A White Paper on Strategic BPO in the US Healthcare Industry

The Current Healthcare Environment

The healthcare environment today faces challenges that it has never seen before. The industry is under attack from every possible direction from cost containment, HIPAA (Health Insurance Portability & Accountability Act) compliance, lack of stability, to an uncertain future. After trying various managed care techniques and concepts the onus to contain costs is now on the healthcare consumer.

Concepts such as defined contribution mutated into various consumer driven health plans are being touted as the nirvana pill for an aching industry. Medical and disease management is expected to play a key role for payors as they try to manage healthcare delivery. While executives are trying to grope for answers in an ever changing environment, the light at the end of the tunnel seems far away and a dim one at that. Regardless of the concepts that will or will not be around three years from now, one thing is certain, the degree of COMPLEXITY is increasing by the day.

Healthcare Payors are facing the following points of pain: 1. Managing increasing medical costs and balancing customer satisfaction

2. Reducing operating back-office costs

3. Complying with HIPAA standards and requirements

4. Upgrading IT infrastructure and moving to the web to provide real-time connectivity

5. Focusing on survival and developing a strategy to differentiate products from other incumbents and new players
Value Chain vs. Value Chain Competition

The healthcare benefit administration value chain is unlike any other. While the manufacturing value chain is easy to decipher and understand, this one is as arcane to do so. The complexity coupled with the dynamism has given rise to multiple organizations offering very specialized services and working together to form the value chain. The final result of this

You May Also Find These Documents Helpful

  • Best Essays

    Healthcare

    • 573 Words
    • 3 Pages

    financing practices in conjunction with the strategic plan. Examine and compare strategic plans of various types of organizations as a means to understand the need for change and diversity Bisognano, M. (2008). Leadership's role in execution. Healthcare Executive, 23(2), 66-66,68,70. Retrieved from the ProQuest database. Crain, R. (2012). Want a better relationship with consumer? First, know your brand. Advertising Age 83(2)17. Retrieved from the EBSCOhost database. Delgado, R. I. (2009)…

    • 573 Words
    • 3 Pages
    Best Essays
  • Good Essays

    healthcare

    • 1103 Words
    • 4 Pages

    is also one of the few American industries that is expected to grow in the next few decades. In fact, the healthcare industry in America is expected to generate 3.2 million new jobs through the year 2018, which is more than any other American industry. It is not only a large industry, but a very broad one with many potential investment opportunities and many potential risks The healthcare division is made up of many different industries, each with different dynamics – from pharmaceuticals and…

    • 1103 Words
    • 4 Pages
    Good Essays
  • Good Essays

    healthcare

    • 471 Words
    • 3 Pages

    Between the years 1750 and 2000, healthcare in the United States evolved from a simple system of home remedies and itinerant doctors with little training to a complex, scientific, technological, and bureaucratic system often called the "medical industrial complex." The complex is built on medical science and technology and the authority of medical professionals. The evolution of this complex includes the acceptance of the "germ theory" as the cause of disease, professionalization of doctors…

    • 471 Words
    • 3 Pages
    Good Essays
  • Powerful Essays

    Healthcare

    • 1272 Words
    • 6 Pages

    Jamie Olszewski Healthcare Paper 2013 Introduction to Public Health Will my insurance cover all of my medical costs? How much medical debt do you need before you can file bankruptcy? Do people commonly file bankruptcy because of medical bills? These are questions American citizens are facing with the failing health care system in the United States. As we, The United States of America, enter a new time, with new laws and a new health care reform act rolling into play, we should explore all…

    • 1272 Words
    • 6 Pages
    Powerful Essays
  • Better Essays

    Healthcare

    • 1105 Words
    • 5 Pages

    program. o The role technology will play in health care organizations in the coming decade. o The financial and economic issues that will affect the health care industry in the next 10 years. With about 10 years of experience, as a secretary, in healthcare industry, I’ve noticed a multitude of changes within the medical field. On many levels, the medical system has changed, from paper charts to computerized patient files, the way prescriptions are handled and distributed, to file and/or medical documentation;…

    • 1105 Words
    • 5 Pages
    Better Essays
  • Good Essays

    HEALTHCARE

    • 863 Words
    • 4 Pages

    HEALTHCARE FRAUD Abuse AND Prevention Health care fraud is a crime. Fraud is committed when a provider or patient intentionally submits false or misleading information to a health plan for use in determining the amount of health care benefits payable. As a Group Health member, there are steps you can take to prevent health care fraud and to report suspected fraud and abuse. There are a lot of things people can do to prevent Healthcare fraud some things that can be done Start by knowing your benefits…

    • 863 Words
    • 4 Pages
    Good Essays
  • Good Essays

    Healthcare

    • 1134 Words
    • 5 Pages

    competitive rates and services they provide for their clients. In higher ambition of wanting to achieve more of what they have already attained, it has led to them contracting with Verde Greene Hospital in order to include them in their network of healthcare providers. The consumers of the health care services in their ability to attain higher satisfaction of service that they acquire from both the insurance company and the health care providers, have led to their…

    • 1134 Words
    • 5 Pages
    Good Essays
  • Good Essays

    Healthcare

    • 975 Words
    • 4 Pages

    Are you satisfied with your health or healthcare? Do your doctors listen to you? Are you involved in your treatment? Do your doctors spend enough time with you? Are you getting individualized or personalized treatment? If you answered “no” to any of these questions you should strongly consider researching the options and alternatives available as many already have. Even though there is limited knowledge and acceptance, Complementary and Alternative Medicine has proved beneficial and successful…

    • 975 Words
    • 4 Pages
    Good Essays
  • Satisfactory Essays

    healthcare

    • 729 Words
    • 3 Pages

    promotes education and research in health information management? What is the difference between data and information? In long term care, the resident's care plan is based on data collected in the ? Protection of healthcare information from damage, loss, and unauthorized alteration is also known as ? Which of the following is not a function of the discharge summary? Which system records the location of health records removed from the filing…

    • 729 Words
    • 3 Pages
    Satisfactory Essays
  • Powerful Essays

    Healthcare

    • 4113 Words
    • 17 Pages

    Hospital Ownership and Community Benefit: Looking Beyond Uncompensated Care Paula H. Song, PhD, assistant professor, health services management and policy. College of Public Health, Ohio State University, Columbus; Shoou-Yih D. Lee, PhD, associate professor, health management and policy. University of Michigan, Ann Arbor; Jeffrey A. Alexander, PhD, professor emeritus, health management and policy. University of Michigan; and Eric E. Seiher, PhD, assistant professor, health services management and…

    • 4113 Words
    • 17 Pages
    Powerful Essays