Healthcare Global Sourcing BPOKPO Solutions to contain rising costs while improving Outcomes

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Healthcare Global Sourcing - BPO/KPO Solutions to
contain rising costs while improving Outcomes
CHSM May 30, 2008
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Introduction

• What is BPO, What is KPO
• State of the BPO Industry
• Benefits of BPO
• Glance at the KPO Market
• Benefits of KPO
• Opportunities for BPO and KPO
• Functioning as an Extension of the Customers
  Team

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BPO vs. KPO

• BPO
• Outsourcing of non-core business processes,
  generally offshore.
• Less involvement with on and offshore teams
• Primary goal to save money
• KPO
• Outsourcing core business processes where highly
  educated professionals perform the KPO tasks,
  generally offshore.
• Highly collaborative between on and offshore
  teams
• Primary goal to gain access to scarce knowledge
  experts
• Risk identification and mitigation is complex,
  individual professionals must use their own
  judgement capabilities for decisioning and risk
  mitigation
• Example
• BPO Claims Processing
• KPO Adjudication

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State of the BPO Industry

• According to Gartner, the global outsourcing
  market in 2000 was approximately 119 billion
• The market is expected to grow to about 310
  billion by the end of 2008
• Contribution from North American continent stands
  at about 59 of the total market
• Europe 27 of market
• Asia-Pacific region (including
• Japan) contributing the Sales,
• marketing and customer care
• remaining portion of the market

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Benefits of Utilizing BPO Strategies

• Immediate Cost Savings (typically over 30)
• Improved Budgetary Compliance
• Improved Service Levels and Compliance Levels
• Steadfast Focus on Quality
• Standards Allowing Client to Focus on Core
  Business, and their Customer
• Business Process Improvement
• Documented Process Methodologies
• Improved Infrastructure for Growth and Security

Customer Relationship
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A Glance at the KPO Market

• According to Gartner the CAGR for BPO in the past
  few years has been 30-40
• In contrast, Gartner is predicting 45-50 CAGR
  for KPO. The revenue from the global KPO market
  was USD 1.2 billion in FY 2003 and this is
  expected to grow to USD 17 billion by FY 2010.
• India will receive the largest of this market
  share.

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Benefits of KPO

• Provides ability to tap into specialized
  knowledge in various vertical business domains
• Ability to tap into highly educated professionals
  without hiring permanently
• Access to top quality, high-level intellectuals
  without HR headaches of hiring and retention
• Access to infrastructure of multiple delivery
  models
• (right shore on-shore, near-shore and
  off-shore)
• Consistent and scalable talent, globally
• Potential for a 40-60 labor cost reduction
• Access to fresh, innovative ideas

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Birds Eye-view The Migration Agenda
Business Process Improvement

• Outsource non-core Transaction Processing l
• Drive Cost Efficiency to low cost destination
• Leverage volume of data for excellent statistics
• Date Access and Reporting
• Standard MIS summary reports
• Additional MIS key KPI Root Cause Analysis
• Organize Data through a systematic Extraction,
  Loading Data Transformation
• Create an integrated View of the Transaction Flow
• Organize Data to build Scenarios by customer/ by
  events, by entities
• Build Business Rules for Querying
• Dynamic Alerts
• Statistical Analysis for KPI's Score cards
  Dash boards
• Data Mining
• Forecasting and Extrapolation
• Predictive Modeling
• Optimization

COMPETTITVE Differentiation
DEGREE OF INTELLIGENCE
We want to help you get here
Knowledge Processing
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The Migration Plan Key steps
Deliver BPO operations
Health Care Customer Information Flow Raw Data
Transaction captured
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Security Compliance and Disaster Recovery

• Compliance Program
• Policies and Procedures
• GAP Analysis
• Risk Assessments
• Security Awareness Training
• Supporting Documentation Evidence of Compliance
  
• Compliance Auditing
• Internal Pre-Audit Process
• On-going Monitoring Process
• Internal Compliance Certification
• External Customer Audits
• Focal Points
• Business Continuity Planning
• Disaster Recovery Planning
• Network and Data Security
• Intrusion Detection Systems

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Healthcare Opportunities for BPO

• Provider
• Electronic Health Record
• Medical Coding
• Billing
• Revenue Cycle Management
• Accounts Receivable Management
• Accounts Payable Management

• Payer
• Enrollment
• Plan Benefit Load
• Provider Contract Management
• Claims Administration
• Adjudication
• Presentment

