June 10, 2024

As if it wasn’t challenging enough to offer a health plan that meets the needs of your employees and your budget, CEOs, CFOs, CHROs now face heightened scrutiny due to The Consolidated Appropriations Act (CAA) of 2021, which mandates transparency in employee health benefit plans. Coupled with rising costs and a complex health care system, working with the right partner to help manage your employee health insurance is more important than ever. Fortunately, one valuable way to evaluate the performance and quality of a third-party administrator (TPA) or other health care vendor is to look for an organization with demonstrated third-party validation for various service delivery functions. Using the example of a TPA, like Nova, this means that an independent organization has verified the accuracy, efficiency and compliance of the TPA’s services such as claims processing, customer service, compliance, and reporting.

Wondering what to look for? While that may depend on the services you are seeking, examples include validation for clinical protocols and commitment to quality health outcomes through an accrediting organization like URAC. Employers who earn “Best Place to Work” awards have an additional focus on their own employees; research shows that engaged and satisfied employees equates to less turnover, which provides greater continuity in service to clients and their members.

The Validation Institute is another entity that analyzes a TPA’s results in population health management. Here is what a validation in common chronic condition management signifies:

1. Efficacy Confirmation: The validation serves as external confirmation of effectiveness in managing common chronic conditions. This reassures employers that a TPA’s medical management strategies are proven to drive measurable improvements in health plan trends, ultimately leading to better health outcomes for members.
2. Cost and Risk Management: The outcomes and savings claims of a validated TPA have been rigorously reviewed and validated by an independent organization. Knowing a TPA has the expertise to optimize health benefits while controlling costs is crucial for employers seeking to provide quality benefits while managing expenses.
3. Member Health and Satisfaction: A consistent achievement of measures like below-average hospital admissions and emergency room visits for chronic diseases suggests a focus on member health and satisfaction. Employers can expect that the TPA’s programs prioritize preventive care, early detection, and appropriate treatment, leading to healthier and more satisfied employees.
4. Long-Term Partnership Potential: Employers are likely seeking a TPA that can provide long-term, sustainable solutions for their health benefit needs. A TPA or other organization with a track record of validation over the course of multiple years indicates a commitment to excellence and ongoing improvement, making them a reliable partner for employers looking for stability and innovation in their health benefits management.

Looking for a TPA with experience and verified results for their customer and client service, medical management programs or even their culture as an employer can help affirm they are a good partner to work with. Award-winning TPAs have earned their accolades for a reason—they excel in navigating the complexities of the health care industry. With a wealth of experience, these administrators bring unparalleled expertise to the table, ensuring that your employee health plan is not just managed but optimized for both cost-efficiency and comprehensive coverage. By partnering with a TPA that has proven its excellence and integrity, you can rest assured that you are offering your employees the best benefits experience, and that you are getting the most value out of your investment. With more than 40 years of experience, Nova’s awards, accreditations and validated results speak for themselves.