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MediBid Supports TPAs in Their Mission

TPAs (or Third-Party Administrators) serve a valuable role for employers utilizing a self-funded plan, offering critical compliance, adjudication, claims eligibility and claims processing services. MediBid offers a transparent, detailed medical bidding platform that leverages reference-based pricing and direct contracting, and bundled case rates to bring costs down, which compliments the activities of a TPA.

How do TPAs and MediBid fit together, then? As partners in developing creative plans. Plans that employers appreciate for their cost containment potential, and plan members appreciate for their value.

 

RBP Without the Balance Billing

Reference-based pricing is an approach that TPAs favor, and for good reason. When an RBP is built carefully, it will reduce employer costs considerably – up to 65 percent in some cases. RBP provides patients with value and the freedom to see the provider they wish.

There is a lingering concern regarding RBPs, in the form of balance billing. Though rare, balance billing does occur, and when it does, it can shake an employer’s trust in the plan. Some TPAs overcome this by direct contracting with providers that will not balance bill. The problem with this arrangement, though, is that in exchange for no balance billing, a provider will typically charge the allowable maximum every time one of the plan’s members walks through their doors.

MediBid resolves balance billing in a different way. All pricing is delivered with 100 percent transparency, so plan members know exactly what their payment obligations are before treatment is provided. Plan members can use this information, along with information on the provider’s quality of outcomes, to make the cost effective choice every time. The plan members act like a healthcare consumer, and providers bidding for their treatment know that this is a prompt pay, direct contracting situation. The need and incentive for balance billing are removed, as nothing is hidden from the patient.

Further, MediBid can build incentives into a plan that steer plan members into making the cost-effective choice – one that won’t end in balance billing. For example, a plan can share some of the savings that members create by shopping MediBid’s competitive market. If plan members are given the option to claw back some of the savings for themselves, they won’t settle when selecting a provider, and not settling is what drives cost reduction for everyone involved.

MediBid is Also Improving How Direct Contracting Works 

MediBid is not a TPA and does not replace a TPA as a plan administrator. Instead, MediBid can act as a consultant to TPAs, helping develop cost-effective plans that TPAs deliver to their clients. There are several benefits to this arrangement, and it starts with MediBid’s access to direct contracting providers.

MediBid is an active bidding platform that brings prompt pay patients and providers together in a per-episode direct contracting arrangement. In this way, MediBid is facilitating consumer-driven healthcare, and empowering employees to make informed medical care decisions.

What’s the benefit of a per-episode direct contracting arrangement? With a per-episode approach to direct contracting, plan members retain the cost containment benefits that come with direct contracting, without the employer having to commit to volume benchmarks or prices that may be set for an entire year. With MediBid, there’s no need to lock in a set of prices, many of which may not be favorable for the employer. Providers (or Bidders, as we call them) are always competing based on cost and quality in a competitive marketplace.

After submitting a request for care, providers bid on the request, and patients choose from them, with pricing and quality metrics clearly presented. With this information, patients are able to make the cost effective choice, and that means employers save money on their self-funded plans. Adding MediBid to an employer’s plan is a simple way to contain that employer’s costs, and something that TPAs should consider as a value add to their clients.

MediBid Makes Direct Contracting as Simple as Possible

MediBid has negotiated direct contracting arrangements with many providers and facilities, achieving lower prices for employers and their plan members. TPAs can leverage these relationships for their clients, without handing any of the administration or compliance over to MediBid. TPAs continue leveraging their own proven processes while taking advantage of MediBid’s favorable direct contracting relationships.

Direct contracting with local providers is something many employers prefer, but they may not want to take on the burden of comparison shopping for their employees. MediBid can perform that role for employers and TPAs and do so with deep insight into how healthcare pricing works.

There’s More to the MediBid Advantage

Additional reasons to consider MediBid’s services include:

  1. Better built plans – MediBid can develop creative plans that act as a win-win for employers and group members. On the employer side, MediBid can combine elements like a minimal essential coverage (MEC) plan, a health savings account (HSA), and enrollment into a health sharing group or ministry. On the employee side, MediBid can optimally match the employee population’s needs with a plan that meets those needs, while maintaining cost containment for the employer. In fact, with this approach – a MEC plan, HSA and a healthcare sharing group – can save employers somewhere between 35 percent and 70 percent off of their healthcare expenditures.Plans that offer this degree of cost containment and customization are difficult for employers to find, and an advantage that TPAs can offer their clients, should they consult with MediBid to develop a smarter plan.
  2. Expert end user training – MediBid works to ensure that the group’s members understand the plan and all of its details. This is important, because MediBid’s plans require more decision making on the part of the employee. For this reason, MediBid considers employee training to be part of the package when developing a plan for an employer. During training, MediBid will work with groups and individuals to ensure they understand how the plan can best be used to their advantage. For example, employees will be shown how to make optimal use of their health savings account, or how to join a healthcare sharing group. MediBid plans can greatly reduce the cost of healthcare to the employee, and training shows them how. MediBid’s “Valet Service” acts as a Healthcare Advocate, coaching the employee through complex healthcare decisions.Once employees have caught on to how the plan works, it will be easier for the TPA to manage processes like adjudication and eligibility.
  3. Support for medical tourism, including domestic medical tourism – MediBid facilitates medical tourism, which is another way to reduce healthcare costs dramatically. Medical tourism is growing in demand, with the number of U.S. medical tourists doubling between 2007 and 2017, and that number is expected to increase by 20 percent every year.MediBid’s online medical marketplace is one of the only in existence that facilitates domestic medical tourism. U.S. patients are often in need of a better deal on healthcare, but many are concerned about traveling to another country for treatment. MediBid resolves this fear by helping U.S. providers and patients communicate and contract directly with each other. MediBid brings competition back to the U.S. healthcare market, so patients can make the cost-effective decision stateside and travel without the culture shock.Internationally, medical tourism can reduce treatment costs by up to 90 percent, without any drop in quality or customer service. The only challenge is locating a reputable, international medical facility. Fortunately, MediBid takes care of this, because its online bidding platform is open to providers around the globe. All international facilities bidding on MediBid are JCI accredited and offer the same price and quality transparency that U.S. providers must offer. By adding MediBid to their plans, TPAs can introduce employees to the global healthcare market, increasing competition and driving down costs.

Though it may seem like there is overlap between MediBid and a TPA, both can support an employer’s healthcare goals simultaneously. With creative plans, expert consulting and a consumer-driven global healthcare market, MediBid can add considerable value to a TPA’s services.