The Right to a Transparent ASO/TPA
We all know that the current construct of ASO/TPA contracts
allows for proprietary contracts to be written between the
ASO and provider. Contracts that shield the QWBP from
conflicts of interest. According to ERISA, Plan Assets should
never inure to the benefit of the employer.…nor should they
inure to the benefit of the TPA/ASO. A transparent model, if
the proper risk management platform is utilized, can deliver
additional savings of 20% to 30% for the self-insured client.
The Right to a Transparent PBM
As with the TPA/ASO model, PBMs provide a myriad of
hidden contracts, rebating and true pricing information.
This opaque system raises costs 5-15%. Employers have a
right to lift the veil on any transaction. They should have a
right to see all the components of PBM pricing.
The right to have policies and procedures in place to
mitigate certain risks that could result in overpayments on
member medical claims.
This can only occur with a transparent model! Employers
should be able to monitor and measure to drive continuous
improvements where needed.
The right to own your own data and have access to your
own data in real time.
You should never have to arm wrestle your “clerk” for data
that you own, after all, you are self-insured! Delays,
truncated and missing data are unacceptable.
The right to hold service vendors accountable and to
independently audit SLA’s.
The technology is available to enact this objective, the
decision to act is yours.
The right to measure for ROI and to drive continuous
improvements and efficiencies where needed.
If you can’t measure it how can you control it? You have the
right to robust data and the right to monitor and measure it.
This is the engine that drives accountability and continuous
The right to expect integration across vendor relationships
to achieve economies of scale and compliance
Information is power. It should be intelligent and
streamlined to avoid duplication of processes. The goal is to
integrate and promulgate like data feeds. HR functions
should be “point and click.” Additionally, end users should
be able to access and navigate a user friendly technology
platform to ease enrollment and find pertinent information
in regards to their health plan information.
The right to equip your employees with the tools to make
informed choices and drive efficiencies so they can focus
on delivering your value proposition.
Contact us today to learn more about the newest
technology platforms …from Wellness Programs and
Medical Concierge to Telemedicine.
Ask us about our newest service offering “Plan Asset