Let’s face it, today’s businesses need to be creative to be competitive. So, as a TPA, how do we do things differently? We lean into our abilities of blending creativity with a strategic approach to help employers get ahead. In a highly competitive landscape, helping people navigate tough challenges is really what we’re all about. Being creative problem solvers ourselves, here’s how we stand apart from the crowd.
Letting employers pick and choose
We think having more choices makes for a better benefits strategy. So, we’re passionate about helping businesses create custom self-funded plan designs. Employers can bundle or unbundle benefits to align with their goals. We’re also keen on suggesting point solutions that are a perfect match for the makeup of an employee population. We help employers narrow down what’s best based on needs, risk factors and cost drivers. For added flexibility, solutions can often be integrated throughout the plan year. With customized solutions, employers can personalize plans, retain talent, improve employee satisfaction, monitor rising costs, and make real impacts on health.
This versatility extends to pharmacy options, too. Employers can choose our in-house solution (Meritain Health Pharmacy Solutions) or incorporate another pharmacy benefit manager (PBM) option.
Drawing from the size and intellectual capital of our enterprise
Being part of a large family has its advantages. As part of Aetna® and CVS Health®, we can incorporate key solutions from the whole enterprise. Drawing on our collective size has other benefits, too, including exclusive pricing, discounts and financial stability. We can pass all these advantages and resources along to the employers and members we serve.
Finding ways to “self-fund your way” with innovative options
No two businesses are really the same. Likewise, no two health care strategies are really the same either. We recognize when it comes to self-funding, size sometimes does seem to matter. However, we can guide our clients toward choosing the right paths for optimal success. This may mean opting for traditional self-funding, captive arrangements, navigation or advocacy solutions or an alternative health plan. Experts across our organization specialize in tailoring self-funded options based on employer size, risk tolerance, industry and more.
Optimizing access, engagement and improving clinical outcomes
We offer broad access to providers so we can help to support members. One network option, the Aetna Choice® POS II, is only available through Meritain Health. This network is a full, nationwide network with competitive, carrier-level discounts.
We also offer many other tailored options and configurations. In addition, we’ve developed our own homegrown, proprietary answers for boosting employee engagement and improving clinical outcomes.
Proactively going after cost savings
Our multi-faceted approach to payment integrity includes performing front-end audits, focusing on out-of-network and high-dollar claims, reviewing facility claims and more. Our special investigative unit is focused on preventing fraud, waste and abuse. On average, we’re able to help clients achieve 55 to 70 percent savings, particularly on high-risk claims. We also identify savings at a lower threshold than others in the industry. In 2022, an independent review confirmed we produce an extra four percent of savings on billed charges (that’s on top of regular plan cost reduction tied to contracted in-network provider discounts).
Doing the juggling for you
Finally, with self-funding comes a great deal of administrative responsibilities. You need a TPA on your side who can handle any task—without dropping the ball. We have four decades of experience behind us to keep your self-funded plan running like clockwork. Claims handling? Member questions? Stop loss? Cost management? Regulatory compliance? We’ll handle it.
As we said before, helping people navigate tough challenges is really what we’re all about. Everything mentioned above shapes how we do things differently. Leaning into our abilities of blending creativity with a strategic approach help our employers get ahead. So, they can get the most out of their self-funded arrangements with optimal flexibility.
