Leading the Way with TPAA Member Rich Mousty

Richard Mousty is president of Unified Group Services, Inc. (UGS), an Indiana-based TPA managing more than $300 million in claims for 50,000+ lives annually. He and his staff of 100 are steadfast in their commitments to quality, as evidenced by 98% client retention and numerous accolades for outstanding business practices and financial achievements.

Many things set UGS apart from other TPAs, but Rich’s progressive thinking and ability to anticipate client needs have always kept the firm several steps ahead. He recently shared with Best Practice some of his firm’s innovation and his thoughts on the health care delivery system.

BP: Before we talk about the present and the future, tell us about your history. How did you get started in the TPA business?
RM: Right out of college, I went to work for a man who was starting a TPA from scratch. This was during the TPA boom of the ‘80s, and I had the chance to work alongside him and get exposure to virtually all aspects of the business. The market was wide-open back then, and it was a great opportunity to learn.

BP: How did UGS come about?
RM: The gentleman I was working for sold out and became part of a national TPA. I sensed the market would be receptive to a service level different from what existed at the time, so I started my own company in 1996 with a focus on service.

BP: How is your service different?
RM: It starts with a personal touch. We have a live-answer phone system, which means no interactive voice responses or voicemail. Real people answer our phones during normal business hours, and our customer service reps are the same people who process claims. Clients can talk directly to the people dedicated to their accounts; if they’re not available, the call goes to someone on the team who supports that group. We also update our website every day, so employers and members can view claims online and e-mail questions directly to the reps who processed them. People love it.

BP: Tell us about your AWARE Medical Management Program.
RM: The whole idea is to make the health care system work more effectively for doctors and patients. Every night, the AWARE program scans claims, lab data and prescriptions for each member and creates a dynamic personal health record that can be analyzed against up-to-date medical standards. If the system identifies an opportunity to improve care or detects a medical error, an alert is issued to the doctor and/or the member. Members on the system are hospitalized less frequently, submit fewer claims and are more likely to avoid potentially serious medical errors. We’re one of the only TPAs in the country with this capability.

BP: Wellness is another hot topic for TPAs. How are you helping your clients in this area?
RM: We offer the usual on-site health screenings, newsletters, health fairs and 24-hour nurse lines, but we also think there’s more to wellness than that. All the member information gathered during these interactions goes into our data vault, so for the first time, we have every piece of information in one place for the nightly scanning and analysis I mentioned earlier. This helps ensure members get not only useful health information; they also get the right care for their individual situations.

BP: What’s your forecast for the future of health care?
RM: No one can argue there are many problems with America’s health care delivery system. Ironically, this presents opportunities for smart TPAs that continually evolve and stay on the cutting edge. I think transparency is the key – finding ways to give members more knowledge and power to make good health care decisions. And of course, technology is the best way to deliver it, so we have to stay on top of new developments in order to grow. We’re also seeing more government regulation, which means employers need more help working through the maze of options. Most importantly, we have to be leaders and innovators. This is one area of business where clients don’t often know what they want or need, so they look to experts like us for the answers. If TPAs are going to be part of the future, we better have good solutions and efficient ways to implement them.