The age of consumer empowerment and optimized experience is here, and healthcare presents new opportunities to engage members at all points in the consumer lifecycle. Payers and providers alike are increasingly turning to BPOs for a powerful, focused approach to cost-containment and the necessary balance of quality customer experience; online via self-service, on an App, in a chat or via a live voice call. The global outsourced CMS healthcare payer and provider market is currently estimated by NelsonHall as $2.5 billion.
According to the recent NelsonHall Vendor Evaluation and Assessment Tool (NEAT) for Customer Management Services (CMS) in Healthcare, the need to ensure administrative cost compliance is the key driver of CMS outsourcing for healthcare payers, followed by budget limitations, and the need to improve channel balance. Additional factors include: open enrollment volume increase and increasing regulations, including privacy compliance. The use of outsourcing partners as a market is expected to grow at 5.7% CAAGR through to 2018 to keep pace with volume demand and innovation as legacy payers and providers try to be nimble through a digital transformation. For further specifics and customer engagement firm benchmarking please download the NelsonHall report.
Some of the factors that that separated Leaders were experiences that highlighted abilities to deliver value for today, but also capabilities to deliver value to organization in the future. Noted in the report were the following attributes that contributed to the HGS high positioning as a LEADER:
- 2%-5% higher NPS scores than average
- Reduced transfer rate in half
- FCR near 100%
- Zero complaints rate
- 100% compliance record
- Exceeded the provider satisfaction target set by the client
- Denials were reduced
- Claims rework was reduced
- Multiple reach out to brokers and sales teams reduced
- Missing information requests were reduced
- Cycle time of cases reduced
See the graphic below for our Payer Capability success, and to see all of our healthcare rankings by NelsonHall, register for the report.
At HGS, every day, we deliver real, bottom-line outcomes—net revenue increases and an optimized customer experience—for our healthcare clients. And we’re doing a pretty good job of it, according to industry rankings. In fact, NelsonHall recently rated us as a “Leader” in the following market segments:
- Payer Capability
- Payer Back Office Capability
- Payer Cost Reduction Capability
- Provider Capability
Our NelsonHall acknowledgement is based on the success of our customer care and consumer (member) lifecycle approach, which comprises both payer and provider solutions to drive cost-containment and quality healthcare outcomes. The NelsonHall report provides an insight into HGS’s key offerings, strategies, and strengths, including the company’s strategy of consumer care management. HGS’s consumer-directed care, from pre-enrollment communication to managing health and chronic conditions, is enabled through personalized multi-channel engagement programs. As defined by NelsonHall, HGS is a “Leader,” by exhibiting both a high ability relative to peers to deliver immediate benefit and a high capability relative to peers to meet client future requirements.
This strategy is augmented by HGS’s recent acquisition of Colibrium and its Tuo sales, service, and wellness platform, which creates a customized health risk assessment, and allows various health plan programs to be set up to monitor a family’s health and to interact throughout the life-cycle of the member.