Problems faced by TPAs

Third Party Administrators are in a competitive market with limited ability to differentiate. Self-insured employers are setting goals for TPAs to reduce costs, increase return from health programs, improve communication with employees, and use all the employers’ health data to improve outcomes.

Main challenges include

  1. Identify future high risk members using all the data to prioritize care, disease and case management.
  2. Provide actionable reports and insights to your clients showing ROI of all the programs and initiatives.
  3. Engage employees in relevant programs to derive value and bend the cost curve while lowering risk.
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How can we help?

ZPH will deliver immediate value to your customers by firstly, aggregating all healthcare data, and running advance predictive models to stratify member population for interventions, care management programs and other services like telemedicine etc. Secondly, we will help in tracking all programs in one place to show you the ROI. Lastly, we will convert insights into actions through targeted and personalized messaging.

In summary, our platform helps TPAs identify risk and target relevant programs, report on various programs in one place and increase engagement in programs like telemedicine, disease management, closing gaps in care etc. by 30% and deliver 3-5% cost containment across variety of programs.

Integrated population health and cost data

Our z5 platform integrates data from disparate sources, aggregates, matches and securely provides analytics of health data across medical claims, Rx Claims, Health Risk Assessment, HR, wellness participation, and lab results etc. Our data integration platform and data services meet industry security standards and are HIPAA compliant using cloud infrastructure. We can scale and maintain unlimited member history data.

 

Proactively identify populations for improvement

Understand highest-risk segments who are likely to be most expensive in the next 12 months and why (health conditions, gaps in care, healthcare utilization). Target those who are likely to change behavior. Prioritize the next 50 people that you can have an impact on.

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Program prioritization

Our risk stratification models along with Milliman’s MARA risk scores help you identify members in your population that are at risk of developing conditions and increasing healthcare costs, before it actually happens. We integrate health risk assessment data with claims data. This allows you to prioritize programs and target them to members for improved engagement.

Actionable Opportunities for savings

Our tool uses industry benchmark, predictive costs, and expert based common cost drivers and risk costs to identify areas of greatest savings.

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Member Communication

Affecting member behaviour through reminders, interventions and information is of great importance in improving health outcomes (close gaps in care) and helping members choose lower cost options (mail order, PCP vs. ER, lower cost providers).

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