How To Select a Third Party Administrator CapabilitiesCost Service Model Jerry L. Ripperger, Director – Business Development Registered Representative, Princor Financial Services Corporation

How To Select a Third Party Administrator Capabilities

Consulting Behaviors Benefit Structures Budgets

Benefit Design

Continuum of Care

Integration Data Integration –Medical claims –Pharmacy claims –Wellness assessment data –Biometric data Program integration –Proactive referrals –Bi weekly “grand rounds” Process integration –Care management and claims management –Health summary record

Incentive Plan Personal Improvement Population Improvement Outcomes Reporting Participation Tracking Communications Plan INDIVIDUAL ACTIVITIES Preventive Screening Health Coaching Wellness Assessment Seminars Challenges Campaigns Wellness Committees Local Events ORGANIZATIONAL ACTIVITIES Wellness Strategy Wellness Programs

Communication and Education

Consumer Driven Healthcare Health Reimbursement Arrangements (HRA) High Deductible Health Plans (HDHP) Health Savings Accounts (HSA) Health Flexible Spending Accounts (FSA)

Comprehensive Reporting Access –On-line 24x7 –In print Breadth of reporting –Financial –Clinical Depth of reporting (drill down capabilities) Ad hoc capabilities Reporting Analyzing Consulting

Stop Loss Preferred carrier relationships –Benefit and provisional match –No audit guarantees (“pay as we pay”) –Expedited reimbursement –No laser guarantees Breadth of options –Paid In/Incurred In Run in Run out –Terminal liability options

How To Select a Third Party Administrator Capabilities Service Model

Implementation approach Employer service team –Account management –Dedicated/Named –Local/Remote Participant service team –Claims –Benefit questions

Service Model Hours of operations On line capabilities Interactive voice response capabilities Tenure of staff Results –Turnaround time –Financial accuracy –Procedural accuracy

How To Select a Third Party Administrator Capabilities Service Model Cost

Claims costs –Provider networks –Pharmacy benefit management Administrative costs –Third party administration –Stop loss

retail Provider Networks Preferred provider organizations (PPO) –National –Quilted Wrap networks Supplemental networks Fee negotiation services

Pharmacy Benefit Management Brand and generic discounts –Retail –Mail order Convenience/locations Formulary Rebates Administration (fees, claims, and reporting)

Third Party Administration –TPA generate revenue from several sources –Most fees will be on a Per Employee Per Month (PEPM) –Other explicit fees may be stated as Percent of savings Per hour Cost plus –Other fees are implicit Administrative fees from vendors (such as disease management) Pharmacy revenue –Rebate capture –Discount Capture Should be fully disclosed to the client

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