Third-Party Administration: A Catalyst for Healthcare Change

Technology, personalization, compliance, data security, and value-based care are revolutionizing health insurance third-party administration and helping to enhance everyone's experience.

Fremont, CA: Third-party administrators (TPAs) are increasingly vital in managing healthcare benefits and services within the evolving health insurance landscape. They liaise between insurers and policyholders, providing various services, including claims processing, customer support, and network management. The healthcare industry faces numerous challenges and transformations; however, several key trends are shaping the future of TPAs, influencing their operations and the value they deliver to insurers and policyholders.

Healthcare sectors leverage technological advances, including AI, machine learning, and big data analytics. There is a high-efficiency improvement, reduced errors in claims, and better information services for clients through the use of AI-powered chatbots and virtual assistants in customer service channels. Technological change remains critical to the development of the insurance sector because it accelerates the trend toward individualized experience in healthcare. To enhance member engagement, health outcomes, and healthcare costs, personal health management programs comprising wellness programs and chronic disease management are being increasingly introduced by TPAs in the form of health data analytics.

The healthcare industry is highly regulated, with myriad rules and regulations under the ACA, HIPAA, and other federal and state laws. The TPAs must comply with all these regulations while keeping their clients compliant. To fight this challenge, TPAs are now investing in compliance management tools and expertise to reduce all non-compliance-related risks. This will protect the TPAs and their clients from litigation due to their actions and enhance mutual trust and credibility among them for the services offered. Today, the importance of data security and privacy has never been more relevant than it is today.

Digital health records and telehealth services increase the risk of data breaches, and thus, TPAs deal with bulk sensitive patient information, requiring appropriate cybersecurity technologies and protocols. To curb this trend, TPAs have increased investments in advanced cybersecurity technologies and protocols that safeguard data against unauthorized access and protect patient privacy. This proactive posture goes further to support the maintenance of compliance with regulations while developing client and member confidence in information safety. Another key trend impacting the TPAs involves a move towards value-based care.

The healthcare system is now moving towards a value-based care model, in which there is an emphasis on optimization of health outcomes, patient satisfaction, and control of costs. Third-party administrators are introducing data-driven solutions for measuring and reporting those factors. Such collaboration with providers will help TPAs advance health outcomes and support insurers in cost management. COVID-19 continues to reshape the TPA landscape; hence, the telecare management capabilities and the process of claims handling must increase during crisis periods. This change requires administratively agile and responsive services in crises. Health insurance packages are changing due to technology, individualized care, compliance requirements, data security concerns, and value-based care.