Crawford mpany : How strategic risk managers build effective TPA partnerships

As a risk manager, you're used to uncertainty. It's part of the job. And if you consider the uncertainty inherent in the macro business environment itself, it may feel like the odds are stacked against you.

The mix of challenges you face is becoming more complex. Rising medical costs, comorbid conditions, mental health exposure… There are endless factors you consider when making decisions. Those are just the ones we know and can expect. What about the surprises, such as a global pandemic?

If the COVID-19 pandemic has taught us anything, it's that the world will continue to change at an unexpected pace. Situations like these only add to the uncertainty for risk managers and create more questions than immediate answers. It also highlights the need for new, unique solutions to achieve optimal outcomes. So where does the TPA fit in?

Strategic risk managers understand the old way of working with a TPA as a reactive, task-driven workhorse is antiquated. They look to their TPAs for integrated, strategic solutions to help declutter and resolve the situation, no matter how big or small. From problem to resolution, here are three practices you can put into place to help you see the benefits of a true partnership.

Embracing open communication with a focus on goals

The most fruitful partnerships are rooted in two-way, intentional communication, paired with a relentless focus on goals. A consultative problem-solving process should be baked into the DNA of the relationship, and include the right mix of key contributors such as data scientists, claims professionals, medical management, and key stakeholders within your organization or risk program such as brokers, carriers and consultants. Through asking the right questions and receiving feedback, your TPA can help make informed decisions, establish the right KPIs based on a deep understanding of your unique challenges at hand, and even help solve some problems you may not have noticed.

A mutual understanding of your goals is critical to long-term success. At Broadspire, Mark DeLew, VP of Consultative Analytics frequently prompts these conversations with clients. 'You don't want to start putting data analysis and solutions into action only to find that you haven't been working toward the right goals,' DeLew said.

'We listen and learn what the client wants to achieve ahead of time, and then match the analysis to meet those goals.' Collaborating on the right solution for a specific challenge

Since one size does not fit all, the next step in the process is creating or matching a solution to your needs or the problem at hand. For the TPA, this involves identifying what service capabilities, technology, tools, and data will be the best fit, then collaborate with you to create the ideal solution. It must be sophisticated enough to account for a variety of scenarios and factors, but also simple and usable enough to add true value.

The right solution can be as simple as providing a specialized tool or set of reports that can look at data in a more useful way. This is true for the tool Mark DeLew's team developed to help clients see the financial impact of COVID-19 claims. Alternatively, the solution can have a much broader scope. On the claims side, Jeff Sickles, Broadspire's Chief Claims Officer, uses data from the analytics for high-impact changes at scale. 'We've taken that data and made changes to programs to effect change and get better results for the client,' Sickles said.

Implementing, learning and adjusting on the path to success

A solution to your problem is only the beginning. An understanding and expectation of agility is a key tenet to custom-developed solutions. Over time, new information, feedback, and shifts in priorities and mindset will come in. Whether it's the development of a single tool or a program change, an agile team will be able to make the timely, necessary adjustments to achieve the right fit and lead you to success.

'Clients may have a goal they're focused on, and then something changes internally - they revamp how a program is run; hire on a new CEO or CFO; they want to implement a new approach to claims. And so, the client is going to need a TPA that has the resources to shift,' DeLew said.

If you would like to learn more about how Broadspire approaches strategic partnerships, you may enjoy this on-demand webinar. We take you through an actual project developed during COVID-19. Here, you can gain actionable insights about how to establish strong partnerships through technology, communication, and effective, agile solutions.