Increasingly, health systems are realizing that direct contracting is the way to stay competitive in the healthcare marketplace. When health systems contract directly with employers, they instantly gain large rosters of new patients. By eliminating traditional insurance companies, health systems can increase their revenue, provide better care and form closer relationships with their patients.
In theory it all sounds great. But, as a health system leader, you may then ask: Where do I begin? The best place to start the process toward direct contracting is to work with an experienced partner: a third-party administrator (TPA). A quality TPA handles the administrative duties, plan design and technological infrastructure that, under the traditional insurance model, would be provided by insurance carriers.
If this territory is new for you, you may find it hard to decipher whose partnership will be most beneficial for your health system as you embark on your direct contracting journey.
Here are the top five features to look for in a directing contracting partner as you do your research:
1. Cutting-edge technology
It’s important to choose a TPA that has invested in cutting-edge technology and can use it to help you lower administrative costs, spur customer satisfaction and keep records and claims organized and accurate.
An effective partner provides a health system with centralized access to all plan and member information, enabling you to review claims, enrollment and eligibility, and create accurate reports easily through a unified, comprehensive platform. Some truly effective partners will even create a provider directory for you, where members can type in specific conditions and receive eligible provider information. This tool makes it easier for members to get the help they need and for health systems to keep revenue within their ecosystem.
Ask potential partners if they provide patient portals to plan members. Offering employers and their employees a portal to receive online access to their plan information and benefits cuts administrative costs for health systems and increases customer satisfaction.
Brighton’s Create Technology platform allows health systems to easily manage their plans and give their clients access to all the information they need. The platform is fully customizable and features all claims and enrollment info, a patient portal with two-way messaging, and a provider directory to help patients easily find providers within your network.
2. Robust administrative services
Perhaps the biggest concern for health systems considering direct contracting is the possibility of increased administrative duties and cost. But with an experienced TPA, your administrative duties should not increase at all. Many health systems may even be able to cut administrative costs. The key is to find a TPA who is prepared to take on the responsibilities of processing claims, managing member eligibility and providing health plan customer service to employers and members. Look for a TPA with a solid track record.
3. Strong customer service
Choose a partner with the customer service infrastructure and availability to field questions and concerns from both your health system and your clients, eliminating extra work for you and increasing customer satisfaction. What’s more, a quality TPA will directly service employees and patients, so your individual providers’ offices aren’t burdened with claims questions that can be easily answered by the partner. With your TPA providing speedy, informed and friendly customer service, you can keep administrative costs down and customer satisfaction up.
4. Flexibility
When designing plans and offerings, a nimble TPA will have the flexibility to customize plans to a health system’s capabilities and their clients’ needs. Customized plans and programs are a huge market differentiator for health systems, as employers value personalization and want to work with health systems that can serve their diverse employee base and their varying needs. With customization capabilities and strong communications, your unique position in the market can translate into greater patient volume and higher utilization.
To help you drive your revenue and utilization, Brighton Health Plan Solutions offers a range of custom programs and reimbursement models. These include benefit tiering, center of excellence programs, on-site services, and other reimbursement models such as reimbursements based on your specific system’s fee schedule.
5. Experience
Direct contracting is a growing trend, but there is no need to settle for less-than-stellar prior experience when choosing a TPA. Work with a partner that has already developed processes that work, is invested in powerful technology, and has a track record of helping their clients increase their revenue and minimize business costs.
Step into the future.
As healthcare costs continue to rise, more and more companies are seeking innovative ways to provide quality and convenient healthcare to their employees. In today’s evolving healthcare landscape, that often means looking at alternatives to private insurance carriers. Working with an experienced TPA that truly understands the pain points of employers and the myriad benefits of direct contracting can open the doors to a growing market for you—and place you way ahead of the competition.
Brighton Health Plan Solutions is a tech-forward, innovative direct contracting partner that brings employers and health systems together to revolutionize patient care. With more than 30 years of experience designing health plans, we eliminate the steep fees and rigid policies of private insurance companies to design direct contracting programs that are a win-win for the health systems and the employers in their area. Are you ready to take the lead? Let’s talk.