Business Process as a Service, Redefining the Future Health Plan Operations Model

An uptick in the market trending over the past three years is the Business Process as a Service (BPaaS) model, where health plans outsource their platform and some to all of the operations tasks based on strategic needs. Though not new, this is becoming a mainstream shift and will likely continue to grow and evolve moving forward.

With this model, health plans looking to gain competitive edges will find an entity that partners with a software vendor and create its own platform using a core technology solution. That BPaaS partner will already have built enough of the ecosystem to host a client and provide key business processes as a service.

These BPaaS providers offer streamlined implementations and a low-cost approach to the solution, including creating different instances and environments for their clients as they onboard them and cater to their specific needs.

This model gives health plans an advantage by enabling them to drastically reduce the need for in-house operations and IT staff while maintaining strategic control of the plan and membership. The BPaaS model is also valuable for smaller plans looking to achieve higher auto adjudication rates or solve specific business problems to improve their business (for example, system consolidations or legacy sunsets).

They can partner with organizations that can help them achieve those goals faster than they could in-house based on the collective experience and best practices brought to the forefront. 

A few years ago, it was in one out of every five or so RFPs, would be looking for a full ecosystem and operations support.  Now BPaaS has gained popularity and is either somewhat in scope or completely in scope for every RFP it seems that comes in the door.

Currently, the list of established BPaaS partners in the field is limited. Yet every month that passes, the market continues to see all kinds of new players pop up with the mindset of disruption leveraging this model.

I foresee an increasing number of software vendors and other technology-driven entities either providing the core solution or creating their own BPaaS offerings. 

As technology moves forward and digital transformation becomes prevalent in these solutions, it makes it very exciting to see what is next in this evolution of the market supporting health plan operations.

About the Author

Dustin Rojas

Dustin Rojas, Senior Director of Sales Engineering and Strategy, HealthEdge
Dustin Rojas is a senior healthcare technology professional with deep expertise and extensive experience in many aspects of Healthplan Operations, and the Payer Software industry.  Dustin primarily focuses on collaborating with the Sales team and the overall organization to lend his collective experience to the achieve the overall strategic goal of "Crossing the Chasm.”  As Senior Director of Sales Engineering and Strategy for HealthEdge, he regularly works with Prospects and Senior Leadership to assist in current sales pursuits, in addition to collaborating and consulting on emerging services opportunities.  Prior to joining HealthEdge in 2019, Dustin spent 22 years in a variety of roles in the healthcare payer space with organizations that include Great-West Healthcare (Cigna West), and Cognizant/TriZetto.

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