Business process services (BPS) was once the gold standard for healthcare payer operations. Its transaction-based pricing worked well to lower labor costs. Although BPS is still a viable option for cost savings, payers need more than just labor arbitrage to compete in today’s rapidly evolving healthcare market; they also need to adapt to value-based care models, improve membership outcomes and experiences, and find new sources of revenue. None of this is possible with outdated, rigid technologies.
Enter business process-as-a-service (BPaaS). BPaaS is a platform-based administrative solution that provides operational agility and efficiency by combining expert people, proven processes and cutting-edge technology to not only lower costs but also improve flexibility, efficiency and effectiveness. With BPaaS, the service provider not only takes full responsibility for the platform-based solution — including keeping the system current with updates, upgrades, maintenance and security — but also provides a long-term strategy to deliver business outcomes in the form of member benefits and revenue growth. The system can scale up or down according to payer needs, and costs are based on a per-member-per-month model.
BPaaS is the next logical step in healthcare payers’ operational strategies. Consider the following benefits of the BPaaS approach:
BPS, meanwhile, delivers this same information in weekly or monthly reports, requiring health plan administrators to wait until the end of the reporting cycle to make needed corrections.
On the plan provider side, easy access to information, typically via the cloud, enables better control over compliance with rapidly changing regulatory requirements and faster response to market demands, both of which are critical to long-term success.
Because BPaaS automates processes, there’s less reliance on manual intervention, which significantly reduces potential risks caused by human error and delays. Because the system automatically adjudicates claims, there’s no need for a claims rep to process it, reducing human touch and potential error.
BPaaS also decreases TCO by reducing capital expenditures on digital technologies. The health plan gets access to new digital systems, accompanying upgrades and ongoing maintenance and pays only for what it uses.
We worked with a large health insurer with membership across Medicare Advantage, Medicaid and Medicare Supplement to provide a more scalable ecosystem to meet its significant membership growth projections. With over one million members, the insurer was facing a high level of technology debt and costly operations.
Within six months, we implemented BPaaS-driven industry-standard processes across the insurer’s lines of business, with functional operational capability guides to minimize customization. We conducted a readiness assessment to address mandates across six states and ensured compliance with CMS and state regulatory requirements. As a result, the plan was able to achieve its goals of scalability, increased efficiency and compliance without the capital expense of replacing its technology systems.
The reality is that payers need to do things better — for less cost. They need to improve the health outcomes of their members and meet members’ increasing demands. With a near real-time view of the business, agile systems, automated processes and the ability to act quickly on that information, health plans will find long-term success.
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 the second installment in this series, “How BPaaS Grows Healthcare Payer Membership, Improves Revenue,” and visit the Digital Operations section of our website.