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HealthCare BPO
 

HealthCare BPO

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  • 02/14/11
  • 02/14/11
  • 02/14/11
  • 02/14/11

HealthCare BPO HealthCare BPO Presentation Transcript

  • Business Process Outsourcing Rahul Sethi Founder & Chief Executive Integral Fusion November 2010 Introduction, Understanding, Capability, Tier2 Cities Exposure Looking after Information properly
  • Ethos In future, the most powerful brands will be customer-centric. Successful companies will know their customer and will be the customer’s advocate – Rahul Sethi (Founder & CEO)
  • Services Exposure and Experience Product Development Services
    • New Product Engineering
    • On-Site & Offshore development Support.
    • Technical Consulting, Benchmarking
    • Remote Product Maintenance
    • Technical Account Management
    • Independent Testing and Verification Services
    • Business Analytics
    • Cloud / On-Demand Solution Deployment
    Customer Segment: Enterprise, SMB, Start-Ups Interactive & Mobile Services
    • Remote Marketing Office
      • Go-To-Market Kit
      • Newsletters Ext/ Int
      • Press Releases
      • Web 2.0 Solutions
      • Social Media, SEO
      • Viral Marketing
      • Graphics Design
    • Digital Publications
    • Social Media Analytics
    • Mobile Apps Development
      • iPhone 3.0 / 4.0*
      • Android Apps
      • Blackberry ISV
      • Win CE Business
    • Mobile Games, Online Viral
    Customer Segment: Partners, SMB,’s Product Investments (Local Products)
    • Business Intelligence Solution (India)
      • Call Centers, BPO
      • Talent Mgmt (HR)
    • Beyond – BEE Mgmt System (South Africa)
      • BEE Scorecards
      • SAP Integrated*
      • Mobile Integration
    • Claims Depot (USA)
      • Meta Claims
      • Medical Audit
      • Medical Mgmt
      • Managed Prov. Network
    Customer Segment: State, Large Enterprises Joint Ventures/ BOT (Offshore Set up)
    • Technology Companies
    • Set up Offshore Practice
    • Team Hiring & Retention
    • Statutory & Regulatory Compliances
    • Build- Operate-Transfer
    • Product Companies
    • Identifying Local Partners
    • Product GO-TO-Market Strategy
    • Call Center Support
    • Supply Chain Mgmt
    • Tele-calling & Leads Generation.
    Customer Segment: Product Companies, Partners
  • Focus AFRICA… Gut to Start, Passion to follow through…
    • Focus on Africa has led us to conquer most unique outsourcing markets in World.
    • Successful & early Recognition (07-10). 40+ Large & Medium sized Customers.
    • Clients in Zambia, Nigeria, Gabon + 3 African Countries including South Africa.
    • South Africa (FY 2010) BBEEE Certified. Government Contract Pipe- $3MM
    Technology & Cloud Partners: IT Services ITeS, BPO Office in JNB , Gauteng 51 – Onsite Employees in South Africa Services provided to 40+ Clients
  • Locations and Uniqueness
      • Unique ‘flat’ open team culture
      • Metrics-based. Transparent.
      • Mature processes – Key is scalability, cost savings, and rapid turnaround.
      • Transparent engagement model providing full visibility into delivery processes and building trust
      • Expertise and experience across technology spectrum
      • Partnership-driven approach becoming a seamless extension of your organization
    Locations and Markets Sales- Johannesburg, SA Development Hub- NCR Region, India Sales and Ops- Las Vegas, NV Seamless Integration across Locations
  • Some of our Clients
    • Our Services
    • Application Development & Maintenance
    • Media Publishing, Product Marketing Support
    • Independent Verification & Validation
    • Business Intelligence / Analytics Outsourcing
    • Managed Services
    Note: - The Client List consists of all Clients served directly or indirectly by Integral Fusion. A permission from Partner Company is taken before representing above Company Logos. Partner Companies- Scan Consulting, Knowledge Woods, Global Technology Pty Integral Fusion is ISO 9001:2000 Certified Company. Please visit out website www.integralfusion.in to acquire our Certification details.
