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Factors Seen to Drive Health Payer BPO Market

by: Sarah Joson

Thursday, March 5, 2015 |

PRWeb.com recently revealed the results of Black Book’s poll which surveyed 5,400 health plan BPOs from Q3 2014 to Q1 2015. Based on the survey, the health payer outsourcing industry was expected to post noticeable growth caused by the expansion of health insurance access - pushing it to more than 30 million Americans. However, it clearly fell short in contrast to what investors were initially expecting.
A new health plan BPO marketplace is said to be emerging as urgency for claims processing modernization, big data collection and interpretation, data security, and operations intelligence is expected to post 22 percent year-to-year increase, resulting to growth and development in business process outsourcing services.

The latest regulatory reform and market disruption are expected to present several challenges for the US healthcare payer industry, which is why it’s anticipated to adopt new techniques such as unconventional business process outsourcing and innovative software-as-a-service. Moreover, new health plan providers and payer organizations are actively seeking the right outsourcing company to help them operate front, middle, and back office processes in a smarter way, and at a more economical operational cost.

A growth of 13 percent was posted by the payer market place of traditional BPO services in contrast to the 7.2 million new paying members from the healthcare reform. Some of the processes that will be outsourced are customer support, claims adjudication, and claims processing.

Other markets which include government payers, private health plans, commercial insurers, hospital and physician/provider sponsored plans, third party payers, managed care organizations, accountable care organizations, and care management groups are also expected to drive healthcare outsourcing from $5.2 billion to $8.0 billion in 2016. As a matter of fact, outsourcing activity has doubled in just the past 12 months.

Black Book also pointed out that over the period of Q1 2013 to Q1 2015, traditional payer BPO services such as call centers, member enrolment, and claims processing posted a CAGR of only nine percent. Emerging processes that are gaining traction in the healthcare outsourcing industry include outsourcing analytics, new plan set-up, claims modernization, alternative payment services, utilization management, security, value-based solutions development, sales and marketing, population health and big data initiatives, and multi-channel contact center management.

Majority (87 percent) of the survey respondents cited their top priorities for 2015-2016: health, software-as-a-service, accountable care/chronic care management assistance, big data aggregation, health information exchange, data security, and analytics. On the other hand, 74 percent reported that they are looking to outsource development and management of new value-based payment models because they do not have the necessary technology, manpower, as well as other resources in-house.

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