Healthcare payers have long prioritized member experience, investing significantly to improve customer satisfaction. However, their approach has often been incremental, rather than transformative, leading to a notable gap between customer expectations and the actual experience provided. Intensifying competition, regulatory pressures, and evolving consumer standards from industries such as retail and entertainment have heightened the urgency for payers to address this challenge promptly. To bridge this gap, health plans are recognizing the need for embracing technologies such as analytics, automation, cloud, and AI. The emergence of generative AI presents an exciting opportunity to revolutionize member interactions, enabling health plans to make better decisions and deliver personalized healthcare solutions. In this viewpoint, we examine the fundamental challenges impacting member experience within health plans, highlighting the importance of transformative strategies to address these issues. The report also explores the essential digital capabilities required for future member engagement, emphasizing the vital role of technology in meeting the evolving needs of healthcare consumers. Additionally, it examines the role of third-party providers in reshaping member experience and fostering a more connected, customized, and continuous member experience. Enterprises and providers across the healthcare industry can leverage this report to enhance their capabilities and thrive in a digitally enabled future, centered around the needs of members. Scope Industry: healthcare Geography: global Contents In this report, we examine: Foundational customer experience issues in healthcare payer member experiences The defining pillars of next-generation member engagement strategy, employing the 3C approach Key digital capabilities vital for future-proofing member engagement Generative AI’s role in reshaping member experience Third-party providers’ potential contribution in facilitating member journey transformation Membership(s) Healthcare Payer and Provider Business Process Outsourcing Excellence

The pandemic initiated a financial downturn for healthcare providers, who were already grappling with administrative inefficiencies, as elective surgeries were halted, and foot traffic decreased. Although patient volumes are gradually returning to pre-pandemic levels, the unprecedented talent shortage exacerbated by the pandemic is posing severe challenges for healthcare providers. As a result, healthcare providers are reconsidering their Revenue Cycle Management (RCM) strategy to future-proof their operations against unexpected disruptions. As part of this strategic overhaul, healthcare providers are becoming more open to outsourcing and even offshoring certain operations to third-party providers. The objective is to alleviate cost pressures and ensure the continuity and consistency of operations. Healthcare providers are also seeking to transform their revenue cycle function by adopting technology to reduce their reliance on talent and streamline operations. Recognizing this opportunity, multiple RCM start-ups with a focus on transforming RCM functions have emerged over the past decade. These start-ups are constantly innovating to provide agile, scalable, and easily integrable out-of-the-box solutions that deliver deep insights and prescriptive suggestions. In this report, we assess start-ups that offer dedicated services, software, and solutions mainly focused on the RCM market, and evaluate their core capabilities and market impact. Scope Industry: healthcare Geography: global Contents In this report, we: Explore the drivers leading to outsourcing in the RCM market Discuss upcoming themes in the RCM industry Provide an outlook on technology enablers in the RCM market Introduce a framework to evaluate high-potential start-ups in the RCM market Highlight the trailblazers in RCM, including their assessment, leaderboard, and profiles Membership (s) Healthcare Payer and Provider Business Process Healthcare Payer and Provider Information Technology Sourcing and Vendor Management

Pharmaceutical enterprises and Clinical Research Organizations (CROs) are transforming their traditional engagement models to align with evolving business needs. Cost, scale, and operational efficiency are no longer the primary factors in sourcing decisions as pharmaceutical companies seek advanced support from CROs. The growing emphasis on patient centricity, cloud-based platform solutions, agile systems, advanced analytics for real-world evidence, and digital support for faster compliance is compelling CROs to reevaluate their value propositions. The service provider landscape is also changing with the emergence of IT/BPOs and startups offering differentiated solutions. To compete in this rapidly evolving ecosystem and meet pharmaceutical requirements, CROs are investing in artificial intelligence enabled solutions, analytics, and automation. In this report, we examine these changes in detail exploring the use of digital elements and tracking CROs’ technical investments. We also assess the evolving pharma-CRO engagement models. Scope Industry: life sciences operations Geography: global Contents In this report, we examine: Traditional pharma-CRO engagement models Evolving pharma needs CROs’ digital investments Emerging pharma-CRO engagement models Membership(s) Life Sciences Business Process Sourcing and Vendor Management

