So Your RFP Results in a TPA Change, Now What?

1. So Your RFP Results in a TPA Change, Now What?

2. • Jo Ann Wood Manager, Claims Consulting Solutions Bickmore Arizona State University education and experience with clients changing TPAs enables Jo Ann to provide helpful tips for meeting needs of your stakeholders. • • Paula Maguire Senior Vice President - Operations TRISTAR Insurance Group Brown University education and experience in operations at TRISTAR, Risk Enterprise Management and GAB Robins equips Paula with practical solutions to share. • • Lauren Eib Risk Manager, Department of Finance and Risk Management Pima County, Arizona An MBA in Finance from the Virginia Commonwealth University and long term experience in Risk Management enables Lauren to provide real experience in changing TPAs.

3. What to Expect • • Devise a strategy for getting the key attributes optimizing your program's effectiveness adopted by new TPA and your stakeholders. • • Adopt a plan for communication, data mapping and a smooth transition. • • Study the critical elements of a request for proposal (RFP) that attracts a strong TPA.

4. First Strategy Follow the Golden Rule • Be appreciative of the outgoing TPA • Gain Cooperation in Making Transition • Service = Future Reference

5. Second Strategy Build Internal Culture: • Clarify program goals • Maintain regulatory compliance • Carry out plans within authority • Develop dispute resolution process

6. Entity-wide Frequency and Severity

7. Reach Entity-Wide Organization • Top claim producing departments • Department heads • Claim liaisons • Key peripheral partnerships • Lines of communication

8. Focus on Selection Strategy

9. Third Strategy Build Relationships • Delegate responsibilities • Set performance targets • Performance Consistency • Claim resolution targets • Expense management targets • Consider incentives

10. Operations Management • Understand Your Current TPA Arrangement • Notice of Termination • Potential Windup Costs in Current Contract • Carrier Notification and Approval for Claim Transfer • Can You/Should You Take the Tail Claims • Announce the Change • Internal to Your Teams • Outgoing TPA – Account Manager • Vendor Partners • State Insurance Departments

11. Operations Management • Bring the Transition Teams Together • Account Managers or Transition Leaders to Coordinate Key Teams • Transition Plan Published and Shared • Identify Key Tasks • Understand Deliverables by Group • Establish and Agree on Due Dates • Schedule Follow-up Calls and Updates Through Transition • Track Progress and Monitor Delays • Delivery Checkpoints – Stay Informed • Be Ready for First New Claim at New TPA • Stick to Your Plan

12. Operations Management • Maintain Cooperation from All Parties • Ongoing Claim Handling at Outgoing TPA • IT Transition Plan • Test Files Received Timely • Data Mapping Progressing on Schedule • Show-Stoppers Identified and Resolved • Preparation of Tail Claims for Transfer • Schedule and Fund Advance Indemnity Payments • Clear Communication to Advance Payment Recipients – Not a Banking Error in Your Favor • Your Claim Handling Instructions Published

13. Operations Management • First Day of the Last Time You’ll Change TPAs • All Transferred Claims Present and Accounted for at New TPA • New Claims Intake, PBM, UR, Early Intervention, Crisis Management – Ready to Go • Kick Off Meetings • Transition Follow-up Meetings • Funding in Place • Wind-down Complete at Outgoing TPA

14. Making it Work RFP – Six month Process What Do You Want the TPA to Do? • Think about what is currently working well. • What isn’t working – how can that be changed to make your WC program better? • What don’t you know? What will you accept as minimum qualifications?

15. Request for Proposal Sections of the RFP • Glossary of Terms: What is… • A Medial Only Claim • A Loss Time or Indemnity Claim • Incident, Near Miss, Exposure, Accident, Claim • Introduce entity, department & WC program • Scope of Project – 1 to 2 Paragraphs

16. Sections of the RFP 4. Outline Responsibilities & Authority • Risk Management Staff • Injured Workers • Department (Supervisors, etc.) • Attorneys • Occupational Providers • TPA

17. Sections of the RFP • Regulatory Requirements • Stakeholder Flowchart

18. Flowchart

19. Scope of Work • Functional Requirements - Statements • Claims Management • Medical Management • Information System • Cost Containment • Prescription Plan • Litigation Management • Regulatory Reporting

20. Scope of Work 8. Project Plan - Transition Plan • List of Questions • Based on Functional Requirements & Transition Plan • What can you provide that has not been addressed in the RFP? • Schedule to go Live • Terms & Conditions: • Data Ownership • Confidentiality & Non-Disclosure

21. RFP: Self Assessment Section • Self Assessment Form to be Completed • Questions to be Answered • Pricing Sheet to be Completed

22. Insurance for Contract • Standard Insurance Coverage • Technology E & O Coverage including Network Security

23. Oral Presentations • Most Important part of the Selection process • Clarifying questions regarding the RFP • Meet staff and management • Present your RMIS, Claims Process and other services • Philosophy – What makes you unique? Why should we hire you?

24. Implementation • Contract • Timeframes • Banking • Annual Service Agreement – Review & Update • Communicate, Communicate, Communicate

25. Teamwork • 1. Risk Management’s Responsibilities • Report injury to TPA within 24 hours of injury • Investigations & Loss Prevention • Identify Recordable Injuries • Modified Duty & Return to Work • Communication with WC team

26. Teamwork • TPA Responsibilities • Claims Management – 3 point contact • Medical Case Management • Cost Containment • Return to Work/Modified Duty • Communication with WC team

27. Discussion PointsRFP Process: What’s Right • Assists purchaser in prioritizing needs • It is a formalized procurement process and more flexible than the bidding process • RFP can provide detail on the entity and needs • Oral Presentations allow both parties to communicate directly • Pricing can be revised at the end • Written proposal becomes part of the contract documentation

28. Discussion PointsRFP: Improvements • Include a Table of Contents • RFPs are difficult to read & respond to • Mandatory pre-bid conferences • Vendors include sales material in responses - increases reading time • If not awarded the contract, opportunity to learn the weaknesses in proposal • How should we negotiate Final Price?

29. Questions, Final Comments and Contact Information • • Jo Ann Wood jwood@bickmore.net 714.426.8509 • • Paula Maguire paula.maguire@tristargroup.net 609.495.0001x3844 • •Lauren Eib Lauren.Eib@pima.gov 520.724.4477