Third Party Administrators

Definition: A third-party administrator (TPA) is an organization that processes insurance claims or certain aspects of employee benefit plans for a separate entity. Responsibilities typically include claims administration, loss control, risk management information systems, and risk management consulting, such as recommendations for Stop-Loss reinsurance.

Third Party Administrators (TPAs) provide a personalized service that is custom-designed for the plan sponsor's needs and specific workforce.  TPAs provide a variety of services to the whole plan, including plan implementation and administration on an on-going basis.  TPAs may also offer a variety of consultative services.

 

One of the major points of value that TPAs bring their clients having a finger on the pulse of the health plan.  This enables them to recommend actions to manage costs and improve plan quality.  This requires that TPAs navigate vast variations of uses of basic vocabulary & terms in order to correctly define and measure the performance of client plans and maximize cost-containment opportunities.

BST works with employers and their trusted advisors using advanced data management tools to maximize every dollar allocated for healthcare.  It all starts with data, which if properly managed can be one of an employer’s greatest assets.  No longer do employers have to rely entirely on third-party risk management services to ‘see inside their plans’.  The visibility that a BST solution provides empowers employers and plan sponsors,  making the self-insured health plan option a more controlled and predictable choice.

BST ENABLES TPAs TO...

Support and enhance the trusted advisor role
  • BST helps TPAs (customers and their brokers) create a client stickiness by delivering customized, leading-edge visual insights into plan performance across the whole health coverage platform, with evidence-based recommendations and complete plan management.
      

  • BST helps TPAs deliver value by holding vendors accountable for promised results.
     

  • BST delivers more insights faster with time-saving automation and customized reporting.  Time-saving automation allows TPAs to deliver the same detail and sophistication for their smaller accounts as they do for their largest clients.
     

  • BST enables TPAs to explore “what if” scenarios for potential plan design, enabling TPAs to have an evidence-based point of view to present to clients.

Improve the speed and access to client information 
  • BST provides TPAs with a convenient, effective tool that will allow partners to manage their medical coverage, pharmacy coverage, stop loss premiums and more – all in one platform.
     

  • BST allows TPAs to look at more data, more often and with more granularity through automated financial and clinical reporting packages, updated monthly.
     

  • Not only does BST aggregate and warehouse all relevant plan data, we provide easy to use toolsets for mining it.
     

  • BST’s secure, web-based platform enables TPAs to gain answers quickly with a powerful ad hoc reporting tool that provides a 360 degree view overall health plan with data blending of med, Rx, wellness, etc..

Understand what is driving costs, and more importantly what to do about it…
  • BST helps TPAs better understand their clients risk, using actual claims data, to evaluate the true risk for an employee population (prospective identification).
     

  • Once a member has been identified for intervention, our analytics will provide better monitoring and understanding of their clinical situation – leading to more effective interactions.
     

  • BST applies modern data science methods utilizing actual claims data to forecast future 12-month cost distribution. Risk scoring is applied to each member and the aggregate population.
     

  • Plan Optimization:  Advanced software considers the employer's budget, financial and quality goals, and the population risk to design next year's health plans and premiums. BST’s proprietary Optimizer generates a pro-forma financial statement to project next year's performance.
     

  • Benchmarking: BST generates more specific, more applicable benchmarks for clients.  Our advanced automation speeds the process and removes much of the tedious process.

HOW WE HELP TPAs

BST Data Warehouse

BST gives plan sponsors unprecedented access and visibility of all relevant plan data.  TPAs have access to their client’s data 24/7 where insights and actionable intelligence are generated through BST’s rich data mining toolsets. Data is refreshed monthly where it can be mined and evaluated.

BST enables TPAs to:

  • Access and analyze client plan data immediately.

  • Aggregate all relevant plan data for immediate or long-term use.

  • Securely store and access client data.

  • Hold vendor’s accountable for effectiveness of results.

  • Normalized for continuous in-depth data analysis.

  • Multi-period/lifetime storage/data blending.

BST Descriptive Analytics

BST applies advanced analytics, machine learning and optimization techniques to identify lag measures, provides high-level views of total block performance and enables drill-down views of individuals through key metrics. We stratify risk, evaluate at a granular level and identify a health plan’s high-cost drivers.

 

BST enables TPAs to…

  • Identify financial drivers of next year’s plan in an efficient, automated, unbiased, transparent and cost-effective way.
     

  • Identify the right plan and level by group.
     
  • Obey the overall premium, business quality and tier movement constraints to efficiently and appropriately place each group into the best risk allocation tier.

BST Predictive Analytics

BST provides insights on global risk factors within a population by identifying high-cost drivers, historic patterns and relationships at a granular level – throughout the plan year.  We deliver actionable business intelligence through customized financial and clinical reports (robust enterprise or client-level) that provide customized views by key metrics of performance and cost.

BST enables Employers to:

  • Process large data sets quickly

  • Uncover insight on emerging risk throughout the year

  • Better advise and hold vendor partners accountable

  • Unbiased, transparent and cost-effective

  • Meets HIPAA/ERISA compliance standards

  • Be accessible anywhere through a secure (SOCII/SAAE16) cloud-based platform.

 

BST Prescriptive Analytics

BST considers millions of scenarios, arrives at an optimal plan design and prescribes specific actions while factoring specific member needs and respecting the budgetary constraints and goals of the employer.

 

BST enables Employers to:

  • Apply advanced analytics and optimization techniques to identify financial drivers of next year’s plan in an efficient, automated unbiased, transparent and cost-effective way to inform future plan design (could include supplemental products)
     

  • Gain confidence to make smart health-plan decisions with evidence-based support.