featured posts:
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Price Transparency in Healthcare Payer BPS Market: Capgemini Spotlight
Aug 02, 2021, by NelsonHall AnalystIn 2020, the U.S. healthcare payer BPS market saw accelerated growth in the adoption and design of digital solutions across all functional areas. The acceleration is driven mainly by consumer demand for an "Amazon" experience from their health plans and providers, to know the cost of care for associated benefit plans to assist in plan selection or inform decisions about ele[...]
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COVID-19: Driving a New Normal for Healthcare, A Cognizant POV
Oct 13, 2020, by NelsonHall AnalystDigital front doors and transparency a new normal for healthcare? U.S. healthcare is no stranger to an environment of continuous change and has not been spared the effects of the COVID-19 global pandemic in 2020. The unique circumstances born from the need for social distancing during the pandemic have accelerated healthcare consumers' demands for digital transformation. The ask comes f[...]
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How NTT DATA Established Enterprise Automation Governance for BCBS Health Insurance Carrier
Apr 29, 2019, by Sven LohseIn this blog, I look at how NTT DATA worked with a large Blue Cross Blue Shield (BCBS) health insurance carrier to establish an enterprise governance structure for automation, and at the lessons learnt along the way. Like many other large BCBS carriers, the company had piloted RPA initiatives, and from the somewhat frustrating results of these experiments, it had formed two conclu[...]
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The Case for Expanding Provider Network Coopetition Among U.S. Health Plans
Apr 18, 2019, by Sven LohseIn my previous blog, I described how, since 2017, Sutherland has created a shared services model that obviates the need for participating California health plans to separately build and update parallel databases to track the availability of providers of nonurgent care for Medicaid recipients. The company estimates that through its consortium of member health plans it has reduced a[...]
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Benefitfocus: Strategy Shift & Other Key Updates
Apr 11, 2019, by Sven LohseBenefitfocus, the cloud-based benefits management platform and services provider, recently hosted 1,200 benefits professionals at their annual One Place conference in Charleston, S.C. The conference featured updates on Benefitfocus’ strategy, enterprise benefits management technology platform, and partners from its ecosystem; and presented an opportunity to learn from[...]
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How Sutherland Facilitated Coopetition Among California Health Plans
Mar 29, 2019, by Sven LohseIn this blog, I look at how Sutherland tackled the challenge of health plans maintaining accurate provider data in the state of California. The challenge: inaccurate health plan data about providers It’s been difficult for health plans in California to maintain accurate, up-to-date information on the current status of providers in the state. According to outsourcing vendo[...]
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Rising U.S. Healthcare Costs: Time to Address the Root Causes
Dec 13, 2018, by Sven LohseThe challenge of rising healthcare costs in the U.S. has been obvious for decades. Or has it? Various interventions have been attempted, but health costs as a percentage of GDP are forecast to continue to climb. National U.S. healthcare expenditure as a percentage of GDP has risen from 17.2% in 2011 to 17.9% in 2017. In February 2018, the U.S. CMS Office of the Actuary estimated t[...]
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Wipro Makes Fresh Start in U.S. Healthcare Payer BPS with HealthPlan Services Acquisition
Feb 12, 2016, by NelsonHall AnalystWipro announced yesterday it is to acquire Tampa-based HealthPlan Services (HPS) from Water Street Healthcare Partners for $460m, including a $20m deferred consideration. HPS' 2015 revenues were $223m. It has achieved a CAAGR of 38% in the last three years, driven both from adding new healthcare payers and from the increase in individuals or groups eligible for[...]
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Insurance BPS: Delivery & Service Line Trends for 2017
Feb 09, 2017, by NelsonHall AnalystThe insurance outsourcing industry is moving at a fast pace in response to the need for rapid deployment of digital platforms and offerings, as well as advancements in new distribution models that are emerging via ‘insurtech’ start-ups. Here I take a look at some of the key trends driving the insurance BPS market in 2017, both in terms of delivery and transformation, and [...]
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Dell Services: Complementing FTEs with Proprietary AFTE Technology
Nov 04, 2016, by NelsonHall AnalystThis is the fourth in a series of blogs on vendors’ RPA initiatives in the insurance sector. We now turn our attention to Dell Services, which has adopted an automation focus across its life and healthcare insurance BPS processes. Focusing on healthcare payer & provider and life insurance process automation In 2016, life insurance accounts for around 30% of Dell Services’[...]
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Cognizant Acquires TriZetto to Add ISV Business to its Healthcare Business
Sep 15, 2014, by Dominique RaviartCognizant is to acquire TriZetto, a healthcare ISV in the U.S., for $2.7bn in cash. TriZetto has a headcount of 3.7k (Cognizant at end of H1 2014: 187k.4). In its last 12 months, TriZetto had $711m in revenues and a non-GAAP operating margin of 18.4% (Cognizant in 2013: 20.6%). TriZetto LTM revenues breakdown by service/product line is: Payer software: 40% (~$277m) Consulting: 23% (~[...]
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Xerox's Loss is Accenture's Gain in Texas Medicaid
Aug 22, 2014, by Rachael StormonthIn a case that has been unfolding for several years now, and which heated up in early May, Accenture on August 1 assumed responsibility for administering Medicaid claims in the state of Texas. Accenture’s first award as a state’s primary fiscal agent was announced in the wake of a dispute between Texas and Xerox over its process for reviewing Medicaid dental c[...]
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Strong Third Quarter for Firstsource As it Continues to Realign its Portfolio
Feb 03, 2014, by NelsonHall AnalystFirstsource has just announced its strongest quarter since FY 2013. Revenue was up 12.1% y/y to Rs. 7,998m (~$128m) and margins increased 210 bps y/y to 9.3%. The margin improvement is due in part to Firstsource’s consolidation of unprofitable accounts in both its customer management business and in domestic accounts in India and Sri Lanka. Telecoms and media, Firstsource&r[...]