EP453: Running a TPA (Third-Party Administrator) RFP Process That Is Less of a Wild West Fiduciary Shootout, With Claire Brockbank

·37 min·3 clips

A CEO reveals how this podcast turned their boredom with health insurance into a strategy that saved millions.

The episode begins with Stacey Richter reading a review from a CEO who credits the podcast with transforming their approach to health insurance. Richter introduces the topic: how TPA contracts can lock employers into unfavorable terms, using the example of 'upside down claims' where 32BJ paid $10 million more than billed amounts. Guest Claire Brockbank explains that 25% of employers lack contracting expertise and defer to TPAs, leading to lost rights over data, innovation, and costs. She details a proactive RFP process: employers should draft their own contract and send it with the RFP, requiring vendors to return a redlined version alongside their proposal. This method flattens information asymmetry, allowing employers to compare vendor responses and negotiate from strength. Claire notes that even large carriers like Aetna and United will respond to a 'decent-sized RFP.' For smaller employers, she recommends using 32BJ's open-source contract as leverage or focusing on key priorities. The conversation covers the importance of vetting brokers for conflicts, assembling a supportive 'kitchen cabinet' of advisors, and educating attorneys on healthcare dynamics. Claire stresses that contract improvements are incremental; celebrating partial wins builds momentum. She concludes by emphasizing ongoing vendor management to ensure contract terms are executed, directing listeners to 32BJ's Health Insights website for tools.

As heard by us

A practical guide to using TPA RFPs to test what vendors will put in writing.

A TPA RFP can start to feel like a fiduciary shootout when employers are unsure what vendors will actually commit to in writing. This episode gives the process a useful spine: send the RFP and the purchaser's contract together, review every redline at once, and treat gaps…

Read the full review in PlayNext →

Why you'd press play

You want vendors to explain their redlines side by side before the TPA decision gets locked in.

Read the full recommendation in PlayNext →

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