According to an HfS Research report coauthored by ValueNotes, the value of the US healthcare payor BPO market was $1.2 billion in 2011, and will continue to grow at a 15-20% CAGR over the next three years. These business research firms came out with their findings in a study entitled â€śThe Healthcare Payor BPO Landscape in 2011: Will Reform Shatter a Complacent Industry?â€ť
Investigating health care industry drivers, major outsourced services, and the BPO services provider scenario, this study points out that outsourcing services for claim management, enrolment, billing, provider contracting, and care management will be responsible for the greatest growth opportunities. The Obama governmentâ€™s healthcare reforms are also driving the healthcare outsourcing market.
Healthcare Industry facing Many Challenges
The report discusses the challenges faced by the healthcare industry â€“ technological innovation, new regulations, new diseases, and population growth, all factors that influence healthcare consumption. Health care costs are rising and so is the use of health care services. This underlines the importance of cost control to maintain affordability.
Some of the main findings of the report:
- New regulations make it necessary for industry players to comply with rigorous and expensive auditing and reporting requirements, ICD-10 mandates, HIPAA standards, complex rules for Medicare and Medicaid, and health IT standards. While payors are planning changes to their business priorities and operations due to the new regulations, their commitments are mostly with regard to only compliance with ICD-10 and HIPAA-related mandates.
- Regulatory changes will impact the healthcare insurersâ€™ competitive marketplace. While companies that cannot face the competition will consolidate, large retail organizations will enter the scene and pose a threat to traditional payors.
Business Process Outsourcing
The rise in demand for improved technology, lower administrative costs and more scalability will have a tremendous impact on the healthcare BPO marketplace. Payors will rely more on more transformational assistance from service providers.
Niche service providers will recruit experts and qualified personnel to provide high-end services. Others will focus on scalability and volume-driven work. Their capability will extend to offering improvements in process-driven tasks and impact costs heavily in routine work.