Business Process Outsourcing for Payers in Healthcare
BPO (Business Process Outsourcing) is defined as a way of “helping payers streamline operations, reduce costs, speed their time to market with new service plans, and use data analytics to reduce risk.”
Due to a surge in enrollment thanks to the Affordable Care Act, as well as an increase in both high-risk consumers and the size of the aging population, payers must process more claims than ever. Additionally, aligning payers and service providers can help ensure smoother claims processing and reduce overall operational costs.
What a concept! Outsourcing to reduce cost and provide better service. The payers primarily because of volume have collectively decided that outsourcing the processing of claims is costing them too much, takes away from their primary mission of selling new coverages and mitigating risk through data analysis.
This is a well-known concept on the provider side. Providers primary mission is the care and treatment of patients. The business side of this mission consumes their time, money and considerable effort to be successful.
It is interesting that the payers light bulbs have suddenly come on at 100 watts to say “wait a minute, we can outsource this part of our business and save money!”
They can, and they will.
Outsourcing claims processing is a mixed bag for many providers. When it was considered most popular, it was because the expertise needed to process claims, not to mention the larger more sophisticated computers, was not found in the average provider practice. Then someone said, hey wait a minute…..why are we paying someone else to look out for our interests? Sure it will cost us something to do our own, but we will watch out for every penny, go after every claim and collect everything that’s coming to us. What most practices have found is that while they do have a vested interest in going after all their owed dollars, the cost of doing that keeps going up. Not only are very sophisticated computers needed, but technology has demanded more expertise in interconnecting the computers and a full time staff to ensure confidentiality and data collection.
With the advent of the ICD 10 c0nversion, not only hardware and software will be positively or negatively affected by the conversion, but cash flow may well feel the impact.
Outsourcing by providers deserves a second look for the same reason payers have decided it is a viable alternative for their industry:
- It will reduce cost
- It will give the Practice attention to primary mission – treating patients
- More time and effort can be spent in developing the EHR for maximum use and gain.
It’s not rocket science to figure that out.