Better Decisions Start Here: How TPAs Can Turn Insight Into Impact

I have spent most of my career in and around the third-party administrator (TPA) space, and I have learned one simple truth: action changes outcomes.

My perspective on that is shaped by an unconventional path. Before healthcare, I coached college football and worked in journalism. Coaching taught me that leadership is about discipline, preparation, and execution under pressure. Journalism taught me to value clarity, ask better questions, and get to the heart of a story. Both lessons still shape how I think about healthcare today: facts matter, but what you do with them matters more.

Over the years, I have seen the TPA market evolve from steady, incremental change to a much more dynamic environment. More small and midsize employers are exploring self-funding. Expectations around service, insight, and cost management are rising. At the same time, many TPAs are still operating with lean margins, limited internal resources, and growing pressure to differentiate.

That is why I believe the next phase of value creation in this market will not come from simply having data. It will come from making that data objective, actionable, and connected to better decisions.

Transparency Has Become Table Stakes

Today, nearly everyone in healthcare says they value transparency. That is understandable. Costs are rising. Employers are under pressure. Patients expect better experiences. Regulators are demanding more accountability. In that environment, transparency sounds like the obvious answer.

But transparency by itself is not the finish line. It is the starting point.

Most TPAs now have some form of transparency capability in place. In many cases, that is driven by regulation. The industry has made progress in making pricing and payment information more available and more visible than it was a few years ago.

That is important. Shared facts are essential. Without them, healthcare stakeholders are often making high-impact decisions with incomplete information. When decisions are made without clear insight, costs rise, inefficiencies persist, and patients are often left with more confusion, increased financial burden, and fewer options. That broader challenge is exactly why transparency remains such an important industry priority.

Just a few years back, I was working for a TPA organization committed to championing reference-based pricing (RBP). We in fact converted our own employee health plan to RBP.

It was not all rainbows and butterflies. There were access issues and balanced bill challenges. But we viewed it as our obligation to find resolution for our employees. It was difficult but important foundational work; work that needed more data to be fully realized.

Little did we know, help was on the way. The evolution of RBP has been accelerated with transparency data becoming actionable after the passing of the Transparency in Coverage Act. A product designed to be disruptive has become more appetizing to all parties with usable data. We lowered employee premiums by 20%, reduced out-of-pocket costs significantly and converted the benefit structure to low co-payments. The overall impact lowered the total cost of our employee health plan by 43%. It can work and it can deliver value.

But we should be honest about where the market truly stands today.

Too often, transparency is still treated like a compliance requirement or a check-the-box capability. Information is made available, a tool is deployed, a login is issued, and the work is considered done.

It is not done.

If transparency does not help a plan sponsor make a better decision, reduce avoidable cost, improve the member experience, or identify a more effective path forward, then its value is limited. Data can be visible without being useful. It can be technically available without being operationally meaningful.

That is one reason transparency alone has not delivered the change many hoped it would.

It’s Time for Action

Plan sponsors do not need more dashboards for the sake of dashboards. First, they need clearer answers to practical questions:

What is driving cost?
Where is friction showing up?
Which decisions will have the biggest downstream impact?
What should change first?

Then, those answers lead to the real opportunity: understanding the data and using it to determine what to do next.

For TPAs, that is especially important because their clients are not buying administration alone. They are buying control, flexibility, and better management. Self-funded employers want the ability to shape plans around the needs of their business and their population. That flexibility is one of the strengths of the TPA model, but it also creates operational complexity. This is where better decision support becomes a competitive advantage.

I worked with A 200-life company in the Houston area experiencing increasingly high premiums as part of their fully insured plan. They needed to be competitive to attract and retain talent in an extremely competitive market. The forward-thinking CFO converted their employee health plan to a self-funded plan and partnered with our TPA. The combination of robust drill-down claim reporting coupled with plan design and vendor flexibility unlocked their ability to compete.

They focused on key disease states and the associated benefits structure. Making strategic changes, their plan began to evolve to meet the specific needs of their employee population. As a result, they outperformed medical trends and leveled their costs. No longer was their health plan something they had to overcome; it was an asset with attracting and retaining talent.

Better Decisions Have Downstream Effects

One of the most important ideas in healthcare today is also one of the simplest: better decisions upstream create better outcomes downstream.

That principle aligns closely with how Claritev talks about affordability. Affordability is not achieved by reducing costs after the fact. Just like the Houston company experienced, it requires seeing cost drivers earlier and more clearly, before inefficiency, friction, and surprise costs compound. System improvement happens when objective insights change how decisions get made over time.

For TPAs, this can show up in many ways:

• identifying where plan design changes may create better value
• improving how cost signals are interpreted
• reducing unnecessary administrative burden
• supporting more disciplined decision-making across stakeholders
• helping employers act earlier instead of reacting later

That is the bigger strategic shift. The goal is not just to know more. The goal is to decide better, drive change, and improve healthcare for everyone.

Why This Matters Now

This conversation is becoming more urgent for several reasons.

First, the TPA market is growing and changing. Employers want more control over spend, more transparency, and more flexibility in how benefits and networks are designed and managed.

Second, operational pressure is rising. Many TPAs are still running relatively lean organizations, often without large technology teams or large internal strategy functions. They are being asked to do more in a complex environment.

Third, the market is becoming less patient with fragmented point solutions. Buying software that sits idle or produces reports no one uses is not a strategy. The industry needs an approach that supports how TPAs actually operate.

In my experience, that means meeting organizations where they are and helping create a practical path from insight to impact. Not noise. Not disconnected tools. A clearer path to action.

A Stronger Healthcare System Requires More Alignment

There is also a bigger picture here.

For too long, healthcare has operated with too much friction between stakeholders and not enough shared understanding. Payers, providers, employers, and administrators see the same challenges from different vantage points. That perspective gap is real, but it is also where meaningful progress can begin.

The healthcare system works better when decisions are grounded in objective, shared facts and when those facts are used to reduce strain instead of shifting it somewhere else. That is how transparency supports something larger than compliance. It supports a more sustainable system over time.

And when the system works better, patients and members benefit most — through greater affordability, fewer surprises, and more predictable experiences when care matters most.

Clarity in Action

TPAs are in a unique position.

They sit close to the operational realities of plan performance. They understand the complexity of customization. They see where friction builds. They know where employers need more clarity and where members need a better experience.

That vantage point is a differentiator.