TCC offers a look behind the curtain at the actual costs of health care for a given population – with each respective insurance carrier. The goal is to overcome the “Black Box” nature of the existing network system. When shopping for a new solution, companies generally compare plans by the network discounts offered, without understanding many behind-the-scenes factors that impact costs. Differing demographics, provider mix, physician referral patterns and carrier/network discount calculation nuances can cause misleading or even erroneous results. Further, there is currently little – if any – contemplation of disease management/clinical efficacy/outcomes in the discount analysis. TCC takes a more holistic approach to cost analysis, examining factors that are typically hidden in a normal network comparison but that could be driving up the cost of the plan for an employer. It allows employers to compare carrier/network A vs. carrier/network B by taking into account things like the carrier’s cost per unit, utilization, provider mix, network penetration, medical management and claims protocol.
Many of you are probably thinking: Duh! Why haven’t we done it this way all along? The short answer: we didn’t have access to all the data. That changed a few years ago when a committed working group made up of industry veterans, actuaries, and executives from the nation’s largest health plans came together to offer an unprecedented level of transparency and data-sharing.
I’m excited about the possibilities of TCC for my clients and frankly, the entire industry. Stay tuned as this new concept evolves in the next year or two.