Page 1 Recording of this session via any media type is strictly prohibited. Page 1 So Your RFP Results in a TPA Change, Now What?

Page 2 Recording of this session via any media type is strictly prohibited. Jo Ann Wood Manager, Claims Consulting Solutions Bickmore Arizona State University education and experience with clients changing TPAs enables Jo Ann to provide helpful tips for meeting needs of your stakeholders. Paula Maguire Senior Vice President - Operations TRISTAR Insurance Group Brown University education and experience in operations at TRISTAR, Risk Enterprise Management and GAB Robins equips Paula with practical solutions to share. Lauren Eib Risk Manager, Department of Finance and Risk Management Pima County, Arizona An MBA in Finance from the Virginia Commonwealth University and long term experience in Risk Management enables Lauren to provide real experience in changing TPAs.

Page 3 Recording of this session via any media type is strictly prohibited. What to Expect Devise a strategy for getting the key attributes optimizing your program's effectiveness adopted by new TPA and your stakeholders. Adopt a plan for communication, data mapping and a smooth transition. Study the critical elements of a request for proposal (RFP) that attracts a strong TPA.

Page 4 Recording of this session via any media type is strictly prohibited. First Strategy Follow the Golden Rule Be appreciative of the outgoing TPA Gain Cooperation in Making Transition Service = Future Reference

Page 5 Recording of this session via any media type is strictly prohibited. Second Strategy Build Internal Culture: Clarify program goals Maintain regulatory compliance Carry out plans within authority Develop dispute resolution process

Page 6 Recording of this session via any media type is strictly prohibited. Entity-wide Frequency and Severity Fiscal Period Employee Full Time Equivalents # Claims $ Incurred $ Avg Incurred / Claim $ Avg / Employee # Claims / 100 Employees 06/074, ,968,65919,1563, /084, ,521,22818,3713, /094, ,981,09424,8444, /104, ,410,17414,7212, /114, ,865,24418,8642, /124, ,713,99117,5622, TOTAL26,6384,36982,460,39018,8743, Claims Data provided by Tristar

Page 7 Recording of this session via any media type is strictly prohibited. Reach Entity-Wide Organization Top claim producing departments Department heads Claim liaisons Key peripheral partnerships Lines of communication

Page 8 Recording of this session via any media type is strictly prohibited. Focus on Selection Strategy CriteriaCriteria descriptionMax. Points Available a.Experience of the Firm15 b.Key Personnel15 c.References 5 d.Project Plan30 e.Cost20 f.Sustainability15 Total Points100

Page 9 Recording of this session via any media type is strictly prohibited. Third Strategy Build Relationships I.Delegate responsibilities II.Set performance targets Performance Consistency Claim resolution targets Expense management targets III.Consider incentives

Page 10 Recording of this session via any media type is strictly prohibited. Operations Management  Understand Your Current TPA Arrangement  Notice of Termination  Potential Windup Costs in Current Contract  Carrier Notification and Approval for Claim Transfer  Can You/Should You Take the Tail Claims  Announce the Change  Internal to Your Teams  Outgoing TPA – Account Manager  Vendor Partners  State Insurance Departments

Page 11 Recording of this session via any media type is strictly prohibited. Operations Management  Bring the Transition Teams Together  Account Managers or Transition Leaders to Coordinate Key Teams  Transition Plan Published and Shared  Identify Key Tasks  Understand Deliverables by Group  Establish and Agree on Due Dates  Schedule Follow-up Calls and Updates Through Transition  Track Progress and Monitor Delays  Delivery Checkpoints – Stay Informed  Be Ready for First New Claim at New TPA  Stick to Your Plan

Page 12 Recording of this session via any media type is strictly prohibited. Operations Management  Maintain Cooperation from All Parties  Ongoing Claim Handling at Outgoing TPA  IT Transition Plan o Test Files Received Timely o Data Mapping Progressing on Schedule o Show-Stoppers Identified and Resolved  Preparation of Tail Claims for Transfer o Schedule and Fund Advance Indemnity Payments o Clear Communication to Advance Payment Recipients – Not a Banking Error in Your Favor  Your Claim Handling Instructions Published

