What is Healthcare BPO and Why Should You Care?

A blog banner for What is Healthcare BPO and Why Should You Care?

A blog banner for What is Healthcare BPO and Why Should You Care?

Are you having trouble managing your healthcare business? Get some help with a Healthcare BPO.

Do you need help with the surge of patients these days? Is your paperwork piling up, and you are looking for ways to cut it?

If you have these questions in mind, I will let you in on a big secret: 

Healthcare BPO.


What is Healthcare Business Process Outsourcing?

Healthcare Business Process Outsourcing or Healthcare BPO provides support to healthcare institutions. We help by processing your daily back end activities. Like coding and billing, processing of medical claims, and updating of medical data.

Healthcare represents 5%-10% of the total BPO deals in the market. Services such as 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 example below:

  • Owning, operating, or managing one or more facilities that dispense, market, or provide healthcare products or services, including and without limitation to pharmaceutical products or services.
  • Purchasing, repackaging, selling, or dispensing pharmaceutical products.
  • Healthcare consulting and billing services
  • Distributing medical supplies and equipment.
  • Infusion therapy products or services.
  • Respiratory services, equipment, or supplies.
  • Parenteral and enteral nutrition products, wound care products, ostomy, and urological supplies.
  • Home health care services.
  • Dialysis services.
  • Contract pharmaceutical research services.
  • Disease and outcome management services, including formulary services.
  • Orthopedic supplies and services.
  • Information technology, including software products and services, to any of the foregoing businesses, including long term care institutions.
  • Any service or product described in the Standard Industrial Classification Manual (1987 Revision) published by the Office of Management and Budget under the heading Industry No. 5047, 5122, 5912 or 8731 or Major Group 80 as a whole or their equivalents described in the North American Industry Classification system (the United States, 1997) published by the Office of Management and Budget.
  • Any product or service ancillary or incidental to the healthcare industry. To any customer or client of any of the foregoing examples.
  • Any other healthcare-related products or services.

In short, if you own, operate, or manage health care 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 like insurance companies. Whereas a provider is a company that conducts healthcare services. Such as hospitals or clinics. 

Both sectors play a vital part in the industry, despite their vast difference in roles.

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 service.
  • Pays provider claims using collected premium or tax revenues.
  • They negotiate the discounts with hospitals on behalf of the patients they represent.

On the other hand, a Healthcare Provider 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 liaisons between patients and insurance companies for billing and payments.

With differing roles from the two sectors, the need for a Healthcare BPO becomes a necessity. Healthcare BPO helps in bridging the function of the two together. We help by making each transaction from both 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:

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?

Patients’ behavior is rapidly changing amidst 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 important Healthcare BPOs are:



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

Patients are starting to adjust their lifestyles in congruent with the pandemic.

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

Healthcare providers can use this shift in behavior to their advantage. By introducing more cost-friendly services, they attract more people in-need of medical services.

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

5% might look like a sad number. But when we applied it to the broader US population, we are talking 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 in building trust and confidence.

88% of these new telehealth users say that 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 is changing the lifestyle of consumers.

These new benefits will force employed consumers to demand better services from healthcare providers, as well.

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

It only means one thing. 

We need doctors. 

Health moves in the opposite direction of COVID-19 infections. And that trend is expected to rise with the appearance of a new strain.

Healthcare providers need help to face this challenge. 

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

This will have a positive impact on the industry.

If 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. And amidst the pandemic, they should focus more on communicating with them. 

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


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

Healthcare BPO is a must because we need to take care of the business side of healthcare while we are in a pandemic. The effectiveness of providers and payers increase if they can focus on their roles. Especially now, when hospitals, businesses, and institutions have to follow safety protocols.

You should care about healthcare BPOs for the reason that COVID-19 has made everything, literally, virtual. Patients are afraid to go outside to see a doctor or buy medicines. You have to make necessary changes to cope up with these challenges.


We are on board with your plans to welcome change. If you are considering getting a healthcare BPO, you can contact us today. And we’ll have our sales team reach you shortly.


Contact us today for more information.