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  • COVID-19: Driving a New Normal for Healthcare, A Cognizant POV

    Oct 13, 2020, by Ashley Singleton

    Digital 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[...]

  • WNS’ Healthcare Business & Approach to Transformation

    Jun 03, 2019, by Sven Lohse

      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[...]

  • How NTT DATA Established Enterprise Automation Governance for BCBS Health Insurance Carrier

    Apr 29, 2019, by Sven Lohse

      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[...]

  • The Case for Expanding Provider Network Coopetition Among U.S. Health Plans

    Apr 18, 2019, by Sven Lohse

      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: Strategy Shift & Other Key Updates

    Apr 11, 2019, by Sven Lohse

      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[...]

  • How Sutherland Facilitated Coopetition Among California Health Plans

    Mar 29, 2019, by Sven Lohse

      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[...]

  • CX, RCM & Other Key Takeaways from HIMSS19

    Feb 26, 2019, by Sven Lohse

    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[...]

  • Rising U.S. Healthcare Costs: Time to Address the Root Causes

    Dec 13, 2018, by Sven Lohse

      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[...]

  • U.S. RCM Outsourcing Services Market Ripe for Consolidation

    Sep 21, 2018, by Sven Lohse

      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[...]

  • Insurance BPS: Delivery & Service Line Trends for 2017

    Feb 09, 2017, by NelsonHall Analyst

      The 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 [...]

  • Dell Services: Complementing FTEs with Proprietary AFTE Technology

    Nov 04, 2016, by NelsonHall Analyst

    This 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’[...]

  • Wipro: Applying RPA to Insurance Claims & New Business, Looking to Holmes to Support KYC

    Jun 23, 2016, by NelsonHall Analyst

    This is the first in a series of blog articles looking at how business process outsourcing vendors are applying RPA and AI in the insurance sector. First up: Wipro.     Wipro started its automation journey in the late noughties and has since gone on to set up a dedicated RPA practice, and also developed its own AI platform, Wipro Holmes. Currently, Wipro is principally partn[...]

  • Wipro Makes Fresh Start in U.S. Healthcare Payer BPS with HealthPlan Services Acquisition

    Feb 12, 2016, by NelsonHall Analyst

    Wipro 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[...]

  • Process Automation, Analytics & Consumer-Centricity: the Keys to Healthcare Payer BPS

    Jan 07, 2016, by NelsonHall Analyst

    The U.S. healthcare payer BPS market is relatively mature, but is also shifting towards changes driven primarily by the Affordable Care Act (ACA), the growing Medicaid and Medicare population, and advancements in technology offerings. Activity is primarily driven by the need for claims administration support with the use of automation services, member engagement services, and improved clinical ana[...]

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