TPA

The Proactive Partner for Today's TPA

Enhance Your Clinical Capabilities. Protect Your Clients.

Stop reacting to high-cost claims. Meeko Health is your proactive clinical partner. We integrate with your existing services to find risk and intervene with physicians before a claim becomes catastrophic. We add a new layer of clinical expertise to protect you and your clients.

Our model is designed to enhance your client's current plan design and works with any TPA, PBM, or other solutions you have in place.

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Find Risk Before It Hits the Stop-Loss Deductible

Traditional care management waits for a member to hit a high-cost trigger, like 50% of the specific deductible. This is too late.

We focus on 'Rising-Risk Members'—employees on a path to high costs before they trigger financial alerts. This provides a critical added layer of protection for your clients and stop-loss partners.

How Proactive Identification Prevents a Catastrophic Claim

The Risk: A 31-year-old member is prescribed two medications by two different doctors. On their own, the claims are minor and do not trigger any high-cost alerts.
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‍Meeko's Proactive Intervention: After a newly discovered pregnancy, our predictive analytics flag a dangerous drug interaction risk. Our clinical pharmacist immediately intervenes by collaborating with both of the member's physicians to change the care plan.

‍The Result: A potential $485,000 high-risk pregnancy and NICU stay is avoided, with the total cost remaining under $29,000. This is the power of addressing risk before it becomes a cost.

example timeline for sarah with meeko vs without

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A Flexible Partnership Model Designed for Your Workflow

We augment your capabilities without disruption to your workflows. Our model is designed to enhance your client's current plan design and works with any other solutions they currently have.

We partner with your existing case management team, providing a dedicated layer of provider-level outreach while your team focuses on member engagement.

Our clinical pharmacists collaborate directly with physicians to optimize care plans, a key difference from member focused solutions.

We strengthen your cost containment efforts. We can integrate at the pre-claim stage through adjudication vendors (WLT) or augment your pre-pay review process with our clinical analysis.

Pre-Claim Integration: Our risk stratification engine can partner with leading-edge adjudication software vendors (WLT) to flag high-risk members at the pre-claim stage, offering the earliest possible opportunity for intervention.‍
Pre-Pay Augmentation: We can work in parallel with your existing pre-pay review process. Our clinical analysis of 'Rising-Risk Members’ provides a powerful new data stream to inform your existing reviews for potential large claims.

Aligning Care Decisions with Plan Design

A critical challenge for any health plan is ensuring that care decisions align with the plan's specific design. Meeko's provider-level outreach model is uniquely equipped to help.

By engaging directly with a member’s physicians, our clinical pharmacists can provide timely, specific insights from the member's plan. This communication helps a provider understand the high-value options available, supporting care decisions that lead to better outcomes and lower costs for the member and the plan.

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