Healthcare business leaders need fresh strategies for thriving as the industry evolves to value-based reimbursement models, “care anywhere” and individualized health experiences. As explained in Part 1 and Part 2 in this series, BPaaS offers payers powerful tools for competing in the digital health ecosystem while reducing total cost of ownership. In achieving these goals, BPaaS touches virtually every aspect of the payer organization, from sales and marketing and member services, to operations and IT. And change can be threatening for many reasons.

Drawing on my own experience leading change within organizations, it’s important to recognize and plan for this resistance by being completely clear and transparent about what BPaaS can achieve. The best and most practical argument for why BPaaS is necessary boils down to two words: sustainable survival.

Most of the payers we meet are running closed legacy core systems that cannot adequately support the digital health experiences consumers expect. Consumers will have plenty of choices to find those experiences elsewhere if an incumbent payer can’t provide them. Competition in the healthcare space is increasingly fierce, from national brands to new entrants. Maintaining business as usual, with the occasional incremental tweak here or there, is the ultimate risk for payers.

Encouraging a Healthy Conversation

Because there’s no guarantee that all stakeholders will accept this reality, leaders need to generate some agitation about their organization’s competitive future and show how BPaaS can change a negative trajectory. The following questions can help get those conversations rolling:

  • In our current environment, are we able to maintain and achieve a modern technology ecosystem to support the agility required to compete in the marketplace?
  • What do our competitors do better than we do, and how are they doing it?
  • How are our high administrative expenses limiting our growth, profitability and innovation?
  • How well are we able to address optimizing medical costs?
  • Imagine what we could offer members if we had:
    • A more efficient, easy-to-use, agile environment.
    • Reduced operating costs and a shorter vendor list.
    • A streamlined cloud-based subscription model for core processes.
    • Relief from keeping up with technology advances.
    • Robust analytics, data management and artificial intelligence/machine learning
    • The ability to swiftly adapt to changing and new compliance requirements.
    • Open, flexible core platform capabilities delivered “as a service” on a cost-effective per-member-per-month (PMPM) basis.
    • “Synthetic scale” and reduced total cost of ownership to compete effectively against much larger organizations.

Asking these questions will likely reveal the need for modernizing infrastructure, data, processes and experiences, even while raising other objections. For example, organizations often think they’ll need to engage with multiple vendors to gain the capabilities they require, and managing many vendors increases complexity and expense. But that’s not true: BPaaS is approached as a single contract implementation project with one trusted service partner operating on an outcomes-based delivery model. Payers gain all the benefits of a modern operations ecosystem while avoiding the time and cost of trying to identify, implement and manage all the required pieces.

From Acceptance to First Steps

BPaaS offers value that should resonate with the executive suite: a single pricing model that enables the organization to move from capital expenses to predictable operating expenses with a lower-cost entry point. This is particularly true for organizations planning acquisitions that will come with legacy technology debt, as BPaaS creates a cost-efficient, digitally modern organization.

Proof of savings is a great persuader. To drive home the value of BPaaS, identify a major pain point, calculate its associated costs and how much could be saved with a BPaaS solution. Compliance is a great candidate, but organizations can also benefit by initiating a broader strategy: Everest Research estimate payers that adopt a comprehensive BPaaS strategy that addresses IT, business processes, payment integrity and care management can achieve eight times more cost takeout than BPaaS focused just on IT and operations. We’ll look more closely at reducing medical costs via BPaaS in part 4 of this series.

Helping your colleagues and stakeholders understand the value of BPaaS can open new paths and resources for delivering next-generation healthcare — individualized care delivered on demand when and where consumers want it. While this is a challenging vision for the industry, BPaaS can help your organization make it real.

John Reynolds

John Reynolds

John Reynolds, Ph.D., has over 30 years of healthcare services, benefit consulting and financial technology experience. He is currently Business Lead for... Read more