There’s such a loud call for change in the U.S. healthcare industry these days, Barbra. \u00a0Please tell us a little bit about what you see going on…<\/strong><\/span><\/p>\nHealthcare is just too complex. Through the Patient Protection and Affordable Care Act, we all have the right to access healthcare, but for a lot of people it\u2019s still difficult and expensive to do so. Healthcare providers and payers are on a mission to take the \u201csting\u201d out of healthcare. The goal is to make healthcare more personal, user-friendly and cost effective. That\u2019s a monumental task and requires change in the way many of them do business. It will take some creativity and new approaches to get it done.<\/p>\n
Of all the activities in healthcare, Barbra, why did we zero in on Population Health and Care Management? <\/strong><\/span><\/p>\nOrganizations need to help individuals engage and manage their own health \u2013 empower them to be healthier. This is the scope of population health and care management. Population health involves understanding who needs what kind of support to live a healthy lifestyle, reaching out and connecting early when there is potential need for medical support. Care management covers the coordination of care for people who are managing chronic conditions, helping them achieve better health, and the authorization of that care from the financing entity. While there used to be a pretty clear distinction between healthcare providers addressing population health and health plans covering financing and care management, these two are overlapping more and more with the focus on the individual as a whole rather than on a single stage.<\/p>\n
So How can service providers help healthcare organizations get more personal with consumers, members, and patients? <\/strong><\/span><\/p>\nService providers have been providing BPO support for healthcare organizations for years now to operate more efficiently and lower costs. And to do it, they have hired clinical executives and staff, developed industry certification and training programs and technology enabled IP, and established onsite and global centers. We believe they have the capability now to work closely with healthcare organizations of all sizes to help them be successful. Service providers have proven they can partner to help increase adherence to care plans, reduce readmissions, and reduce administrative costs, for example. They work with sets of population data to help design models that identify and drive interventions, and make calls to targeted patients to remind them about appointments and help them figure how to get there, and provide smooth back office operations for utilization management with a combination of skilled clinical and non-clinical resources and automation.<\/p>\n
How is this Blueprint going to help current and potential services buyers? <\/strong><\/p>\nThere\u2019s a lot of discussion about healthcare IT capability for population health, and not much about BPO. So we took a look at which service providers are offering business services and experience addressing:<\/p>\n
\n- Consumer engagement and interaction: identifying whom to target and reaching out with assessments, wellness programs, and medical interventions<\/li>\n
- Utilization management: processing authorizations, reviews, appeals and grievances administration for medical care<\/li>\n
- Care Coordination: referring and enrolling members and patients in programs, helping them navigate and manage their care and administration, planning and documenting discharge after hospitalization, and remote patient monitoring<\/li>\n
- Performance management and operational analytics: measuring outcomes, analyzing, reporting, and providing insight on metrics for administrative and compliance purposes.<\/li>\n<\/ul>\n
It\u2019s a collection of activities that together help healthcare organizations manage outcomes focused on well-being, health, and care \u2013 wellness in every day life or specific times like pregnancy, adherence to care plans and medications, emergency room visits, hospital stays, and readmissions, for example.<\/p>\n
How did the Blueprint analysis turn out?<\/strong><\/span><\/p>\nThere are 8 service providers who stepped up to the opportunity to share their current capability \u2013 skilled resources like clinicians and healthcare data scientists and technology IP and platforms \u2013 as well as vision for the future of population health: Accenture, Cognizant, Dell, EXL, HCL, Hinduja Global Services (HGS), Sutherland Global Services, and Wipro.<\/p>\n
Winner\u2019s Circle:<\/span><\/strong><\/p>\n\n- Cognizant, a flexible, adaptive risk taker; led by technology and building up the strategy and consulting layer<\/li>\n<\/ul>\n
\n- Accenture, an engaging thought leader with a full suite of services and community connections<\/li>\n<\/ul>\n