Page 13 Recording of this session via any media type is strictly prohibited. Operations Management  First Day of the Last Time You’ll Change TPAs  All Transferred Claims Present and Accounted for at New TPA  New Claims Intake, PBM, UR, Early Intervention, Crisis Management – Ready to Go  Kick Off Meetings  Transition Follow-up Meetings  Funding in Place  Wind-down Complete at Outgoing TPA

Page 14 Recording of this session via any media type is strictly prohibited. Making it Work RFP – Six month Process What Do You Want the TPA to Do? Think about what is currently working well. What isn’t working – how can that be changed to make your WC program better? What don’t you know? What will you accept as minimum qualifications?

Page 15 Recording of this session via any media type is strictly prohibited. Request for Proposal Sections of the RFP 1.Glossary of Terms: What is… A Medial Only Claim A Loss Time or Indemnity Claim Incident, Near Miss, Exposure, Accident, Claim 2.Introduce entity, department & WC program 3.Scope of Project – 1 to 2 Paragraphs

Page 16 Recording of this session via any media type is strictly prohibited. Sections of the RFP 4.Outline Responsibilities & Authority Risk Management Staff Injured Workers Department (Supervisors, etc.) Attorneys Occupational Providers TPA

Page 17 Recording of this session via any media type is strictly prohibited. Sections of the RFP 5.Regulatory Requirements 6.Stakeholder Flowchart

Page 18 Recording of this session via any media type is strictly prohibited. Flowchart

Page 19 Recording of this session via any media type is strictly prohibited. Scope of Work 7.Functional Requirements - Statements Claims Management Medical Management Information System Cost Containment Prescription Plan Litigation Management Regulatory Reporting

Page 20 Recording of this session via any media type is strictly prohibited. Scope of Work 8.Project Plan - Transition Plan 9.List of Questions Based on Functional Requirements & Transition Plan What can you provide that has not been addressed in the RFP? 10.Schedule to go Live 11.Terms & Conditions: Data Ownership Confidentiality & Non-Disclosure

Page 21 Recording of this session via any media type is strictly prohibited. RFP: Self Assessment Section Self Assessment Form to be Completed Questions to be Answered Pricing Sheet to be Completed

Page 22 Recording of this session via any media type is strictly prohibited. Insurance for Contract Standard Insurance Coverage Technology E & O Coverage including Network Security

Page 23 Recording of this session via any media type is strictly prohibited. Oral Presentations Most Important part of the Selection process Clarifying questions regarding the RFP Meet staff and management Present your RMIS, Claims Process and other services Philosophy – What makes you unique? Why should we hire you?

Page 24 Recording of this session via any media type is strictly prohibited. Implementation Contract Timeframes Banking Annual Service Agreement – Review & Update Communicate, Communicate, Communicate

Page 25 Recording of this session via any media type is strictly prohibited. Teamwork 1. Risk Management’s Responsibilities Report injury to TPA within 24 hours of injury Investigations & Loss Prevention Identify Recordable Injuries Modified Duty & Return to Work Communication with WC team

Page 26 Recording of this session via any media type is strictly prohibited. Teamwork 2.TPA Responsibilities Claims Management – 3 point contact Medical Case Management Cost Containment Return to Work/Modified Duty Communication with WC team

Page 27 Recording of this session via any media type is strictly prohibited. Discussion Points RFP Process: What’s Right Assists purchaser in prioritizing needs It is a formalized procurement process and more flexible than the bidding process RFP can provide detail on the entity and needs Oral Presentations allow both parties to communicate directly Pricing can be revised at the end Written proposal becomes part of the contract documentation

Page 28 Recording of this session via any media type is strictly prohibited. Discussion Points RFP: Improvements Include a Table of Contents RFPs are difficult to read & respond to Mandatory pre-bid conferences Vendors include sales material in responses - increases reading time If not awarded the contract, opportunity to learn the weaknesses in proposal How should we negotiate Final Price?

Page 29 Recording of this session via any media type is strictly prohibited. Questions, Final Comments and Contact Information Jo Ann Wood Paula Maguire x3844 Lauren Eib