Breaking Down the Self-Funded Data Problem
Here is a very basic summary of what happens when an employer is self-funded. They hire a TPA or carrier to pay their claims. Providers submit their bills from Member visits to the TPA for payment. The TPA then reports to the Employer on amounts paid for claims.
Those of us in the industry know that’s not the whole picture and the process is much more complex. There are more players involved in the reporting game and the TPA is responsible to pass information to the Broker, Reinsurance Carrier, Population Health Vender and others. With current methods of spreadsheet reporting, the sharing of information is never as easy as “Me-to-You and back-to-Me”. Everyone gets a piece of data and is expected to accurately report to all parties. If we’re honest, the process resembles a school PE teacher setting up a dodgeball game by just dumping out a bag of rubber balls and saying “go”. Let’s follow the bouncing ball?