White Paper: The Business Case For Outsourcing First-Level Physician Review

For Health Plans, Medical Management Organizations and TPAs

With the new federal healthcare reform laws, healthcare payer and medical management organizations expect to process about 32 million new enrollees during the next 10 years, which will dramatically increase the volume of utilization reviews for complex and critical care services. This increased volume will force them to re-examine their core business processes and determine how to best focus their organizational resources on core strategic functions and competencies. As a result, the outsourcing of non-strategic functions will continue to increase. While first-level physician review is a critical function in healthcare payer organizations, it can easily be outsourced at low cost, while ensuring high quality and compliance.

The drivers for outsourcing within the healthcare industry include health reform mandates to spend 80% to 85% of all premiums on actual medical care, the pressure to reduce administrative expenses, and the need to convert fixed overheads to variable costs. A business process outsourcing (BPO) partner can oftentimes offer a complete solution more cost effectively, because they have a tight focus, the appropriate tools and sufficient staff. By spreading costs over multiple organizations, they are able to invest in more effective systems that are specific to the business function. In addition, an outsourcing partner can adjust staffing levels based on workload, because resources can be switched to different clients, which helps to offset the impact of fluctuations in volume.

To read more fill out the form to the right to download this white paper.