Global Healthcare BPO Industry

Global Healthcare BPO Industry

  • July 2020 •
  • 397 pages •
  • Report ID: 5798721 •
  • Format: PDF
The global market for Healthcare BPO is projected to reach US$371.2 billion by 2025, driven by the growing pressure on hospitals and healthcare organizations to reduce costs and enhance efficiency in all aspects of patient care and revenue cycle management (RCM) to survive in the era of value based care. Under the value-based care payment model where hospitals are paid or reimbursed only based on patient outcomes, healthcare organizations will need to reduce their overall costs by over 25% to 30% by the year 2022 in order to break even. The scenario catalyzes the importance, role and attractiveness of outsourcing. Benefits of outsourcing for hospitals include freeing up of resources to focus on patient care, CAPEX savings on infrastructure and technology, lower cost of operation, cost effective conformance to changes in regulations and standards related to patient data i.e. Health Insurance Portability and Accountability Act (HIPAA); easy access to specialists in the area of back office processing; reduction in billing mistakes which cost the hospitals sector over US$130 billion each year; and ability to offer higher quality of patient care services.

In addition to value based care which is driven by the unsustainable cost of healthcare which currently stands at US$2.8 trillion or conversely 18% of global GDP, other factors are also driving demand for healthcare BPO services. These include rapid advancements in healthcare IT especially analytics that require professional management by third party service providers; increasing use of digital technologies in healthcare; increasing insurance claims; growing healthcare burden of aging population; increasing complexity of treatment; and political and social goals of providing universal healthcare coverage to all by reducing costs and increasing accessibility. Outcome based payments and/or reimbursement exerts pressure on healthcare providers to derive the maximum insights and value from analytics. Also, changing reimbursement models and declining levels of reimbursements are driving hospitals and other healthcare establishments to adopt comprehensive revenue cycle management (RCM) strategies. The burden of fraud and wasteful healthcare expenditure additionally steps up the need for aggressive payment integrity monitoring.

In the United States, the implementation of the tenth revision of the International Classification of Diseases (ICD-10) is bringing in immense administrative cost challenges for hospitals. ICD is used by physicians and healthcare providers to classify and code all diseases, diagnoses, symptoms and procedures and forms the basis for reimbursement arrangements and payouts; patient outcome measurements; clinical, financial and administrative performance measurement; and disease process management. Hospitals are now faced with the challenges of recoding all patient records to the new format, upgrade systems to transition to ICD-10; re-train billing staff, medical transcriptors and physicians. All of these factors create a challenging environment for hospitals to effectively manage and balance their operational cost efficiency and also focus on patience care and quality of healthcare services. Against this backdrop adoption of healthcare BPO services as an antidote to the aforementioned challenges is poised to grow in the coming years.

With cost reduction being the primary reason for outsourcing healthcare related business processes, BPO service providers, not surprisingly, also face intense competitive pressure to remain cost-effective. Cloud BPO is growing popularity for its ability to eliminate infrastructures that support BPO and their associated costs while simultaneously ensuring access to "best-of-breed technology"; deliver business value & create high-performing engagements with client companies; technology cost reduction and ability to offer competitive service pricing. The cloud allows service providers become a strategic partner to their clients by using even technology as a tool for innovation in addition to just infrastructure. The United States and Europe represent large markets worldwide with a combined share of 67.8%. China ranks as the fastest growing market with a 11.1% CAGR over the analysis period, supported by the country`s growing competitive edge in the outsourcing space as evidenced by developing infrastructure and talent pool. As a preferred location for outsourcing, China remains ahead of India and Singapore.