Q: Do most TPAs have an interest in the same core metrics or is there considerable variance from TPA to TPA?
A: “Be wary about making generalizations based on anecdotal information. You might have had an experience with one or two TPAs and you assume they all think the same way, but it is risky to think that way.”
A: “Assume that there is specific variance depending on the TPA and their respective interests. Part of your job is to unearth what that variance might be and, over time, look for commonalities.”
Q: Vice versa, should we request metrics from TPAs, and if so, what?
A: “Anytime you have direct contact with a TPA, it’s a good idea to ask, ‘Are there any metrics you have for us that will help us work with your clients?’”
Q: What tends to be the most important metric to TPAs? What are examples of metrics that are of minimal value or even counterproductive?
A: “A specific company drives the TPA’s interest. If you’re in a heavy manufacturing base, for example, they’ll be interested in temporary lost days, because their safety directors focus on that. The TPAs for those companies will want to be notified of visits (to any program delivery point) and recordable issues.”
Q: What do we need to focus on for outcomes?
A: “You should set up, right in the beginning, what your program outcomes are. What do you look at specifically? Do you look at wait times, operational outcomes, and satisfaction with your patients and clients? What kind of outcomes are the TPA looking for that they want to develop and report?”
A: “Communication is number one for TPAs. They want you to call them immediately regarding your determination of a treatment plan or expected time to return to work or MMI.”
A: “Once you have a methodology, database, and history, you have a large pool of information you can share with the employer level and the TPA.”
Q: Who is the primary driver for the client?
A: “The TPA has one role, and the occupational health program or blended clinic has another one. We work in concert and partnership to ensure that both the client’s and patient’s best interests are served.”
Q: Our program has a lack of time to deal with anything other than day-to-day issues as they arise. If in fact you’re really pushed for time, what is the bunker mentality of what you need to do above and beyond anything else?
A: “The patient comes first. Our communication with the client and the TPA comes second. I take care of my patients first and foremost and document what I’ve done. My mantra is patient-focused, communication-centric.”
A: “We are medical providers first, and the patient’s well-being and health, emotionally and physically, is number one on our minds and in the minds of our clinicians.”
Q: What metric do clients consider most important?
A: “Return to work, because that impacts cost on two levels: the medical cost and productivity. Our clients typically want to ensure that they have a productive line, so they want their employees healthy and productive. They often prefer no work restrictions and that you see employees for one visit only, but that’s not realistic.”
