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An uptick in the market trending over the past three years is the Business Process as a Service (BPaaS) model, where health plans outsource their platform and some to all of the operations tasks based on strategic needs. Though not new, this is becoming a mainstream shift and will likely continue to grow and evolve moving forward.

With this model, health plans looking to gain competitive edges will find an entity that partners with a software vendor and create its own platform using a core technology solution. That BPaaS partner will already have built enough of the ecosystem to host a client and provide key business processes as a service.

These BPaaS providers offer streamlined implementations and a low-cost approach to the solution, including creating different instances and environments for their clients as they onboard them and cater to their specific needs.

This model gives health plans an advantage by enabling them to drastically reduce the need for in-house operations and IT staff while maintaining strategic control of the plan and membership. The BPaaS model is also valuable for smaller plans looking to achieve higher auto adjudication rates or solve specific business problems to improve their business (for example, system consolidations or legacy sunsets).

They can partner with organizations that can help them achieve those goals faster than they could in-house based on the collective experience and best practices brought to the forefront.

A few years ago, it was in one out of every five or so RFPs, would be looking for a full ecosystem and operations support.  Now BPaaS has gained popularity and is either somewhat in scope or completely in scope for every RFP it seems that comes in the door.

Currently, the list of established BPaaS partners in the field is limited. Yet every month that passes, the market continues to see all kinds of new players pop up with the mindset of disruption leveraging this model.

I foresee an increasing number of software vendors and other technology-driven entities either providing the core solution or creating their own BPaaS offerings.

As technology moves forward and digital transformation becomes prevalent in these solutions, it makes it very exciting to see what is next in this evolution of the market supporting health plan operations.

I’ve worked in the healthcare industry for over 30 years and with Burgess for a little over ten years. At Burgess, we strive to anticipate the clients’ needs before they are even aware they have the need. We’re always looking for the next problem to solve to make the clients’ experience better and ultimately shift the overall healthcare system forward into the future.

We value our customers’ input. Getting client feedback is important and allows us to build a better product. When we introduce a new feature, we love to get positive reinforcement from our clients because it confirms that we’re hearing them, understanding them, and building and delivering the right solutions.

On the other hand, if we receive not-so-positive feedback, we always turn that into an opportunity to improve the product and make the customer’s experience better.

While there are certain problems that all of our clients share, each company experiences unique challenges; this requires us to detect those nuances and dive deeper to understand the client’s specific needs, what they want to achieve, and how we can find a solution.

Several capabilities we’ve built into the product over the years have started with one client’s particular need. For example, one of my customers recently had a special need for pricing a provider contract provision. Coincidentally, one of my colleagues on the service delivery team was working with a different client that raised the same issue three days earlier. This immediately signaled to us that this function was not just a “nice to have,” but could offer value to a range of clients. Through ongoing collaboration by listening to and sharing our clients’ feedback internally, gave this enhancement―and other features in the past― the traction and attention it needed to move forward.

The best part of my job is working with our clients. I enjoy helping our customers improve their workflows and processes, do things more efficiently and cost-effectively, and achieve their goals.

HealthEdge CEO Steve Krupa and I both graduated from The Wharton School at the University of Pennsylvania. Benjamin Franklin, who founded the institution that became the University of Pennsylvania, advised Americans to “do well by doing good,” an early and broad expression of stakeholders. He founded the Colonies’ first subscription library, a volunteer fire department, and a property and casualty insurance company to spread catastrophic risk along with founding his adopted colony’s leading educational institution. It was a mix of profit and non-profits exhibiting an advanced view of how individual success and the success of your community are inextricably tied together.

Historically, there has been a view that in order to do good for society, one must work for a non-profit, work in government, take a vow of poverty, or work in some bureaucracy. However, business is also part of the answer to creating social change.

Through Wharton and its other schools, UPenn has begun to offer programs to build the skills for social entrepreneurship, where students can learn how to develop business plans for both non-profit and for-profit ventures that contribute to social change.

Dr. Ariel Schwartz, Post-Doctor Fellow at UPenn’s Center for Social Impact Strategy, said, “the activity of any sustained venture—a business, a non-profit, a government, a university—has an effect on the world. And the effect of any organized action that systematically engages with the market or a group of people in society can be positive or negative…With careful planning, any venture in any sector can use its financial, social, technological, and knowledge resources to leave a lasting systematic positive mark on the world.”

HealthEdge values social entrepreneurship and aligns our company’s goals with what is good for society to contribute to positive social change through our business. We recognize that capitalism and social equity can work together to make the world a better place.

An example of someone who is doing well by doing good is Ric Geyer, my former grad school housemate, and fellow Wharton alum. Ric created a for-profit venture, Triangle Arts, that supports social change in Macon, Georgia.

HealthEdge promoted our values by promoting and sponsoring Triangle Arts and its mission at a recent Wharton Graduate School reunion program. The video and subsequent speech were intended to make people aware of social entrepreneurship and social ventures. Passionate about building strong communities, Ric has held various urban development roles in both Detroit and Atlanta.

Most recently, Ric was at the forefront of the urban exodus, moving an hour from Atlanta to Macon, Georgia, a city of about 150,000. While we have seen an increasing amount of people moving out of major urban areas to anything from mid-sized cities to small towns, COVID-19 accelerated this trend.