  • ClaimDepot – Strategic Dev Partners
    • Claim Depot is a group of products which manages workers’ medical compensation claims. It consists of four products specifically designed to manage the expenses associated with lost-time claims:
    • - Metaclaims – a medical claims’ archiving and management system
    • - Managed Medical Audit – a medical bill audit system
    • - Medical Management Services
    • - Managed Provider Network
    • Benefits & Numbers Analysis: -
    • - A 70% reduction in paper copying costs on a yearly basis (pilot savings $40,000 per month).
    • A 50% + reduction in document storage (pilot file room savings 15,000 sq. ft. / $20,000 per month). Today that % would be considerably higher due to industry acceptance of the paperless paradigm.
    • - Reduction of document storage costs over a seven year useful life paper document per page cost $1.00 versus electronic image cost $.02 (savings of $12,000 per month).
    • - 40% of all claims admin. staff telecommuting (15,000 sq. ft. / total savings of $40,000 per month).
    • - Staffing reductions e.g. file room, mail room, etc. (savings of
    • $15,000 per month).
    • - Productivity benefits of 10% for claims admin staff; real time document access/responsiveness for medical appointment scheduling – benefit of 2% + on indemnity costs; cost avoidance – employee turnover (savings of $25,000 per month).
    Presently the Employers’ Fraud Task Force, a large private group of self insured employers in Southern California, has chosen Claims Depot as the key tool to be used in the collection and analysis of claims data for fraud detection. This group is working very closely with law enforcement throughout the state as well as assisting the Fraud Assessment Commission in its preparation to launch its own fraud research study. Claims Depot is also being used as the paperless platform by the Nevada Victims of Violent Crime Department. http://www.slideshare.net/integralfusion/claim-depot
  • E-MediWorld - Strategic Dev Partners
    • Quick Document Capture : A production-grade scanning solution for capturing documents is provided, which can scan in batches,and quickly convert the document to digital format. Also include high speed OCR and ICR capability to allow you faster search and elimination of manual data entry. Supports virtually all industry standard ISIS - TWAIN Compliant scanners.
    • Consolidated Document and Records Repository : Elec. Medical Records are indexed and classified in the repository for immediate access. Various policies for admitting, transferring, retaining, printing, and disposing patient records are also defined for efficient management of records.
    • Electronic Patient Charts : Complete treatment history and statistics of the patient are organized in Patient Charts under various heads and subheads such as Indications, Impressions, Immunizations, Current Medication, Medical History, Social History, Procedures, Tests- Results and so on. The information is presented using intuitive interface, which facilitates quick comprehension with drill-down capability and informed decision making. Ready to use, easy plugins to industry leading specialty EMR products for General Practice, Family Practice, Internal Medicine, OB-GYN, Pediatrics, Cardiology, Dental, Orthopaedics, Solo and Group Practice and Emergency Care Centers, etc.
    • Rapidly Deployable : A no-hassle, rapid deployment enables quick ROI realization by eliminating compatibility glitches and
    • ensuring minimum downtime.
    • Based on Industry Standards: Built on platform-independent technologies and industry standards, the solution is capable of
    • delivering sustained high performance and easy integration with other applications.
    www.e-mediworld.com
  • Understanding of present BPO economics & relevance of Tier2 City that adds incredible value to long term business proposition for your Clients. Proposal to Set up Back-end Processing center in Ambala Cantt (HRY)
  • The Indian BPO industry has experienced robust growth Source: NASSCOM India BPO Study India BPO exports revenues and employment FY 2004-2008 Employees (’000s) Revenues (US$ billion) Large number of processes delivered Multiple industry verticals served Global customer base Part of a global ‘eco-system’
  • Capturing this opportunity is critical for India as a nation ~11 ~30 ~50 India BPO export revenues and growth estimates US$ billion Current momentum (28-30% CAGR) Accelerated momentum (45-50% CAGR) ~11
      • At stake is:
      • 2.5% of India’s GDP by 2012
      • 2 million direct additional jobs
    US$ 39 billion Source: NASSCOM India BPO Study
  • Multiple internal and external constraints need to be managed Sustainable economic model Viable value proposition Talent shortage Supporting infrastructure Internal Competitive Local Challenges Changing Buyer’s expectations
    • More Challenges Within: -
    • Cost of Real Estate, New Facility has risen.
