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Problems and Prospects of TPAs in the Healthcare Industry

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Problems and Prospects of TPAs in the Healthcare Industry

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    1. Problems and Prospects of TPAs in the Healthcare Industry IIRM National Seminar Mr. Girish Rao 24th January 2012

    2. Why were TPAs created?

    3. Why were TPAs created?

    4. Why were TPAs created?

    5. Health Insurance - Growth

    6. Health Insurance - Growth While the CAGR of premiums collected between 2001 and 2008 has been over 22%, the CAGR of insurance penetration has been only 12%

    7. Impact of TPAs on HI

    8. Impact of TPAs on HI

    9. In sourcing of TPAs

    10. In sourcing of TPAs

    11. In sourcing of TPAs

    12. Challenges : Tiny Sector Mindset

    13. Challenges : Evaluation

    14. Future Focus : Network Management

    15. Future Focus : Integrated Partnership Large bancassurance portfolio of >100,000 credit card holders Claims data available from 2003 onwards. Adverse claims ratio from 2003 to 2005 (>105%) Analysis of claims patterns and disease profiles showed the need to change product features. Sub-limits for specific disease and cost elements introduced based on TPA advice. Claims ratio improved and since then has been profitable.

    16. Future Focus : Long term Partnership

    17. Future Focus : Standardisation

    18. Future Focus : Consolidation

    19. Summary

    20. Thank You!

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