Sagility Experts Weigh In: As-a-Service Solutions Drive Improvements for Payers

Healthcare organizations face tight budgets, a continued need to increase productivity, lower costs, enhance technology, and reinforce IT infrastructure all while continuing to improve the healthcare consumer experience.

While building and implementing a strategy to holistically address each of these challenges may seem counterintuitive at first, using an as-a-Service process makes it possible to achieve across-the-board advancements and improvements for health plans.

Implementing as-a-Service Solutions

Making modifications like these is a challenge no matter the approach. But using an as-a-Service approach, designed to mitigate the issues that come with organizational change, can help improve overall acceptance.

On February 14, Sagilty hosted a webinar, “Reducing Costs & Driving Innovation through as a Service Healthcare Solutions.” At this session, we explored exactly how payers can use the as-a-Service model to quickly react to business changes, improve consistency across business units and ensure compliance with regulations. This model fully addresses the challenges faced by healthcare organizations.

During the event, Sagility experts detailed how member engagement, claims and provider data management could be upgraded using the as-a-Service framework.

The Sagility experts who participated and shared their expertise:

  • Amitabh Singh, Chief Strategy and Practice Officer
  • Sivarama Rambhatla, SVP and Global Head, Solutions
  • Srikanth “Sri” Lakshminarayanan, SVP, Healthcare Practice

The group offered insights into as-a-Service programs in healthcare and how their use could drive cost reductions and help an organization innovate and build for the future.

Webinar Participant Questions

During the Q and A session, the presenters offered practical insights to help participants understand the model’s benefits and value.

Question: What is BPaaS? Answer: BPaaS is more than the sum of its parts when compared to traditional outsourcing services. BPaaS includes cloud-based technology, people and processes working together toward a common goal expressed by the health plan. BPaaS delivers holistic healthcare services using cloud-based platforms, creates end-to-end benefits to drive cost savings, enhances risk management, and provides access to innovative technology. Sagility’s programs are completely scalable and deliver substantial business outcomes, with up to 45% ROI compared to other Contact Center as a Service providers, for example.

Question: What are the benefits of implementing a BPaaS solution for provider data management?

Answer: Health plans can achieve multiple benefits when implementing Provider Data Management as a Service. The plan can consolidate processes, automate workflow and data comparison, and improve accuracy using analytics and business intelligence. Doing so reduces provider abrasion and helps build member satisfaction.

Question: What’s the best way to implement a BPaaS program?

Answer: Choose the journey that works best for your health plan. We’ve worked with organizations that wanted to experiment with Contact Center as a Service or Claims BPaaS before implementing additional services. They rolled out a pilot program that was expanded in the future. Many have found that adding more as-a-Service modules generates better operational and business results because of the holistic view the technology affords.

Question: What level of support do you expect from the health plan?

Answer: To implement a BPaaS solution, a high level of support is necessary. Typically, a health plan will assign a dedicated person or group to assist. This is important because we must build familiarity with the health plan’s existing technology and understand, at a granular level, all of the business needs and challenges. The health plan also must be highly active in rolling out a change management program for the project because BPaaS touches on areas throughout the health plan, and staff must be made aware of and become comfortable with the upcoming changes. Finally, engendering a trusting relationship between the partners is critical to long-term success.

Question: How long does it take to implement a BPaaS solution?

Answer: Implementations are not one size fits all. It depends on the complexity of the process, the type of health plan, member demographics, change management execution and other considerations. In general, however, an implementation takes six to 12 months.

Participants speak out on as-a-Service solutions

We asked webinar attendees questions about different as-a-Service topics to understand the current state of acceptance in the healthcare market and the challenges they see as most pressing.

What is a key driver for you to consider a Claims BPaaS solution?

  • 0%: Access to better technology
  • 33%: Reduction in per-claim cost
  • 8%: Increase member/provider NPS
  • 59%: All of the above

What are the most important components of an omnichannel CCaaS program?

