By Sivarama Rambhatla
With ever-increasing pressure on profitability and medical loss ratios, healthcare payers face tight budgets, a continued need to increase productivity, lower costs, enhance technology, and reinforce IT infrastructure while improving the healthcare consumer experience.
Without additional assistance, payers have an arduous task—one that may take many years to accomplish—at hand. That’s where the “as-a-service” delivery model could come in handy for payers.

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While building and implementing a strategy to holistically address each of these challenges may seem counterintuitive initially, leveraging service providers in an as-a-service model could help ease some of the tech debt while variablizing operations spend for the payers so that they shift their focus on bringing better products for the members. Service providers can help payers achieve across-the-board advancements, particularly digital and artificial intelligence enablement for health plans.
Implementing as-a-service solutions
Making modifications like these is a challenge no matter the approach. But using an as-a-service approach, designed to mitigate the issues that come with organizational change, can help improve overall acceptance.
Payers can use the as-a-service model to quickly react to business changes, improve consistency across business units, and ensure compliance with regulations. This model fully addresses the challenges faced by healthcare organizations.
Provider engagement, claims, enrollment, eligibility, and provider data management are ideal candidates for the as-a-service framework. And as-a-service programs can help healthcare organizations reduce costs while supporting future innovations.
So, what Is BPaaS?
BPaaS, or business process as a service, is more than the sum of its parts compared to a traditional outsourcing arrangement.
BPaaS includes cloud-based technology, people, and processes working together toward delivering seamless and standardized delivery of plan administration for and by the health plan. BPaaS delivers holistic healthcare administration services using cloud-based platforms, creates end-to-end benefits to drive cost savings, improves risk management, and provides access to innovative technology.
BPaaS solutions are frequently used for claims, provider data management, and adjacent areas. The beauty of the BPaaS model is that it could be delivered as a holistic end-to-end or integrated service or in a componentized mode. For example, health plans have faced inconsistent provider data issues contributing to provider abrasion, claims not getting paid accurately and provider directories not being current or accurate. Each issue often leads to member dissatisfaction. For componentized services, payers can reap benefits when implementing provider data management as a service. The plan can consolidate processes, automate workflow and data comparison, and improve accuracy using analytics and business intelligence. Doing so reduces provider abrasion and helps build member satisfaction.