    • Talent Training, Retention, Hiring is higher Cost
    • Infrastructure and Corporate Management Cost
    • Need to be managed more effectively.
    External
  • An ‘ecosystem’ that is getting ready in Tier 2/3 cities for BPO Sub-contracting Developed educational setups Quality healthcare facilities Hotels Security Shopping and entertainment options BPO hubs in Tier-2/3 cities Developed transportation infrastructure Affordable housing and real estate International connectivity Telecom / Internet connectivity Utilities (Power, gas, sewage etc.) Physical infrastructure Social infrastructure
  • Ambala district is located on the North-Eastern edge of Haryana surrounded by Yamunanagar to the South-East, Kurukshetra to its south, Patiala and Ropar districts of Punjab and the Union Territory of Chandigarh to the west. The Shivalik Range of Solan and Sirmaur district of Himachal Pradesh bound the Ambala district in the North and North-East. Transport Ambala is a divisional headquarters of the Northern Railway Zone and is an important railway junction. The Ambala Cantonment railway station was founded on the junction of the Delhi-Kalka and Ludhiana-Saharanpur lines. The historic Delhi-Ambala-Kalka railway line dates back to 1889 while the Ludhiana-Saharanpur line was built in 1870. Situated 200 km north of Delhi, this town is extremely well connected by the rail and road network. Ambala is a major railway junction. It has 7 railway platforms and a daily passage of about 250 trains. Education Number of Colleges and Schools in Ambala Composite Ranking Index Ambala, अम्बाला , ਅੰਬਾਲਾ Ambala – Education & Scientific Industry Hub of Haryana Source: The City Skyline of India , 2008-09 (http://www.indicus.net) Based on inverse of unemployment rate, employment growth rate, reside in Index, economy index, market size and inverse of population growth (higher ranking on any of these indicates easier and better living) Area 1568.85 sq. kms Population 10, 13,660 Literacy Rate 66.47% STD Code 0171 Postal Code 133001 (Ambala Cantt.) Total          Colleges 18 High School 180 Middle Schools 43 Primary Schools 558 Polytechnics 2 Medical College 1 Engineering College 3 Top Ten Rank Gurgaon 1 Chandigarh 2 Noida 3 Shimla 4 Delhi 5 Ambala 6 Ludhiana 7 Jaipur 8 Rupnagar 9 Indore 10
  • PROPOSED CENTER
    • Center Located in the Posh- Commercial Area of Ambala Cantt
    • 2 Kms from Main Railways Station, 2 Kms from Main NH1
    • Distance from Delhi ISBT to Proposed center by Road = 210km
    • Seat Capacity – 50 Seats. Fully Secured 24X7. CCTV Installed.
    Pictures of Proposed Center in Ambala
  • Offshore Lifecycle Offshore Expertise & Experience Market & Supplier Knowledge Codified Methodologies and Offshoring Tools Manage 4 Source 3 Buy/Build/Outsource Plan 2 Knowledge 1 Proposed Offshore Outsourcing Lifecycle
  • Adopted Strategic Information alignment Framewor k Source: “Competing with Information,” Donald Marchand (2000) Marchand’s Strategic Information Alignment Framework Add value Customers, destinations Minimise Risks market, financial, legal, operational risks Reduce Costs transaction and processes Create New Reality Intelligence (social, political, technological, etc)
  • [1] Avg size of the project/engagement assumed ~50+ FTEs; if the size is lower than this, the JV, BOT, and insourcing models potentially not cost effective. In case of Tier2, the number to economy are lesser than comparison to Offshore. Ownership Comparison Ownership Model Comparison Model Definition Pricing / Cost [1] Control Management Effort Operation Risk Financial Risk Scalability JV Split invest-ment and revenues between Partner & supplier Medium High (if the Partner has a majority stake) Medium (depends on the shareholding pattern) Medium (majority stake) / Low (small stake) Medium High BOT Supplier build, operate, transfer Low Initially medium, High after transfer Medium initially, High after transfer Medium initially, Low after transfer Medium Very Low Insourcing Do it yourself Low High High Low Medium Low Transparent Integrator deal who contracts out to Tier2 High Low Medium Medium Low Medium Direct Go direct to Tier2 provider Medium Medium Medium Low Low High
  • Current Healthcare - Business Paradigm (Case- US Based Company) Member Management Group Management Network Management Transactions Management Knowledge Management Business Enablers Management
    • Group Admin
    • Enrollment
    • Other Group
    • and Member
    • Processes
    • Member
    • Services
    • Analytics
      • Care Mgmt
      • Disease Mgmt
      • Wellness Prog.
