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Industry Landscape
The Third-Party Administrator (TPA) industry is experiencing robust growth, driven by employers seeking greater control over healthcare costs through self-funded plans. Innovation in technology and data analytics is key, with a focus on transparency, value-based care, and personalized solutions. Regulatory changes and increasing demand for specialized benefit administration continue to shape the landscape.
Total Assets Under Management (AUM)
Self-Funded Employer Health Plans in United States
~67%
(3-5% CAGR)
- Growth in employers opting for self-funded health plans.
- Driven by cost control and customization desires.
- Small to mid-sized businesses increasingly adopting self-funding.
Total Addressable Market
30.5 billion USD
Market Growth Stage
Pace of Market Growth
Emerging Technologies
AI-Powered Predictive Analytics
AI and machine learning can analyze vast datasets to predict healthcare costs, identify at-risk populations, and optimize benefit plan designs for self-funded employers.
Blockchain for Healthcare Data
Blockchain technology can enhance data security, transparency, and interoperability for claims processing, patient records, and supply chain management in the healthcare ecosystem.
Value-Based Care Platforms
Advanced platforms facilitating value-based care models, connecting providers, payers, and employers to reward quality outcomes over fee-for-service, driven by transparent data.
Impactful Policy Frameworks
No Surprises Act (2022)
The No Surprises Act, effective January 1, 2022, protects consumers from surprise medical bills for emergency services and certain services provided by out-of-network providers at in-network facilities.
It requires TPAs like Auxiant to ensure compliance with billing protections and provides avenues for dispute resolution, impacting claims processing and network negotiations.
Consolidated Appropriations Act (CAA, 2021) - Transparency in Coverage Final Rule
The CAA's Transparency in Coverage Final Rule, with various effective dates starting July 1, 2022, mandates health plans to disclose negotiated rates for in-network providers and out-of-network allowed amounts through machine-readable files, and later, price comparison tools for consumers.
This policy increases the demand for Auxiant's transparency tools like FocusHealth and requires robust data management and reporting capabilities for compliance, making cost transparency a core offering.
Patient Protection and Affordable Care Act (ACA) - Employer Mandate and Reporting (Ongoing)
The ACA, signed in 2010 with ongoing regulations, requires Applicable Large Employers (ALEs) to offer affordable health coverage that provides minimum essential coverage or potentially pay a penalty, and includes various reporting requirements (e.g., Forms 1094-C and 1095-C).
Auxiant must ensure their self-funded solutions help employers meet ACA compliance, including affordability and minimum value requirements, and support complex reporting obligations.
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