Sponsored Content byMaestro Health

Self-funding is nothing new. In fact, it has been around fordecades. Until now, third party administrators (TPAs) have proventheir value through fast and accurate claims administration, customplan designs, and cost management tools. However, when traditionalself-funding services are combined with today’s leading technology,this intersection createsunprecedented opportunities for both brokers and employers.

Self-funding has been growing in popularity as a result of itsmany benefits, including the fact that ERISA exempts self-fundedplans from state insurance laws, including reserve requirements,mandated benefits, premium taxes, and consumer protectionregulations. In a December 2015 third-party research study byMaestro Health, over 80 percent of brokers agreed that their firmwas increasingly advising clients about self-funded health plans.

Likewise, much-needed technological advances have been sweepingthe entire health care industry. Private exchanges, onlineenrollment and a wave of benefits administration and other HRautomation like PPACA compliance have dominated thespace in recent years. “Automated PPACA reporting is the mostimportant feature when looking at technology solutions. This iswhere they bring the most value and will continue to in comingyears,” said a broker participant surveyed in the 2015 study.

At the same time, over 50 percent of HR professionals say theirspending on new technology grew from 2014 to 2015 according to asurvey by Human Capital Media Advisory Group.

The reason for the proliferation of self-funding and innovationsin technology is no mystery: Health care costs continue toskyrocket for employers while PPACA has created a heavy reportingand compliance burden. As expected, employers are seeking modernsolutions for their modern headaches. When searching for a “newage” medical TPA, what should employers and brokers lookfor?

1. Start with the basics. If a TPA can’tprocess claims accurately and efficiently, leverage years ofexperience in custom plan design, or provide quality service andsupport, then even the best technology means next to nothing. Thesetraditional TPA services must come with provenexcellence.

2. Seek innovative leaders. Once a TPA showsthat they can handle traditional services, then look at whatthey’ve done to keep up with today’s dynamic employer needs. Dothey offer online enrollment solutions, dashboards for HRadministrators, or advanced data analytics and reporting? Theseexamples of advanced technology will provide enhanced value toemployers in the form of personalization of plan designs, more costcontrol measures and better experiences for both employees and HRadministrators.

3. “Right-size” your TPA. Essentially, thereare three types of TPAs. On one end of the spectrum, "monster" TPAslack capabilities to truly customize solution and often havedifficulty offering personalized service. On the other end of thespectrum, "mom and pop" TPAs lack the latest technology, ability toscale, and capacity to evolve with a business. The ideal sweet spotis in the middle, with a “tech-meets-service” TPA who combinesflexibility with customization and integrated technology.

4. Go beyond enrollment. A self-fundedtechnology platform should go beyond an attractive front-endinterface and simple enrollment experience to contain resourcesthat empower all parties (broker, employer and employee) tosimplify, personalize and optimize their benefits experiencethroughout the other 364 days of the year as well.

5. Integrated health and wellness. A TPA thatcan offer comprehensive health and wellness programs on top ofclaims administration will be able to take analytics to the nextlevel. This provides for a more holistic view of each member’swell-being, allowing for quicker identification of at-riskemployees. What automated process is in place for flaggingat-risk members? This ability to takemeasures that are personalized to each employee’s health historywill lead to healthier populations and lower costs.

6. A self-funded private exchange. With theright partner and strategy, self-funded employers can gain thevalue of a private exchange without having to move to a fullyinsured model. This integration will drive heightened employercontrol, cost savings, hyper-personalization, deeper data insightsand optimized employee and HR experiences.

While self-funded insurance and modern technology trends are notparticularly groundbreaking in and of themselves, theirintersection presents unique opportunities to thrive in the modernworld of healthcare for both employers and forward-looking brokersalike.