By Anand Natampalli
In the emerging value-based world, healthcare providers and payers increasingly align incentives to drive improved patient health outcomes, more patient-centric services, and reduced medical cost for individuals. BPO (business processing outsourcer) service providers can bring a neutral consultative perspective, with design thinking and innovation, to meet the provider’s complex challenges.
To solve individual provider’s specific needs, BPO organizations bring customized solutions using a service incubation approach. It incorporates the following:
- A new breed of patient engagement and experience solutions, with a consolidated, targeted strategy
- Data management and integration, sharing intelligence from different segments of the collective healthcare ecosystem, including payers, providers, pharmaceutical companies, and durable medical equipment (DME) providers
- Process optimization through automation and analytics, with a population health management (PHM) focus
A New Breed of Patient Engagement and Experience
Often, consumers of healthcare services encounter confusing phone directories, difficult-to-navigate-websites, and representatives who may not have the training or resources to make a patient encounter meaningful and productive. One of the most critical areas where BPOs can contribute is by helping provider organizations improve the patient experience and drive better health outcomes.
With the added patient choice in today’s marketplace, patient engagement, and experience—an area traditionally of lesser importance to health systems—is now critically paramount to attracting and retaining patients, driving healthier outcomes, and achieving higher ratings.
Patient engagement and experience is often a critical missed opportunity for provider organizations of all sizes. Patient access centers are legitimate business departments and have an important role to play in the transition to value-based, patient-centric care. They have the potential to create new streams of revenue. They engender patient brand loyalty. Most importantly, access centers are a critical first impression that ultimately determines whether a patient chooses to purchase healthcare services.
In a patient-centric healthcare economy, BPOs offer the right balance of technology and talent for seamless, patient-experience delivery. BPOs play an effective front-line role to drive revenue and patient satisfaction, reduce no-shows, and eliminate the need for patients to fish around for answers to their questions. These partners can more effectively employ their analytics and automation expertise to make the patient experience as easy as possible through both personalization and self-service—striving for that perfect balance between automated bots and live, human-touch interaction.
Data Management and Integration
In the new healthcare landscape, PHM is a key area of focus for providers. According to a May 2017 Deloitte Center for Health Solutions survey of hospital CEOs, population health analytics investment is the highest-rated analytics priority for healthcare organizations.
The amount of data attached to every patient has grown exponentially. This must be gathered, integrated, and interpreted according to compliance guidelines and processes that can vary widely between payers and providers. Additionally, the datasets held by payers and providers can be different. For example, payers possess data on claims, financial analytics, and risk models. Providers have administrative and clinical data that includes case histories and outcomes.
BPOs with both payer and provider expertise can best assist, by bridging the data gap between these two organizations. For example, BPOs not only have claims data from provider groups but also from payers. By leveraging this comprehensive information, providers have a better, more holistic view of patient health. Armed with this intelligence, providers can positively affect a patient’s health outcomes, through PHM processes that also bend the cost curve.
Further to this point, each data set is valuable, but in isolation it doesn’t provide a holistic and contextual perspective of the patient. Providers need to leverage health plan data to move from episodic care to delivering outcomes-based care across the care continuum. Payers need access to patient information to work with providers to establish appropriate care plans for their members. Again, this is where BPOs bridge the gap for providers, as well as payers.
Automation and Analytics with a PHM Focus
With better patient engagement and data integration to leverage PHM, there is an ideal scenario for best use of automation and analytics. BPO partners can bring the requisite advanced automation and analytics, as key drivers of business improvements or process changes. With more understanding and awareness of the data coming downstream, BPOs know how to analyze these data points and decouple nonessential activities with automation for a positive impact on health outcomes and to drive costs down.
They also can offer “automation and analytics as a service,” relieving organizations of the capital and time investment of developing these abilities in house. Today’s cognitive computing capabilities will affect more complex, judgement-based activities (like origination and underwriting) with compliance objectives, too. Agility, speed, and accuracy are all positive customer satisfaction results derived from these transformations. Most impactful may be the automation data and applied analytics that will dramatically improve outcomes, for more forward-thinking strategies.
Today, BPO partners take an active role in helping provider organizations manage change, internally and externally. This puts them in a better position to take advantage of the opportunities found by optimizing patient experience journeys. By selecting the right partner, hospitals and health systems can position themselves to gain a competitive advantage in the present, while setting themselves up for an even brighter future.
Anand Natampalli is a senior vice president, global business development, for HGS, a provider of end-to-end business process services for numerous Fortune 100 health insurance companies and large provider organizations.