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By Upp Consulting

Speak with any Health Payer Executive and you’ll begin to understand the headwinds facing the industry.

healthcare it staffing

Since the 1980's, staff augmentation has played an active role in business operations. Staffing organizations that have established market leadership over the last few decades were able to do so, in part, by increasing office presence and expanding the breadth of their offerings to support a variety of businesses and business processes (accounting, assistance, IT, manufacturing, etc.). As a result, deep industry experience fell into the background and was no longer a prerequisite. A business systems analyst from the manufacturing industry could find that his or her next contract was for a healthcare organization.

In the past, the Health Payer market was largely dominated by a few organizations, with little differentiation in plans. This growth phenomenon was conducive to market factors and remained virtually unchanged for many years. Staffing partners were labeled and only considered for very specific needs and not in a manner that fully quantifies the many ways staffing can impact balance sheets. Today, those dynamics are changing as many forward thinking organizations are digging deeper into the subject, especially in light of the changing Health Payer market.

Changing Health Payer Market Dynamics

Speak with any Health Payer Executive and you’ll begin to understand the headwinds facing the industry. Whether it’s the largest overhaul of the medical coding system in history (ICD-10), the need for strategic acquisitions, intense federal regulatory factors, or the adoption of a business to consumer model (ACA), the industry is crossing the Rubicon.

Further complicating matters is the profound change in technology solutions (cloud computing, big data, etc.) and improvements in business process strategies that enable Health Payers to exceed their competition. A successful technological, contract, or process advantage can have a trickle-down effect to positively impact enrollment and the balance sheet. Adversely, and of critical importance, is the impact compliance or security violations can have on a payer, especially regional or smaller payers that do not have extensive reserves to offset the penalty of loss of revenue.

Best of Breed Staffing

While multi-industry staffing continues to play an active role in organizations, Health Payers are recognizing the benefits of best of breed staffing. Best of breed staffing organizations have an intense focus on the industry they serve. Most of their recruiting, technology, and consultant employees have years of claims and relevant Health Payer project experience. This experience can be seen in their understanding of complex payer processes, compliance risks, payer-related technology solutions, and an ability to comprehend how exactly to augment a payer business unit.

Ultimately, the intense focus culminates in improving Health Payer profitability, enrollment, and quality of care. Take for example a recent success story in which a Health Payer utilized a single business process analyst and was able to improve adjudication processes allowing for a 30% increase in related profitability. Or, how an experienced architect assisted a payer in the on-time and on-budget design, development, and delivery of new data warehouse that will provide strategic analytics. Experience counts! As a recent customer explained to us, nothing frustrates his staff more than a consultant who does not understand the claims market. 

Blog Type: 
Upp IT Staffing Blog