Four reasons MCOs should outsource administrative tasks

May 26, 2015
Sean Allen
Sean Allen

By working with service providers that are employing robotics and advanced analytics, organizations can leverage automation and innovation to address key challenges.

While providing high quality patient care is at the forefront of a managed care organization’s agenda, back-end processes such as billing and claims management receive less attention, but are no less critical to business health. Yet, achieving excellence in these processes is often not a focus, despite their ability to create significant financial and operational benefits.

Complicating matters is an ever-evolving, complex healthcare landscape. Legislation like the Affordable Care Act and Health Insurance Portability and Accountability Act (HIPAA), as well as the upcoming ICD-10 transition, combined with a rise in enrollment makes handling these processes a more difficult, costly and time-consuming proposition than many other industries might experience.

To better balance time and resources, and focus more on change management, patient care and other core activities, more managed care organizations are beginning to outsource administrative processes. By working with service providers employing disruptive solutions like robotics and advanced analytics, organizations can leverage automation and innovation to address the challenges of healthcare’s dynamic business environment.

One example is Robotic Process Automation (RPA), essentially the application of technology that allows employees to configure software, or a “robot,” to process and manipulate data, trigger responses and communicate with other systems. RPA has already seen early success in other global sectors, like insurance, where it has reduced process time by as much as 90 percent in certain instances.

Another example is more advanced analytical solutions. In tandem with robotics, analytics lends the flexibility and scale needed to successfully implement an outcome-based pricing model, which can significantly reduce costs and spread risk.

Sean Allen

In short, technology-enabled process management delivers operational efficiency, improves employee productivity, ensures compliance control, provides businesses visibility and enhances organizational agility. Now and in the future, smarter process management will deliver benefits to managed care organizations in several key areas:

1. Revenue cycle management
Billing, claims management and collections are all essential to revenue generation-and each can be significantly streamlined through automation and analytics. We’re already seeing increased use of analytics rein-in billing time by identifying delinquent payment risk. Robotics can also further automate each process, decreasing overall revenue cycle time, while outcome-based models driven by advanced analytics deliver significant cost savings.

2. Margin optimization, vendor and provider management
Selecting the best and most cost-effective vendors and providers is essential to both ensure high-quality care and maintain profitability. Through advanced spend analytics models, viewed in an easy-to-understand dashboard, organizations can analyze their vendors’ and providers’ cost performance and identify areas for margin optimization. Through a central, credentialed database and integrated purchasing platforms, these solutions will be able to automatically select and trigger purchases from vendors and providers based on cost and quality.

3. Records management
Whether collecting or transmitting patient medical records, most solutions on the market ensure compliance with privacy regulations, like HIPAA. In addition to driving time and cost savings, outsourcing records management eliminates risk of non-compliance, which can lead to costly fines.

4. Customer service and experience
One of the most time-consuming processes for a managed care organization to handle internally is inbound and outbound customer communication. And it can often be fragmented, inconsistent and may not align to customers’ preferred communication methods. By outsourcing these processes, organizations can unify contact center operations, reducing personnel and training costs and ensuring best-in-class experience through preferred channels, whether through e-mail, voice or social media.

Taking a technology-enabled approach to outsourcing generates efficiencies that can be passed on further along the service chain. So, while organizations realize increased productivity, patients ultimately benefit from innovation.

Sean Allen is vice president for Xchanging’s business process services (BPS) group in North America. Xchanging, the business technology and services provider, delivers technology-enabled process services across finance and accounting (F&A), CRM and customer administration, and analytics, with industry specific solutions within the healthcare, insurance and financial services industries, among others. Sean has more than 18 years of experience as a leader in the business process outsourcing (BPO) industry, working with some of the largest insurance and financial services firms in North America to reengineer processes from billing to payment to reporting.