TPAs

Third-Party Administrators (“TPAs”) administer benefit plans for self-funded employers. They manage the entire suite of benefits and programs that employers need in order to offer those to their employers. Some TPAs are owned by large insurance companies, and either operate as an extension of the insurance companies or as a semi-autonomous arm of the insurance companies. Most of the remaining TPAs are independent companies that operate outside the world of the large insurance companies. TPAs can be large or small, often measured by how many lives they administer and what geographies they cover. TPAs can also offer a multitude of ancillary services and programs, and can also administer other kinds of programs: workers’ compensation, voluntary benefits, life insurance, and so on.

Benefits to TPAs partnering with Luminary include:

Expanded access to a high-quality, surgeon-led surgical network
Transparent, episode-based pricing with defined reimbursement
Lower total cost of care through site-of-care optimization
Seamless coordination with existing case management or navigation teams
Securing contracts and handling payments with downstream entities

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This approach allows the aggregator to focus on the relationship with their client while Luminary handles the care management.

Overview:

TPAs need to engage with Luminary to gain access to the contracted providers either in a remote manner or by hosting the provider rates internally and facilitating the members’ access to them and the ultimate referrals.

How It Works

Luminary Health has longstanding partnerships with many of the nation’s leading self-insured employers and third-party benefits administrators. When you contract with Luminary Health, employees from these organizations will be referred to your practice for surgical care.

Luminary offers a “bundled” reimbursement model where you control the downstream contracts and reimbursement to your facility, anesthesia group, and pathologist. Alternatively, you can opt for Luminary to control distribution of downstream reimbursements on your behalf.

01

Self-Insured Organizations

Many of the nation’s largest companies and government organizations now self-insure their workforce. Instead of paying monthly premiums to an insurance company, these “self-insured” organizations directly reimburse the healthcare services consumed by their employees. Most of the fortune 500 and may SMB companies are now self-insured.

02

What is a convener?

Most self-insured organizations partner with one of several third-party benefit administrators (otherwise known as a convener) to control and predict healthcare expenditures. Some conveners specialize in guiding employees who need surgical care.

03

Care Advocates

Most convener organizations employ care advocates. A care advocate works one-on-one with the employees of an organization to recommend where they and their family members can go to receive appropriate healthcare services. Care advocates recommend preferred surgeons to the patient whenever surgical services are required. Once the patient makes a selection, the care advocate communicates the referral to the practice.

04

Luminary Health Providers

Luminary Health is a collective of surgical practices, hospitals, and ambulatory surgery centers. As a group, Luminary Health has contracted with many of the nation’s top convener entities. As a result, Luminary Health providers are recommended to employees from hundreds of self-insured companies each and every day.

05

New Patient Referrals

Once you contract with Luminary Health, your practice will receive patient referrals from many of the nation’s largest self-insured companies and government organizations.

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Quality Care at Fair Market Prices

Direct contract networks are superior to traditional PPO networks. Direct contracts are fixed prices whereas PPOs are based on meaningless billed charges and arbitrary top-down discounts.

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