In the post-pandemic era, healthcare providers’ priorities have shifted, with an increased focus on reducing administrative spend, enhancing processes with digital/technology adoption, and prioritizing the integration of Revenue Cycle Management (RCM) operations. This shift has prompted RCM service providers to undertake the inorganic route to quickly develop the capabilities and digital prowess required to serve enterprises’ evolving priorities. In 2021, Private Equity (PE) investments and M&As in the RCM service provider space surged and included Omega Healthcare’s acquisition of himagine and AccessOne’s takeover of CueSquared. In this viewpoint, we examine the driving factors behind market consolidation, analyze its benefits, and examine how these strategies will evolve in the future. Scope Industry: healthcare provider (RCM) Geography: North America Contents This report examines: PE investments and M&A activity in the RCM service provider market  Investment and M&A trend analysis Key factors behind market consolidation Service provider acquisition strategies in the future Membership(s) Healthcare Payer and Provider Business Process Sourcing and Vendor Management

Intelligent Automation (IA) in Healthcare – Service Provider Compendium provides accurate, comprehensive, and fact-based snapshots of 18 providers, including their scale of operations, solutions, and capabilities, along with Everest Group’s PEAK Matrix® service provider assessment. The study will enable current and potential buyers of IA in healthcare operations to assess the providers on their strengths and limitations based on desired capabilities. Scope Industry: healthcare BPS and healthcare ITS Geography: global This assessment is based on Everest Group’s annual RFI process for the calendar year 2021, interactions with leading healthcare service providers, client reference checks, and an ongoing analysis of the intelligent automation in healthcare market Contents This report features a detailed analysis of 18 healthcare service providers. Each provider profile includes: Service suite and scale of operations: key leaders, FTEs, recent developments, adoption and capability overview, key locations, and third-party technology partners Capabilities: split of healthcare IA FTEs, split of IA client mix, and split of total IA bots deployed across value chain processes Solutions portfolio Top healthcare-specific IA solutions Everest Group assessment: service provider’s position on the Everest Group PEAK Matrix®, market share and delivery capability assessment, and overall evaluation of service provider capabilities Membership Healthcare Payer and Provider Business Process Healthcare Payer and Provider Information Technology Sourcing and Vendor Management

Healthcare providers in the US incur the highest share of total expenditure (~25%) on administrative activities in comparison to their peers in other countries, and Revenue Cycle Management (RCM) activities account for a major proportion of this expenditure. A majority of this spending is wasteful, driven by broken payer-provider information exchange processes – attributed to relatively low technology penetration, manual intensive operations, and untrained staff. These legacy issues, coupled with emerging challenges such as rising out-of-pocket expenses and a regulatory push toward transparency, are further adding to the woes of healthcare providers as they firefight newer inefficiencies in RCM processes. Having lagged in technology investments for a long time, health systems, hospitals, and physician practices are gradually adopting digitally enabled modular solutions to revamp their RCM operations. In fact, healthcare providers are quickly realizing the benefits of putting technology at the forefront to solve their RCM issues by collaborating with third-party service providers. This viewpoint studies the various RCM challenges, describes technology solutions, assesses their benefits to mitigate those challenges, and illustrates ways in which healthcare providers can utilize third-party support. Scope Industry: healthcare provider (RCM) Geography: US Contents In this paper, we: Scrutinize the key factors contributing to revenue cycle inefficiencies across front-end, mid-office, and back-office RCM operations Make a case for digital elements such as automation, analytics, platform, the cloud, and wrapper tools in alleviating RCM challenges Describe the benefits of these digital solutions across the RCM operations value chain Outline the issues that healthcare providers face in in-house RCM investments Recommend strategies to collaborate with third-party service providers for efficient and outcome-driven RCM processes Membership(s) Healthcare Payer and Provider Business Process Sourcing and Vendor Management

Challenges facing the healthcare sector have never been greater. Amid COVID-19, there is increased demand for services but not enough resources to pay for them. In this scenario, emerging technologies can help bridge the gap. Intelligent automation, including Robotic Process Automation (RPA), Natural Language Processing (NLP), Artificial Intelligence (AI) / Machine Learning (ML), and cloud platforms, not only help reduce costs and increase efficiencies, but also enhance member/patient satisfaction and engagement. In countries facing a shortage of medical and administrative personnel, automation can provide the much-needed support in catering to healthcare operations. Service providers that are leveraging this opportunity are emerging as leaders in this segment and paving the way for smaller organizations to adopt next-generation technologies to keep up with the dynamic healthcare needs globally. In this research, we present a detailed analysis and assessment of 18 operations service providers featured on the Intelligent Automation in Healthcare – Solutions PEAK Matrix®. We provide the relative positioning, a comparison of the service providers’ capabilities, and our evaluation of the providers’ strengths and limitations. Scope Industry: Healthcare BPS and Healthcare ITS Geography: global This assessment is based on Everest Group’s annual RFI process for the calendar year 2021, interactions with leading healthcare service providers, client reference checks, and an ongoing analysis of the intelligent automation in healthcare market Contents This report features a detailed analysis of 18 healthcare service providers and includes: A relative positioning of the service providers on Everest Group’s PEAK Matrix® for Intelligent Automation in Healthcare A comparison of the service providers’ capabilities Everest Group’s analysis of the service providers’ strengths and limitations Membership(s) Healthcare Payer and Provider Business Process Healthcare Payer and Provider Information Technology Sourcing and Vendor Management

