Obamacare: Outsourcing opportunities in revenue cycle management

Pune, India, 30 June 2011

• US healthcare providers in a rush to meet deadlines following the 2009-2010 healthcare reforms
• Global outsourcing industry to cash in from current changes; massive opportunities in EMR (electronic medical records implementation and revenue cycle management (RCM)
• Huge demand for healthcare outsourcing professionals, particularly coding and billing professionals

The Obama administration has been spearheading several changes to the expensive and inadequate US healthcare system. Cost pressures along with the after-effects of the recent economic meltdown have triggered major reforms, intended to control healthcare costs and provide universal coverage. These healthcare reforms, enacted in 2009-2010, pose significant challenges for healthcare providers including:

- a potential increase (estimated to be about 30 million) in the volume of records driven by the rise in the number of insured people;
- the need to identify, test and adopt electronic medical records (EMR); obtain certification and demonstrate meaningful use of EMR/EHR by 2014;
- the need to upgrade all revenue cycle management (RCM) recording systems

There are significant outsourcing opportunities resulting from code and standard updates that healthcare providers need to meet before the stipulated deadlines. RCM vendors can help their end clients meet HIPAA 5010 and ICD conversion upgrades. For example, healthcare providers (or even large US RCM vendors) will need to outsource to companies who can help them implement ICD version 9 to 10 conversions on a large scale by October 2013. Indian vendors, especially the large and mid sized RCM vendors can cash in on this opportunity as they have the advantages of:

- cost effective infrastructure,
- established position to move up from base level jobs like transcription to higher RCM jobs,
- ample scalable workforce and volume absorption capacity.

Similarly, US healthcare reforms and the resultant challenges for the industry are creating a window of unique opportunities for healthcare outsourcing vendors. For example, implementation and maintenance of EMR /EHR systems is reportedly a $20 billion IT outsourcing opportunity. Global IT-BPO and healthcare ITES vendors are best positioned to make the most of this opportunity. Vendors can provide advisory and consulting services such as interface development for a client’s existing EMR systems, testing and implementing upgrades and helping them obtain mandated certification. Vendors can also add value by training client’s staff and provide ongoing and post implementation support.

Runa Mookerjee, Analyst, ValueNotes Sourcing Practice says, “We believe that there are four types of vendors who are best positioned to make the most of the current challenges in the healthcare market. The opportunities that they have, are spread across RCM services, KPO and Analytics, Conversion and compliance, EMR/EHR implementing and IT Advisory and consultancy services.” She adds, “Besides, this is also a period of immense recruitment activity, not just for the provider market, but also for the healthcare outsourcing industry.”

ValueNotes’ latest report on the healthcare outsourcing industry, Obamacare: Outsourcing opportunities in revenue cycle management, identifies specific changes that will affect the healthcare provider market challenges in adapting to the resultant regulatory and procedural upheavals. It also discusses the various opportunities that outsourcing vendors can avail as a result of these reforms. Buyers of outsourcing can benefit from an overview of the current vendor landscape and chose from vendors best positioned to deliver.

ValueNotes, based in Pune, India, is a leading provider of market intelligence and research, with expertise across industries particularly in financial services, media, engineering, healthcare, IT and the outsourcing industry. Our customers include some of the leading global corporations, asset and wealth managers, management consulting firms, research publishers, PE and VC firms, and money managers.

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