Market Scan on Healthcare Bps offerings for Selected 5 Segments

Report on

MARKET SCAN ON HEALTHCARE BPS OFFERINGS FOR SELECTED 5 SEGMENTS

Submitted by:

Deependra Sharma

Contents

Project Description        7

Scoring Criteria        7

CLINICAL ANALYTICS        14

UNDERWRITING SUPPORT        17

Recommendations        21

REFERENCES        22

Executive Summary

This project aims at gathering the market intelligence about Healthcare BPS offerings for Healthcare Payer in 5 Segments viz. (Fraud, Waste and Abuse; Payment Integrity and Subrogation; Clinical Analytics; Underwriting Support; Sales and Marketing Support) and analyze the service and product capabilities of top players in each segment.

10 companies are selected in each segment and a competitive analysis frame work and a scoring criteria is defined for these companies in order to accumulate the service and product offerings by these companies to the Healthcare Payers in order to ease their business and to find solution for the challenges they are facing.

The main focus is to decide whether these capabilities can be developed with in cognizant or by a potential acquisition or partnership. These 5 segment are the part of various department of the Payer value chain, below are the information about them:

• Fraud, Waste and Abuse comes under Financial Management of healthcare payer’s operation value chain.
• Payment Integrity and Subrogation comes under Claims administration and Financial Management part of the value chain.
• Clinical Analytics comes under the Care Coordination of payer value chain.
• Underwriting Support and Sales & Marketing come under the Administrative part of value chain.

The above 5 segments are highlighted in the Healthcare Payer Value Chain below:

[pic 1]

Project Description

The project allocated to me is to do a market scan on Healthcare BPS offerings for selected 5 segments. It is a desk job and I need to analyze the Healthcare BPS offerings in the market through secondary research.

I need to analyze the services and product capabilities of top players in the below segment:

• Fraud, Waste and abuse
• Payment Integrity and Subrogation
• Clinical Analytics
• Underwriting support
• Sales and marketing support

Scoring Criteria

Before getting in to the details of each of these 5 segments we have defines a scoring criteria on the basis of which a score is given to each of the company on the scale of 5 for various attributes and then the total score is again normalized on the scale of 5 to represent their position on the graph along Service Maturity Vs Capabilities.