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Opportunities for KPO

• Healthcare
• Medical Coding
• Adjudication
• Healthcare Data Mining
• Pharmaceuticals Biotechnology
• Market Research Business Intelligence
• Teleradiology
• Education
• Medical Tourism

• Financial Analysis Equity Research
• Legal Solutions
• Intellectual Property (IP) Search
• Data Analytics
• Training Consultancy
• Engineering Design Development
• RD Work on Various Vertical Domains
• Various Educational Services

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Medical Tourism

• The term was initially used by travel
  agencies and the mass media to describe the
  rapidly-growing practice of traveling across
  international borders to obtain healthcare.
  Services typically include elective procedures as
  well as complex specialized surgeries, such as
• joint replacement (knee/hip)
• cardiac surgery
• dental surgery
• cosmetic surgeries

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Medical Tourism Selling points

• High cost of health care
• Long wait times for certain procedures
• Ease and affordability of international travel
• Improvements in both technology and standards of
  care in many countries

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Functioning as an Extension of the Customers
Team

• Effective knowledge transfer and training is
  critical
• Have agreed upon Transition Plan including
  training, resources and timeline
• Have the proper reporting, tracking and security
  measurements in place
• Customer and Provider are engaged and aligned in
  the following
• Due Diligence and
• Planning
• Scope Development
• Cost Projections
• Contract Negotiations
• Planning and Project Management
• Process Development
• Training

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Most Common Outsourcing Mistakes

• Organizational readiness, unclear business
  objectives and fluid strategic plan
• Underestimating the total costs, complexity of
  managing the offshoring relationships and
  contracts
• Wrong processes/functions and partner selection
• Lack of expert guidance and adequate due
  diligence in vendor selection process
• Inadequate transition management and governance
• Overestimating the overall cost savings
• Selecting a partner and country before
  understanding objectives and performing internal
  assessments
• Selecting a single source provider, poorly
  structured contracts
• Failure to develop effective communication plans
  and retention plan for internal core talent

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Outsourcing Value Proposition

• End-to-End Integrated Processes
• Efficiency Throughout, Directly
• and Indirectly
• Complex Claims and Attachment Processing
• HCFAs, UBs
• Medicare/Medicaid
• Superbills
• Rx/Dental/Vision
• Improved, Guaranteed Quality (Routinely Achieve
  99.5)
• Reduced Turnaround(Routinely Provide 24-48 Hours)

Outsourcing reduces costs by as much as 60-75
(depending on the service) AHIP Conference 2006
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What This Means To You
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Sample Case Study

• HOVs comprehensive solution enabled University
  Health Network to
• save an initial 2.5 million and on-going savings
  of more than 1million
• annually. HOV is proud of our strong and
  long-lasting partnership with
• this highly esteemed network of hospitals and our
  solution that helped
• the organizations clinicians focus on whats
  most important their
• patients.

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BPO-KPO Summary

• BPO and KPO are growth Industries
• BPO and KPO provides significant value and ROI to
  the Customer
• If done correctly, BPO and KPO offers very strong
  financial, operational and resource benefits
• BPO and KPO requires a Partner relationship
  between the Customer and Provider
• From Due Diligence through Ramp to Steady-state
  Services
• BPO and KPO Provider should have right-shoring
  Global capability and scalability
• BPO and KPO further enables Organizations to
  achieve Competitive and Strategic Advantage

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Highlight

• Outsourcing is strategic initiative and
  requires
• organizational buy-in and management
  commitment to succeed
• Choose qualified outsourcing consultant
  with Business Process
• and offshore cultural background to
  assure value, objectivity and
• bottom-line results
• Choose outsourcing partners based on
  careful evaluation process
• and due diligence
• Choose project suitable for organizational
  maturity level
• Plan for the hidden costs and complexity
  of off-shoring
• including knowledge accumulation and
  transfer
• Offshore transition, engagement management
  and governance are
• the keys to the successful execution

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• www.hovservices.com
• Contact Ed Katz
• 770-395-1455
• HOV Services is proven business process and
  knowledge process service provider with an
  extensive 20 year history of improving outcomes
  for our customers.
• We provides Services to over 50 of the Fortune
  100, employing over 11,900 People in our 50
  Multi-functioning Service Centers in the United
  States, Canada, Mexico, India China

• www.sourcenetglobal.com
• Contact Paul Vibhandik
• 303-790-0770
• SourceNet Global, based in Centennial, Colorado,
  is a strategic sourcing consultancy specialized
  in Healthcare Business and Knowledge Process
  Outsourcing.
• We work in collaboration with specialized global
  delivery partners on both side of the globe for
  full life-cycle of the engagement