Conduent - Healthcare Payer BPS
Who Is This Vendor Assessment For?
NelsonHall’s profile of Conduent’s Healthcare Payer Business Process Services (BPS) is a comprehensive assessment of service offerings and capabilities designed for:
• Sourcing managers monitoring the capabilities of existing suppliers to deliver business process services to healthcare payers
• Vendor marketing, sales and business managers looking to benchmark themselves against their peers
• Financial analysts and investors specializing in the support services sector.
Key Findings & Highlights
In January 2017 Xerox spun off its Business Services unit to create Conduent. This included Conduent's healthcare payer BPS business. Conduent continues to serve healthcare payer and provider clients, including government Medicaid agencies and commercial health plans.
In 2018 Conduent reports that Conduent's revenue from commercial and public sector healthcare customers will total approximately $1.7bn. This constitutes 29% of the company's 2018 revenue. NelsonHall estimates that Commercial payer clients contributed $664m and government payer clients contributed $1,245m in BPS revenue. Distinctive elements of Conduent’s payer BPS practice:
Government health services: Conduent's substantial business shrank from 2015, when it supported 31 states and D.C., to 2017, when it served 24 states, Puerto Rico, and D.C. Primary capabilities include:
• Fiscal Agent Operations (supported by MMIS on two Conduent platforms in addition to state specific platforms
• Provider Services
• Program integrity
• Pharmacy Benefit management.
Commercial industries: Conduent serves 19 of the top 20 health plans, 20 of the top 20 BCBS health plans, and many smaller payers.
• Digital Transformation
Customer/member services (omni-channel communications offerings)
Claims administration (medical, pharma, dental/vision, workers comp. etc.)
• Payment integrity (including overpayment ID, recovery, credit balance audits)
• Care integration (including population health, member and provider communication)
• Care management (utilization -, disease -, case management, patient outreach, wellness)
• Private health insurance exchanges.
Conduent acquired a company relevant to its payer healthcare practice, Health Solutions Plus (HSP) and its Core Administration Processing System (CAPS) on January 3, 2019. HSP provides services to the following segments: commercial payers, managed care organizations (MCOs), and Medicare Advantage payers. HSP's software supports medical, dental, vision and specialty health benefits and claims administration.
Scope of the Report
The report provides a comprehensive and objective analysis of Conduent’s offerings, capabilities, and market presence in support of business process transformation through the application of healthcare payer BPS including the company’s:
• Offerings and key service components
• Delivery organization
• Customer base, including the company’s targeting strategy and examples of current contracts (where available)
• Revenue estimates for healthcare payer BPS
• Strategy, emphasis and new developments in support of healthcare payer BPS
• Strengths and weaknesses.
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