Business Process Outsourcing (BPO) used to be a strategy organizations in many industries implemented primarily as a way to cut costs.
By "lifting and shifting" expensive, people-intensive operations to areas of the world where labor costs were lower, they could improve margins or maintain capabilities that would have otherwise been too expensive.
While that thinking still exists to an extent in healthcare, 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 that 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.
Now, with a new administration coming in with its own ideas of how healthcare (and reimbursement) should be delivered, those limited IT resources will be stretched even further. Perhaps to the breaking point.
Working with a BPO partner helps spread the crushing workload more effectively. But if arms and legs are the only assistance the partner is providing, you are missing a tremendous opportunity. Because rather than just shifting inefficient processes to another venue, or helping check tasks of a list, a great BPO partner will dig into those processes and look for ways to make them more efficient, or even eliminate unnecessary processes entirely.
In other words, they're not just looking to make your work theirs. They're 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 nine qualities to look for in a BPO partner. The best of them will have all eight.
1. Compliance expertise. Much of the legislation around healthcare includes a compliance element, which means compliance is a focus for healthcare stakeholders. A great BPO partner will have knowledgeable experts on-staff whose primary focus is understanding the nuances and details of compliance programs so they can help your organization meet ever more stringent requirements.
2. Extensive healthcare experience and an end-to-end capability set. When looking to engage with an outsourcing organization it is very important to select a partner which has an understanding of not only your operations but also the industry as a whole. These BPO organizations typically have the most robust solution offering as it relates to your current and future needs. Although it may not be need at the time of implementation there needs be an emphasis put forth finding a partner that has the abilities offer end-to-end solutions as these organizations can not only help with current needs but could potentially assist with new challenges which may arise post implementation.
3. Expertise in enhancing methodologies. As we have discussed, rather than settling for lift-and-shift strategies, an optimal BPO partner will evaluate current processes and make recommendations for improvements or even elimination of methodologies that are no longer needed.
4. Understanding of how to increase productivity of the payer as well as its own organization. As work continues to increase and budgets decrease, improving productivity is critical. A great BPO organization will constantly measure and evaluate the performance of payer and internal resources to drive greater productivity or possibly reduce headcounts when appropriate.
5. Offer quantifiable savings. A great BPO partner should be able to demonstrate and commit to the financial lift new processes or methodologies will bring and operate transparently enough to share those findings with clients.
6. Ability to provide solid governance documentation. This includes Master Service Agreements, Statements of Work, Service Level Agreements and timely operational reporting. Particular attention to these areas will allow for peace of mind that your chosen partner will be looking out for your best interests and will be held accountable to these agreements
7. Advanced analytics capabilities. With an increased focus on data and the customer experience, a great BPO partner will rely on advanced analytics rather than experience or "gut instinct" as the key driver of business improvements or process changes. They will also have the ability to offer "analytics as a service," relieving your organization of the capital and time investment of developing these capabilities on your own.
8. Have an end-customer focus. 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. A great BPO partner will also have the expertise required to deliver on the recommendations and exceed client expectations.
9. Incorporate effective IT infrastructure. The partnership's infrastructure must be capable of managing operational, regulatory, and member- and client-driven needs. Whether the work is performed on proprietary systems, web-based tools, or other technologies, a great BPO partner makes the interaction seamless, enabling the payer to focus on serving members rather than solving technology interoperability issues. Additionally these organization should take additional efforts to ensure the security of the data being transferred from internal to external systems to protect member, provider, and internal propriety data.
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.
Anand Natampalli is vice president, global business development, for HGS, a provider of end-to-end business process services for numerous Fortune 100 health insurance companies and large provider organizations. Read the BPO white paper here.
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