Self-Funded w/ Spencer - Episode 23 - Dwight Mankin

This video provides an in-depth conversation with Dwight Mankin, President of WebTPA, a Third Party Administrator (TPA) specializing in large group self-funded health plans. The discussion centers on the unique challenges and operational complexities inherent in administering highly customized benefit plans, encapsulated by WebTPA’s tagline, "We Do Weird." The conversation explores Mankin’s extensive entrepreneurial background in clinical management and health tech, detailing his journey through companies like Intracore (clinical management), Value Check (focused on TPA stop-loss issues), and Trusseltree (early health coaching). This history establishes the context for WebTPA’s specialized approach to complex healthcare administration.

The core theme revolves around the necessity of customization in the large group market (5,000+ employees). These large employers seek bespoke solutions—such as direct provider contracts, bundled arrangements, tiered networks, and integrating multiple specialized vendors—rather than standard, "cookie-cutter" network solutions. WebTPA positions itself as the administrative platform capable of wiring these disparate elements together seamlessly. Mankin emphasizes that success in this "weird" space requires meticulous definition of the client's end goal, stressing the importance of asking, "How would you know it was successful 12 months from now?" This focus on defining success metrics (savings, customer service, workload reduction) guides the complex implementation process, preventing assumptions and ensuring alignment with the employer’s fiduciary responsibilities.

A significant portion of the analysis focuses on the challenges of data and analytics in the self-funded space. Mankin highlights the difficulty in determining ownership and accountability for data when multiple vendors (e.g., transparency tools, fraud detection, health coaching) are involved. The industry is currently strong on the "what" (historical data) and the "so what" (analysis), but the future lies in the "now what"—the predictive and actionable actuarial component that guides the employer’s next steps. WebTPA is actively building out capabilities to provide this prescriptive feedback, moving beyond traditional TPA roles to offer strategic insight based on their comprehensive data capture. Furthermore, Mankin addresses the critical need to improve patient engagement, noting that the burden of navigating complex benefits often falls on the individual at the moment of crisis. He stresses the need to focus administrative efforts on the high-cost 5% of the population that drives half of all claims, acknowledging the difficulty in predicting and managing these catastrophic, singular events.

Key Takeaways:

• Customization is Key for Large Groups: Large self-funded employers (5,000+ lives) demand highly customized benefit plans, requiring TPAs to integrate unique elements like direct provider contracts, bundled services, and tiered networks, moving away from standardized network-only solutions.
• Defining Success in Complex Administration: Before implementing customized plans, TPAs and consultants must clearly define success markers (e.g., measurable savings, improved customer experience) with the client, using Stephen Covey's principle: "Begin with the end in mind."
• The Data Ownership Challenge: In multi-vendor environments, determining who owns the data, who is responsible for reporting, and who is accountable for the "now what" (actionable insights) is a persistent challenge that requires clear upfront agreements.
• Moving to Predictive Analytics ("Now What"): The future of TPA services lies in evolving from historical reporting ("what" and "so what") to providing prescriptive, actuarial-driven feedback that guides employers on the next strategic steps to manage costs and improve outcomes.
• The Importance of Human Intelligence (HI): Technology (AI) can automate processes, but the inherent complexity of healthcare administration, especially during crisis events, necessitates strong human intelligence (HI) and a passionate, culturally rich team to solve complex issues and provide empathetic customer service.
• Focus on the High-Cost Population: Effective cost control must target the 5% of the population that accounts for half of all claims, requiring sophisticated predictive modeling and engagement strategies to identify and manage these unpredictable, catastrophic events.
• Navigating Industry Consolidation: Recent trends of hospital consolidation and venture capital buying up provider groups (dermatology, oncology, etc.) are driving up healthcare prices and complexity, making the TPA's role in cost control and customized administration more critical than ever.
• Addressing Patient Engagement Burden: The industry must solve the problem of requiring individuals to be experts in their complex benefits at the "moment of truth" (when they access care), necessitating seamless, real-time integration of all benefit tools and information.
• WebTPA's Operational Segments: WebTPA operates in three primary segments: outsourcing (back-room administration for companies like Hartford/Transamerica), health plan space (administering for 40+ hospitals focused on domestic steerage), and the large employer self-funded segment.
• Strategic Acquisition Rationale: WebTPA's move to Guidewell (Florida Blue Cross's parent company) was driven by the need to maintain independence (non-publicly traded), secure additional investment for scaling technology, and gain a new sales channel while continuing to work with existing national networks (Cigna, Aetna).

Key Concepts:

• TPA (Third Party Administrator): An organization that processes claims and handles administrative tasks for companies with self-funded health insurance plans.
• Self-Funded Plan: A health insurance plan where the employer assumes the financial risk for providing healthcare benefits to its employees.
• Stop-Loss Insurance: Insurance purchased by self-funded employers to protect against catastrophic claims (specific stop-loss) or high total annual claims (aggregate stop-loss).
• ASO (Administrative Services Only): A contract where an insurer or TPA provides administrative services (like claims processing) but the employer retains the financial risk.
• AI and HI: The necessary combination of Artificial Intelligence (for automation and scale) and Human Intelligence (for complex problem-solving and customer service) in modern healthcare administration.

Examples/Case Studies:

• WebTPA's Origin: Started by consulting with East Texas hospitals (Sprinx) to help them create community-based insurance plans and solve internal employee benefit problems, leading to the creation of proprietary administrative software due to the lack of suitable third-party options.
• Value Check: A clinical management company co-founded by Mankin focused specifically on TPAs to get in front of high-dollar claims and work closely with stop-loss carriers, using the tagline "No Surprises."
• Intracore (Cigna Division): A large clinical management company where Mankin learned entrepreneurial scaling, managing 130 offices and 2,300 nurses, focusing on pre-certification and continuous day review services.