The Triadic BPaaS Model: Optimizing Efficiency, Building Experience For Health Plans

First in a three-part series

The healthcare industry is constantly evolving and health plans, in particular, face numerous challenges ranging from regulatory changes to rising operational costs. In this changing landscape, health plans may not have a clear vision of the course needed to successfully navigate the continuous evolution of the healthcare system.

The current healthcare infrastructure requires many healthcare organizations to explore partnerships to help mitigate inherent business challenges and better position the business for the future.

To this end, Business Process as a Service (BPaaS) emerges as a powerful solution, offering comprehensive process management and operational efficiencies. In fact, BPaaS is ideally suited to accelerate and improve provider, member, and business outcomes for health plans, irrespective of size. The solutions help payers invest where it matters most by modernizing infrastructure, applications, and services—all with one partner.

BPaaS and the Triadic Business Model

BPaaS aligns well with a triadic business model that encompasses the BPaaS partners, health plan, and member.

The BPaaS healthcare partner assists members and providers on behalf of the health plan. This work, in turn, forms a triadic business model that represents the three relevant stakeholders:

the health plan,
the BPaaS partner, and
the customers (members and providers).

The BPaaS partner provides services to the health plan’s customers without a contract with the customers. In a way, this may seem odd, but it works well because the BPaaS partner is beholden to both the health plan and their customers. It helps ensure the solutions offered, serve each group.

Each of the three stakeholders are tremendous influencers of market position, image, and, ultimately, success. It’s a symbiotic relationship that supports and benefits each stakeholder.

The triadic model fosters and encourages collaboration. This in turn ensures that the needs of all key stakeholders are met. Collaboration—internally within the BPaaS partner—and among the triadic constituents is critical. Information and collaboration within and across BPaaS are critical as outlined in this 2 by 2 matrix shown below.

	Information flow	Collaboration
Within BPaaS partner	Training new employees on how to service the members and providers of the health plan Error correction measures through knowledge sharing amongst employees to eliminate errors Information across processes to ensure a better end-to-end process.	Teams both back office and call center collaborating amongst themselves rather than working in silos Evaluation of end-to-end processes to eliminate waste and solidify the process Dashboards created to measure end-to-end efficiency with the objective of lowering cost per member per month
Across triadic partners	Processes and procedures across health plans to ensure a reduction in provider and member touchpoint Access to dashboards to monitor the effectiveness and efficiency of touchpoints Root cause of errors shared by BPaaS partners to health plans to modify and correct policies and procedures	BPaaS partner and health plan working as one team in creating policies and procedures for effective touchpoints Use of Artificial Intelligence to enhance the member touchpoints through information sharing

Partnering for Success

The success of the triadic business model hinges on the collaboration between the health plan and the BPaaS partner. This partnership is characterized by mutual trust, shared goals, and a commitment to excellence. BPaaS experts are ideal partners, as they typically have capabilities and expertise that extend across numerous functional areas within payer and provider organizations. The appropriate experts bring a consultative approach to payers and can manage stakeholder expectations.

One advantage of the BPaaS model is the expertise of the service partner to accept end-to-end accountability and ownership. This is not the case in all outsourced solution relationships. BPaaS partners, however, readily assume the risk of complete ownership of the processes they manage, thereby positively impacting customer outcomes. In turn ensures processes are executed efficiently and effectively.

BPaaS partners also create service innovations that help impact business and member outcomes. Health plans can rely on their BPaaS partners to handle everything from claims processing to customer service, freeing up internal resources for strategic initiatives.

With a full lifecycle and turnkey focus, BPaaS partners are ideally positioned to impact outcomes, which, in this context, is an optimized member and provider experience.

A senior executive of a third-party administrator told me that implementing BPaaS at their organization had immediate and positive benefits. “The implementation of the BPaaS solution has allowed us to easily accommodate the variances that are typical within call center environments,” the executive says. “In addition to the volume accommodation, our team’s ability to respond more in-depth to the various complicated and sensitive customer inquiries has been increased. This results in greater client satisfaction and team member engagement.”

So how can the partner make this possible is the obvious question. The key is to create managed reports available through dashboards that measure across-the-board touchpoints as agreed to by the BPaaS partner and the health plan. For example, measuring the call-to-claim ratio or vice versa would indicate where former process inefficiencies lead to new process improvements.

Health plan and customer improvements are made possible by the controlled environment proffered by BPaaS partners, which can monitor and control the entire process, leading to better outcomes.

BPaaS: The Health Plan Game Changer

By offering cost-effective, scalable, and technologically advanced solutions, BPaaS partners empower health plans to optimize operations, focus on core competencies, and enhance customer satisfaction. In the triadic business model, the partnership between health plans and BPaaS partners ensures that members and providers receive high-quality services.

“I’ve been working in the financial services sector for more than 30 years supporting operations and customer service,” says a senior executive of a medium-sized company. “I have worked for Fortune 500 companies, start-ups, and small to midsize firms. What most mid-sized companies don’t get is that they don’t need to be a Fortune 500 company, or anywhere near that, to gain scale and accelerate growth by partnering with a BPaaS provider.

“Doing so unlocks a host of technology capabilities, process improvement, analytics, optical character recognition, and AI that can take your mid-sized company to the next level with relative ease and confidence. If you are an operations executive for a firm with 1,000 or more employees, you should be actively partnering with BPaaS providers. If you aren’t, you’re falling behind and falling behind fast.”

As the healthcare industry evolves, BPaaS adoption will become increasingly important. Health plans that embrace this model will be well-positioned to navigate the complexities of the industry, drive operational efficiencies, and deliver exceptional value to their members and providers. BPaaS is not just a service; it is a strategic enabler that can transform the way health plans operate and thrive in the modern healthcare landscape.

As the first in a series of three articles on this topic, I hope you’ll join me in the coming months as I continue to explore the triadic BPaaS model.