Payer Business Process Outsourcing Trends for 2004

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1 Markets, J. Young Research Note 15 January 2004 Payer Business Process Outsourcing Trends for 2004 An assessment of business drivers, user adoption and BPO criteria for the healthcare payer industry corroborates Gartner's predictions for tactical and incremental market growth through Core Topic Healthcare: Critical Healthcare Applications for Business Efficiency and Improvement Key Issue How will healthcare organizations successfully justify, evaluate, select, deploy and support vendor application and sourcing services? Healthcare payer organization (payer) business process outsourcing (BPO) adoption has been incremental and sporadic, reflecting a mix of drivers and barriers, including: A broad range of solution maturity for different business processes and subprocesses A widely varying management maturity in assessing and managing BPO relationships Gartner conducted the healthcare payer BPO survey in August The survey of 51 respondents assessed the extent of BPO adoption among healthcare payers (see "Outsourcing Market Trends for Healthcare Payers in 2004"). Here, we present survey results and discuss their implications for Survey Results Percentage of BPO Processes Outsourced: Eighty-six percent of healthcare payers reported that they outsourced some business process to an external party (see Figure 1); 60 percent indicated that they outsourced less than a quarter of the full business process; 27 percent indicated that they outsourced between 25 percent and 49 percent of their business process. Only 6 percent of the healthcare payers surveyed indicated that they'd be adding any additional BPO services in Tactical business process outsourcing is the norm; full- or more-strategic BPO is rare. Gartner Reproduction of this publication in any form without prior written permission is forbidden. The information contained herein has been obtained from sources believed to be reliable. Gartner disclaims all warranties as to the accuracy, completeness or adequacy of such information. Gartner shall have no liability for errors, omissions or inadequacies in the information contained herein or for interpretations thereof. The reader assumes sole responsibility for the selection of these materials to achieve its intended results. The opinions expressed herein are subject to change without notice.

2 Figure 1 Percentage of the Business Process That Payers Outsource 75 percent to 99 percent 50 percent to 74 percent 100 percent Don't know 1 percent to 24 percent 25 percent to 49 percent Drivers for Outsourcing BPO Processes: Healthcare payers were asked to rank different reasons for BPO on a scale ranging from extremely critical, somewhat critical and not at all critical. Figure 2 presents the percentage of respondents that ranked a particular reason as a critical driver toward BPO solutions. The top BPO drivers were tactical: To reduce transaction costs (47 percent reporting as a critical driver) To improve service levels (45 percent reporting as a critical driver) These results reflect the rapidly growing customer demands for cost control and better customer service performance. The next top drivers were related more to business or technology strategies: To focus on the core business (36 percent ranked as critical) To migrate to new technologies (36 percent ranked as critical) To introduce innovation (most frequently in the context of implementing defined contribution products; 35 percent ranked as critical) 15 January

3 Improve shareholder value Gain process knowledge Introduce innovation Convert fixed asset to variable cost Migrate to new technology Re-engineer process Focus on core business Reduce transaction cost Reduce implementation cost Shorten implementation time Supplement IT staff Improve service levels Figure 2 Critical Drivers of BPO for Healthcare Payers 0% In 2003, the majority of executed BPO initiatives were tactical and limited. Although more than a third of the survey's respondents ranked strategic drivers as critical to BPO business decisions, few strategic initiatives were reported by the healthcare payers themselves or the vendors serving this market. Criteria for Selection of BPO Vendor: Healthcare payers were asked to rank several criteria as extremely important, somewhat important or not at all important in the selection of a BPO vendor (see Figure 3). Industry expertise and customer service were the two most-highly ranked, with 80 percent and 76 percent of respondents ranking these as important criteria. The next-mostimportant criteria are six categories with responses clustered between 56 percent and 64 percent designating the category as an important criteria technology expertise, process expertise, trusted partner, low-cost per transaction, financial stability and referenceable accounts 15 January

4 Figure 3 Healthcare Payer Criteria Ranking in Selecting a BPO Vendor Referenceable accounts Low cost of implementation Low cost per transaction Process expertise Industry expertise Technology expertise Trusted partner Cultural fit Level of customer service Past experience Financial stability Global capabilities 0% Extremely important Not at all important What is notable about the healthcare payer responses is that criteria that rank as extremely important in the BPO selection process are very similar to criteria that rank very important in the technology selection process. This is not sufficient to create a strong business partner alliance. Two key criteria unique to the success of a more-strategic BPO relationship, cultural fit and process expertise, were ranked lower by the healthcare payer vertical market than by all but one of the other vertical markets included in the 2003 BPO survey. This suggests a continuing immaturity in the healthcare payer market about how to identify and establish strategic alliance relationships. Of note, global capabilities (also known as offshore BPO) ranked extremely low in importance as a selection criteria, likely reflecting sociopolitical challenges to offshore BPO adoption, as well as the relatively immature and evolving solutions market. Implications According to the survey results: There was a tactical focus on healthcare payer BPO in 2003, and there will be limited growth in 2004: Most BPO is tactical, and healthcare payers are looking for solutions to tactical and near-term critical business 15 January

5 challenges, including the reduction of operational costs and improving customer service. Healthcare payers report limited interest in new BPO initiatives in 2004, suggesting limited growth in this market. There's a ripple of strategic interest in healthcare payer BPO, but very little understanding of the alliance strategies that would create successful strategic relationships: Healthcare payers show an underlying interest in moving toward more-strategic BPO alliances to address morestrategic drivers innovation, new technology migration and refocusing/redefining core competencies. Healthcare payers still use IT or tactical vendor assessment criteria. Important new criteria, such as organization cultural fit, critical to strategic relationships are not yet appreciated by most of the healthcare payers surveyed. This suggests that healthcare payers are interested in moving ultimately to more-strategic relationships, but that most healthcare payers have immature understanding of the models to create success. This suggests a high potential rate of failure for the initial strategic alliance initiatives. Healthcare payer strategic alliance immaturity, the focus of tactical initiatives in 2003, the limited additional adoption in 2004 and the continued absence of strong strategic alliance examples and vendor/business partner reference sites are all inhibitors that will limit strategic BPO and alliance growth until at least Bottom Line: Healthcare payers will and should continue to seek business process outsourcing opportunities to address critical tactical business requirements cost reduction and customer service increases. Business drivers, combined with maturing solutions, may increase payer interest and execution of more-strategic relationships in As payers begin to embrace more-strategic alliances, they must focus on realigning their organizations to refine and mature their processes to successfully identify and manage these strategic alliances, or face initial failure or poor return on investment. 15 January