Navigating TPA Operations

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This conversation explores what it takes to run a TPA that actually puts the member experience first in an era of consolidation, KPI-driven management, and specialty drug cost explosions. We talk about why independent TPAs still have an edge, how GLP-1s are creating a new category of risk that most employers aren't equipped to manage, and why the industry keeps losing what made it work in the first place — relationships. Caryn brings four decades of perspective, starting from when her family opened their first TPA in 1982, and she's not afraid to say what others won't about what's broken.

"The worst middleman in healthcare is the one that takes the relationship out of the equation and converts it down to just a spreadsheet or a number."

00:39 Introduction and background

• Growing up inside a TPA family since 1982 and learning every operational element by the time she was a teenager

• Choosing self-funded healthcare over a career in Washington politics

• Why being a child of a TPA owner means you're immediately thrown into the work

02:35 Joining Northwind Health

• Why the entrepreneurial flexibility of an independent TPA was the deciding factor

• Building on 20+ years of existing operations while expanding into new vendor partnerships and operational efficiencies

• Tying together TPA, PBM, and disease management into a full member advocacy program

04:44 Member engagement and AI

• You have to meet the member where they are — some want chatbots, some want a phone call, some don't want to feel like big brother is watching

• Using prescription drug utilization data to proactively identify and reach out to at-risk members

• Nurse case managers and coaches working with populations to bring A1C counts from 15 down to single digits over a year

07:17 What employers care about

• Selling to the CFO is a spreadsheet conversation; selling to the HR person is a member experience conversation

• You have to know your audience before you know which value proposition to lead with

• Data is important, but knowing where the highest costs come from and whether they're manageable is what matters

09:33 Specialty drugs and GLP-1s

• GLP-1s without physician oversight are creating dangerous downstream consequences

• An 80-year-old man lost dangerous amounts of muscle in two months on an unmanaged GLP-1, going from 195 to 161 pounds and ending up hospitalized

• Disease management programs that work with members to wean off medications safely rather than penalizing them

• Gene and cell therapy as the next wave of specialty drug risk

12:04 Build vs partner

• Why trying to be everything to everybody is a losing strategy for TPAs

• Cost benefit analysis of vendor integrations — a company that implemented 41 different PBMs on January 1 is not a value proposition

• TPA account managers should help deliver the story and the solution, not just the brokers

15:14 When implementations go wrong

• Miscommunication and unmanaged expectations are the top two failure modes

• Always work backwards from the go-live date to set realistic milestones

• A major food chain account required 180 different plan designs loaded into the system — all driven by how they wanted their reporting to come out

17:41 AI at Northwind

• The full package: Clinical Blueprint product aligned with PBM and TPA services following the member experience end to end

• Independent TPAs can focus on clients as the primary priority rather than cost-of-goods reduction

• Consolidation is making TPAs optimize for KPIs instead of the member experience — and that's stripping out what made the industry great

20:18 Lightning round

• If not healthcare: lobbying in Washington — "call me crazy, I wanted to get a salary"

• Worst middleman: the one who converts relationships into spreadsheets and numbers

• What people misunderstand: directness isn't coldness — "I think in bullet points"

Caryn Rasnick

VP of Health Benefits Administration at Northwind Health

About

Caryn Rasnick

Caryn Rasnick is Vice President of Health Benefits Administration at Northwind Health. She also serves on the board of the Health Care Administrators Association (HCAA).