Regulatory Changes in the US
Regulatory norms in the U.S. health-care system are imposed by private and public entities at the federal, state and country levels. These reforms are introduced as there is a constant need of enhancing quality, expanding access, and controlling costs in healthcare.
Some of the major federal regulatory organizations under the umbrella of the United States Department of Health & Human Services (HHS) include:
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Pressure to Reduce Rising Healthcare Costs:
The United States has the highest healthcare cost when compared with other nations. In 2016, the nation spent about $3.3 trillion on healthcare. Healthcare costs have increased drastically over the past few years in U.S. It used to be 5% GDP in 1960 which rose to 18% in 2016. The CMS projects that this trend will only rise and will reach about $5.7 trillion by 2026.
Hidden Costs of Outsourcing:
Outsourcing is a common practice used by many businesses in order to gain expertise in a particular geography, improve performance and to provide a greater level of service to their customers that could not be achieved with internal management.
However, in recent years the shift to outsourcing has included complete outsourcing of coding and medical records, dietary services and housekeeping. In fact, nowadays services such as ER Services, Imaging, Lab, Nursing, Supply Chain, Human Resources or even Administration are outsourced by various U.S. leading hospitals.
Fear of Losing Visibility and Control Over the Business Process:
One of the biggest restraints in the future growth of outsourcing market is the loss of visibility and control of your own business. Loss of control in outsourcing can mean very high costs with a sub-par product that was developed behind schedule. Many a times management fear that transferring the back-office finance & administration to an outsourced provider is equal to transfer control.
Big Data Analytics in Healthcare
Data science plays an important role in many industries. In facing massive amounts of heterogeneous data, scalable machine learning and data mining algorithms and systems have become extremely important for data scientists. The growth of volume, complexity and speed in data, drives the need for scalable data analytic algorithms and systems.
The rapidly expanding field of big data analytics has started to play a pivotal role in the evolution of healthcare practices and research. It has provided tools to accumulate, manage, analyse, and assimilate large volumes of disparate, structured, and unstructured data produced by current healthcare systems.
Shift to ICD-10 Coding Standards and Upcoming ICD-11
World Health Organisation (WHO) International Statistical Classification of Diseases and Related Health Problems (ICD) is a protocol while translating diagnoses and other health related problems in patient’s medical record. The classification of diagnoses using ICD-10 is a mandatory national requirement for the NHS Admitted Patient Care (APC). ICD-10-CM is a seven-character, alphanumeric code in healthcare. Each code begins with a letter, followed by two numbers. The first three characters of ICD-10-CM are the category. The category describes the general type of the injury or disease. The category is followed by a decimal point and the subcategory. This is followed by up to two sub classifications, which further explain the cause, manifestation, location, severity, and type of injury or disease. The last character is the extension, which means encounter.
Few examples from ICD-10 Coding Systems
Dearth of Skilled Workforce
The healthcare business processing outsourcing (BPO) industry is a blooming industry but it faces a certain challenge which is hard to overcome. Healthcare BPO often require skilled labour like a person who is trained in medical coding or a person trained as medical scriber. This person should have in depth knowledge of medical terminologies. However, there are limited trained staffs for Healthcare BPOs. Also they are often unable to keep up with the field’s ever growing demands.
On the basis of component, themarket is segmented into payer services, provider services and pharmaceutical services. The payer segment is further segmented into integrated front end and back office operations, provider management, billing and accounts management, human resource management, claims management, customer relationship management, operational/administrative management, product development and care management. The provider segment is further segmented into medical billing, medical coding, medical transcription, finance and accounts, patient enrollment and strategic planning, device monitoring, revenue cycle management. The pharmaceutical services segment is further segmented as manufacturing outsourcing, pharmacovigilance services, clinical data management, research and development, non-clinical services, sales and marketing, supply chain management and logistics, other non-clinical functions and others. In 2019, provider services segment is growing at the highest CAGR and expected to reach USD in the forecast period of 2019 to 2026.
On the basis of end user, the market is segmented into hospitals, dental clinics, public services, life sciences companies, medical devices companies, pharmacy benefit managers and others. In 2019, hospital segment is growing at the highest CAGR and expected to reach USD in the forecast period of 2019 to 2026.
Some of the prominent participants operating in this market are Accenture, Cognizant, GeBBS Healthcare Solutions, United Health Group, Firstsource, Charles River, Genpact, Invensis Technologies Pvt Ltd, HCL Technologies Limited, Iqvia, WNS (HOLDINGS) LTD, Pharmaceutical Product Development, LLC., Parexel, Catalent, INC, Lonza, Covance INC., Sutherland Global, INC., Premier BPO, INC., HGS LTD.,Boehringer Ingelheim.
Global Healthcare BPO Market – Industry Trends and Forecast to 2027
North America Healthcare BPO Market - Industry Trends and Forecast to 2026