Abstract
This Health Industry Insights report describes business process outsourcing
drivers and adoption trends among U.S. healthcare payer organizations and
projects these trends for 2008-2010. Many of the recent inconsistencies in
healthcare payer BPO strategies and execution reflect highly variable business
strategies and rapidly changing market dynamics within the past 10 years,
including HIPAA compliance, the rise of consumerism, ebusiness and the
subsequent evolution to Web 2.0, transaction automation and, more recently,
cost and quality reporting initiatives and health, wellness, and care
management programs. With each new wave, healthcare payers have paused to
reevaluate their business models and reassess where the differentiation and
opportunities for future success lie.
And healthcare payers embrace BPO for different reasons. Some view the BPO
relationship as a tactical strategy to "keep the lights on" of the existing
business while using their own resources for strategic investment. Tactical
initiatives tend to include outsourcing critical but nonstrategic transaction
acquisition and data processing, for example enrollment or claim submission and
data verification. Others include BPO partners in strategic initiatives,
including strategic product launches such as consumer-driven health plans and
various Medicare programs, outsourcing of all services, and management for a
specific product (CDHP, Medicare Drug Program) or a particular strategic
process (care management, health and wellness programs).
"The variability of health plan BPO initiatives and perspectives will continue.
However, the extreme business challenges facing healthcare payers and all
constituents, the expanding business model of the healthcare payer, and the
need for expedient and cost-efficient execution will most likely drive an
increase in BPO in the healthcare payers' market in the next two to three
years," reports Janice Young, program director, Healthcare payer IT Strategies.
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