Medical TPA RFP Management

Findley Davies | BPS&M was engaged by a Fortune 300 company to facilitate a Medical TPA RFP process. The company covered two-thirds of its 6,000 active employees with a national carrier, while the other third was administered by a TPA using leased networks. The national carrier was also responsible for COBRA, FSA, HRA and Retiree Reimbursement Account administration.

The objectives of the RFP were to 1) consolidate under one TPA; 2) reduce claims expenses; and 3) improve the member experience through use of technology tools and care coordination/navigation resources. The client decided it would not competitively bid its standalone PBM arrangement, EAP, Wellness, or HSA administration. However, they intended to ensure that the successful Medical TPA could effectively communicate and integrate with their other vendors.

Solution and Results
Findley Davies | BPS&M conducted provider disruption and Medical claims re-pricing analyses. In addition, our e-procurement system was used in scoring an extensive RFP Questionnaire customized for the client to gauge each respondent's capabilities and suitability in meeting their unique needs.

Findley Davies | BPS&M facilitated finalist interviews and two on-site visits. In addition, we negotiated reductions in proposed ASO fees and the fine points of discount and claims trend guarantees. The results achieved included:

• A national carrier was selected under which all TPA services would be consolidated, including COBRA, FSA,
    HRA and RRA services;
• A 3-year contract was negotiated with discount and Zero claim trend guarantees that would reduce
    projected claims and ASO fees by nearly $14 million;
• New Concierge member services were introduced to improve member education and care coordination;
• New chronic condition management and high cost imaging services were introduced and projected to save
    an additional $8 million over three years;
• Improved implementation and operational performance guarantees were negotiated with significant
    amounts of fees put at risk; and
• Ample lead time was created to execute the transition and required change management services with the
    benefits administration outsourcer and corporate communications.

This process demonstrates our firm's expertise in conducting complex vendor procurement projects and delivering results that are on schedule and of high quality and value.

Print this Success Story