1. Unprecedented consumer demand, driven by chronic illnesses, lifestyle diseases, and an aging population, will require healthcare payors to facilitate more claims than ever before.
2. Government reforms, principally adoption of ICD-10 standards, HIPAA, and the Patient Protection and Affordable Care Act (PPACA), will pressure healthcare payors to prioritize investment while restructuring their operations to address dramatically new competitive pressures.
3. Payors have been slow to outsource strategically. Encumbered by aging contracts with a median age of six years and largely based on labor arbitrage, only 7% of service provider contracts provide improved technology platforms. 60% of healthcare payor BPO contracts do not incentivize service providers on a gainsharing basis.
4. Payor outsourcing has focused on operational processes. 56% of payor outsourcing has targeted claims, enrollment, billing, and service. These are areas where greater automation and process design could eliminate substantial effort.
5. Payors are ill prepared for dramatic increases in high-touch individual product sales. The individual market size could increase by 422% by 2014, demanding substantial scalability and use of service providers to avoid enrollment problems experienced during Medicare Part D’s initial enrollment period. Yet no service provider reported a payor who had adjusted its contract.
6. Competitive pressure will drive hyper-focus on utilization, care management, and network management. However, service providers are ill prepared to provide these services.
Copies of HfS Research’s 2011 Research Agenda are available to HfS Research member organizations and can be downloaded through our research website.
Commenting on the report, HfS Research Vice President for Healthcare Strategies, Tony Filippone, stated, “Decades of complacency have left payors with systems that require substantial manual intervention. Faced with the perfect storm of regulation, spiraling costs, and unprecedented demand, healthcare payors have no other choice but rely on service providers’ strategic assets and experience.”
HfS Founder and CEO, Phil Fersht, stated, “The healthcare payor BPO marketplace is one of the most immature marketplaces in the outsourcing industry and has significant growth potential in this current climate.” Fersht, who was named 2010 Analyst of the Year by the Institute of Industry Analyst Relations (IIAR) (link), added, “Our research shows several services providers are ramping up their focus and capabilities in this industry to respond to the demands that these secular changes to the sector have created.”
With a growing base of 57,000 subscribers to the HfS research website and the “HfS 25” leading research network for buyers, HfS’ access and influence to senior buy-side decision makers of outsourcing and shared services is today unrivalled in the industry.
About HfS Research
HfS Research (http://www.HfSResearch.com) is the foremost research analyst firm and social networking community, focused on helping enterprises make complex decisions with their business process operations, IT outsourcing and shared services strategies. It has the largest audience and regular following in today’s global sourcing industry.
With 57,000 subscribers, HfS Research provides the most impactful and frequently-visited global collaborative community platform in the global services industry, providing rapid and insightful commentary, analysis and debate of enterprise outsourcing and shared services dynamics. The organization is distinctive in that it integrates personable social networking with market research and expert advisory services.
The HfS Research mission is to provide a unique environment for collective research, opinion, experience and knowledge across the global outsourcing industry to help enterprises explore new performance thresholds. Led by industry expert Phil Fersht, the HfS Research team is a multi-disciplinary group of analysts across North America, Europe and Asia/Pacific regions, with deep domain knowledge in business process outsourcing, information technology services and cloud business services.
Launched in 2007, HfS Research's acclaimed blog Horses for Sources has more than 120,000 monthly visitors across the global outsourcing industry, and is widely recognized as the leading destination for collective insight, research and open debate of industry issues and developments. The HfS LinkedIn community, The BPO and Offshoring Best Practices Forum, is thriving with over 13,600 industry professionals sharing views and information daily. You can access information about HfS at HfSResearch.com and on Twitter at www.twitter.com/
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