Healthcare Payor BPO in 2011: Will Reform Shatter a Complacent Industry?

The conservative healthcare industry faces the strong headwinds of regulatory change, dramatic changes to its mix of commercial and consumer businesses, and a legacy of outdated technology. While HIPAA and ICD-10 changes have absorbed most of the immediate attention, open enrollment for the year 2014 and medical loss ratio mandates will present unforeseeable challenges to the industry. While most payors have some limited experience in labor arbitrage-based outsourcing, the future requires payors to increasingly leverage the capabilities of their service providers if they are to defend and win new market share. The highlights of this report include:

Demand, demand, demand. Global healthcare expenditure continues to rise as chronic illnesses, lifestyle diseases and an aging population consume more services, products and pharmaceuticals. Improved access in less developed countries and a growing global population are also contributing to rising expenditures.