Business Process Outsourcing (BPO) of healthcare requirements was primarily used by providers as a strategic way to cut costs and make profits through savings. This perception existed until a couple of years back, till some critical developments sprang up to change it. 

Firstly, changes and mandates brought on by the Affordable Care Act (ACA) have stressed provider IT departments to the farthest. The challenges introduced by the act has been further exacerbated by outdated technology Therefore, the primary challenge before providers is to catch up with the world characterized by sophisticated technology, and more so without exerting their margins.

The onset of the pandemic has made the going all the more challenging for providers. While on the one hand they had to meet maximum with minimum, on the other they had to deal with issues like skilled resource crunch, which severely impacted areas like teleradiology, billing and denial management. This stretched their capabilities to a breaking point.

In the last two years, healthcare BPOs have played an important role in assisting providers overcome these challenges in very effective ways.  Besides assisting providers spread the pandemic induced crushing workload more effectively they have delved into processes and looked for ways to make them adapt to affordable care act in more efficient ways. On the work optimization fronts, providers have banked on them immensely to identify and eliminate unnecessary processes entirely.

Today, the seismic change in perception about healthcare BPOs has even forced self-dependent providers to take BPOs more seriously than before. The moot question however is how do they identify the right BPO partner? In this blog we take a look at all those qualities that you must look for in a BPO partner.

The global healthcare BPO market is predicted to witness phenomenal growth. Reports suggest the figure is all set to reach USD 468.5 billion by 2026 from USD 296.4 billion in 2021, at a CAGR of 9.6%.

What to Look for in a Healthcare BPO Partner

Here are some of the important factors on which you need to hinge your choice for selecting a BPO partner:

Tech Agnostic

Transformational changes in healthcare such as the conversion from ICD-9 to ICD-10, the introduction of the Affordable Care Act, and the policy of shared-risk arrangements, have raised the stakes to such a level that healthcare providers now require specialized expertise to manage operational challenges. To meet these complexities, efficient BPO providers are bringing innovation and strategic thinking to back-office management, along with advanced technology such as robotic process automation and predictive analytics. These technologies have assisted them solve complex issues, such as claims accuracy, network management, claims accuracy, denial and cost management etc. In the process providers have been able to compete more effectively in volatile market conditions.  

Ability to Scale.  

Given today’s market volatility and suddenness of requirements, healthcare providers need to scale up in very short notice of time. The ability to scale sooner than possible is a challenge that health insurance organizations have not been able to cope with easily. Even though many providers have many well-designed strategies in place, they have not been able to scale up because of reasons such as lack of budget, skilled resources, time zone challenges etc.  Banking on BPO service providers have eliminated scalability issues to a large extent. The biggest benefit with an expert BPO partner is that they will help you ramp up on a temporary basis, and then scale back down once the seasonal challenges subside. 

The impact of the pandemic and the possibility of a repeat is compelling healthcare organizations to outsource their non-core functions to third party vendors and focus on core competencies for better patient outcomes. 

Proven Ability in Process Optimization  

Healthcare providers need highly optimized processes for optimum business outcomes. Some of these include improving patient inflow management, reducing variations across processes, prioritizing KPIs, adopting 6 lean methodologies and model synchronous and asynchronous processes and their interactions. Given that process optimization is a continuous process and demands adaptation at a speed faster than competition, making this happen on time is an uphill task. When you opt for outsourcing, you need to ensure that your partner is capable of playing an active role in process optimization. This means having extensive experience in examining all the options to find the best course of action. It entails rising above just applying technology to make an inefficient process more efficient and understanding goals from a larger perspective.

Capability to Meet Enhanced Requirements

The one big challenge that confronts the health industry, among many others, is talent shortage. This challenge stands further compounded by issues like workforce attrition and a growing retiring workforce. The magnitude of this problem assumes greater significance when viewed in the light of growing demand for healthcare as the baby boomer population ages. Every provider needs to plan for this by having in place a comprehensive workforce planning, setting up a robust talent pipeline, drawing strategies for retaining their current workers, appealing to the younger generations etc. However, this stands easier said than done. Partnering with a BPO organization will help providers mitigate this problem to a large extent. They can bring skills to your organization immediately with limited lead time. Therefore, before partnering, you need to check for your partners ability to help you overcome skill crises.

Expertise in HIPAA Compliance 

As it has always been with healthcare outsourcing, partnering with a HIPAA compliant call center is important for your business. Given that HIPAA penalties can cost a provider $1.5 million per violation, hospitals cannot afford to flout compliance requirements, and this applies to their business partners in equal measure. As all upcoming legislation around healthcare will continue to revolve around compliance element, compliance must be the primary focus for healthcare stakeholders. To meet this need, a sound BPO partner will lay emphasis on understanding the details and nuances of compliance programs and assist providers meet ever more stringent requirements. While making a pick, you need to look for a partner, who trains employees as per HIPAA requirements, has a dedicated team to oversee HIPAA requirements, has all hacker and ransomware protection in place, and provision for remediation and audits.

Expertise in Payer-Provider Service 

In the healthcare landscape the payer -provider relationship has always been adversarial in nature. However, in recent times it has evolved to become more collaborative and patient-centric in nature. In the current consumer-centric stage, providers and payers have much to gain by working together for a better member/patient experience. As BPOs with both provider and payer experience have a complete understanding of both markets, providers can tap into their partners learnings and experience to foster better relationship with payers. With this in mind you need to look for a partner who can assist you optimize processes with their understanding of payer processes and requirements. This way it would become easy for your business to develop a holistic focus on patient experience.

Command in Governance Documentation.

An experienced BPO service provider will provide you with expert Master Service Agreement / Service Level Agreements. Besides, they will have all pre-requisites in place for proper operational reporting. This ability will give you the peace of mind about your interests being taken care off with the right degree of accountability. Such partners will leverage their expertise to document agreement in a manner that ensures performance assessments do not get muddled because of too many factors.  They will take it upon themselves to create accountability and define ways to communicate on key issues that take place within operations with focus on remedies and actions in case of any deviations. This sets the stage for a strong working relationship between you and your partner. 

Before identifying a BPO partner, it is important to carry out an internal assessment of your exact needs and have a clear idea, both at macro and micro level of what you want to achieve. This will help you align your visions with that of your BPO partner and ensure they deliver solutions to enhance your strategies.

Who are We and What Makes Us an Expert?

This article is brought to you by Medbilling experts, a pioneer in healthcare back-office support services. We have years of experience is managing a range of services which includes medical billing, revenue cycle management, teleradiology, insurance verification etc. Over the years we have honed our customer-centric and process-driven workflows and embraced advanced tools to assist healthcare businesses streamline their operations for desired outcomes. If your business is looking for an ideal BPO partner with proven experience in healthcare processes, get in touch with our experts now.