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Assessing the Opportunities for Document

Services Outsourcing in the Healthcare
Industry
by: Mark Voytek, Managing Director, Healthcare
Stan Lepeak, Managing Director, Research

The American Recovery & Reinvestment Introduction

Act of 2009 articulates the over-arching
Print, mail and outbound client and partner communications
goal for health IT spending is to facilitate
operations are not a core competence for most organizations.
the adoption of an electronic health
They are typically viewed as a “necessary evil” or, when
record (EHR) for every US citizen by 2014.
considered more strategically, an opportunity to improve
Long term, this should term cut back on
the quality of outbound communications. Healthcare
the volumes of paper produced as part
organizations face special challenges relative to these
of the healthcare process. Document
types of outbound communications given the sensitive and
services, especially those related to print,
highly regulated nature of the data and information they
mail and related outbound patient and
manage and process. There is a growing trend for healthcare
client communications, represent a costly
organizations to explore options to outsource components
and labor-intensive operational area in
of these document services areas. Their goals in outsourcing
any healthcare organization. Despite the
these areas are to reduce costs, better address regulatory
growth of electronic communications,
requirements and improve communications.
the healthcare “paperless office” remains
aspirational. Additionally, healthcare Document services outsourcing as a category of business
organizations face burdens and complexities process outsourcing (BPO) is not new, especially printing
related to managing documents due to and mail services. Document services BPO scope has been
the highly regulated and sensitive nature expanding in recent years. Today it includes basic print and
of many of their communications. Given mail services, integrated imaging and electronic document
the trend towards more restrictive and services, and a focus on managing and optimizing the overall
comprehensive regulatory environments, document services lifecycle. The nature of the service provider
these standards will continue to grow. As market is changing as traditional IT service providers become
with any paper-based and labor-intensive more active in the space.
process, there are outsourcing options that
healthcare organizations should evaluate
as a potential means to reduce cost,
improve process performance and provide a
stepping stone for electronic health records
management.
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The Numbers Make Sense for Today’s
Economic Environment
Healthcare organizations have clear fiduciary responsibilities
to facilitate earnings growth for investors. Succeeding at this
in a fiercely competitive business climate requires that firms
maximize available capital and deploy capital that enable
both organic and acquisition growth initiatives. Healthcare
payers are increasingly outsourcing their print, mail and
related document services as one means to help achieve
these objectives. One of the benefits is that organizations that
outsource their print and mail services can better maximize
and redeploy capital assets. Document services are capital-
intensive functions that require significant ongoing investment
with little identifiable or captured direct benefits in terms of
driving top-line growth. More often poor quality document
services capabilities take away from top line growth.
Healthcare organizations must communicate effectively and
on a timely basis with their members and providers. This is
driven by both an objective for consumer satisfaction and by
extensive regulatory mandates. Print and mail services are an
important function but the production of the communications
(primarily print) is generally not a core competency for most
healthcare organizations, nor should it be. Appropriately,
this function could be accomplished more efficiently and
effectively by someone with core expertise in this arena.
The potential benefits healthcare organizations can gain
from improving the operational efficiency and effectiveness
of their print, mail and document services operations is
not insignificant. While it is possible to gain some benefits
from internal process improvement efforts, outsourcing is
increasingly a viable means to maximize and extend these
gains. The range of savings is 15-25%, based upon EquaTerra’s
current projects and previous deals completed.
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Get to what matters.
By implementing options for print and mail services, healthcare
providers can focus on their core strengths, potentially reduce
costs and strategically plan for a future that allows for secure,
electronic exchange of health information and ultimately
better client care.
Current State Print and Mail Service Models
in Healthcare Organizations
Operating Models
Most healthcare organizations use a distributed model to
support print, mail and related document services. The model
typically includes the following components:
• Production print (e.g. billing statements and routine
mailings)
• Print on demand (e.g. test results, patient records, ad-hoc
mailings)
• Specialty print (i.e. for color documents and other inserts
to be included in distributions)
• Electronic communications and fulfillment
• Mail operations (i.e. to gather, process and distribute
mailings)
Typically these operations are not centralized nor is it
possible to ever fully do so. Redundant and underutilized
production print and mail operations can create significant
overhead costs. Adding to the complexity is that many
healthcare organizations have grown through acquisition
and the delivery model for their print and mail services
has grown and fragmented in a similar pattern. There is no
simple way to centralize and manage these operations, and
most organizations do not have the bandwidth needed to
undertake these efforts.
