3 reasons why TPAs need healthcare navigation to contain costs

August 8, 2023
Amino Health

Healthcare is expensive for everyone. How many people do you know open a letter from their mail and are shocked about a high-cost healthcare bill they received? Unfortunately, more than half of Americans have experienced this.

Increasingly, self-insured employers are looking to their third-party administrators to help contain costs. Here are three ways healthcare navigation can help TPAs save their clients money without compromising member experience or quality of care. 

Improve access to in-network and preferred providers

Many people simply don’t know how to find in-network care or utilize direct contracts and other plan initiatives made for their benefit. They often rely on word-of-mouth referrals or look to subjective review sites like Google or Yelp to find care, without regard for whether the referral is best for their unique plan design. 

Some members know to reference a provider directory for help. Surprisingly, even when members rely solely on the information in a provider directory for healthcare decisions, they are still likely to go out-of-network. Unfortunately, provider directories are frequently inaccurate, show outdated information, and are unable to configure to unique plan designs, so they don’t always serve as the trusted source they’re made out to be. In the case of mental health, patients using their provider directory were twice as likely to go out-of-network and four times more likely to get a surprise bill. 

Healthcare navigation platforms make finding care simple and direct members to the right care for their plan design. 

Provide healthcare cost transparency

The price transparency of medical services and products is key to containing costs. A benefit of many, but not all, healthcare navigation platforms is the insight they provide into the cost of care, helping members to understand that widespread variation exists within the system, even if a member stays in-network. Depending on the navigation platform you choose, you might also give them access to additional information they need to make an informed decision about their care, including:

  • Quality of the provider
  • Location of the doctor
  • Scheduling assistance

In an effort to encourage more price transparency in healthcare, the U.S. government passed the Transparency in Coverage (TIC) Rule, which federally mandates greater cost transparency from healthcare providers and insurers. Many self-insured employers have looked to their TPA to ensure their compliance. With different parts of the Rule being enforced in 2023 and 2024, many TPAs are turning to navigation platforms to satisfy the regulatory requirements so that they don’t have to build these compliant solutions on their own. 

Guide members to point solutions

Point solutions are a convenient way for employers and health plans to fill gaps in the benefits they provide to members and help deliver a comprehensive and personalized program. But unfortunately, 95% of members are not using the digital health solutions available to them. 

This means that, despite the outreach programs a point solution vendor might have to drive awareness of their offering, there remains a disconnect in the moments that a member searches for care. Certain navigation solutions solve for this. By integrating with the point solutions that employers have made available to their members, these platforms can surface the ones relevant to a specific search query. 

Not only does this help members leverage their available benefits, but it also helps employers maximize their existing investments in point solutions. Offering this as a feature to employer clients is a great way for TPAs to differentiate themselves, provide better support for clients, and offer more cost-saving services.

Contain costs with healthcare navigation

To win in a competitive market, TPAs must contain costs for clients and members alike. Engaging with a healthcare navigation platform offers a unique value proposition with employer groups that want to improve member satisfaction and decrease costs. 

Amino Health is the leading data-driven healthcare navigation platform. Not only does Amino offer price transparency and integrate with point solutions, but members utilizing this service are three times more likely to choose providers who are in-network, provide quality care, and are the most cost effective.

Download Discover the best way to contain costs for your clients eBook to learn more ways TPAs can save clients money and improve care outcomes at the same time.

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