‘Offshore BPO units will not help in the long run’

Chennai-based Vision Healthsource is one of the leading Health care Business Process Outsourcing (HBPO) companies in India with a client base of over 25 US-based healthcare billing companies. A part of $1.3 billion Perot Systems of the US, Vision offers its services to the US-based medical billing companies, hospitals, payors and third party processors with specialisation in claims, administrative processing and revenue-cycle management. The company handles US$ 1 billion worth provider claims per year for physicians and hospital-based and physician specialties across the US and over 500 people process more than 25 million transactions from Chennai. Anurag Jain, Chief Executive Officer of Vision Healthsource, shares his views about the emerging HBPO landscape in India with G Sanakaranarayanan.

What are the segments that the US health care industry is willing to outsource to Indian companies?

At Vision, we pioneered the outsourced offshore transaction processing for the US health care industry. Companies like ours provide BPO for the US hospitals in billing information, handling patient registration and coverage, eligibility verification, medical coding, charge and demographics entry, payment posting and reconciliation, denial/rejection analysis, patient collections, etc.

I think what is very important to bag outsourcing orders is the domain knowledge. We established our domain knowledge in medical specialties like cardiology, radiology, etc., and evolved services and products that met client-specific requirements.

Will IT-enabled services (ITES)/ BPO bring about a change in the market?

Our job involves understanding of the procedures: how doctors do the treatment, how bills are prepared and how claims are submitted to the insurance companies. The billing process normally used to take on an average two weeks for hospitals, that too, only with 80 per cent accuracy. However, a BPO with strong domain knowledge can reduce the time taken for billing and increase the accuracy thus enhancing the quality of heath care experience of the patients. For this, the processing company needs to know the incredibly complex insurance company procedures and the medical practices. At Vision, we process medical bills with 99 per cent accuracy and the whole process of submitting the bills with insurance companies takes just 48 hours - in some cases we are offer service levels of less than 24 hours.

How big is the market for offshore health care transaction processing services for health care providers? What is India’s advantage in this business?

The value of the health care business is estimated at US $2 trillion and at least 25 per cent of the business could be outsourced. The cost of providing health care is going up and the insurance companies are not paying more. So there is an increased pressure to cut cost and outsourcing becomes inevitable.

What are the challenges you face in dealing with the US health care industry customers?

Project management is one of the very important factors that determine customer retention and getting new business. It is one area where India as a country lacks trained manpower. Thanks to our schooling, we are not good at communication, customer relation, and project management skills.

What are the lessons in client servicing that a BPO unit must realise?

When an American client wants to know when the product will be delivered, the Indian service provider would say, “tomorrow.” But what he actually means is “not today...some other day.” In the US, tomorrow means tomorrow. Not just informed communication, but we also need to understand the American culture and the basics of how businesses function there.

One of the reasons we partnered with Perot Systems is that they had enormous expertise in training on project management skills, methodologies. We have taken the project management to a new level with increased participation of users, who are empowered to track, monitor and manage work that takes place in the company’s India base. Satellite up and down links guarantee seamless communication and firewalls protect client information.

How big is the Indian health care BPO industry? What reputation have these companies built over the years in the overseas market?

Currently, there are around 30 companies who operate in this field though the players that can be reckoned are only three or four. All put together, they do business to the tune of $20 million. The potential for the business is at least 30 times more but the majority of Indian BPO units are not completely ready to seize the opportunity.

Indian companies have to improve their sales model, business delivery model and will have to have onshore and near-shore outsourcing units. I think there are three stages that the Indian health care BPO passed through: we crossed the first stage (1997-2000) when customers said “prove it to me.” Then came the next stage, in 2001-2002, when the industry wanted to scale up the outsourcing operations. The third stage is only evolving now - the industry is asking the BPO units to manage the entire business for them. I think we are moving in that direction.

How should we gear up to meet the BPO requirement?

For this, we need to provide not only people solutions but also technology solutions. We need to set up onshore outsourcing units or at least the near shore units; the pure offshore models will not help in the long run. India has advantage in terms of ready supply of people who are good at coding and understanding the medical terminology. We have a supply of English-speaking population; we are good at analytical process and not just data entry.

Take the case of Ireland, which was once a struggling economy. They converted the entire economy with the help of BPO. We need to train professionals in large numbers in communication and client relation skills. The health care BPO industry needs people who understand the culture of other countries they serve, the project management skills and basic concepts of how the industries operate in the US.

What are the challenges that Indian health care BPO companies face in performing offshore processing with the US hospitals?

BPO is not about data processing job, it is almost like problem-solving for which you need people with analytical skills. If you come to our cafeteria, you will find people engaging in informal knowledge-sharing exercises; they discuss why a particular doctor had followed a certain procedure. It is about the application of analytical skills and solving problems for your customer. The challenge is also in developing appropriate technologies that would help us to keep abreast of ever-changing government, payor regulations.

How does Vision keep itself updated?

Vision has developed proprietary knowledge management software that keeps track of the changing federal and state government regulations. Thanks to the technology, we could confidently sign the service level guarantees that assure over 95 per cent accuracy for claims, adjudication, claims entry, and other transactions.