U.S. Commerical Healthcare Payer BPS

U.S. Commerical Healthcare Payer BPS

Who Is This Report For?
NelsonHall’s U.S. Commercial Healthcare Payer BPS Client Perspective Report was written for:
• Sourcing managers investigating “the art of the possible” and the perspectives of their peers towards healthcare payer BPS
• Vendor marketing, sales and business managers looking to benchmark themselves against their peers regarding healthcare payer BPS being delivered by the vendor community
• Financial analysts and investors specializing in healthcare payer BPS

Background & Scope of the Report
As part of NelsonHall’s most recent healthcare business process services (BPS) research, U.S. Commercial Healthcare Payer BPS, we interviewed leading vendors of these services. In addition, we surveyed the BPS vendors’ U.S. commercial healthcare payer clients. The findings from standardized interviews with clients of these services represent payers that range in size from membership of 200,000+ to 20m+; that vary in terms of products and services offered; and that vary in geographic distribution across the U.S. (and to a small degree outside the U.S.). Respondents were primarily senior executives that ranked as Directors, Vice Presidents, or functional leaders (e.g. Claims).

The standardized interview format was designed to gain insight into buyer perceptions of the BPS vendors’ current performance and capabilities, as well as the BPS vendors’ likely capabilities for meeting their healthcare payers’ future needs:
1. Primary payer challenges that BPS vendors help address
2. Delivering BPS benefits to payers
3. Guidance from payers to BPS vendors

In each focus area we asked healthcare payers to rate their vendors on a standard scale (1-5, with 1 being “poor” and 5 being “very high” or “excellent”). We also asked standardized, open-ended questions to gain context about business and technology needs - both present and future.

Key Findings
The findings identify where payers are largely satisfied with their payer BPS vendors’ capabilities, and where they have significant concerns.

For context, the findings identify primary challenges that drive healthcare payers to turn to BPS vendors: demand for cost reduction and for capabilities to adapt to structural market changes.

With respect to satisfying current requirements in running existing payer functions, payers are largely satisfied with their BPS partners.
• Payer satisfaction is highest with regard to “strength of partnership” with their BPS vendors, scoring 4.6 out of 5 (with 5 = very high)
• Payers also give high marks for satisfaction with BPS vendors in current BPS functional areas, such as claims administration.
However, payers are not confident in their BPS vendors’ transformation capabilities.
• Payers give their BPS vendors only middling marks with respect to their capabilities to “reimagine services” (3.7 out of 5) or “apply new technologies” (3.8 out of 5)
• Payers also concretely identify misalignments on the relative importance and delivery of business benefits by their BPS vendors in areas such as RPA and member satisfaction.
Finally, these findings sketch out the payers’ collective vision of the ideal BPS vendor and offer constructive criticism about their current BPS vendor relationships.


1. Introduction
2. Executive Summary
3. Top Challenges That Vendors Help Address
4. Satisfaction Rankings by Payer Function
A. Current Use and Current Satisfaction
B. Future Suitability of Services
C. Importance and Effectiveness of Benefits Provided
D. Importance of and Satisfaction with BPS Vendor Operational Capabilities
5. Guidance from Payers to BPS Vendors
A. Lack of Confidence in BPS Vendors’ Transformation Capabilities
B. Payers Value Importation of Best Practices and Innovation
C. Payers Doubt BPS Vendor Capabilities to Meet Future Requirements
D. Ranking the Importance of Capabilities of the Ideal BPS Partner
E. Payers Likely to Recommend Current Partners, but Offer Criticism

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