But there’s a key detail many self-funded employers overlook: whether their third-party administrator (TPA) manages these services in-house or outsources them to another vendor. That distinction can make all the difference in cost, experience, and outcomes.
Self-funded employers know the drill: Rising healthcare costs, pressure to deliver quality benefits, and the constant search for strategies that make a difference on both fronts.
But there’s one factor that could be undermining your efforts. It’s how your TPA delivers care navigation and member advocacy. Specifically, whether they handle these critical services in-house or outsource them to external vendors.
It’s a small detail on paper but a critical one in practice. Here’s why.
On the surface, care navigation and advocacy sound straightforward: Help employees find the care they need at the right price, then support them through the process.
But in practice, it’s far more complex.
Delivering meaningful guidance requires real-time access to claims data, insights into provider performance, and a deep knowledge of plan design. That level of coordination allows care teams to step in to help your employees make informed choices, from choosing cost-effective providers to coordinating procedures or managing chronic conditions. Advocacy takes it a step further, resolving billing disputes, explaining confusing medical bills, and ensuring employees understand exactly what their benefits cover.
When navigation and advocacy work together, it generates clear results:
Outsourced care navigation is what happens when your TPA plugs in an external vendor, sometimes a call center, to handle member outreach and guidance. That means your employees will be looking for support from a third-party source, which creates a disjointed system that works against your interests in three key ways.
Ultimately, an outsourced model adds complexity for both employers and members and often fails to deliver the cost savings it promises.
In-house care navigation means the TPA’s own clinical and member advocacy teams (nurses, case managers, care guides, etc.) work directly inside the same platform that handles claims, provider networks, and plan rules. When care navigation and advocacy are fully integrated into your TPA’s platform, they function as a core component of your health plan, not an afterthought.
This way every element of plan administration, clinical support, and member advocacy works in sync to drive better results.
In-house care navigation and advocacy offer clear results:
By working within the same system that houses claims and cost data, in-house teams can deliver timely, relevant guidance when members are weighing care options. Nurses and advocates can see real-time claims data, plan design, and provider performance. The result? No more guessing. They know exactly which providers deliver better outcomes at lower costs in your specific plan.
Members work with a steady, knowledgeable team that understands their plan. That familiarity builds trust, which translates into higher participation and better outcomes. In-house teams can also reach out proactively when a high-risk claim hits the system, giving employees consistent help from people who know their plan inside and out.
True engagement is a two-way street, and members are more likely to pick up the phone or trust advice when it comes from their known benefits team, not an unfamiliar vendor.
In-house teams adapt more easily to custom plan designs, regional networks, and unique employer goals than vendor-based models. Due to their stand-alone system, external vendors are not always able to do this efficiently.
When everything is under one roof, there’s no confusion over who’s responsible. Savings, outcomes, and member satisfaction are directly tied to the core claims and plan management.
Your TPA owns the outcomes and the responsibility for delivering results.
Every dollar wasted on unnecessary care or poor provider choices comes straight from your balance sheet. As a self-funded employer, keeping care navigation in-house gives you more control over quality and costs.
Choosing the right TPA is about how well every part of your plan works together to manage costs and support your workforce.
When care navigation is built into the core of your plan, you gain more visibility and better results. This means fewer handoffs, more informed decisions, and a simpler experience for your employees. It’s a key lever for making your health plan truly work for you and your employees.
At Healthgram, outsourced care navigation and advocacy are non-negotiables. It’s a core part of what we offer self-funded employers. We use an in-house care navigation model built to help you spend smarter, support members more effectively, and drive lasting results – without added complications.
Contact us today to learn how our integrated approach can transform your self-funded health plan.
