NelsonHall predicts that by 2022, 35% of insurance industry carriers will be in the process of adopting AI technology across multiple use cases within the enterprise. This is based on NelsonHall survey data from the insurance industry that tracks adoption of both RPA and AI (NLP/ML/DL) technology across the property & casualty, health insurance, and life & annuities insurance[...]

  A magnitude-6.4 earthquake struck Puerto Rico on January 6, killing one person, toppling homes and buildings, and triggering a blackout on the island that is still recovering two years after Hurricane Maria. Governor Wanda Vázquez declared a state of emergency and activated the Puerto Rico National Guard to help with recovery efforts. How might this earthquake disaster have[...]

  Convex Group is a start-up specialty insurer and reinsurer focused on complex risks, launched with $1.8bn of committed capital in April 2019. Convex will underwrite insurance and reinsurance for “complex specialty risks across a diversified range of business lines” in London and Bermuda. The company aims to adopt a conservative investment strategy with a predominantly hig[...]

  Dozens of influencers recently attended the WNS U.S. Influencer Day in New Orleans, where the theme was 'Co-create to Outperform’. Through general overviews of its approaches and through client presentations, the company provided insight into its recent success and its future plans. The backdrop for the conference was cheery, buoyed by 7% annualized growth over the prior fi[...]

  In 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[...]

  In 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[...]

  Benefitfocus, 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[...]

  In 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[...]

NelsonHall recently attended HIMSS19 in Orlando, Florida, the largest healthcare IT conference in the world, with over 45K delegates attending and 1.3K vendors in the exhibition. Here are three highlights from the many conversations we had about the state of the healthcare industry. Obstacles to improving CX The conversation about “consumer experience” in healthcare organizat[...]

The healthcare revenue cycle management (RCM) BPS market is becoming technically more advanced as vendors experiment with RPA to drive greater efficiency and productivity, and to improve competitive positioning. Here I look at one such vendor, Access Healthcare, and the lessons they have learned from their own RPA initiatives. Access Healthcare generates ~$145m in revenue delivering RCM BPS[...]

  The 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[...]

  The healthcare revenue cycle management (RCM) outsourcing services market in the U.S. seems ripe for disruption and consolidation. The macro factors include: Contraction in the number of hospital locations and hospital systems Speedy erosion in the number of small, independent physicians’ practices Increasing complexity in reimbursement models and processes Increasi[...]