Building the TPA of the Future
As many of my friends know, for the past 18 months I have been working on a very exciting project, the development of Centivo.
For 35 years I have worked closely with all constituents in the self-insurance industry to help our industry be the best that it can be. From my perspective, the development of Centivo is the culmination of every effort I have made for a TPA to be “world class” and represent the future. I believe in the efforts that Centivo is making to change the delivery of health benefits and to advance primary care- centered coordinated benefits. The quality of the platform, team and resources committed to delivering an exceptional experience to Plan Sponsors, Participants and Providers is truly second to none.
I am very blessed that Centivo’s management and Board, led by Ashok Subramanian, has asked me to build and lead Centivo’s TPA Sales and Account Management Teams. While Centivo is a great solution for companies of all sizes and is getting a lot of traction with the Fortune 500, my focus will be on those middle market organizations with up to 5,000 employees that are in such dire need of a superior alternative to what’s in the market today. This will include assembling a team of effective communicators who believe in our approach, understand our capabilities, and create powerful solutions for prospects and clients. Our Team will grow together and always strive to exceed expectations. Members of the Team will receive the support they need to be exceptionally successful, enjoy themselves in the pursuit, and change the world of healthcare.
Why is Centivo the “Future”?
Centivo puts into practice and executes the very ideas being explored by entities ranging from the Health Transformation Alliance to Health Rosetta to the multitude of firms passionate about creating real change in the delivery of health benefits.
Central to Centivo’s focus is Advanced Primary Care, including identifying and contracting PCPs which have shown the commitment to managing their patient base, helping self-funded employers get more value for their money, and creating an amazing experience for their patients. Centivo’s full-time Chief Medical Officer, advisors and contracting staff use unique analytical tools to identify these PCPs, then develop direct contracts with them with fair and aligned incentives including bonuses for the right behaviors such as patient access and working effectively within prescription drug management programs. There are also risk sharing programs built around reducing the total cost of a Plan Sponsor’s benefits. Centivo also integrates highly effective DPC and on-site clinics into the equation.
Since care is required beyond the scope of the PCP, Centivo has developed relationships with best-in-class networks on a market-by-market basis, specialty carve-out arrangements, and providers of reference-based reimbursement solutions.
One area of “network management” where Centivo is pushing the existing, rather limited envelope, relates to promotion of provider cost and quality data. Rather than turning plan participants loose on an imperfect rating tool, a real “matching” process occurs where a patient’s complete health profile and clinical needs are used to identify providers demonstrating the most success in treating people with similar characteristics. Better yet, think about the implication of compensating PCPs for appropriate referrals to specialty resources, and providing credible profiles of the handful of specialists best suited to manage their patient’s condition. This is precision-guided coordinated care at its best.
The founders of Centivo have spent the last two decades re-inventing the consumer experience in employee benefits. Included is a comprehensive program of effective initial and ongoing member communications, a “futurist” app and portal, and a fully integrated and internally managed Concierge function offering as broad a reach of services as specialty companies in the space. Centivo Concierges provide traditional service functions, but also establish the relationships necessary with the covered population to meaningfully influence their health and their use of their Plan.
I am personally most proud of the operational strength which Centivo brings to the table, coordinated by one of the most experienced, yet forward thinking Operations Managers in our industry, Paul Wann. Centivo’s founders, investors and advisors made it clear from the start that no shortcuts could be taken in building an exceptional “platform operation”. That included months spent analyzing technology, business partners and workflows to ensure Centivo was built to support the initiatives required for the TPA of the Future. As anyone knows however, the heart of an operations is it culture, and hand-picked technical experts in every area of operations have demonstrated a desire to provide an exceptional level of service and continuous commitment to improvement.
I would be remiss if I didn’t mention the work done with analytics and pharmacy benefit management. Centivo will be one of the few TPAs to pair a team of data scientists and clinicians with a leading-edge data warehouse analytical tool and make that comprehensive and highly transparent service available to Plan Sponsors and brokers. From a PBM perspective, our search and negotiation had led to a transparent and beneficial contract with a team of leading innovators prepared for the coming wave of innovation and the impact that will have on Plan Sponsors. Equally as important is the integration that has been built around care management and patient compliance.
So, What Does This Mean for Me?
For 35 years I have worked closely with all constituents in the self-insurance industry to help our industry be the best that it can be. From my perspective, the development of Centivo is the culmination of every effort I have made for a TPA to be “world class” and represent the future. I believe in the efforts that Centivo is making to change the delivery of health benefits and the quality of the platform, team and resources committed to delivering an exceptional experience to Plan Sponsors, Participants and Providers.
I have accepted the responsibility of building Centivo’s book-of-business by leading its sales, stop loss and account management efforts. I look forward to working with my many friends and meeting new ones as we demonstrate Centivo’s ability to deliver an alternative approach to a health benefit plan.