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Health insurers across the U.S. are in a battle to boost revenues and grow membership by offering new member-focused products and services. Although there’s plenty of growth opportunity, however, many health plans are unable to capitalize on it due to outdated technology. As outlined in the first part of this series, business process as-a-service (BPaaS) can help neutralize these challenges by introducing digital technologies into the health plan’s operations.

BPaaS is a platform-based administrative solution that provides operational agility and efficiency by combining expert people, proven processes and cutting-edge technology, allowing health plan staff to focus on more complex endeavors and strategic work that improves the member experience.

For instance, staff who traditionally would be assigned to administrative processes are free to focus on such things as:

  • Benefit design and structure (i.e., adding enhancements to the benefits package).
  • Incentive programs and new lines of business (i.e., Silver Sneakers and medical transportation).
  • Avoidable injuries (i.e., teach seniors how to avoid physical injuries).
  • Marketing initiatives to identify potential members and retain existing members, which naturally leads to increased revenue.

Although healthcare payers know they need to do these things, they often don’t have the resources to adequately focus on such initiatives, or they pursue each item individually rather than as a holistic program. Because BPaaS helps free up resources, it provides needed additional bandwidth.

Expanding Brand Exposure

Boosting the membership experience can also directly impact the health plan’s Star Rating, which is a Medicare point system that rates how well Medicare Advantage and Part D plans perform across five categories. Three of these categories are directly related to the member experience: plan responsiveness, member complaints, and attrition and health plan customer service. Ratings range from one to five stars, and dropping below three stars for three years in a row flags the plan as low-performing.

Figure 1

A higher Star Rating can improve revenues because it can impact Medicare bonus payments, and it can increase membership because consumers are encouraged to use these ratings when comparing plans. Higher-rated plans may also be listed more prominently on search engines and the Center for Medicare and Medicaid Services website, and improve their brand reputation through positive reviews and member satisfaction ratings in both the physical and social media worlds.

Higher star ratings can also help smaller plans compete more effectively with large health insurers with tens of millions of members and hundreds of billions of dollars in annual revenues.

For example, a customer health plan chose BPaaS with the goal of increasing its Star Ratings and growing its membership. Through the BPaaS model and its integrated tools, the insurer was able to raise its Star Ratings from 3.5 to above 4.0, increase membership by 1,000% and realize increased revenue of $250 to $300 per member because of bonus eligibility.

BPaaS for Health Insurers

By combining automation, insights, best-in-class processes and industry-leading platforms, BPaaS supports health plans in their mission to invest in product and service innovation and focus on the member experience, both of which create strong competitive differentiation.

Through BPaaS, payers have the opportunity to achieve new levels of efficiency and effectiveness in their core operations by giving staff more time to focus on strategic health plan initiatives and growing the customer base. Applying BPaaS controls — such as process optimization and digitization — helps bring payers to levels of effectiveness they would not be able to achieve on their own.

Venkatgiri Vandali is a Vice President at Cognizant and heads the company’s Healthcare Business Process-as-a-Service (BPaaS) practice. For more on how BPaaS benefits payers, please see our first installment of this series, “From BPS to BPaaS: Increasing Value for Healthcare Payers,” and visit the Digital Operations section of our website.