13-Steps to Operational Efficiency, Quality, Cost Management and Transparency

It is just after the first of the year, and I have been very pleased to hear of the many successes experienced by TPAs with respect to growing their books-of-business. This came on the heels of one of the best SIIA conferences I have attended. It was great to see old friends, and the Exhibit Hall and sessions showed that our industry is brimming with strategies and services that continue to improve our advantages over network-driven BUCA solutions.

Having spent 30 years working with, building, selling and acquiring TPAs, I know that those strategies and services work best when deployed over a strong foundation. Those who have heard me speak know that these are characteristics of my “World Class TPA”. A few friends have suggested that I publish a blog with tips and reminders TPAs can use to make sure that their foundations are strong.

Operational efficiency, quality, cost management and transparency/analytics are critical elements of the foundation, showing up in everything a TPA does, and in most of the decisions they make. Over the next several weeks this Blog will address the top 13 steps TPAs can do to ensure that they focus on these elements:

  1. Complete Business and Sales Planning

  2. Maintain a Disciplined Sales Approach

  3. Improve the Focus on Implementation

  4. When in doubt…Communicate!

  5. Know your Networks and Provider File (and alternative approaches to provider access)

  6. Avoid Enrollment Meltdowns

  7. Building Blocks of Successful Plan Building

  8. Effective Claims Work-flows and Resource Use

  9. Re-work the Re-work

  10. CQI in Customer and Provider Service

  11. Avoid Stop Loss Administration Drama

  12. Focus on Vendor Contracting and Management

  13. Effective Generation of Management Information

Each Blog is intended to be thought provoking, actionable and based on my 30 years consulting with TPAs. I’ll also provide my insight into other issues facing the self-insured industry, like legislation, alternative strategies to traditional PPO networks, population health strategies, technology and risk management via stop loss and captives.


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