Medical TPA RFP Management

Background:

A Fortune 300 company engaged Findley to facilitate a Medical TPA RFP process. At the time, the company covered one-third of its 6,000 active employees using leased networks administered through a TPA. The rest were covered under a national carrier who was also responsible for COBRA, FSA, HRA, and RRA administration.

The objectives of the RFP were to 1) consolidate under one TPA, 2) reduce claims expenses, and 3) improve the member experience through use of technology tools and care coordination/navigation resources. Our client decided to not competitively bid its standalone PBM arrangement, EAP, Wellness, or HSA administration. However, they indicated that the successful Medical TPA would effectively communicate and integrate with their other vendors.

Solution & Results:

Findley conducted provider disruption and medical claims repricing analyses. In addition, our e-procurement system was used in scoring an extensive RFP questionnaire customized for the client to gauge each respondent’s capabilities and suitability in meeting their unique needs.

Findley facilitated finalist interviews and two on-site visits. In addition, we negotiated reductions in proposed ASO fees and discount and claims trend guarantees. The results achieved included:

  • selecting a national carrier that consolidated all TPA services, including COBRA, FSA, HRA, and RRA services;
  • negotiating a three-year contract with discount and zero claim trend guarantees that would reduce projected claims and ASO fees by nearly $14 million;
  • introducing new concierge member services to improve member education and care coordination;
  • introducing new chronic condition management and high cost imaging services, which were projected to save an additional $8 million over three years;
  • negotiating improved implementation and operational performance guarantees ; and
  • creating ample lead time to execute the transition and required change management services.

The Findley Difference:

Findley works with our clients to determine the best solutions to all their employee benefit challenges. Our firm’s expertise in conducting complex vendor procurement projects demonstrate our ability to deliver results that are on time and of high quality and value.

Complex vendor procurement project delivers results that include improved member experience and millions in healthcare expense savings.

Category: Findley Proof
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