SIIA SELF INSURED WORKERS COMPENSATION EXECUTIVE FORUM 2014

Transcription

1 SIIA SELF INSURED WORKERS COMPENSATION EXECUTIVE FORUM 2014 Taking Your TPA From Good to Great Wednesday May 21, 2014 Miami Beach, FL Barry D. Bloom Principal The bdb Group 1

2 Quotes from a Genius We cannot solve our problems with the same thinking we used when we created them. Insanity: doing the same thing over and over again and expecting different results. Albert Einstein Claim Program Blueprinting Bring in all of the constituents that touch the program (HR, Legal, Finance, Risk, Operations, etc) Define the key characteristics of the program (Claim Intake, Clinical Management, RMIS & Data Management, Claim Management & Financial/Statistical Analytics) Senior Executive sponsor, sign-off, endorsement & execution authority 2

3 Pushing the Marketplace vs. Pulling from the Marketplace Present your customized program to the selected marketplace in person - no traditional written RFP Solicit customized non-boilerplate proposals Invite the top 3-5 proposers for oral presentations Develop a customized and objective scorecard How to Find the Right Claim Partner(s) Look for a true business partner - not just a claim handler Insist on a shared & keen understanding of the business Match your needs to your partner s strengths (regional configuration or technical discipline expertise) Only do win-win arrangements 3

4 The Best Way to Fail in Your Claim Programs Penny-wise & Dollar-foolish One Dollar s worth of services for Eighty Cents Be general and non-specific Don t measure results Review your program once a year Don t reward performance Full Cost Benchmarking Properly define ALL costs benefit and claim payments administrative and program costs collateral expenses (overtime, temporary personnel, lost productivity, etc) Capture and analyze disparate sources of data (claim, absence and medical data) Intra-business and Industry sector comparative analyses & studies 4

5 Key Performance Indicators (KPI s) & Incentive Programs Use objective measurements to monitor and prioritize program performance Define the key characteristics of the program that you want to emphasize Select a limited number (3-7) of KPI s which can be objectively measured (data accuracy, staff turnover, customer satisfaction, etc) Consider the unintended consequences Celebrate the payouts and the successes The Best Plan is Still Just a Plan: Execution & Oversight No successful program runs on it s own Develop a comprehensive Oversight program: claim reviews and audits KPI s scorecards Annual Executive Board meetings Stewardship reports for senior management 5

6 Keep Your Perspective: Claim Administration Costs vs. Claim Costs Claim/Program costs are only approximately 20-33% of Total Costs Claim Administration costs are only approximately 10-22% of Total Costs You truly do: Get what ya pay for The moral of the story: Do NOT buy on price!! Data Data Data: It s What Drives Everything Develop a Data Blueprint Collect as much relevant data as possible from all of the necessary disciplines (Risk, HR, Finance, Operations, Claim/Medical, etc) Stop paying for and/or receiving useless RMIS reporting Analyze the data to develop actions and strategies that reduce overall costs and increase quality & satisfaction Data Warehouse 6

7 Claim Program Business Decisions: ROI Analyses Never make a good claim decision that is a bad business decision All claim program designs and characteristics should be fundamentally supported by ROI Analyses Define program performance results in terms of business metrics ( Heinz Ketchup, Delphi Components or Roadway Express M pounds ) Engage Operations into the program results 7