Recognizing that people still want a sense of community, culture, and connection, Ric’s company, Triangle Arts, brings the arts to Macon and combines with urban redevelopment to revitalize parts of the city with economically challenged populations.

Triangle Art’s mission ties directly to our mission at HealthEdge. Today, Triangle Arts Macon lifts up the voices in the community, creating an environment where people feel both safe and empowered. That uniquely aligns with our vision at HealthEdge, which is to innovate a world where healthcare can focus on people and not process.

At HealthEdge, we’re focused on promoting good health, working with our health plan customers to enable them to be more efficient so they can focus on providing access to quality care and creating healthier communities across the country.

As a nurse, my passion and purpose have always been to make healthcare more accessible and improve the overall health of the communities I serve. And I know social determinants of health (SDoH) are crucial for a person’s well-being. I’m always looking at what support system does a person have? Do they have access to adequate food? Transportation? To improve the health of an individual or community, we must look at these factors.

Twenty percent of healthcare costs are clinical or medical services, and the other 80 percent is around the community. I have been thrilled to see more health plans embracing social determinants of health (SDoH) and creating community-based programs that address these factors.

And at work, we are all part of a community. In addition to focusing on members’ health, as employers, health plans should prioritize their employees’ health and well-being. Health plans must consider how to make employees’ work purposeful, meaningful, and engaging.

Focusing on your employees’ well-being and creating a sense of purpose and connection is not only good for their overall health, but it’s also good for the business.

Suppose employees are not passionate about what they do or don’t think their job delivers meaningful value to an organization. In that case, it’s much more challenging to wake up every day and be purposeful about their work. There is a link between meaningful work and professional effectiveness that drives success for the entire organization.

When it comes to successful innovation in health plans, technology is the enabler, but people are drivers. Often, implementing the technology is not what causes delays; it’s getting people to adopt and use it.

An organization can invest in a technology solution, but without a purpose-driven goal, why would the employees take time to learn a new tool, configure it, and begin using it in a way that transforms the business? The health plan must provide context to how each employee is valuable and their experience and insight play an essential role in transforming the organization.

To make real change, there must be buy-in and collaboration amongst an entire organization. Employees must know how they fit into the big picture and their purpose. For health plans that focus on creating a strong community that supports employee well-being will drive business transformation.

When it comes to business transformation, the biggest roadblock is often resistance to change.

In a former role, prior to working at HealthEdge, I was among 30 consultants hired to tackle a company’s backlog of work. The client did not ask about our individual experience that they could tap into or recommendations for improving the process. The project was incredibly inefficient. We all had different skills and knowledge to help move their project along faster, but we faced resistance. The client wanted to keep the process as it was, having all 30 consultants working on the exact same tasks.

It was clear that everyone was working at different speeds. Some people were fast but had a few errors, while others were slower yet analytical. I recommended that we push to have a tiered system― the tier 1 people would quickly work through the backlog, tier 2 people audit the work, catch any mistakes, and tier 3 people focus on any complex issues that arose. Leveraging our talent in a different capacity, this process would allow our team to meet the production schedule, reduce errors and ultimately boost morale.

I finally convinced the client to let us try something new. We assigned people to the tiers where they would perform best and set up a model so that the process wouldn’t get caught in a bottleneck. As a result, we took care of the backlog that had been accumulating for months in less than 30 days.

With a fresh perspective, we implemented a new process that capitalized on the strengths and expertise of our people and allowed the company to transform and gain productivity moving forward.

That’s just one example; not every project is the same. To transform your business, it’s always key to revisit and improve processes, leverage the vast experiences of your people and find the right technology partner.

When it comes to software, it’s important for the company’s technical side and business side to work together and collaborate. When IT and business join forces, they can achieve so much more and faster.

HealthEdge, in partnership with independent market research firm Upwave, recently conducted a survey of more than 220 health plan executives across the country; results revealed that increasing membership is a top organizational goal for payers.

With increasing demands to grow membership, market pressures are changing how health plans invest the resources made available from lowering costs and increasing efficiencies― top responses included consider new partnerships or acquisitions and invest in a new geography or line of business.

This year especially, payers are facing unique pressures to grow. Many health plans lost a lot of membership due to COVID-19 and businesses closing. As the economy opens back up, health plans will focus on different ways to establish themselves and attract members as consumers re-enter the market.

We’ll see large nationals strategically entering into new geographies and product lines to expand their market share. As a result of acquisitions, large national plans also often have multiple legacy systems. I also expect to see increased due diligence in potentially consolidating those systems to cut administrative costs and have a best-in-class ecosystem. Provider-owned regional plans, which were particularly hit hard in the last year financially, will also expand new product lines and focus on member retention. Overall, innovation in consumerism will be essential across the board.

The executive survey also revealed that one of the top challenges to acquiring new members is offering the variety of plans necessary to satisfy members. In order to create new plans that appeal to the consumer, health plans must make strategic business decisions; this requires the ability to model new benefit plan design and quality-based pricing in their system against real-utilization data to understand outcomes and predictability.

Additionally, with COVID-19 and society in general, we’ve seen an increased emphasis on behavioral health. This increased prevalence will certainly impact benefit design going forward, especially with new models to reach consumers, like telehealth.

Whether through new geography, line of business, innovative offerings, or acquisitions and partnerships, health plans today want to take advantage of all available resources to expand in the current landscape.