to the increased administrative burden to remain ACA compliant that has been placed on employers and it's no wonder there's such a demand for new solutions that offer cost savings and workload relief. The market is ripe for modern medical TPA services, so here's a list of warning signs to ensure your clients aren't getting stuck with the retro version of a TPA.
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1. Their tech isn't up to par.
One common trend amongst the more retro, mom and pop-style medical TPAs is their technology lacks scalability and depth. They simply aren't built to handle the needs of larger companies and likely don't have the ability to offer fully integrated, user-friendly solutions. Those who can provide a more comprehensive suite of solutions, like population health management, self-funded private exchanges, online enrollment, ACA reporting and benefit account administration (HSA/FSA) along with their core claims administration service, can deliver the modern value that today's employers expect and demand.
2. They're way too rigid.
Today's workforce is more dynamic than ever. No two members are alike, and no two employers are either. They have different needs, depending on their demographics, location, industry, etc. TPAs that actively listen to their clients' needs and have a built-in capacity to personalize their services — from plan designs, to employee communication and education, to customer service — ultimately optimize results.
3. They don't use smart data.
It's essential for TPAs to offer advanced analytics in order to provide maximum value to your clients. Those who can most effectively transform data into actionable information to help employees change their lifestyle behaviors before a trip to the emergency room are ahead of the game. This ability to flag at-risk members and analyze gaps in care not only makes a positive impact on members' lives, it helps employers reduce the risk of catastrophic claims.
4. Their customer service is ice cold.
TPAs can have a major impact on real lives. People are often scared and frustrated when a problem arises with their benefits. They deserve a calm, knowledgeable and caring person to help guide them through whatever issue they're facing. A TPA that embraces a culture of empathy and urgency is key to client satisfaction. If they're not recording their call representatives or performing regular evaluations to ensure quality, they aren't doing enough. Find out how a TPA measures customer care metrics, such as first call resolution rate, to determine how smoothly customer concerns are resolved.
Let's be honest. Skyrocketing health care costs, along with the ACA, have heightened employer demand for efficient, cost-cutting solutions. Retro medical TPAs that haven't upgraded their offerings to meet modern HR needs won't cut it for your clients. If any of these warning signs hit close to home, it is time to reevaluate your options in order to remain competitive in this post-ACA world.
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