The Order Management and Fulfillment (OMF) process is a foundational part of the supply chain, impacting every process, from manufacturing to logistics to payment for goods and services procured/delivered. Yet, OMF is a cumbersome process consuming valuable resources and time in many organizations, characterized by manual effort, disconnected platforms/systems, and multiple hand-offs among stakeholders across different business processes. This makes the OMF process prone to human errors, which can have significant implications on a company’s revenue and operations. Given rapidly changing business environments, companies that rely on traditional, highly fragmented OMF processes requiring high levels of manual intervention risk becoming uncompetitive and irrelevant. In this study, we explore how organizations can revamp their traditional OMF processes through an integrated approach and digitalization of transactional activities, thereby improving stakeholder experience across the entire supply chain and associated business functions – sales, finance, procurement, and customer service. Scope All industries and geographies Contents Drawing insights from our extensive research and interactions with market stakeholders, this study addresses the following topics: The traditional OMF cycle in enterprise supply chain management Key issues plaguing the traditional OMF cycle A new approach to OMF success – integration and how it can be achieved The future of OMF integration Membership(s) Procurement and Supply Chain Finance and Accounting Customer Experience Management (CXM) Services, including Contact Center Outsourcing Sourcing and Vendor Management

Around 8.8 million Americans enrolled in a new health plan during the 2018 open enrollment period, most without completely understanding the plan they were buying. For most people, the enrollment process is a nightmare to say the least. With a multitude of options available in the market that can be purchased through a variety of mediums (exchanges, employers, agents, apps, portals, etc.), the enrollment process has become highly complex. As a result, the member need is shifting from “availability of options” to a “seamless enrollment experience,” including the ability to: Seamlessly select, compare, and purchase plans Get personalized recommendations Interact with stakeholders through the channel of their choice Feel secure about the data they are sharing Be sure they are purchasing the best plan to suit their needs For payers, enabling the seamless enrollment experience is becoming a key factor for new member acquisition. The “Amazonization” goal for payers is not easy to attain; however, the right approach and strategic investments enable them to offer an enhanced experience to members. This viewpoint details the key issues in the health plan enrollment process and explores potential solutions that can enable payers to service their members more effectively. The viewpoint explores: The member journey map and key touch points Pain points in the health plan enrollment process Key roadblocks for payers inhibiting investment in member engagement The leaner, meaner, and faster solution approach to member engagement Membership(s) Healthcare & Life Sciences BPO

After a year of stalled investments owing to market uncertainty, healthcare payers restarted investments in areas such as value-based care adoption, care management, utilization & disease management, population health, and consumer experience. On the technology front, automation, analytics, and BPaaS continue to be areas of interest for the healthcare community. In fact, inclusion of analytics in total contracts is reaching a whopping ~50%. Outsourcing – both traditional and technology-focused – is expected to continue growing at a healthy double-digit rate in near future. In this research study, we look at the healthcare payer BPO market from the point of view of adoption trends as well as prevalent solution characteristics. Some of the findings in this report are: The healthcare payer BPO market witnessed a spike after a year of slow growth, with the market reaching ~US$11 billion in 2017 KPIs for outsourcing are moving away from cost towards new-generation metrics such as innovation, domain expertise, and digital knowhow Outcome-based contracts – based on factors such as NPS scores and claims settled – are coming to mainstream; however, transactional pricing has maximum penetration Manila is the biggest and one of the fastest growing offshore locations for healthcare payer outsourcing services Several trends are shaping how healthcare stakeholders act and have an indirect impact on the service providers too In addition, service providers themselves are under pressure from other market participants and are trying to reinvent existing business models Accenture, Cognizant, Conduent, and DXC Technology continue to lead the market, both in terms of revenue and number of clients Claims management, followed by member engagement, continues to be the largest and most competitive space Membership(s) Healthcare & Life Sciences Business Process Outsourcing