      • Underwriting
      • Risk Mgmt
      • Accumulators
      • Denial Mgmt
      • Fraud and Abuse
    • Provider Mgmt
    • Contracting
    • Network Mgmt
    • Capitation
    • P4P
    • Fee for Service
    • Rev. Cycle Mgmt
    • F & A
    • HR
    • Call Center
    • Admin
    • Data Security
    • Legal
    • IT Infrastructure
    • Compliance
    • Broker
    • Management
    • Quotes
    • Pre-Sales
    • Sales Admin
    • New Products
    • Transactions
      • Claims
      • Eligibility
      • Enroll / Dis-Enroll
      • Status
      • Pre-Certs
      • RA / ERA
      • Premiums
    • Portals
      • Broker
      • Sales
      • Member
      • Prospect
    • Dashboards
      • Broker
      • Member
      • Sales
    • SFA
    • Sales Analytics
    • Pricing
    • Portals
      • Group Services
      • Member Services
      • Prospects
    • Dashboards
      • Groups
      • Member
      • Prospects
    • Portals
      • Provider
      • Group
      • Hospital / Institutional
      • Out of Network
    • Contracting
    • Network Mgmt
    • U & C Admin
    • Medicare and Medicaid Fees admin
    • Rev. Cycle, Denials Mgmt
    • Claims Systems Mgmt
      • System Selection
      • Core Systems Migration
      • Sun setting
      • Data Migration
      • Remote management
      • Second pass admin.
      • Rules Engine mgmt
    • Member, Provider, Group data
      • Data Quality
      • Mining
      • Warehousing
      • Analytics
      • Intelligence
      • Knowledge management
      • Business value creation
      • De-Risking
      • Accumulators, alerts Mgmt
      • Fraud and Abuse Rules management
      • Denial Rules Mgmt
    • F & A, HR Systems
      • Upgrade, Sun-setting, Management, Modification, Remote management
    • Call Center
      • Outsourcing, Remote mgmt., Metrics
    • IT Infrastructure
      • Management, Upgrade, Modification
    • Compliance, Data Security
      • Audit, Upgrade, Mgmt,
    • Portals
      • Group Services
      • Member Services
      • Prospects
    • Dashboards
      • Groups
      • Member
      • Prospects
    • Portals
      • Provider
      • Group
      • Hospital / Institutional
      • Out of Network
    • Contracting
    • Network Mgmt
    • U & C Admin
    • Medicare and Medicaid Fees admin
    • Rev. Cycle, Denials Mgmt
    • Claims Systems Mgmt
      • System Selection
      • Core Systems Migration
      • Sun setting
      • Data Migration
      • Remote management
      • Second pass admin.
      • Rules Engine mgmt
    • Member, Provider, Group data
      • Data Quality
      • Mining
      • Warehousing
      • Analytics
      • Intelligence
      • Knowledge management
      • Business value creation
      • De-Risking
      • Accumulators, alerts Mgmt
      • Fraud and Abuse Rules management
      • Denial Rules Mgmt
    • F & A, HR Systems
      • Upgrade, Sun-setting, Management, Modification, Remote management
    • Call Center
      • Outsourcing, Remote mgmt., Metrics
    • IT Infrastructure
      • Management, Upgrade, Modification
    • Compliance, Data Security
      • Audit, Upgrade, Mgmt,
    Business / Technology Process Business Process Activity
  • Healthcare Process Outsourcing- Core Expertise
    • Our services increase accuracy in the rate of bill processing and claims processing. It also reduces turn-around-time of reporting and thereby increasing the productivity and profitability. It follows flexible management methodologies that can be tailored according to the needs and requirements of the client.
      • Member Acquisition
      • Sales and marketing such as inbound telemarketing, outbound telemarketing, online sales assistance, quoting, lead generation, direct response programs and enrollment inquiries.
      • Member Care
      • Member inquiries related to coverage, claims, coordination of benefits, PCP,
      • emergency or urgent care, referrals, ID cards and prescriptions.
