Leveraging BPO

As an industry, healthcare has undergone enormous change. The landscape is dynamic, and new challenges are on the horizon. Mergers, acquisitions, and partnerships are occurring at an unprecedented rate. Disruptive players like Apple, Google, and Amazon, have entered the market. And, of course, the government continues to introduce mandates to which the health plan must adhere.

These factors continue to add demands on health plans that are already facing budgetary and resource constraints.

To manage these challenges, health plans are increasingly outsourcing business processes. Just like organizations in other verticals, health plans are working to drive down costs and activities – but, more importantly, outsourcing also allows them to focus on what they do best, which is: improving the healthcare outcomes of their membership.

And this is where Catalyst Solutions can help.

Catalyst Solutions offers a full-service BPO. Our team of fully-trained, US-based employees can deliver the operational and technology functions required by a health plan:

  • Claims
  • Configuration
  • Call Center
  • Enrollment
  • Billing
  • Appeals and Grievances
  • Application Management
  • Testing

All these services come with Service Level Agreements and financial guarantees.

Catalyst works with some of the most innovative technology vendors in the industry – and we have acquired that technology for our BPO, meaning that we can provide plans access to our platforms and systems without the need for lengthy and costly implementations or expensive licensing arrangements.

Clients can pick and choose the technologies that best meet their needs – and those solutions can be customized and configured to meet the unique demands of their members and providers – and, of course, all of our technology is HIPAA-compliant. All of our client’s data is secure.

Case Study:  Catalyst provides outsourced claims processing, configuration, and a machine learning application to a midwest client with just over 400,000 members. The health plan’s lines of business include Commercial, Medicare Advantage, and Managed Medicaid.

Before collaborating with Catalyst, the health plan incurred an annual claims-related expenditure of about $16.5m annually. Once the claims work was outsourced to Catalyst, Catalyst conducted an exhaustive review and optimization of the health plan’s configuration – and improved their auto-adjudication from 65% to over 85%.  Additionally, they integrated Catalyst’s machine learning solution, eliminating the need for human intervention in almost 92% of claims. These technological innovations, coupled with Catalyst’s highly trained and highly efficient resources, reduced the annual cost to the health plan for claims operations by almost $11m annually.

The external forces placing pressure on the health plan are numerous. The challenges posed by financial and budgetary restrictions, resource constraints, and technological changes are unrelenting – and it is these demands that require health plans to take a hard look at their current strategies and business models.

To be successful, health plans must focus on their core business: delivering affordable healthcare that improves the lives of their membership. Anything that is not a core business should be outsourced to a trusted partner, like Catalyst Solutions.

Our customers find that the initial cost savings are significant, but the benefits go beyond outsourced labor and technology. We engage with you at a strategic level. We commit to long-term collaboration. We invest in continual improvement to our people, processes, and technology – always looking for ways to innovate and produce business results that drive tangible results: hard-dollar cost savings, cost avoidances, and enhanced revenue streams.

We believe true success in a BPO relationship can only be built on collaborative partnerships. Our mission is to extend our competencies and scalability to help your plan focus on what really matters: changing healthcare – making it affordable for your members and making the health of those members better.