The Value of Integrated Care
by Scott Geyer, SVP, Client Services
Timely, accurate administration of claims is a minimum expectation of a TPA. But plan sponsors today need more than timely and accurate. They need cost reduction strategies that apply to their specific group and deliver good clinical outcomes with high member satisfaction. As one of the largest TPAs in the country, with over 500 clients, we process $6 billion of health encounter claims every year. Every one of those encounters creates a data touchpoint.
It’s well established that a small number of members typically accounts for a disproportionate portion of total health benefits spend. Severe, chronic and rare conditions account for the disparity in cost. Plan sponsors point to oncology, peri-natal cases and dialysis as common drivers of higher costs. Conditions like these often require multiple hospitalizations, consultation with multiple specialists over the course of care and treatment with new classes of specialty drugs that come with hefty price tags.
Any TPA can process the claims that come in as members seek care for these maladies. Plans that contract out Utilization Management can see some incremental benefit from ensuring that the care being provided is medically necessary and delivered by credentialed providers. There are an endless number of PBMs in the market, each claiming to produce cost savings via negotiated discounts, rebates and other strategies.
We have clients who purchase claims processing, Care Management and PBM services separately, and in those cases, there is often segregation of data and delays in data sharing between major service lines. And we deliver those services in an efficient manner that creates value for the clients and their members. But the many clients who engage with us on all three of those service lines also benefit from the synergies that result from an integrated, data-driven, clinically informed platform that brings the best of those disciplines to bear.
The result? Lower overall costs and very high client satisfaction. The three-year cost trend for our clients who use our integrated claims management, care management and pharmacy benefit management services is 6.9 percent, compared to the overall industry combined medical and pharmacy trend increase of 19.7 percent for the same time period. And clients are very happy with our integrated approach. In our 2021 satisfaction survey, clients gave us a Net Promoter Score of 71
, which ranks us in the top 1 percent of health plans!
If you have a client challenged by high-cost medical and pharmacy spend from a membership that is demanding better coverage at lower costs, our integrated care solution may be just what the doctor ordered.
About the Author
Scott Geyer was named Senior Vice President of Client Services for HealthSmart in 2019, with overall responsibility for HealthSmart client relationships.
Scott’s entire career has been focused on client service, beginning in 1997 with Wells Fargo Insurance Services as a customer account manager, claims supervisor and account executive. He had 15 years of service with Wells Fargo when it was acquired by HealthSmart in 2012. He continued his role with HealthSmart as account executive, soon being promoted to senior account executive, Vice President of Client Services, and most recently, Senior Vice President of Client Services. In all, Scott has been serving our customers for more than 23 years.
Scott holds a Bachelor’s degree in Social Science from the University of Charleston.