Blending Oversight and Empowerment to Maximize TPA Results

This session at the 2017 National Workers’ Compensation & Disability Conference offered a behind-the-scenes look at how to build a relationship with third-party administrators (TPA) that drives claims results.

Speakers included:

• Caroline Burhenne, Regional Client Service Manager, PMA Companies
• Caryl Russo, Senior Vice President Corporate Care, RWJBarnabas Health

To create an effective partnership, both employer and TPA must focus on the following four main areas:

1. Leadership

Set a vision for what you want to achieve and how the partnership looks. To do this, you must create an atmosphere where both employer and TPA is empowered, has influence up and down the organizations, is focused on the right things and is involved in the program on a day-to-day basis. This all must be built around each organization’s’ senior leadership buy-in and both organizations should be accountable for themselves.

2. Framework

No one will achieve desired results without first creating the right framework for the program. Begin with initial account set-up meetings to map out a plan together. Create realistic expectations by determining elements like response time for e-mails/phone calls and scheduling appointments. Establish communication strategies and goals and share organizational charts with contact information for the entire team.

Yearly planning is key to maintain the framework. Conduct yearly kick-off meetings to set goals, conduct checkpoint meetings throughout the year and hold stewardship meetings help you measure results and make improvements.

The employer can help the TPA by educating them on their business needs. This can be achieved by inviting them to onsite meetings and sharing business plans. On the other hand, it is important that the employer understand that the TPA may do things differently and understand why. Micromanaging is ineffective. Set standards and have a discussion about how to achieve results, but be open-minded and willing to set up different systems for elements like loss reporting procedures and early intervention.

3. Empowerment & Unity

To create an empowered, unified team, you must start with establishing values (personal, professional and organizational), then collaborate to develop goals and strategies that support those values. This is how you instill a sense of accountability in the team as well.

It is important to remember that power and reciprocal trust lead to pro-active behaviors that improve day-to-day work practices leading to organizational efficiencies. Empowerment comes from explaining the “why”. Show what the dollars mean to your business, help them understand the goals and enable them to aggressively manage to achieve them.

4. Communication

Weekly calls are essential because they keep the team focused. If you do not make time for these, you will spend more time later. These calls are the opportunity to review status and take action.

It is also important for the employer to connect with the TPA account manager. This individual is a critical peer with whom you must foster an open dialogue to share ideas and aspirations.

Finally, you cannot measure results without communicating the data. The TPA should send data monthly, then set up monthly meetings with senior management to identify and discuss trends.