Payers increasingly recognize the value proposition that external — and often offshore — vendors can handle many support functions, such as IT, and business processes, such as claims adjudication, call centers, customer service, enrollment, and billing, more efficiently. Payers frequently transition these support services in piecemeal fashion, without an enterprise-wide strategy. By taking a more holistic approach, payers can manage multiple vendor relationships to drive broad-based operational efficiencies and enhance the strategic value of vendor services.
Outsourcing relationships, individually and collectively, often fail to deliver maximum value as a result of political and cultural risks, inadequate or inflexible contracts, and lapses in managerial oversight and control. A more coherent outsourcing strategy leads to more successful outcomes.
To increase the value of their outsourcing relationships, payers should establish a vendor management organization or a program management structure that helps them drive change, institutionalize their processes, measure outcomes, and continually evaluate the business case for outsourcing. The vendor management organization can assist the enterprise in structuring the right outsourcing contracts, negotiate appropriate service levels, leverage economies of scale, and drive process improvement and ongoing innovation based on best-available technology and business practices. Post-contracting, the vendor management organization plays an important role in managing a comprehensive plan for transitioning processes to vendors and for managing vendor relationships to ensure maximum, sustainable benefits.
How we can help you
PricewaterhouseCoopers is an internationally ranked, full-service outsourcing and offshoring advisor. We can help you devise a holistic outsourcing strategy and select vendors based on their capabilities, performance, and suitability to that strategy. We can provide guidance, independent validation and verification, and management oversight to properly transition and consolidate your business-critical functions, helping you achieve the best value from your outsourcing relationships.
Case study
Payer leverages outsourcing to expand its Medicare-related business*
