The healthcare industry itself is not immune to the challenges of managing health benefits costs for its own workers.
Benefit administrators for health systems are faced with the same challenge that all employers are addressing in 2021 and beyond: how to provide employees with the highest-quality care while optimizing costs and maximizing plan flexibility for both their employees and the organization.
As the cost of healthcare continues to rise, employers – whether they are retailers, financial institutions or hospitals – are finding it increasingly difficult to ensure their associates receive high-quality and affordable care.
A survey in August by the nonprofit Business Group on Health showed that large employers projected their health benefits costs to rise 5.3 percent in 2021, up from the 5 percent increases that large employers projected in each of the last five years.
Third-party administrators (TPAs), which work with businesses to manage an aspect of their administrative services, can address this by empowering employers with a flexible approach to employee benefits to improve access to quality care, achieve cost savings and increase satisfaction.
Health systems must consider a myriad of business factors when evaluating a TPA relationship.
In addition to the increasing costs of employee care, health systems are immersed in a volatile industry environment that’s inclusive of:
- Rising patient care costs
- Tight operating margins
- Reimbursement pressures
- Complex partner relationships
- Moves to new care delivery models that require greater accountability for patient outcomes
At the same time, they are balancing the benefits of new technologies with electronic health record and data management complexities, regulatory issues, aging patient populations with more complex medical issues and highly competitive workforce challenges.
A specialized TPA relationship can address this need for control and customization, and it can respond to differing priorities across the system. From HR and finance to clinicians and business development, each function can realize positive impacts from an effective TPA partnership.
A TPA that is attuned to a health system’s ecosystem can create a flexible approach that empowers unprecedented collaboration and optimized results.
Contigo Health is an organization focused on optimizing care through clinically led partnerships with large, national employers and their health plans. When Contigo Health launched in November 2019, it sought to leverage Premier’s deep relationships and technology assets to create a platform and products that add more value to the healthcare ecosystem. It also sought to bring health systems and self-funded employers together in new relationships, while building a network of provider organizations committed to delivering clinical products for employers.
Contigo Health continues to add new capabilities that adapt to the changing market. Recently, Contigo Health added a Contigo Health Sync Health Plan Administration™ offering that specializes in the development of customized solutions for self-funded health systems and employers.
Two leading healthcare organizations that are working with Contigo Health on their employee health plan administration are Genesis HealthCare System and Western Reserve Hospital.
Genesis Healthcare System is an integrated healthcare delivery system based in Zanesville, Ohio. The system includes a not-for-profit hospital, Genesis Hospital, in Zanesville, an extensive network of more than 300 physicians and multiple outpatient care centers throughout southeastern Ohio. In total, Genesis has more than 3,500 employees.
Western Reserve Hospital serves as one of northeast Ohio’s most advanced community hospitals, dedicated to exceptional patient care and excellence in healthcare services, education, community outreach and the overall wellness of Cuyahoga Falls and the surrounding areas. Western Reserve employs 980 healthcare professionals.
Contigo Health is helping these providers take more control over their self-funded employee health plans to achieve their strategic benefit objectives. Both Genesis and Western Reserve will leverage tools for administration cost reduction, network utilization strategies and population health management.
Since healthcare coverage is one of the key benefits employers provide to employees, its management requires a tremendous amount of thought and consideration.
Healthcare workers are obviously among the most discerning healthcare consumers and look at their employer policies through a lens colored by their profession. It’s no surprise that more than 70 percent of Contigo Health’s TPA customers are healthcare organizations.
Domestic utilization – meaning the percentage of health system employees who go to their employer for their own care – is a critical metric and a particular strength of Contigo Health. By leveraging a health system’s own capabilities, Contigo Health drives further value to the plan financially while providing a superior member experience.
Today's healthcare world is more complex than ever before. Building a self-funded plan requires a TPA partner that will help "uncomplicate the complicated" while facilitating quality care, savings and innovation.
While numerous TPAs exist, health system decision-makers must closely examine the additional value a specialty TPA can offer. An experienced TPA partner understands the complexities of health systems and effectively navigates self-funding design and implementation to realize the plan's full potential across the entire organization.
Contigo Health’s TPA work is redefining health systems' expectations for TPA services with a combination of offerings and continuous innovation. Learn more.