The Heathcare Payor BPO Landscape in 2011: Will Reform Shatter a Complacent Industry?
This industry analysis report, co-authored with HfS, examines the key business challenges faced by the global pharmaceuticals industry and the resulting impact of outsourcing within this segment. This industry has traditionally been the main support function for the healthcare system by innovating, marketing and supplying drugs. However, over the past few years, with increasing costs for research and development and marketing services, major pharmaceutical companies have turned towards external partners to help them design better drugs, control expenditures, and reduce capital investment.
This report, co-authored with HfS Research, explores the heavily regulated healthcare payor industry which is in the midst of a continuous flux of its commercial and consumer businesses. Rapid industry developments in the global healthcare industry during the past two years have been a pre-cursor to the advent of new technology and reforms in the industry along with an increase in the amount of outsourcing. There is a dire need to upgrade policies, execution and technology across healthcare systems across the globe. The major healthcare payors currently have a limited experience in labour-arbitrage based outsourcing. The future for the industry requires these payors to increasingly leverage the capabilities of their existing service providers to ensure better quality and win new market share.
This report, co-authored with HfS Research, explores the heavily regulated healthcare payor industry which is in the midst of a continuous flux of its commercial and consumer businesses. Rapid industry developments in the global healthcare industry during the past two years have been a pre-cursor to the advent of new technology and reforms in the industry along with an increase in the amount of outsourcing. There is a dire need to upgrade policies, execution and technology across healthcare systems across the globe. The major healthcare payors currently have a limited experience in labour-arbitrage based outsourcing. The future for the industry requires these payors to increasingly leverage the capabilities of their existing service providers to ensure better quality and win new market share.
The global healthcare industry in 2011 – an overview
The healthcare industry stakeholders
Drivers to continuous growth of healthcare
Demographic change creates volume pressure
Significant increase in costs
Transformation in healthcare to meet challenges
Key takeaways
Healthcare payors’ outsourcing forecasted to rise over the coming years
Healthcare payors’ outsourcing exemplifies conservative, tactical and low-value “lift and shift” models
Lift and shift approaches are not enough to ensure healthcare payors’ market competitiveness
Healthcare payor sourcing is too specialized for many third-party advisors
Service providers must bring value beyond solely low-cost labor arbitrage to their payor relationships
Experienced sales and marketing providers enter the outsourcing fray
Labor arbitrage for transactional activities will give way to consultative support
Payor customer service enters the modern, mobile and social world
Improving network quality and efficiency will differentiate payors
High labor costs and high quality care drive medical management outsourcing
Actuarial costs drive offshore adoption, while enrollment volumes drive comprehensive underwriting solutions
Small numbers of employees in administrative organizations shift outsourcing focus toward combined BPO/ITO
solutions
Multi-shoring important for industry
Global vendor base altering to meet changing demand
Trends: Volume and value uptick as buyer demand outpaces supplier maturity
HfS Recommendations for Healthcare Payors
HfS Recommendations for Service Providers
About the Authors
About HfS Research
The healthcare industry stakeholders
Drivers to continuous growth of healthcare
Demographic change creates volume pressure
Significant increase in costs
Transformation in healthcare to meet challenges
Key takeaways
Healthcare payors’ outsourcing forecasted to rise over the coming years
Healthcare payors’ outsourcing exemplifies conservative, tactical and low-value “lift and shift” models
Lift and shift approaches are not enough to ensure healthcare payors’ market competitiveness
Healthcare payor sourcing is too specialized for many third-party advisors
Service providers must bring value beyond solely low-cost labor arbitrage to their payor relationships
Experienced sales and marketing providers enter the outsourcing fray
Labor arbitrage for transactional activities will give way to consultative support
Payor customer service enters the modern, mobile and social world
Improving network quality and efficiency will differentiate payors
High labor costs and high quality care drive medical management outsourcing
Actuarial costs drive offshore adoption, while enrollment volumes drive comprehensive underwriting solutions
Small numbers of employees in administrative organizations shift outsourcing focus toward combined BPO/ITO
solutions
Multi-shoring important for industry
Global vendor base altering to meet changing demand
Trends: Volume and value uptick as buyer demand outpaces supplier maturity
HfS Recommendations for Healthcare Payors
HfS Recommendations for Service Providers
About the Authors
About HfS Research
