A central theme emerged, at the HCAA Executive Forum: the imperative for TPAs to evolve as a fiduciary-like partner for their groups and their employees. In this dynamic landscape, the call for transparency and control in medical claims and administrative costs has never been louder or clearer.
A New Paradigm for TPAs
In the face of pending nationwide lawsuits, the demand for transparency in the management of medical expenses and associated administrative costs is escalating. Employers and groups are increasingly vigilant about how their funds are utilized, pushing TPAs into the spotlight to justify their operational efficiencies and financial stewardship.
The challenge for TPAs lies in overcoming the opaque practices that have traditionally governed their relationships with vendors, especially in areas like out-of-network (OON) management, reference-based pricing (RBP), and compliance with the No Surprises Act (NSA) or state balance billing regulations. The status quo, where vendors offer scant insights into the handling and outcomes of claims, is no longer tenable.
Technology is the Solution
At Expion Health, we’ve been closely monitoring these industry shifts and understand the urgent need for solutions that empower TPAs with greater control and transparency. To meet this need an ExpionIQ SaaS subscription offers TPAs direct access to our award-winning pricing and analytics platform, providing a level of insight and control previously unattainable. With a volume-based pricing model, ExpionIQ presents a cost-effective alternative to the contingency-based models that have dominated the industry.
A Call to Action for TPAs
The HCAA Executive Forum underscored a shared vision within the industry for enhanced transparency and control. As the realm of healthcare administration undergoes significant transformation, TPAs find themselves at a pivotal juncture. Those forward-thinking TPAs who proactively adapt to change and integrate innovative technologies will undoubtedly secure a competitive edge. Expion Health’s ExpionIQ platform is at the forefront of this transformation, equipping TPAs with the tools they need to meet these challenges head-on.
We invite TPAs to explore how ExpionIQ’s SaaS subscription can elevate their operational efficiency and fiduciary responsibility. By embracing transparency and leveraging innovative technology, TPAs can not only fulfill their obligations to their groups and employees but also position themselves as leaders in a rapidly changing industry.
