CLIENT CASE STUDY


Major health benefit provider: Strategic offshoring

A major health benefit provider teams with Accenture Health Administration BPO Services to harness the value of strategic offshoring.

Overview

This major health benefit provider worked with Accenture Health Administration BPO Services to develop a two-year strategic outsourcing plan that encompassed its three primary stakeholders: members, providers and employers. Through a competitive process, the company selected Accenture Health Administration BPO Services as its outsourcing partner because of the expertise demonstrated in developing the company’s outsourcing strategy as well as its proven success in managing similar functions for other health plans.

Accenture’s High Performance Business research has demonstrated that health care providers are turning to outsourcing to achieve high performance in an increasingly competitive and consumer-driven market. Outsourcing vendors are able to combine the business process expertise, global delivery and deep industry expertise that are transforming health care providers’ back-office support services to deliver competitive advantage through improved quality of services and greater control over their core business operations.

Opportunity

In this emerging era of consumerism in health care, this major health benefit provider recognized the need to become more nimble and cost-efficient. But its complex processes and information systems stood in the way of greater flexibility and productivity, especially by contributing to a prolonged product development cycle of up to two years.

The company decided that teaming with Accenture Health Administration BPO Services could help it remedy its issues by accomplishing two major goals:

  • Take its business operations to a higher level of performance at lower cost

  • By turning over responsibility of the critical but undifferentiating operations to a strategic partner, the company could focus on building key marketplace differentiators, such as developing its provider networks and introducing innovative products.

Solution

The organization worked with Accenture Health Administration BPO Services to develop a two-year strategic outsourcing plan that encompassed its three primary stakeholders: members, providers and employers.

As a first step in implementing the plan, the company set out to outsource billing and accounts receivables for its employer services operations. A joint team comprising people from Accenture and the health plan transitioned the work over three months to the Accenture Delivery Center in Manila. The Delivery Center in Manila hosts the Accenture Health Administration BPO center of excellence, thus ensuring rapid transition of processes and deployment of appropriately skilled resources for client engagements. Because of the improvements in accounts receivables and billing, the company has since moved several other functions in employer services operations to the Delivery Center in Manila. 

In a second competitive process, Accenture won the outsourcing contract to manage the data for this client's provider services operations. Employees at the Delivery Center in Manila enter, maintain and update information such as the credentials and fee schedules for each doctor in the company network. Accenture also ensures that the correct information is available when needed by the company’s call centers and claims processing operations. When there is a question about a claim, Accenture’s experts track down the right answer to resolve the issue.

Given Accenture Health Administration BPO Services’ successful track record at the company, it recently turned over another major function to the Delivery Center in Manila—claims processing operations for its member services operations. This core function is responsible for a great deal of revenue for the company and accuracy is paramount in managing legal liabilities.

Results

This major health benefit provider’s performance has improved across the board. Through increased productivity and improved management of the premium reconciliation process, Accenture Health Administration BPO Services was able to reduce the client’s days sales outstanding to its lowest historical level just 18 months after transition.

In all cases, Accenture is handling the operations more efficiently and at higher service levels. The program is expected to deliver more than US$25 million in annual savings.

With Accenture’s Provider Data Management, Accenture Health Administration BPO Services is increasing claims payment accuracy, reducing transaction cycle time, minimizing internal rework and improving overall customer service. In a recent month, Accenture achieved 98 percent on a key quality metric for the health plan, the highest score the company has ever experienced in that function. The metric requires measuring some 30 data elements for each procedure to achieve zero critical defects. Accenture also expects to save the health plan more than US$8 million annually on this function.

Accenture is producing similar results for the health plan’s claims processing operation. During the recent transition to Accenture, 99.5 percent financial accuracy was achieved once the operation was turned over to Accenture. In addition to improved service levels, the company is projected to save at least US$6 million annually.

Industry & topics highlighted

Health Technology