The new US Healthcare Reforms Bill means Big Business for BPOs

DQI Bureau
New Update

The much awaited US Healthcare Reform Bill was passed under the leadership of

President Barack Obama on March 23, 2010, when the Patient Protection and

Affordable Care Act was signed into law. Accordingly the Healthcare and

Education Reconciliation Act of 2010 was passed by the Senate on March 25, 2010

by a vote of 56-43, and was signed into law on March 30, 2010, leading to

several opportunities for BPO and IT outsourcers.


Says Partha Sarkar, CEO, Hinduja Global Solutions, This act brings 35 mn

more Americans under the insurance cover. To begin with, it would mean millions

of more enrollments and transactions. It would extend the scope for customer

support, especially in the first few years when customers would need clarity on

the changed regulations. Agrees Amit Kothiyal, head, emerging markets, Infosys

BPO, BPOs can play a significant role in helping both payors and providers

align their strategies with the enacted Healthcare Reform.

There is tremendous opportunity for data

entry, validation and maintenance of records


head, emerging markets, Infosys BPO

As the implementation turnaround time is

less, the experienced service providers would benefit more than the

uninitiated ones

Partha Sarkar, CEO, Hinduja Global


The reform has also made it mandatory for a change from the present paper

records to digitized records. Says Sarkar, Currently, less than 30% of the

physicians in the US have electronic health records (EHRs). The opportunity is

huge. Says Kothiyal, There is a tremendous opportunity for data entry,

validation, and maintenance of records. There would also be a need for data

migration to allow for consolidation of recorded data. An OCR solution would

play an important role in data capture.

The Reform Bill Highlights
Implications Imperatives
Increased price

competitiveness: To offer affordable insurance coverage to the current

marketplace of 55 mn Americans
Reduce cost: To price

Increased loss ratio: All

existing health insurance plans need to cover preventive care and check-ups

without co-payment by 2018
Reduce cost: Administrative

Reduced margins: Fee to be

paid to the government for high premium policy administration
Reduce cost: To increase

Increased focus on quality:

Increased competition necessitating for quality and services for customer

retention and differentiation
Maximize customer retention

through quality customer service
Higher transaction volumes:

With the expansion of coverage to eliminate 60% of the uninsured, payors

could expect significant increase in membership and claim transaction

volumes by 2019
Scalability to accommodate

increasing membership and claim volumes
IT requirements: Payors need

to be prepared to develop new enrollment system and in ensuring secure

electronic transmissions for such enrollment transactions
Additional IT investments

However, it is believed that many providers are not prepared with the

services and technology that is required to meet the growing needs.

According to Sarkar, experienced service providers would benefit more than

the uninitiated ones. At the very outset, we are expecting more business from

our existing healthcare clients. Our recruitment plans are already in place.

This area would continue to witness amendments and changes as we move along. So

we are also putting in place regular training sessions for our employees to

update them with the latest changes. Says Kothiyal, Infosys is currently

directing all its efforts in areas such as industry solutions to address the

challenges, building capability onshore, exploring alliance with leading

platform providers, pricing strategy, IT and BPO collaboration, and last but not

the least, market visibility and credibility.

PC Suraj