      • Provider Care
      • Provider inquiries related to eligibility, copays/limits/deductibles,
      • patient information, coverage, referral requests, policies/procedures, plans
      • and products, health and wellness.
      • Back-Office
      • Non-voice processing such as claims data entry, edits/exception corrections, enrollment processing, account payable, accounts receivables.
  • Publishing 2.0 Traditional content New business models New distribution models New usage behaviors New delivery platforms New formats Functional Areas
      • Operations Management
      • E-commerce / Online applications
      • Search Technologies
      • Content Management
      • Content Delivery
      • Social Media & UGC
      • Media Analysis and Monitoring
    Technology Areas
      • Packaged Applications /Platforms
      • Workflow Solutions
      • Digital Rights Management
      • Cloud Computing
      • Identity Management
      • Performance Engineering
      • EAI (SOA, ESB)
      • BI/DM/DW
    Our mission is to provide our media clients with solutions and technology expertise that enable their businesses to effectively compete in the new digital era Media & Publishing: key focus area
  • Search Technologies Page Full-Text Search Entity Extraction
    • Customization of
    • Lucene
    • Solr
    • ISYS
    Platform & Technology People Search Ecommerce Business Areas Online Publishing Enterprise Search 3 rd Party Engines Custom Solutions Categori-zation Web Data Mining Clustering Ontology Taxonomies Hybrid Search Patterns Grammar/State Machines Noise Reduction Relevancy Algos Probabilistic Methods Contexts Filtering/Triangulation
    • Fuzzy Search
    • Specific feeds
    • Semi-structured data
    Vertical Search Social Search
  • Platform & Technology Business Areas Ecommerce Platform Development Professional Services MS Ecommerce Server DotNetNuke Commerce Platforms Travel & Hospitality Online Financial Transactions Retail Social Networks Media & Publishing Web Interactive TV Sabre SonicWeb ATG Elastic Path EBIF Tibco Business Events Tru2Way Multichannel Commerce Mobile Car Infotainment Custom Solutions Personalization Engines Comparison Engines Consumer Portals Identity Management Advertising Networks Oracle Financials Payment gateways IBM TPF Oracle Clusters Media & Publishing: key focus area
  • Content Management Systems Page Enterprise CMS Media Content Management Ecommerce Publishing Banking Web CMS Lighttpd OSA/Parlay SMPP Document Management Documentum Mobile Browser- and MDS-based XIAM Media Workspace Streaming Tagging Adobe Streaming Server VeoTags Telligent Community Server FileNet ISYS OO SDK/UNO EDMS/Workflow Architecture Centera Alfresco DotNetNuke Bitrix Joomla Drupal Confluence Web Portals Mobile Portals IBM Content Manager Flux SharePoint Collaboration Workflows/BPM Portals White Label/Branding Capital Markets Content Management Mobile Content Management Integration Document Capture Indexing / Search Access Management / Distribution Format Conversions Platform & Technology Business Areas Page
  • Full spectrum of business intelligence capabilities ranging from historical reporting predictive behavior insight to basic reporting and performance dashboards.
    • Advantage
    • Critical service reports are provided standard with fully customized reports available easily to any user
    • Seamlessly integrated to SQL Server Analytic Services & SQL Server Reporting Service for robust OLAP, data mining and reporting.
    • Mobile Based Reporting, Web to e-mail, e-mails to Mobile Integration.
    • Real-Time Insight, Reporting and Analytics Components
    • Customer Analytics
    • Standard Service Reports
    • Custom Reports
    • OLAP & Data Mining
    • Dashboards & Scorecards
    MIS – Business Intelligence, Analytics
  • Business Intelligence Architecture PMS’era Ops Mgmt Actuals/Targets Dashboards Single Signon User interface Planning Security Financial Reports SQL Source ERP Source Legacy Source Online Source Excel Source SOA Source BI Tool-Kit – PMS’era Platform Any Source Costing Models Profitability Integration Map Governance
  • Thank you!!! Rahul Sethi Founder & Chief Executive [email_address] India                +91 99103-49494 United States  +1   408-459-0657 South Africa    +27 713-818-663
  • A big transition is on its way. Ask me any questions about IdeaTriangle
  •