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Follow UsThe 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.
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| There is tremendous opportunity for data entry, validation and maintenance of records Amit |
As the implementation turnaround time is less, the experienced service providers would benefit more than the uninitiated ones Partha Sarkar, CEO, Hinduja Global |
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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 aggressively |
| Increased loss ratio: All existing health insurance plans need to cover preventive care and check-ups without co-payment by 2018 |
Reduce cost: Administrative costs |
| Reduced margins: Fee to be paid to the government for high premium policy administration |
Reduce cost: To increase margins |
| 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
surajp@cybermedia.co.in