HIMSS News

8 Simple Rules for Selecting an Outsourcing Partner

A rapidly changing landscape has created new financial risks (as well as new opportunities) for healthcare organizations. Developments such as the transition from fee-for-service to value-based care, ever-evolving compliance requirements and renewed efforts to build alliances between and among hospitals, payers, clinicians, the government and employers are just a few of the challenges keeping hospital finance managers up at night.

It is a lot for any organization to take on, especially all at once. As pressures grow, healthcare organizations may want to consider looking into working with business partners that bring the experience, tools and goal-driven processes that will help providers meet their internal and external objectives.

Business Process Outsourcing (BPO) and Contact Center Outsourcing (CCO) partnerships will give healthcare providers the skills and synergy they need to optimize their own contact management strategies, improve internal policy and process maps, and ensure the highest levels of compliance in an increasingly complex statutory environment. A successful BPO/CCO partnership returns value beyond the terms of the Statement of Work between the provider and vendor; the partnership should enable providers to focus on their core mission and service to the community.

Here are eight simple rules to follow when measuring whether a BPO partner can help the organization achieve effective healthcare receivables. They must:

  1. Demonstrate competency in compliance – in the post-reform environment, healthcare stakeholders are focusing on compliance. Many are turning to outside experts to create or manage more stringent and effective compliance programs.
  2. Be expert at enhancing methodologies – New demands such as post-ICD-10 process management, ongoing value-based reimbursement reforms, and patient-as-consumer marketplace shifts require new strategies and insights.
  3. Know how to increase productivity within the provider’s shop as well as their own organization.
  4. Offer quantifiable savings – From denials reversals to bad debt collections, BPOs that specialize in RCM strategy can deliver significant cost-containment outcomes.
  5. Provide solid governance documentation – This includes Master Service Agreements, Statements of Work, Service Level Agreements and timely operational reporting.
  6. Use advanced analytics – With the increased focus on data and the customer experience (CX), BPO partners are now offering analytics-as-a-service technologies.
  7. Have an end-customer focus – BPOs can sharpen the consumerism focus with service excellence, smart processes and a fresh perspective on CX – and the expertise required to deliver it.
  8. Incorporate an effective IT infrastructure – The partnership’s infrastructure must be capable of managing operational, regulatory, patient- and client-driven need. Whether the work is done on proprietary systems, web-based tools for claims, or denial workflow automation, BPOs help keep providers solvent and focused on next-generation solutions.

These qualities form the foundation of a strong Provider / BPO partnership. The BPO/CCO that has built these 8 factors into their corporate DNA will be better able to meet the many pressures and challenges they face, and the more successful those organizations will be no matter how the landscape continues to change. 

About the author:  As Senior Vice President of Provider Healthcare  at HGS,  Daniel is responsible for Operations and Client Development of all services HGS delivers to providers of healthcare, across the full spectrum of healthcare.