RESEARCH REPORT

In brief

In brief

  • Payers should defy conventional thinking and drive additional growth from an often-overlooked area: the back office.
  • Unutilized funds exist in the back office, but getting at that capital requires elevating the back-office function and reengineering operations.
  • The back office should have a leading seat at the table in crafting an analytics-driven, multi-channel customer experience strategy.


Beyond cost-cutting. Cost cutting has been the dominant approach to improving the back office—for example, by using global sourcing strategies and reengineering processes. But margin compression and erosion of covered lives cannot be sufficiently addressed only through alternative sourcing and process optimization. With a lean operational engine guided by automation and analytics, and with new operating models, organizational structures and talent approaches, the back office can create significant value for the enterprise.

Deep cuts that are not contextualized within a clear growth strategy can actually damage culture and brand.

Bringing the back office into the new

Companies need to ensure that the back office is a focal point of capability investment, seeing such spending as an essential part of unlocking value. Investments in automation, analytics and artificial intelligence (AI) are especially important.

However, according to Accenture Strategy research, while many companies know that AI is important, they’re not moving quickly enough to ramp up relevant capabilities. For example, 90 percent of health payers expect AI to open new categories of products, services, business models and markets. Yet, across industries, only 45 percent of companies are currently realizing positive business results from AI, with the majority yet to reap benefits or only entering a pilot phase.

The back office must transform to become a focal point of the "new payer economy"—a combination of data and financial capital.

Focusing on the customer experience

The back office should have a leading seat at the table in crafting an analytics-driven, multi-channel customer experience strategy focused on experience drivers such as member convenience, coordination of care and wellness services.

The potential payoff for a renewed focus on the customer experience can be substantial. For example, one national health plan recently began a customer experience transformation, redefining its member communications journey to enable more innovative and personalized—and digital—member touchpoints. Initial work identified US$2 million in savings that could be reinvested to fuel a multi-year effort to reshape member journeys and communications.

Examples of increased customer expectations:

72%

Customer service and support to be faster.

69%

Customer service and support to be easier/more convenient to obtain.

53%

The company to communicate and respond to me via my preferred channel(s).

New talent approaches

Payers have long invested in their workforce’s functional expertise to perform a range of operational tasks. But activities such as data entry, claims and policy processing are becoming increasingly commoditized and automated. As organizations change to become more nimble, so too must the workforce.

Certain kinds of work will go away or no longer require deep (and often expensive) expertise. That means companies need to reshape their workforce to address the new needs created by innovation and market change. Enabling this type of agility requires a different kind of workforce—a fluid workforce with a multi-faceted skillset and more adaptability to change.

Generating growth from the back office

Regional and mid-size health plans can work to compete and win in a highly competitive environment by taking several important actions:

  1. Create a modular organizational design in the back office that is ready to pivot with new payment models and changes in member mix. A modular back office allows the enterprise to pursue new strategies, lines of business and offerings, while maintaining confidence in its ability to deliver value-generating performance and customer experiences.
  2. Enable the shift to personalization and experience by positioning supporting capabilities within core operations. To provide the fuel that drives growth, the reimagined back office needs to be supported by key analytics-backed capabilities that reside within the back office itself: strategic planning, innovation and continuous improvement. These capabilities unlock capital from the core delivery engine to fuel a cycle of investment and growth built on member personalization and experience.
  3. Transform the talent approach to enable transition from legacy operational roles. Buck the traditional reliance of health plans on experienced functional experts and supercharge the organization’s agility with a change-ready workforce to provide flexible and efficient delivery, further enabled by intelligent uses of AI and automation to drive improved performance.

Payers that invest to enable quick, strategically aligned, operational pivots will do more than beat their competitors to the latest trends. They will unlock value from core operations to fuel growth.



Frank Pino

Managing Director – Accenture Strategy, Health and Public Service


Kazim Zaidi

Senior Manager – Accenture Strategy, Health and Public Service​

Contributor

Tristan Sather

Business Strategy Manager – Accenture Strategy, Health​

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