Case Study: Plan Replacement

Boosting Client Acquisition and Retention

How a midwest TPA stayed ahead of the competition with help from Reliant

Problem

In 2018, a Third-Party Administrator (TPA) in Indiana called was watching their local market shift under their feet. There was so much healthcare provider pushback against Reference-Based Pricing (RBP) statewide that RBP vendors were leaving the state altogether.

In the wake of this exodus, the TPA was about to lose a group to one of the large health insurers. They urgently needed an alternative to RBP that wouldn’t run into provider pushback. So management started a conversation with Reliant about our capabilities.

Solution

We introduced them to Reliant’s proprietary pricing strategy, which we call Fair Market Pricing. It’s a more thoughtful approach to achieving deep savings on healthcare benefits. Instead of pressuring providers to accept a rigid percentage of Medicare pricing, we priced every bill individually using our reimbursement data and dynamic methodology. The outcome was a strategic balance of aggressive savings and manageable appeals, customized to the TPA’s needs.

Results

Reliant not only stepped in where RBP vendors couldn’t... we helped the TPA retain the group that was planning to leave, and improved their results over time. Their clients saw savings climb from 55.6% off billed amount in 2018, to 59.4% in 2023, with appeals rates falling from 3.3% in 2018 to 0.70% in 2023. As savings and appeals rates continued to improve year over year, the TPA was able to improve client retention while winning new groups. 

By leveraging Reliant’s partnership as part of their services, the TPA has found that access to Reliant’s solution has become a competitive edge. The results we get for their clients help make them a leader within the self-funded marketplace.

“Reliant has been a great arrow in our quiver for winning new business. They are a fantastic alternative to other, more disruptive re-pricing solutions. Reliant has made all the difference for many of our groups. Our customers see the value Reliant delivers over the long-term.”

– Midwest TPA