Building a Long-Term TPA Strategy for Self-Funded Plans - Elizabeth Vire - HPI

Welcome back to another episode of our podcast, where we dive deep into the world of insurance and healthcare. Today, we have a fascinating conversation between Spencer Smith and Elizabeth Vire, Vice President of National Sales at HPI (Health Plans, Inc.). They discuss the importance of a long-term strategy when working with third-party administrators (TPAs) in the insurance industry, along with practical insights and data-driven advice. So, let's jump right in!

The Power of Strategy and Exceptional Service:

Elizabeth Vire emphasizes the significance of vetting TPAs based on their ownership and long-term solution or exit strategy. She stresses that TPA is not a one-year sell, but rather requires a three to five-year strategy. By asking the right questions about ownership and long-term plans, employers can ensure they are partnering with a TPA that aligns with their goals and values.

Navigating the Healthcare System: Challenges and Hope for Change:

During the conversation, the challenges of navigating the healthcare system are also explored. Elizabeth shares her personal experience of waiting weeks to see a primary care physician and facing delays in referrals to specialists. This struggle resonates with many individuals, even those who are relatively healthy.

However, Elizabeth and Spencer are optimistic about the potential for positive change in the healthcare system. They believe that the private sector has evolved and is paving the way for improvements. They express hope for approaches like direct primary care that prioritize actual care and emphasize the need for change to happen gradually over a few years.

Practical Advice for Employers and Consultants:

Throughout the conversation, Spencer and Elizabeth offer practical advice for employers and consultants in the insurance industry. Here are some key takeaways:

1. Vetting TPAs: When considering a TPA, inquire about their ownership and long-term plans. This will help ensure a strategic fit and a lasting partnership.

2. Understanding Intent: It is crucial to understand the intent of the client's plan and effectively communicate the messaging to employees. This clarity aligns everyone towards the same goals.

3. Full Integration: Invest in partners who offer full integration rather than settling for half-decent solutions. This ensures a seamless experience and maximizes the benefits of the partnership.

4. Data-Driven Decision Making: Before recommending cost containment solutions, gather and analyze data and utilization patterns. This approach allows for informed decisions that yield the best results.

5. The Value of Continuous Learning: Both Spencer and Elizabeth emphasize the importance of continuous learning and professional development. Staying updated with industry trends and insights is vital for success in the ever-changing insurance landscape.

Conclusion:

In this engaging podcast episode, Spencer Smith and Elizabeth Vire shed light on the importance of a long-term strategy when working with TPAs in the insurance industry. By vetting TPAs based on ownership and long-term plans, providing exceptional service, and navigating the challenges of the healthcare system, employers can ensure success in their insurance endeavors

Stay tuned for our next episode, where we explore the innovative solutions offered by Pareto Health, a leading player in the healthcare industry!

Time Stamps:

(00:00:00) Transition from College to Banking

(00:05:48) Career Path in Banking

(00:11:28) Skydiving Mishap

(00:16:53) Transition to HBI: An Independent TPA with a Unique Approach

(00:22:28) Refreshing and Expanding: Rebranding and National Growth

(00:27:56) Opportunities for Dual Option Networks

(00:33:40) Importance of Understanding Client Intent

(00:38:48) Ideal Consultant Partner

(00:44:08) Challenges in Navigating Healthcare