Correspondence Types
There are many types of correspondence that healthcare
organizations generate and distribute as part of their normal
course of business. Adding to the complexity of document
services, each type has different levels of regulatory oversight,
process, retention and communication requirements. There
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are several member document types: EOB (explanation of
benefits); individual premium bills; system-generated letters;
and additional information requests (i.e. student status forms,
letters, etc). There are also several provider document types:
single claim check/remit; bulk check/remit; capitation remits/
checks; encounter reporting; system-generated letters; and
general provider communication letters.
Print and Mail Alternative Services Delivery
Options
Healthcare organizations have several alternative delivery
options to choose from when considering how to improve
their print, mail and related document services capabilities.
The best option for the future state is dependent on the
current state situation. Ideally any improvements will extend
and improve the existing organization operating model, limit
service disruptions and leverage systems and information
technology capabilities. Below are four options available to
buyers:
Buyer Options to Address Print, Mail and
Document Services Improvements
• Status quo
–– Live with it as is. Make incremental improvement to
distributed operations over time.
• Internal process improvement/move to shared services
environment
–– Gain benefits from economies of scale,
standardization, consolidation of new investments.
–– Drive consolidation efforts and address change
management needs.
–– Fund any required staff, IT and facilities investments.
–– Treat investments as capital expenditures.
–– Maintain risks associated with fluctuating document
services volume, improperly addressed document
handling and management requirements, etc.
• Facilities management outsourcing
–– Undertake partial outsourcing, for example, to a print
services provider or a provider that can take over
production and mail facilities.
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–– Leverage third party expertise, divest capital assets
and offload operational management requirements.
–– Requires, most likely, multiple service providers to
support different services and geographies.
–– Invest to upgrade and improve document services
capabilities as required.
–– Access to innovation and economies of scale more
difficult via centralization.
• Full outsourcing
–– Migrate print, mail and related document services
operations to an existing commercial service provider
for a multi-year term.
–– Focus of the benefits gained from the service
provider’s delivery of IT and process innovations is on
print, mail and document services.
–– Mitigate risks associated with fluctuating document
services volume, improperly addressed document
handling and management requirements, etc. This
approach is better able to address changes resulting
from acquisitions, divestitures and other business
change events.
–– Receive prorated investment costs made by
the service provider for operations and process
improvement, often at a lower total cost.
–– Leverage service provider best practices for further
innovation and transformation.
Key Benefits from Document Services
Outsourcing
Healthcare organizations can achieve financial benefits when
migrating from a traditional to a fully outsourced print and
mail services solution. In addition, by implementing a solution
that gains access to third party capabilities and technologies,
the buyer can focus on their core strengths. One of the
challenges will be for healthcare providers to adopt and
meaningfully use certified electronic health records within the
next decade. Today, we are still using paper. Forms are filled
out in triplicate. The introduction of electronic medical records
will reduce error rates, improve care and provide significant
savings. Addressing the print and mail challenges of today will
position healthcare providers to clear their agendas to work
on their IT plans and strategy for obtaining electronic records
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capabilities. And, it is likely that the print and mail service
providers will have a part in the creation and/or execution of
those solutions.
This is not to imply an outsourcing effort is a quick or easy
solution. Outsourcing of any type is always easier “on paper,”
and document services outsourcing is no exception. A
requirement to make outsourcing work is that the key parties
must understand their requirements and obligations as part
of the effort and address them. Stakeholders must participate
in the planning, transition, execution and management of any
outsourcing effort.
Key Challenges to Document Services
Outsourcing
There are many potential barriers that healthcare
organizations must address when planning and undertaking a
print, mail and related document services outsourcing effort.
The following are some of the most common barriers.
• Inability to define a solid, realistic and defensible business
case.
• Lack of business unit stakeholder and executive support
or interest.
• Incomplete understanding of how to account for
all relevant regulatory requirements if activities are
outsourced and/or a misperception that it is not possible
to adequately address them.
• Perception that improved operational efficiency and
maintaining good customer service are incompatible
goals.
• Inability to identify viable service providers to effectively
deliver the required savings and benefits.
• Inadequate understanding of required change
management requirements.
• Inability to “sell” change effort inside and outside the
organization.
