BPO, supercharged: business process as a service drives scale, savings while exponentially enhancing outcomes

By Srikanth Lakshminarayanan, , Senior Vice President, Center of Excellence for Healthcare Engagement Services; Umesh Chandorkar, Vice President of Solutions for Sagility’s payer segment;  and Nikki Henck, Senior Director, Utilization Management

Health plans have long understood the benefits of business process outsourcing (BPO). Faced with the heightened prioritization of customer needs, experience, and value stream impact, these health organizations are now looking to drive more positive business outcomes through service providers on an “As a Service” model rather than the traditional transactional models.

Simply defined as the delivery of Business Process “As a Service,” (BPaaS) supercharges benefits — with end-to-end advantages from breakthrough cost savings and predictability of spend to enhanced competencies focus, risk management, and access to new technologies. 

Health plans are well suited to taking the benefits of BPaaS solutions spanning:

• With the pay-as-you-go model, organizations can better scale and align with needs as the business changes. This is additionally bolstered by metered tech investment and reduction, with system, platform, and solution costs assigned to the “As a Service provider.” BPaaS provides assured tech currency, data security, and scalability — reducing tech investment risk. With this shift from technology and operations spending “As a Service” enables health plans to accelerate growth with a core focus on product development.
• BPaaS helps centralize siloed operations for consistency across all units and improved process flows and outcomes. The BPaaS partner is uniquely incentivized to drive performance and optimize the resources and service levels—regardless of volume fluctuations.
• Professionally operated, auditable “As a Service enables stringent compliance that addresses the nuances of regulations and how they can affect business from an end-to-end perspective. These “As a Service” models also provide a lot of efficiency due to the experience BPO organizations bring, which is a core differentiator.

In The Front Office

Exceptional member experience is more important than ever, as supported by a modernized contact center and measured by value-based benchmarks. This experience is integral both for differentiating healthcare organizations and for preventing the loss of valuable customers. Contact Center As a Service (CCaaS) — essentially, the front door of “As a Service” —provides:

• An optimized consumer or member journey: CCaaS end-to-end journey mapping drives an enhanced experience. These member journeys can be enhanced using the CCaaS model, where all customer touchpoints are integrated, reducing the customer effort for the member.

• Plug-and-play experience optimization: The CCaaS solution suite comprises a fully integrated, cloud-based platform with bolt-on digital accelerators, including chat and chatbots, text, and speech and data analytics. AI-based omnichannel provides seamless resolution over multiple touchpoints and channels. In addition to channel preference customization, the results are improved efficiencies and a higher rate of touchpoint resolutions for the customer. 
• Up to 30%  cost savings in tech investment alone: With vendor accountability for bringing forward more robust, latest-and-greatest technology, health plans can also rely on additional predictability of spend and reduce their capital expenditure.

In The Back Office

In the back office, BPaaS delivers critical benefits—reducing administrative burden with access to modern tech and reducing the legacy burden and overall spend, with enhanced speed to market. BPaaS provides seamless integration with artificial intelligence (AI) and machine learning (ML) boosting benefits between claims, provider network operations, and pre-payment integrity checks. In these critical areas, BPaaS delivers:

• BPaaS seamless integration starts with claims intake, FWA rules, and auto adjudication rules. The result is the delivery of a streamlined processing environment, leading to more lean and efficient operations with significant cost savings. This includes interoperability between internal and external departments. Additionally, there is one-stop accountability from a compliance standpoint.

• Value-added robust analytics processing leverages the latest AI and ML tech, driving precision in payment accuracy and elimination of claims leakage.
• Accurate data management and timely payment ensures that provider and member abrasion is minimized – with quality provider data — and faster speed to pay.

Clinical

With the regulatory landscape and high cost of operation, health plans are critically evaluating their Utilization Management (UM) strategy and performance.  These organizations must focus on high-efficiency, end-to-end workflows that eliminate silos and bottlenecks in critical areas of health service management.  

• Real-time determinations and faster case turnarounds can reduce up to 40% of operating costs. This can be achieved by leveraging AI-enabled technology like automation, natural language processing, ML, and assistive technology. A well-connected UM workflow bridges critical touchpoints across operations and compliance with seamless service delivery – from intake to clinical and post-service review. One key use case is the high cost of manual prior authorizations — a fulcrum point where faxes and phone calls are inherent processes from which inaccuracies and inefficiencies result in delayed care and provider dissatisfaction. 
• Improved provider satisfaction can lead to higher NPS scores and Star ratings and better member engagement. Access to multi-channel prior authorization submission processes makes it easy for physician practices to submit prior authorizations over their preferred process at a time that is convenient, minimizing provider abrasion. The ability to obtain real-time decisions makes a world of difference to providers, as they ensure their patients get timely care — ultimately boosting member satisfaction, resulting in higher net promoter scores (NPS) and Star ratings. 
• Evidence-based care guidelines support appropriate ordering that is clinically indicated, thus ensuring patients get the right care. UM as a Service leverages evidence-based guidelines that support clinically indicated health services, resulting in better care quality, safety and cost savings, with a first-time-right process and more precise clinical decisioning. 
• The right BPaaS partner brings healthcare domain expertise that bridges gaps across these three areas of Front-Office, Back-Office, and Clinical. Additionally, a considerable advantage will be found with a partner that has end-to-end understandings and capabilities across the entire payer-provider ecosystem.

Article originally published in Healthcare Business Today.
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