Business Process Outsourcing (BPO) used to be a strategy organizations in many industries implemented primarily as a way to cut costs.
Today, lift and shift is no longer the primary driver of BPO in healthcare. Instead, it's the overwhelming need to keep up with a rapidly changing healthcare landscape.
Changes and mandates brought on by the Affordable Care Act (ACA) are already challenging payer IT departments. These challenges are exacerbated by core technology systems that are 30-40 years old, which means they are ill-equipped to operate in a world characterized by ubiquitous Internet availability being accessed on smartphones and other mobile devices.
The new administration has its own ideas of how healthcare (and reimbursement) should be delivered, and those limited IT resources will be stretched even further. Perhaps to the breaking point. Today's BPO partners are looking to help your payer organization re-imagine itself to better meet the challenges of the healthcare landscape in the 21st century. How do you know if any of the BPO partners you're considering can help you elevate your organization to that lofty plane? Here are seven qualities to look for in a BPO partner. The best of them will have all of them.
1. Leading with automation and analytics. With an increased focus on data and the customer experience, a great BPO partner will rely on advanced automation and analytics, as key drivers of business improvements or process changes. They will also have the ability to offer "automation and analytics as a service," relieving your organization of the capital and time investment of developing these capabilities on your own. Today's cognitive computing capabilities will affect more complex, judgement-based activities (like origination and underwriting) with compliance objectives, too. Agility, speed, and accuracy are all customer satisfaction positives derived from these transformations. Most impactful may be the automation data and applied analytics that will dramatically improve outcomes, for more forward-thinking strategies.
2. Process maturity and design thinking. Great BPO partners do more than offer best practices, which are often built around retrofitting past experiences. Recent HfS research showcases the rise of a design thinking approach, collecting the viewpoints of 178 major enterprise operations executives. This study points to creative idea generation as critical to more than four out of 10 enterprises, second only to investment in analytics tools and skills.
3. Co-creation. As a means to the design thinking end, the best service providers drive genuine collaboration and new ideas. There is a solid foundation of partnership trust, transparency, and accountability to work from.
4. Productizing service with targeted solutions. The right solutions portfolio will be supported by depth and breadth of service capabilities of the right BPO partner.
5. Referencability of processes. Member Lifecycle Management. Provider Lifecycle Management. Claims Benefits Management. Medical Cost Management. A healthcare-focused service provider will provide solutions focused in all of these areas of the lifecycle—with a strong end-to-end industry understanding and holistic capability set.
6. Ability to scale to tomorrow's market changes and demand, with domain expertise and end customer focus. With the right toolset and innovation, BPO partners have the ability and the agility to scale with the evolving needs of their client partner. To appropriately strategize and scale, BPO partners should provide end-to-end solutions to help with challenges that may arise post implementation. Effective BPO organizations can help payers elevate the customer experience to a level comparable to other industries through a focus on service excellence, smart processes and a fresh perspective. BPOs with experience across verticals can provide the consumerism focus, as healthcare can certainly learn and adapt to the B2C mindset of other industries.
7. Payer-provider expertise. What was traditionally an adversarial relationship is now more about payer-provider collaboration with member/patient at the center. In the current consumer-centric climate, payers and providers have much to gain from working more cooperatively toward a better member/patient experience. To this point, BPOs with both payer and provider experience have the comprehensive understanding of both markets, and they can leverage relevant learnings and insights. HGS, for example, has employed our operational understanding of provider groups to optimize processes for payer clients, and vice versa. This enables a holistic focus on member and patient experience.
Take full advantage
If you still think of BPO as strictly a cost-cutting measure, you're missing an incredible opportunity to make meaningful changes that will impact your members in a positive way as well as improving your operation from top-to-bottom. But it all starts with choosing a BPO partner that has the capabilities you need.
By using this handy checklist to vet potential BPO partners, you can ensure you're ready not just to meet the known challenges you face today, but whatever new concerns crop up tomorrow. That's a great place to be.
By Anand Natampalli, HGS SVP, Sales and Business Development, Healthcare
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.