Healthcare BPO: A Comprehensive Explanation from A to Z

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Trinh Nguyen

2023-08-04 03:22:18

gct solution healthcare bpo

Healthcare BPO: A Comprehensive Explanation from A to Z

Nowadays, healthcare BPO has been applied popularly to many medical businesses thanks to its significant benefits to companies such as reducing cost, increasing efficiency, improving quality, improving patient experience. 

This 5-minute article will bring out a comprehensive explanation of the mentioned practice and bring you closer to the process. 

1. Definition of healthcare BPO

Healthcare BPO stands for healthcare business process outsourcing. It is a strategy where healthcare organizations outsource some of their clinical or non-clinical tasks to an external service provider.

The main benefits of healthcare BPO are to reduce costs, increase efficiency, improve quality, and focus on core competencies. Some of the common healthcare BPO services are medical coding and billing, membership and provider services, utilization management, population health, and care value. 




2. Common healthcare BPO services

•  Medical coding and billing: This involves processing medical records and claims using various scientific codes such as ICD, CPT, HCPCS.

•  Membership and provider services: This involves managing the enrollment, eligibility, verification, authorization, credentialing, contracting, etc. of members and providers.

•  Utilization management: This involves reviewing and approving the appropriateness, necessity, and quality of healthcare services provided to members. 

•  Population health: This involves analyzing and managing the health status, risks, needs, and outcomes of a defined group of people.

•  Care value: This involves measuring and improving the value of healthcare services delivered to members based on cost-effectiveness, quality, safety, satisfaction.




3. Pros and cons of healthcare BPO

Healthcare BPO can offer various benefits and challenges to a healthcare organization, depending on the type, scope, and quality of the services outsourced. 

Here are some of the pros of healthcare BPO:

•  Reducing costs: Healthcare BPO can help healthcare organizations save money by outsourcing some of their tasks to external service providers who offer competitive pricing models, value-added services, reduced overheads and risks, and measurable results and benefits.

•  Increasing efficiency: Outsourcing some of their repetitive, manual, and redundant tasks to external healthcare business process providers can help healthcare organizations improve their productivity and performance, then deliver faster and more accurate solutions. 

•  Improving quality: When outsourcing some of their complex and dynamic tasks to external service providers, hospitals can provide customized and effective solutions that meet the specific needs and goals of healthcare organizations.

•  Focusing on core competencies: Healthcare BPO can help healthcare organizations concentrate on their core activities and competencies by outsourcing some of their non-core tasks to external service providers who can handle them efficiently and reliably. This way, healthcare organizations can devote more time and resources to patient care, clinical innovation, strategic planning.


At the same time, there are cons that a business should consider:

•  Losing control: Healthcare BPO can entail losing some degree of control over the outsourced tasks, as they are performed by an external party who may have different policies, procedures, cultures, and expectations than the healthcare organization. As a result, it create communication gaps, coordination issues, quality variations, and compliance risks. 

•  Facing hidden costs: It can involve hidden costs that may not be apparent at the outset of the outsourcing agreement, such as transition costs, training costs, contract management costs, dispute resolution costs, etc. These costs can erode the expected savings and benefits of outsourcing.

•  Exposing data: Healthcare BPO can expose sensitive and confidential data of the healthcare organization and its patients to potential breaches, thefts, or misuse by the external service provider or its subcontractors. This can damage the reputation, trust, and loyalty of the healthcare organization and its stakeholders.

•  Facing legal issues: These issues can include contractual disputes, liability claims, regulatory violations, intellectual property rights infringements, etc. 




4. The optimized process for medical companies to healthcare BPO

In fact, each organization will have different internal process but in general, there are some common steps that companies could refer to set the first look of the collaboration:

•  Step 1: Assessing the current situation and identifying the IT needs and goals of the medical company. This may involve conducting a SWOT analysis,  a risk assessment,...

•  Step 2: Researching and evaluating potential healthcare IT outsourcing partners based on their expertise, experience, reputation, quality, cost, security, compliance, innovation, and customer service. 

•  Step 3: Negotiating and finalizing the terms and conditions of the outsourcing agreement with the selected IT outsourcing vendors, including but not limited to the scope, deliverables, timelines, payment terms, performance indicators…

•  Step 4: Transitioning and transferring the IT functions and processes from the medical company to the IT outsourcing provider. Some tasks are setting up the infrastructure, systems, software, data, staff, training, documentation, and quality assurance measures required for the successful execution of the outsourced IT services.

•  Step 5: Managing and monitoring the performance and outcomes of the healthcare IT outsourcing partner. For example, establishing regular feedback loops, conducting audits and reviews, measuring results and benefits, resolving issues and challenges, ensuring compliance and security standards, and fostering continuous improvement and innovation.

In general, the process for a medical company to IT outsource their healthcare services may vary depending on the type, scope, and complexity of the services they need, as well as the outsourcing partner they choose. So before you make any decision, you should conduct thorough research and evaluation of your current situation and your potential outsourcing partners.




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