7 Things Employers Should Do to Conform to Perform their Trust Obligations

Analyzing medical claims data is essential to fulfilling a trust obligation of a self-funded employer, which is the best medical benefit for their employees at the best price. However, many employers are struggling with this, accusing third-party administrators of not giving them full access to their data.

Some employers have sued their TPA for this, while others are on the receiving end of the lawsuit. For example, a class action lawsuit filed against JPMorgan in March alleging that the company mismanages its employee health and prescription benefits programs and that it causes employees to overpay premiums and out-of-pocket expenses.

However, there are some steps that employers can do to ensure they utilize medical data and fulfill their fiduciary obligations, starting with the establishment of a welfare committee.

“Having a cross-functional team that includes your CFO, CHRO, legal team, welfare team members and your consultants, all meet regularly to review the financial metrics of the program, govern and even basic management affairs to ensure that you fulfill your fiduciary obligations is best practice,” Samuels-Fuerst held at Midwest Business Group of Chickagocago’s Midwest Business Group in Chickago.

After the commission was formed, Samuels-Fuerst shared seven other things employers should do to fulfill their fiduciary responsibilities:

1. View your contract: Employers should carefully study contracts with TPA and other partners and review content such as terms and definitions mentioned in the contract, audit rights, network access fees, etc. This will help them identify areas of improvement.

“While it’s not very exciting, the details are important, and they are very important in our contracts,” said Samuels-Fuerst. “If it’s proprietary, please be cautious.” This can lead to a lack of transparency in the data process. ”

2. Take advantage of your suggestion request (RFP): According to Samuels-Fuerst, the best time an employer gets the required one is during the RFP process, which is when an employer evaluates the supplier partners they want to work with. She said that in Sargento’s recent RFP process, one of the TPA’s languages ​​limit employers’ audit rights to 200 claims. Sarkinto pushed back and asked for access to all claims, while the TPA agreed.

“You have leverage during RFPS and you need to use it,” she said.

3. Create a dashboard: Employers should create a dashboard to monitor and benchmark their healthcare data. Samuels-Fuerst said Sargento’s dashboards are reviewed quarterly and used to educate CFOs and CEOs about healthcare trends over time.

4. Proposition analysis: According to Samuels-Fuerst, getting a more detailed claim analysis can help employers understand trends and find opportunities to improve their interests. Some of the things they can review are diagnostic trends, emergency room use, RX utilization and compliance, high price claimants, etc. Sarkinto also raised a high claim alert. With its TPA, for example, it raises alerts for any medical claims over $25,000.

5. Check registration review: Check register is a recording tool that follows all written checks, cash payments and outflows in a bank account. Sargento reviews its check register weekly.

“Our TPA has our checkbook, and although our finance team balanced the checkbook, do we really know what they are paying is legal? … A quick review can determine potential duplicate claims or significant outliers.”

6. Basic demographics: Employers should span their basic demographic information such as employee age, gender, race, family size, etc. Beneficiary leaders should often assess whether demographic data will change dramatically over time or will change dramatically in the future.

7. More data points: Other data points that employers can consider include employee survey results, Rand research, focus groups, and more.

“Make sure you inform you as much as possible and help you make your decision,” Samuels-Fuerst said.

Source: Weiyi Zhu, Getty Images