{"id":1001,"date":"2015-09-10T10:10:00","date_gmt":"2015-09-10T10:10:00","guid":{"rendered":"http:\/\/localhost\/projects\/horsesforsources\/hc-payer-blueprint-091515\/"},"modified":"2015-09-10T10:10:00","modified_gmt":"2015-09-10T10:10:00","slug":"hc-payer-blueprint-091515","status":"publish","type":"post","link":"https:\/\/www.horsesforsources.com\/hc-payer-blueprint-091515\/","title":{"rendered":"Cognizant, Accenture, EXL, Concentrix, HGS and HP are the top healthcare payer performers"},"content":{"rendered":"

We made the conscious decision to invest in\u00a0researching the healthcare and life sciences industries\u00a0when we founded\u00a0HfS, and one of those investments was to hire Barbra McGann<\/a> to define the space, really sift through the core processes, issues and political dynamics to form a concise picture of who is genuinely innovating, who is effectively executing and aligning their capabilities to solving (and finding) problems for stressed healthcare clients.<\/p>\n

To this end, we’re proud to release our third healthcare-related flagship industry analysis:\u00a0HfS Blueprint Report: Healthcare Payer Operations 2015<\/a>, authored by Barbra McGann<\/a>.<\/p>\n

The Blueprint\u00a0goes in-depth as the market transitions to As-a-Service<\/a>, with a focus on the consumer\/member\/patient, and\u00a0more flexible solutions. Barbra\u00a0looks at\u00a0the increasing use and integration of automation, analytics, and other digital technologies into offerings; examines the changes in demand for talent; and investigates the increasing need for more collaborative and value-based engagements.<\/p>\n

So, we thought, who better than Barbra to tell us about it?<\/p>\n

\"RS_1509_HfS-Blueprint-Healthcare-Payer-Operations-2015--Axis-Only--Blog--578\"<\/a><\/p>\n

Click to Enlarge<\/p>\n<\/div>\n

Barbra, with all the market perspective published on healthcare today, what is unique about the HfS Healthcare Payer Operations Blueprint?
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Phil, the only place that seems to be cutting back on reading material is the waiting room at the doctor\u2019s office. (Am I the only one who misses Highlights?) Of course, that is just one change in the midst of many for waiting rooms, really, as technology and regulation are both expanding the opportunity for mobile health care. All that aside, healthcare organizations, service buyers and providers who are looking for a different perspective on trends and opportunities for increasing the value of sourcing in Health Care, here it is.<\/p>\n

Many of the larger healthcare organizations have achieved the maximum potential benefits from legacy BPO by this point. In our recent \u201cIdeals of the As-a-Service Economy<\/a>\u201d research, just about three out of four participants (72%) from this industry indicated that there was \u201cno value left\u201d in the current BPO sourcing model. At least one out of three are ready for more \u201cintelligent engagement\u201d managed by \u201cbrokers of capability.\u201d Simply put, organizations increasingly realize the need to shake up their operations and engagements, and are looking for the people and the partners to help them put together a solution with the best capabilities to drive results.<\/p>\n

What is increasing the value of sourcing in the healthcare industry? <\/span><\/p>\n

\"\"<\/a><\/p>\n

Barbra McGann, HfS EVP, Business Operations Research (click for bio).<\/p>\n<\/div>\n

The healthcare industry is being \u201cshaken, not stirred,\u201d by new ways and means of defining, delivering, and managing health and care. It is being impacted by regulation, consumerism, digital technologies, and maturing sourcing models. Healthcare is also an industry that is traditionally slow to embrace change. However, change is exactly what is needed in order to deliver on the \u201ctriple aim\u201d of better health, better care, and lower administrative and medical costs.<\/p>\n

Payers, providers and other healthcare organizations are all part of the same value chain in the effort to deliver on this triple aim of healthcare. The common factor is the focus on the consumer, who is also seen as a patient, a member, or a customer, depending on the lens. It\u2019s time to line up the lenses.<\/p>\n

There are many elements of the operations\u2014processes and technology\u2014that underlie healthcare that are common and repeatable. What we see is an increasing need to continue\u2014and continue to improve\u2014managing the processes for example, the steps for enrolling a new member or patient into a plan, ensuring they have the right coverage that is funded appropriately, enabling access to high quality care in the right place when needed, and processing referrals, claims and payments, etc. At the same time, health plans and healthcare providers also need to create better and higher quality experience in the healthcare system so that people will continue to subscribe and use their services and do it in a way that will keep them healthy or address their health and care issues expediently.<\/p>\n

With years of BPO and ITO experience in healthcare, clinicians and other healthcare professionals on staff, best practices that many can tap into from other industries that have gone through similarly regulated and high profile change, and pilots and platforms with newer technologies, many service providers are in a position to partner in new and more collaborative ways. Newer entrants in the market will increasingly challenge the established players, driving new innovation, as well.<\/p>\n

How did this shake out in the Healthcare Payer Operations grid? <\/span><\/p>\n

In this report, we use the term \u201cHealthcare Payer Operations\u201d to refer to:<\/p>\n