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Home | Blog | What is Healthcare BPO and Why Should You Care?

What is Healthcare BPO and Why Should You Care?

By M. Edosma

Updated on April 8, 2024

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Are You Having Trouble Managing Your Healthcare Business? Get Some Help With a Healthcare BPO.

Are you finding it challenging to manage your healthcare business due to the rising number of patients? Are you struggling to keep up with the administrative paperwork? If so, you might want to consider Healthcare BPO as a solution to your problems.

It can help you transform your business and streamline your operations, making it more efficient and organized. So, why not discover the benefits of Healthcare BPO today? Read on to learn more!


What Is a Healthcare Business Process Outsourcing?

Healthcare Business Process Outsourcing, or Healthcare BPO, supports healthcare institutions. We help by processing your daily back-end activities like coding and billing, processing medical claims, and updating medical data.

Healthcare represents 5%-10% of the total BPO deals in the market. Banking, financial services, and manufacturing remain the hottest trend. However, the growth potential of the industry is high.

The projection shows that the healthcare market size will grow significantly. From $211.57 Billion in 2020 to $337.8 Billion by 2025. This all means that the industry is getting bigger.


Who Belongs to the Healthcare Industry?

You are part of the industry when you engage in at least one of the examples below:

  • Managing facilities offering healthcare and pharmaceutical services.
  • Purchasing and selling pharmaceuticals.
  • Healthcare consulting and billing.
  • Distributing medical supplies.
  • Infusion therapy services.
  • Respiratory services and supplies.
  • Nutrition, wound care, and urological supplies.
  • Home healthcare services.
  • Providing dialysis services.
  • Contract pharmaceutical research.
  • Disease management and formulary services.
  • Orthopedic supplies and services.
  • IT solutions for healthcare businesses.
  • Services/products are as per the Standard Industrial Classification Manual.
  • Ancillary services to the healthcare industry.
  • Other healthcare-related products/services.

In short, if you own, operate, or manage healthcare facilities, healthcare operations, or healthcare services. You are part of the growing healthcare industry family.

Now, we have to identify which sector you belong to so that we can assess what services will suit you best.


Healthcare Payer vs. Healthcare Provider

In the industry, you can be either a healthcare payer (or payor) or a provider.

A payer is a company that pays for an administered medical service, such as an insurance company. At the same time, a provider is a company that provides healthcare services, such as hospitals or clinics. 

Despite their vast difference in roles, both sectors play a vital part in the industry.

The role of a Healthcare Payor is to: 

  • Negotiate or set rates for provider services. 
  • Collects revenue through premium payments or tax dollars.
  • Process provider claims for assistance.
  • Pays provider claims using collected premium or tax revenues.
  • They negotiate discounts with hospitals on behalf of the patients they represent.

On the other hand, a Healthcare Provider’s role is to:

  • Assist with the physical needs of patients.
  • Offer medical advice and direction for illness prevention and injury.
  • Evaluate disease and injury.
  • Deliver necessary treatment through a variety of venues.
  • Short- and long-term care.
  • Operates the facilities that offer health care services to the community.
  • Respond to the health care needs of the community.
  • Act as liaison between patients and insurance companies for billing and payments.

With differing roles in the two sectors, the need for a healthcare BPO has become a necessity. Healthcare BPO helps in bridging the function of the two together. We help by making each transaction from the payor and provider fast and hassle-free.


What are Healthcare BPO Services?

Why do hospitals, doctors, nurses, practitioners, patients, and entrepreneurs avail of our services?

Because we can do a lot of things for you, like:

  • Medical Transcription
  • Medical Coding
  • Medical Billing
  • Claims Processing
  • Data Entry Services

We don’t just provide the necessary support, though. We have a roster of experienced and well-trained agents to help you.


Why should you care more about Healthcare BPO?

Patient behavior has been rapidly changing since the COVID-19 pandemic. And these changes may be permanent.

In a study by PricewaterhouseCoopers’ Health Research Institute. They lay down some figures that will show you how vital Healthcare BPOs are:



11% of the 2,533 American patients surveyed have already adjusted their healthcare visits or medication spending.

Patients are starting to adapt their lifestyles in unity with the pandemic.

That means they will be more dependent on the health system than ever.

Healthcare providers can capitalize on this shift in behavior. Introducing more cost-friendly services attracts more people in need of medical services.

5% of American consumers say they or a family member used telehealth for the first time during the pandemic.

5% might look like a sad number. But when we apply it to the broader US population, we talk about 16.5 million Americans!

Providers should start to consider offering telehealth services to their patients. 

It’s the easiest way for them to get medical care advice and treatment. Plus, taking the extra mile to serve helps build trust and confidence.

88% of these new telehealth users say they will use it again.
62% of employed consumers said their employer offered them at least one new benefit to cope with the pandemic.

As stated before, the pandemic has changed the lifestyle of consumers.

These new benefits will force employed consumers to demand better healthcare services.

61% of consumers reported that social determinants affected their healthy lifestyles. Sleep, affordable housing, and childcare are examples of social determinants.

It only means one thing. 

We need doctors. 

Healthcare providers need help to face this challenge. 

84% of Americans said they are willing to share their medical data.

This will have a positive impact on the industry.

Suppose more people are willing to share their medical data. Providers can use it to find new ways of delivering care.

32% of consumers are receiving health-related information from local news.

Healthcare providers usually communicate with their patients on a per-transaction basis. During the pandemic, they should focus more on this. 

By staying connected with your patients, you welcome more business opportunities.


These all mean the health system is opening rooms to provide better services.

Healthcare BPO is a must because we need to take care of the business side of healthcare during a pandemic. If providers and payers can focus on their roles, their effectiveness increases, especially now that hospitals, businesses, and institutions must follow safety protocols.

It would be best if you cared about healthcare BPOs because COVID-19 has made everything, literally, virtual. Patients are afraid to go outside to see a doctor or buy medicines. You have to make the necessary changes to cope with these challenges.


We are on board with your plans to welcome change. If you are considering getting a healthcare BPO, contact us today. Our sales team will reach out to you shortly.

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      What is Healthcare BPO and Why Should You Care?

      M. Edosma

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