  • 7%: Scalability
  • 7%: Seamless integration of digital assets
  • 6%: Increased customer engagement
  • 80%: All of the above

What is your organization’s BPaaS readiness?

  • 14%: I would like to learn more about Claims BPaaS
  • 0%: I would like to learn more about Provider Data Management as a Service
  • 72%: I would like to learn more about Contact Center as a Service
  • 14%: I am aware of BPaaS solutions and can make decisions on choosing a partner
  • 0%: Not interested in as-a-Service solutions at this time


Fiscal Health for Providers: Precision Cost Takeout in 3 Areas

By Titus Leo and Jason Besterfeldt

As today’s hospital margins are increasingly in the red, and health systems are asked to do more with less, all eyes are on cost removal. According to a recent survey on healthcare outsourcing conducted by Black Book Market Research LLC, 90% of healthcare executives are exploring cost savings through relationships with third-party vendors. Here we address three main areas for cost takeout: call center/customer service, AR resolution, and clinical functions.

Call center/customer support: In the past 10 years, providers have responded to consumer demand with more focus on the patient financial journey and a unified, seamless experience.  Omnichannel outreach leveraging both technology and phone conversation are essential to addressing the needs of a diverse patient base.  Technology has improved but the phone calls have suffered since the pandemic because of the labor shortage.  This continues to create problems whether it’s with scheduling, prearrival financial counseling, prior-authorization, or inbound/outbound calls related to patients balance after insurance.  Recent research points to increasing average hold times and the negative impact this has patient satisfaction. 

In this new environment, hospitals and health systems are leveraging RCM services companies to augment and scale their workforce.  These partners bring essential capabilities to improve the patient experience pre-visit but also address essential clinical functions like prior authorizations preventing denials.  These resources can be a mixture of onshore, offshore and nearshore talent who can assist with insurance/support functions, patient calls (both inbound and outbound) as well as provide much needed bilingual support. The review of this process, cost, and scalability can provide substantial operational cost savings, greater operational stability, and an improved patient experience.

Accounts receivable (AR) resolution: Hospitals and health systems are facing increased labor costs and payer requirements while reimbursements have fallen.  Technology has accelerated progress with bots performing  real-time claim statusing, AI driving intelligent workflows, and automation removing highly repetitive/repeatable steps.  With all of these advancements, there is still the need to review, handle exceptions, and write appeals, to maximize reimbursement in a timely manner.  Not only has COVID-19 caused a labor shortage in business offices but the cost of resources has increased at an alarming rate.  According to a recent PWC and Becker’s Hospital Review survey, 83% of respondents reported experiencing labor shortages across the revenue cycle.  Insurance companies have moved many of their calls centers off shore to contain these costs and hospitals are increasingly embracing this move.  Business offices looking to increase capacity, remove cost or mitigate risk are seeing a huge impact as they look to India/Philippines to not only meet the needed scale of their office but, do it at less than half the cost.  The right partner can bring expertise, technology, and visibility to provide confidence for those facilities looking to remove expense from their cost to collect with this approach. 

Clinical support resources: Recent American Hospital Association (AHA) research states that 95% of providers spend increasing time seeking prior authorization approval. The reason for this is often stated as a lack of front-office staff and clinical resources to have payer conversations or improper documentation.  Again technology is assisting here but, the need for resources, especially clinical, are getting expensive and difficult to find.  This presents an opportunity to partner with organizations that have access to clinical resources both here in the US and in the established clinical environment of the Philippines.  The most frequent functions for cost take out are nursing support, case/care management, care coaching, transitions of care, navigating network, case management referral, care plan generation, transport coordination, and remote patient monitoring. With blended delivery models, outside experts can provide the requisite scale and significantly reduce cost. 

From shortening patient appointment hold times to taking the frustration out of prior authorization and billing—the right cost takeout strategies also deliver improvements in patient experience.  As hospitals continue to reduce their cost to collect, they are increasingly turning to RCM service providers for the required scale, cost removal, and risk mitigation.