A Hands-On Guide to Working Effectively with Your TPA

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By Constitution State Services
5 minutes
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Strong relationships are key to effectiveness and over time become the reason companies continue to work together. A weak working relationship with your third-party administrator (TPA) may often appear as a series of frustrations that can indicate a broader and more fundamental set of issues.

The opposite is true, too. Rewards increasingly flow to those teams who build the most effective working relationships with each other. Frontline team members can feel free to do their best work and the environment can allow them to be nimble, creative and responsive. The best way to view your TPA is not so much as a separate entity, but as a trusted advisor to your organization.

You can benefit broadly from the expertise of your TPA's staff. For example, when you take advantage of your TPA's data consultant, you can improve your understanding of relevant trends. Is your data telling a cautionary or predictive story? Because there can be a lot of noise within data, it's important to dig deep before taking action. At Constitution State Services (CSS), your Risk Management Information System (RMIS) data consultant can create meaningful reports to help you monitor trends throughout the year.

Another great advantage to make the most of is when your TPA is able to blend digital self-service capabilities while encouraging appropriate in-person medical treatment. For this, CSS embraces CustomCareSM to provide a personalized experience for injured employees, enabled by self-service capabilities, while also encouraging the appropriate medical treatment and maintaining oversight over key claim milestones.

Get a head start on building strong relationships

“At Constitution State Services, we know that strong working relationships with our client organizations stem from creating a unified mission,” said Todd Mattiello, Vice President, Claim Account Executives at Constitution State Services (CSS). When your organization and its TPA come together to form a common strategy, the best possible claim outcomes are more likely.

According to Mattiello, a shared understanding is critical. "This means an important first step is confirmation that your TPA knows your claim management objectives, and then set goals for how you'd like your TPA to work with you to achieve them," said Mattiello. "At CSS, we really believe establishing that clear understanding leads to more success."

Establish a unified mission

Here are several ideas on how to get started on establishing a unified mission – and what you can expect from CSS:

  1. Mesh your risk management team's expertise with the expertise available through CSS. There's a wealth of digital resources at your fingertips. Getting the most out of this information involves knowing where to access content and how to effectively apply that guidance to your situation and objectives.
  2. Form strategic relationships among leaders within each organization that go beyond one to one. Clear messaging starts at the top and filters down through the balance of your organization, and loyalty builds over time. "When there are strong day-to-day working relationships, the job is fun because both sides are on the same team. The best relationships are the ones where together we are accomplishing the work and when it works, it works extremely well," said Mattiello.
  3. Blend the end goal with the journey along the way. Don’t forsake the periodic processes and procedures needed to make progress. In addition to regular meetings, be flexible enough to meet whenever needed and make sure your managers have open pipelines to the resources and data they need to make decisions.
  4. Stewardship happens throughout the year and is not just a one-day event. Always be on the lookout for what works well and what doesn’t. Bring to the table the best of what you have and discuss any upcoming challenges that you will tackle together with your TPA.
  5. Leverage data and analytics. Leverage the insights you’re getting from your TPA, as well as their expertise and awareness of what the data means and which trends to pay attention to. Your TPA’s Risk Management Information System (RMIS) should have broad data and analytics capability to identify trends, and assess claim costs and activities easily.

Keep track of resources and use them

Here is a detailed list of resources to look for from your TPA that are available through CSS:

Expertise and experience

  • Staff experience
  • Staff training
  • Claim process systems
  • Data analytics and predictive modeling
  • Industry knowledge
  • Thorough investigations

Customer experience

  • Claim acknowledgement
  • Mobile communications support
  • Call centers - 24/7
  • Investigate capabilities
  • Accident reconstruction

Litigation management

  • Litigation management guidelines
  • Established external counsel relationships

Employee experience

  • Empathy training for our employees to assist injured employees
  • Temporary transitional duty (funded employment)
  • Return to work

Medical management

  • Nurse triage
  • Nurse case management

Medical peer review

  • Pharmacy review
  • Evidence-based guideline review
  • Medical bill review
  • Preferred provider networks (PPNs)

The importance of ongoing evaluation

Regularly evaluating how the relationship is working can be beneficial for both your team and getting the most out of your TPA. Mattiello recommends these four categories for regular evaluation:

  1. Expertise and experience. Managing risk is a dynamic process, with TPAs often adding new capabilities. The first order of business might be a review of how new tools might help mitigate medical expenses or litigation costs.
  2. Customer experience. As a customer, it's important to provide input on whether expectations are being met. Your CSS Claim Account Executive will lead the way with your team.
  3. Medical management. Post-injury medical care accounts for a large piece of total claim spend. Make sure you’re benefiting from provided services. For example, CSS provides the Early Severity Predictor®, which identifies injured employees at risk for developing chronic pain so we can work with medical providers to develop an alternative, medically appropriate, treatment regime to avoid this outcome.
  4. Litigation management. Sidestepping the possibility of high-profile and costly verdicts helps contain the cost of litigation. Stay up to date on comprehensive litigation strategies. CSS uses advanced legal analytics to lead in this arena.

Build a strong relationship over the years

By leveraging the expertise of your TPA, you're adding an invaluable resource that can support and bolster the efforts of your internal team.

“At CSS, we want our customers to optimize the value we bring to the relationship. We’ll keep front and center the topics of interest and available services that matter most – many of which can’t be duplicated by our peers in terms of breadth and quality. We will share our latest thinking and recommendations, including actions to take,” said Mattiello.

As your TPA, CSS provides a prompt, focused response to claims. Working collaboratively with your team, we leverage our national scale and technical expertise. State-of-the-art technology, data analytics and continuous training empower our Claim professionals to handle claims with proficiency and integrity, and to deliver the best possible outcomes.

Find out more about forming an invaluable relationship with CSS today. Contact a CSS representative today.

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