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CLIENT CASE STUDY


Major US health benefits company: Health Management BPO

This leading US health benefits company teamed with us to outsource portions of its health management operations.

Overview

Accenture is helping a major US health benefits company source its Utilization Management and Care Coordination processes through an emerging type of business process outsourcing (BPO) arrangement in health management.

Sourcing health management support functions at scale in the US health management industry is a growing trend. More than half of the top 10 US health payers are already sourcing or beginning to outsource portions of their health management operations. Today, this client is not only lowering administrative costs by $30 million per year—representing a 33 percent reduction—but also achieving other tangible business outcomes.

These outcomes include realizing medical cost savings, achieving important health outcome metrics, and positively impacting the health of its members across 29 Medicare Star rating measures. As a result, the company is positioning itself for other high-priority initiatives.

"Accenture Health Management BPO helps a leading US health benefits company lower administrative costs, expand service offerings and improve health program quality and outcomes."

Opportunity

This leading US health benefits company faced increasing administrative cost pressures driven by health care reform mandates and challenges in designing and implementing new, cost-effective programs.

It teamed with Accenture in 2010 in a seven-year arrangement to outsource portions of its health management operations as well as to move toward additional business outcomes, including helping to improve health outcomes, reduce medical costs, diversify products and services, and expand capacity.

Solution
  • Brought extensive experience in the US health industry, an end-to-end approach to BPO, and the resources and skills of the Accenture Global Delivery Network.

  • Successfully scaled from zero to more than 1,000 nonclinical, Philippine-licensed and US-licensed nurses in 18 months.

  • Currently support both Utilization Management and Care Coordination functions from Manila, Cebu, and Bengaluru.

  • Enables US personnel to spend more time on providing differentiating services and managing high-complexity cases.

Results

Accenture helped the company to not only lower administrative costs, but to also move toward additional business outcomes—improved health program quality and outcomes, expansion of services, and improved consumer experience. Highlights include:

  • Lowered administrative costs by $30 million per year, representing a 33 percent reduction.

  • Processed more than 3 million service requests in one year, helping patients get care in a timely manner.

  • Enrolled nearly 40,000 members each year in additional health management programs designed to improve health outcomes.

  • Provided reminders to more than 200,000 seniors each year for recommended services like mammograms and cholesterol screenings.

  • Helped to manage hospital readmissions by reaching out to more than 14,000 discharged patients per year to survey for gaps in care, saving up to $42 million annually in medical costs.

"Lowered administrative costs by $30 million per year, representing a 33 percent reduction."
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