EP436: Let's Talk About TPA and Health Plan Inertia Instead of Jumbo Employer Inertia, With Elizabeth Mitchell

When a TPA gets acquired by a health plan, history suggests it stops being a TPA and starts acting like a full health plan — ancillary fees, opt-out-proof bells and whistles, and all, whether or not that's what the self-insured employer actually wants. Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health, joins Stacey Richter to widen the inertia conversation beyond employers and look at the TPAs, ASOs, and health plans that are supposed to be helping jumbo employers deploy their benefits — and often aren't. WHAT YOU'LL LEARN ✅ What a jumbo employer actually needs from a TPA or ASO, versus what many are getting instead: a de facto health plan charging health-plan-level fees ✅ Why the market genuinely lacks effective, independent TPAs that aren't owned by a health plan — and why that ownership structure tends to choke off both cost and quality data sharing ✅ What recent lawsuits against major carriers reveal about the scale of undisclosed fees flowing through TPA and ASO arrangements ✅ Why direct contracting between employers and providers is gaining traction as a way around TPA and health plan inertia ✅ Why some regional health plans are quietly doing this differently, and what that suggests is actually possible at scale WHY THIS MATTERS Employer inertia gets a lot of attention, but it's only part of the story: TPAs, ASOs, and health plans have their own structural reasons for maintaining the status quo, and those incentives don't always point toward serving the self-insured employers paying the bills. Lawsuits alleging hundreds of millions in undisclosed fees aren't outliers; they're a signal of just how much money is at stake when these entities operate with limited transparency and limited accountability. For jumbo employers trying to actually deploy their health benefits well, understanding where TPA and health plan incentives diverge from their own is a prerequisite to fixing it — whether that means direct contracting or simply demanding better data. MENTIONED IN THIS EPISODE Encore! EP337 with Olivia Webb: Apple Podcasts | Spotify | Other Apps EP427 with Rik Renard: Apple Podcasts | Spotify | Other Apps === LINKS === 🔗 Show Notes with all mentioned links: Episode Page ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify 📺 Subscribe to our YouTube channel === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 00:00 Introduction. 06:48 What is the overarching context for health plans in healthcare purchasing? 09:00 Encore! EP337 with Olivia Webb. 11:44 Why is it important to reestablish a connection between the people paying for care and people providing care? 14:07 What are the needs of a self-insured employer when managing employee benefits? 19:41 Is it doable for employers to set their own contracts? 22:11 Is transparency presumed? 23:25 Will the new transparency upon us actually expose wasted expense? 27:45 "This is not about individual bad actors. … The systems … that is not aligned." 29:32 Are there providers who want to work directly with employers? 32:46 Why is it important that incentives need to be aligned? 34:25 Why is the quality of care even more important than transparency? 36:29 EP427 with Rik Renard. 38:08 What's missing from the conversation on changing health plans?