Over 60%1 of employers plan to move to self-insured arrangements, and over 35%1 expect to switch brokers in the next four years. Employers are moving away from fully insured plans, demanding more control, more transparency, and more meaningful strategies for managing health plan costs. At the center of this shift is a decisive move toward self-funding and independent third-party administrators (TPAs).
If you advise self-insured clients or clients considering the transition, you already know pressure is rising. Costs are up, budgets are tight, employee expectations are soaring, and dissatisfaction with traditional Administrative Services Only (ASO) models is growing. Employers aren’t just shopping for new plans; they’re rethinking the entire administrative model behind their benefits.
For brokers, this creates an enormous opportunity; but only if you’re aligned with the right TPA partners.
The market is shifting fast
Recent analysis shows significant migration toward self-insured plans administered by third-party administrators (TPAs), with employers’ interest rising sharply year over year. More than 60%1 of employers say they plan to move to self-insured arrangements, and many express frustrations with traditional ASO models and limited carrier flexibility. Employers want more options and better cost control. And they’re willing to change relationships to get it.
As their most trusted advisor, brokers must be ready to guide that shift. And this starts with evaluating which TPAs are truly delivering.
Why do employers prefer independent TPAs?
The appeal of independent TPAs isn’t complicated to understand. Employers are tired of “handcuffed” arrangements where carriers dictate networks, systems, and add-ons. They want the freedom to unbundle, mix and match partners, and adapt quickly to new needs.
A smarter TPA goes beyond claims administration. It’s about delivering a more connected, integrated health experience. Today’s self-insured employers need partners who combine best-in-class technology with human expertise to deliver seamless navigation, transparent insights, and proactive support.
The modern TPA model is no longer administrative. It is a tech and people-powered solution that enables a more intuitive experience for members and a more strategic lever for employers.
A smarter TPA empowers employers to:
- Access broader, more flexible networks without carrier restrictions
- Integrate preferred partners and point solutions
- Gain real transparency into claims and cost drivers
- Manage plan design without carrier constraints
- Offering employees a better support and navigation experience
For brokers, partnering with smarter TPAs means more strategic influence, stronger client retention, and more aligned benefits strategies.
What makes a TPA truly smarter? 9 essential criteria
A smarter TPA doesn’t just pay claims. It orchestrates the entire benefits experience. That means bringing together clinical resources, digital tools, partner integrations, navigation, and insights into a single, cohesive experience to reduce friction and deliver meaningful outcomes.
Brokers can evaluate TPA partners against these nine essential criteria:
1. Cost Consciousness
Clients want real, scalable savings. Smarter TPAs go beyond analytics to actively reduce spend through:
- Payment integrity and deeper claims audits
- Strong out of network negotiations
- Expertise in Reference-Based Pricing (RBP) administration
- Multi-lever cost containment strategies
2. Operational Scale & Capacity
A TPA must be large enough to deliver negotiating power and technology investment – yet disciplined enough to maintain service quality. Size should translate into capacity.
3. Strong Core Administration
Claims accuracy, network access, member services, consolidated billing, and stoploss coordination must be executed with excellence.
4. Flexibility & Customization
The best TPAs are partner agnostic and ready to integrate new solutions without red tape.
5. Clinical Capability
Smarter TPAs invest in in-house nurses, pharmacists, case managers, and other clinical staff equipped to manage utilization, chronic disease, and complex care needs.
6. Prevention & Wellbeing
They offer holistic prevention and wellbeing programs proven to reduce long-term risk and engage broad employee populations.
7. Engagement Excellence
Today’s members expect on-demand digital access and proactive outreach. Smart TPAs deliver both.
8. Proven, Validated Results
Smart TPAs have independent accreditation, can validate their outcomes, and provide credible ROI/VOI data.
9. Strategic Partnership
Your TPA partner should act as an extension of your consultative team – proactively bringing forward strategy, data insights, and problem-solving execution.
Why this matters for Brokers moving forward
Employers want smarter TPA solutions that go beyond traditional administration to deliver a connected, tech and people powered healthcare experience. And they trust you to guide them toward partners who deliver on that promise. Choosing the right TPA not only strengthens your strategic role, but directly impacts client satisfaction, cost control, and long-term retention.
If you already have a TPA that delivers this level of excellence, now is the time to strengthen that partnership. If not, begin identifying the TPAs that can support you and your clients more effectively.
Download our newest eBook to learn how to guide self-insured clients toward smarter TPA solutions.
For more information about Personify Health’s TPA solutions, speak to our team today.
1 The State of Benefits Satisfaction,” September 2025, Leader’s Edge, The Council of Insurance Agents & Brokers