• Culture of inertia.
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Get to what matters.
Organizations can overcome these barriers. The key is to
address them early and “head-on”. An inability to successfully
address and overcome these challenges indicates an inability
to successfully execute on the overall outsourcing effort.
One of the common reasons for failure in document services
outsourcing is an inability by those initiating the project to
gain and maintain adequate executive commitment and
sponsorship. The same holds true with other key business unit
stakeholders.
It is not just CXO’s whose active support is required for major
document services outsourcing efforts. All stakeholders must
have active buy-in, regardless of whether it’s gained via direct
or coercive support. When undertaking a multi-business unit
or multi-regional project, the key stakeholders are multiplied
many times, particularly if distribution channels or business
models differ. This is often the case, for example, in healthcare
payer organizations that have grown through acquisition.
While a complicating factor, it is one that business change
owners must address.
This challenge highlights the need for a robust change
management plan that addresses effective communications
to many different business and operational leaders. The
requirement is to validate and sell the potentially conflicting
goals of improving internal and external customer service
while lowering operating costs.
Key Message for Stakeholders
The key message is that efficiency and customer service are
compatible. Even for customers that prefer to have it done
the way it has always has been done, there is a potentially
better way. Below are more key points to keep in mind when
educating CXO’s and stakeholders on the benefits of print and
mail outsourcing, as well as the requirements to make it work.
• Select a service provider that has exhibited expertise
in comprehensive print, mail and related documented
services outsourcing in the healthcare industry.
This is a bifurcated market with many small, legacy
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providers and a small but growing number of larger
and more comprehensive providers, often with other
complementary service offerings. Many of the legacy
providers offer narrow point solutions around off-site
printing and mailroom services, and they may not
exist five years from now. Select a provider with strong
regulatory knowledge and a strong IT strategy, including
capabilities around electronic document management.
• Do not cut corners. Engage in a formal sourcing process
and structure a formal contract. Utilize statements of
work, requests for proposal, service level agreements,
resource unit-based pricing (where possible), etc.
• Ensure relevant stakeholders are involved through-out
the process. Ensure all relevant angles (business, IT,
regulatory) are represented within the stakeholders.
• Ensure that the strategy for print and mail will
complement the IT strategy for electronic health records.
• Streamline the distribution of information. This can
have a direct impact on member/provider satisfaction,
and could reduce the number of calls into a health
plan’s contact center due to a better and more efficient
communication strategy.
• Determine the best use of scarce investment dollars.
While investing more IT into current operations may
improve existing capabilities, it may not offer the best
return for the business.
• Clearly define and promote the change benefits to
stakeholders as part of preparing their support for
change efforts.
• Build the business case on comprehensive and
measureable metrics, including current and future
performance levels, total postage spend, potential paper
savings, benefits from facility centralization, etc.
• Include estimated savings from indirect sources (e.g.
report rationalization) as well as direct savings (e.g.
postage savings, paper and envelopes, staff reduction,
facilities costs, etc.).
• Model an end-to-end process view across print and mail
services.
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Get to what matters.
Getting Started
The first step is to socialize the business plan “straw man”
with key operational and business executives. It is also
important to staff a project team and appoint process owners
empowered to affect change at all steps in the process, not
just in individual departments. These individuals will drive the
following key steps:
• Redesign end-to-end print and mail processes.
• Develop a base case for the current state, including
volumes, pricing and facilities, and highlight scheduled
projects.
• Develop the business case.
• Indentify the service providers that have this capability
and those that will align with your company.
Conclusion
Print and mail services are a back-office healthcare function
that has traditionally received little attention from operational
executives. Yet it is a function characterized by significant
and growing costs. It is also an important link to clients and
partners because it processes and manages sensitive and
highly regulated data and information. Based on market
trends, including the increase in basic print and mail costs,
increased regulatory requirements, and the growth in viable
comprehensive third party service providers, the potential
cost savings are greater than ever. Leading service providers
are making strides in delivering comprehensive print and mail
outsourcing tailored to the healthcare industry. It is important
that healthcare organizations assess their opportunities to
both reduce print, mail and document services costs and
receive added value for the dollars they spend. Implementing
a forward-thinking approach to print and mail services
addresses regulatory requirements and provides savings that
will effectively position healthcare providers to address future
electronic challenges and opportunities.
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