When the pandemic broke out, U.S. health services went too far. One of the top U.S. health insurance companies, which is on Fortune 500’s list of ten companies, increased the number of outsourced agents in Nearshore more than tenfold.
A Latin American provider of provider management with the health care provider (who chose not to be named) told Nearshore Americas what the company is looking for when it hires provider services. “Before last year, Latin America was very small (for the company). Due to the pandemic, the company expanded hiring in the region. Our staff went from 300 defenders to more than 4,000, ”the source said.
The pandemic is driving health expansion
The global pandemic has had lasting consequences. On the one hand, the heavy human toll that was felt in the US which, as of May 26, recorded more than 585,000 Covid-19-related deaths and nearly 33 million confirmed cases according to World Health Organization.
In the meantime, interest in Nearshore services has been robust. Earlier this year, Nearshore Americas predicted this in between 20,000 and 25,000 full-time equivalent sites would migrate from the Philippines to the Americas within 18 months.
“Our workforce went from 300 advocates to more than 4,000” – Director of Supplier Management
The director is the first VM virtual machine leader based in Latin America, emphasizing the scope of the company’s growth and the likelihood of its continued involvement in the region. But the health care provider has clearly taken note the shortcomings of the Philippine market, and has diversified its footprint in several countries in the region.
“We opened five countries in the region with nine sites divided between them,” the director of supplier management said. “In Colombia alone there are four places with the rest divided between Guatemala, Costa Rica, Nicaragua and the Dominican Republic and Colombia.”
Companies that provide contact with customers, including Sitel, Concentrix, Teleperformance and Alorica, as well as an “internal” call center, they explained.
Peaks in demand caused by the U.S. annual national health insurance record, Medicare, are one of the main periods of activity for the health care provider.
Medicare is generally aimed at people over 65, although younger people can enroll in the program in specific cases. The health care provider has more than 7 million clients who are part of the Medicare program. These are the people to whom the vendors serve the customer.
“Advocates will deal with older people on health issues, so compassion is very important” – Supplier Management Director
“Advocates work on a wide variety of products, including general billing, reviewing a client’s medical benefits, changes to plans or prescriptions. These are the types of daily calls we handle,” the director explained.
The type of clients that advocates will address addresses performance metrics and demands on providers that the health care provider is looking at, according to the director: “Advocates will deal with older people in health care, so compassion it is very important”.
But the metrics are maintained and the benchmarks are specific.
“Senior leaders consider performance when it comes to supplier selection. It’s a combination of several things, including improving performance from one month to the next, ”they said.
“We use different benchmarks for different verticals, but for health, most companies want about 70 in NPS. We want to see a minimum of 77 because that helps us understand if our members will recommend us to others. CSAT scores should be 90 to 93, ”the director said.
When looking at a site as a whole, having leaders in place and team “union” is important, while RPA and AI components are added benefits, the director said.
The huge growth in interest that Nearshore service providers are receiving, including call centers, BPOs, IT subcontractors and others, due to the pandemic, has driven many regional businesses.
But with the rise in outsourcing that occurs in verticals such as healthcare, questions have also been raised about the processes that healthcare providers make to ensure that their customers ’data remains secure and meets legal requirements. .
Keeping customer data safe starts with the outsourcing contract, says Sonia Baldia
Nearshore Americas spoke with Sonia Baldia, a partner at Kilpatrick Townsend & Stockton LLP, which specializes in technology, privacy, cybersecurity and outsourcing, and works with health care providers and insurance companies in the U.S.
“It all starts with the contract,” Baldia said.
“The outsourcing contract is really key and critical because this is where we detail all the clauses and protections related to issues like any breach of data security, civil liability, how it will be applied and other similar issues. The contractual clauses of the seller are solid for the seller to pay attention to ”.
Because Latin American-based agents will process sensitive data of U.S. citizens, U.S. federal statutes regulate details about data access and transmission.
“There will be a lot of personal information involved. This is PII: personally identifiable information and PHI: personal health information. It is the PHI that is regulated by HIPAA (Health Insurance Portability and Accountability Act), ”he said.
“With data breaches, it’s really more about ‘when’ instead of ‘if'” – Sonia Baldia
Vendors should not be able to store or have direct access to customer data: “Requirements from a security and operation point of view are that the non-US delivery service accesses the customer’s system only for They can’t download, take photos, or replicate data. There’s usually a lot of security around handling PHI around these providers. Support is perfect, but all servers and systems data will be located in the US. All this is established in the contract “, he explained.
Cybersecurity is a growing concern within the outsourcing community. While the problem has been on the radar for a long time, recent cases of security breaches such as Colonial Pipeline hacking have boosted the security of sensitive data at the forefront of customers ’minds.
“With data breaches, it’s really more about‘ when ’rather than‘ yes, ’” Baldia said. “The question is whether the seller and the buyer are prepared so that when it happens, they are not trapped. The slower the response to a data breach, the greater the responsibility. It’s one thing to plan data security, but infringement planning is another important element of the medical outsourcing contract. ”