Does Your TPA Offer a Custom Solution?
Apr 07, 2020
3 min read
The cost of healthcare continues to increase at an unsustainable pace, but growing price transparency is showing that employers could improve their health benefits solutions. Employers who self-insure have access to more information about billed costs and, as a result, have more opportunities to redesign their health benefits.
But they need health benefits brokers who can deliver solutions that address key employer concerns. Delivering those solutions can be tricky, because there’s no one-size-fits-all solution for employer health benefits. Every employer is different, with its own set of circumstances and unique needs.
The right third-party administrator (TPA) can deliver innovative benefit solutions that are customized to the needs of each employer, making it easy for your clients to access cost control opportunities.
At Lucent Health, our solutions are both cutting-edge and completely customizable. If something is not working for a particular employer, we can change it. It’s our job to continually evaluate next-generation cost control programs. Consider these four ways Lucent Health sets itself apart from the competition.
- Size. With offices across the country, Lucent Health serves employers and employees nationwide with self-funded health plans that reduce costs while improving the member experience. Lucent Health has 400 employees serving more than 3,000 employers and 250,000 members nationwide.
- Scale. Backed by a data-driven platform, Lucent Health’s care teams are experienced at helping members manage their episodes of care and holding down employer spend. Lucent Health drives savings of 25% to 30% in year one, then stabilizes the cost of care year over year. Lucent Health’s track record is holding member costs at 53% below the national average.
- Integrated care management. The best self-insured health plans combine strong data and a knowledge of how to use that data to better control costs. At Lucent Health, we receive daily data reports for covered members, which means we’re notified within 24 hours of a claim being filed about any potential medical condition. We reach out to the individual as soon as we’re notified, offering care and support for every decision. By integrating care management into every step of the healthcare journey, we help create better outcomes, mitigate risk, and control overall costs.
- Reference-based pricing (RBP). RBP can be an ideal pricing strategy for self-insured health plans to cut costs and provide members with the freedom to choose their own providers. Most RBP plans establish agreed-upon pricing with providers in advance, at a standard such as 1.4 times Medicare reimbursements. That is significantly lower than the standard payment to a private insurer: On average, private plans pay 241 percent of Medicare, one study shows. However, when chronically ill or uninformed members use healthcare more than necessary, the costs can still add up.
That’s why Lucent combines RBP with detailed pricing information and ongoing support for members as they make healthcare decisions. Research shows that when employees have more information about cost and quality, they will search out the least-invasive and least-expensive option. A 2019 partnership with Zelis enables Lucent Health to boost its ability to deliver the largest number of RBP contracts (more than 1.4 million) and a team of 30 handling back-end balanced billing resolution.
In our own research, brokers tell us they expect a TPA partner to provide a solution that is innovative, integrated and human. At Lucent Health, we provide solutions that meet all three criteria and can be the hub around which your clients’ healthcare plans revolve.
To learn more about Lucent Health’s solutions, visit https://lucenthealth.com.