Friday, May 17, 2024

Brief Blog: An Updated View of Third Party Administrators and Pitching Innovation (TPA/ASO)

Much health insurance is directly employer funded, through systems called "administrative services only" ASO or "third party administrators" TPA.   In a new podcast (transcript also available), Elizabeth Mitchell of PBGH, Purchaser Business Group on Health, discussing how this approach to health benefits could be improved.   

She's interviewed by Stacy Richter for the Relentless Health Value podcast (Ep. #436).  Find a summary, a transcript, and the 40 minute podcast here:

Note that TPA/ASO employer funding falls under ERISA benefits, and so escape most state insurance laws (such as new state biomarker laws - here).

Are employer-driven (ASO) plans a good place for you to market innovation?


AI Corner

A ChatGPT4o Summary.

In episode 436 of the podcast "Relentless Health Value," Stacey Richter interviews Elizabeth Mitchell from the Purchaser Business Group on Health (PBGH). The discussion centers on the inertia present in the healthcare system, specifically related to third-party administrators (TPAs), administrative services only (ASOs), and health plans, and how they impact jumbo employers.

The episode highlights the following key points:

Role of TPAs and ASOs: TPAs and ASOs often act like full health plans, which is not what self-insured employers always need. This leads to additional charges for services that may not be required.

Market Gaps: There is a need for independent TPAs that are not owned by health plans to provide more transparent and efficient services. The acquisition of TPAs by health plans often leads to a lack of true independence and transparency.

Inertia in the System: Despite the challenges, some jumbo employers are taking proactive steps, such as direct contracting with providers, to improve healthcare access, quality, and outcomes. This approach can result in significant cost savings and better care.

Transparency and Accountability: The conversation emphasizes the need for transparent pricing and data sharing between health plans and employers. Federal actions like the Consolidated Appropriations Act (CAA) aim to enforce this transparency.

Direct Contracting: Direct contracts between employers and providers are becoming more common, leading to better alignment and improved healthcare delivery. This bypasses some of the inefficiencies and costs associated with traditional health plan administration.

Challenges and Opportunities: The episode discusses the resistance from health plans to adapt to employer needs and the importance of finding aligned partners who prioritize high-quality care. There is also a call for new market entrants to provide transparent and responsive TPA services.

Mitchell concludes with the interview for greater accountability from health system and health plan executives and emphasizes the importance of collaboration between employers and providers to drive better healthcare outcomes.