With 20 million people who now have healthcare insurance because of the ACA and 8 million who enrolled in a private health insurance exchange this year, rising healthcare costs and member expectations mean health plans are feeling the pressure to compete in a fierce marketplace need to outsource.
According to Black Book Market Research, nearly 40 percent of small- to medium-sized plans work with partners for some processes and 8 of the 10 largest health insurers outsource “significant portions of their operations.”
If you’re still on the fence about outsourcing to a partner, here are 5 signs it’s time to act.
1. You’re growing
If you’ve experienced unprecedented growth in your membership because you introduced a new product, gone through a merger, acquired another health plan or expanded into several new territories, outsourcing is non-negotiable.
Your core competencies are designing and managing health insurance products, the provider network, processing premiums and dispersing claims. If you haven’t invested in the time and money into the technology, process and people you need to support that growth, there’s no way you’ll be able to keep pace with this new growth.
2. You need help with ANOC mailings
If you’ve grown from 40,000 to 100,000 members virtually overnight, for example, ANOC will be an insurmountable undertaking. You will need an experienced partner who can seamlessly execute the job within the time frame and by the due date to avoid costly penalties.
3. Your technology is obsolete
In 2015, 72 percent of the top revenue producing U.S. health payers outsourced at least some part of their IT infrastructure management, a report by Black Rock found.
If your customer call center is outdated, you need to overhaul your IT infrastructure, or you cannot manage multichannel marketing, outsourcing can be the one stop shop you need to get it all done and allow you to save time and money.
4. You need a new CRM platform
You may have an in-house system that was effective when your goal was member loyalty, but now you need a CRM platform that is suited for member retention as well. You have to change your customer from someone who has been around to someone who will always stay. An outsourcing partner who has both the technology and the skill set can help you get up to speed fast.
5. Your staff attrition is increasing
If you’re stretched so thin that you cannot effectively manage your staff, you have a high rate of turnover and you’re investing too much time and money in hiring and training, the quality of your customer service and FCR targets will diminish and your costs will soar.
An experienced outsourcing partner can help you implement systems and practices such as a learning management system to help train and retain employees.
When you outsource to a partner that has the infrastructure and innovation to use downtime and repeatable processes to simultaneously manage the acquisition, engagement and loyalty journeys and manage all of the processes from beginning to end, you’ll significantly lower your costs and increase your revenue.