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Manu Aggarwal

Manu Aggarwal is a member of the Business Process Services team and assists clients on topics related to various business processes, delivery optimization, go-to market strategy and future investments, etc. across multiple industries such as Banking, Financial Services, Healthcare, and Life Sciences. Manu’s responsibilities include leading Everest Group’s BFSI and HLS BPS offerings. To read more, please see Manu’s bio.

Apple-Goldman Sachs Partnership Could Steal Credit Card Market Share from Consumer Banks | Blog

By | Banking, Financial Services & Insurance, Blog

Apple’s March 25, 2019, announcement of a physical credit card, called Apple Card, might initially seem like a strange step away from its highly entrenched Apple Pay digital wallet. That Apple and Goldman Sachs partnered on this initiative might also seem odd, as neither operate in the consumer banking space. But when you take a closer look, you realize this is actually a very well-crafted go-to-market strategy for both Apple and Goldman Sachs.

What’s in it for Goldman Sachs?

Goldman Sachs wanted to enter the retail banking space with a credit card. But the U.S. cards market is already crowded and growing at 6-7 percent, payments is a volumes business, and it would have taken a long time to gather significant market share if it went solo. And while the wallet market is growing fast, a standalone wallet is unlikely to make a near-term impact. Goldman Sachs chose the best of both worlds; a card in partnership with a wallet service provider. This helps it enter the cards market while getting easy access to Apple’s wallet user base and future proofing the business.

What’s in it for Apple?

For Apple, this physical credit card partnership opens the path to new customer segments, particularly baby boomers who are still more comfortable with a card and have been slow to adopt digital wallets like Apple Pay. It will also help Apple expand more quickly into geographical markets beyond the U.S., where it doesn’t dominate the mobile devices market. And because Apple sells the synergy of its ecosystem and ease of use, and is promoting the card’s intuitive design, simplicity, and transparency, Apple might also boost its device sales.

Apple Card comes with an EMV chip but there is no number on the card, which means that users will have to use Apple Pay to use the card online or for NFC transactions. The physical card can only be used at point-of-sale (PoS) terminals. This may translate into a higher fee for Apple Pay and explains why Apple chose Goldman Sachs over other banks.

Further, Apple lags a bit behind some of the other BigTechs in the war for data. For example, Facebook has massive amounts of social data, and Google has enormous quantities of location and search data. Goldman Sachs can help Apple with financial analytics, an area in which it’s not particularly strong, and having access to financial data surely gives Apple an edge in its marketing efforts.

All in all, we firmly believe that Apple Card is a sound and strong market entry and growth strategy for both Goldman Sachs and Apple. Indeed, this move could prove to be a strategic masterpiece in the dynamic payments industry.

What does it mean for BigTechs and banks?

We can expect to see BigTechs like Facebook and Google make similar partnering moves to enter the cards market and tap into the larger PoS network to attract new users with their marketing power and brand name cachet.

Banks need to move faster on their journey towards digital payments or risk losing market share to other more nimble companies or partnerships like Apple/Goldman Sachs. To accelerate their move into the digital payments space, increase customer satisfaction, and avoid making huge investments on their own, banks should strongly consider partnering with FinTechs, which can be more agile and respond faster to the changing market with the right infrastructure and technology capabilities.

What’s your reaction to the Apple/Goldman Sachs partnership? Please share your thoughts with me at: [email protected].

Apple Pay Timeline

Apple Pay timeline

Technology is the Key to Innovation in Pharmacovigilance | Sherpas in Blue Shirts

By | Blog, Healthcare & Life Sciences

The critical nature of Pharmacovigilance (PV) is obvious. For patients, it can mean the difference between better health or death from an Adverse Drug Reaction (ADR). For pharma companies, it can mean the difference between a profitable, life-saving drug, or multi-billion dollar fines and loss of reputation and revenue.

Although global PV spend has increased from 0.3 percent of total sales in 2003 to 1 percent (the equivalent of ~US$15 billion) in 2016, some of the pharma industry’s most expensive drug recalls/fines/lawsuits occurred during this timeframe.

Everest Group does not think that a further increase in PV spend is the best way for pharma companies to curb safety breaches. Rather, we believe the answer lies in creating a more effective PV process through use of technology, including analytics, automation, cloud, and mobility.

There are some well-publicized technology use cases in the pharma industry. For example, led by a consortium of world-leading experts from industry, regulatory agencies, and academia, the Web-RADR project will deliver an EU-wide mobile phone app that enables users to report adverse drug reactions directly to their National Competent Authority (NCA). And the U.S. Food and Drug Administration (FDA) has launched Sentinel, a distributed data system through which it can rapidly and securely access information from large amounts of electronic healthcare data from a diverse group of data partners.

And there are myriad ways in which technology can support pharma companies’ PV initiatives. For example:

 

 

eg pv

 

 

Digitized medicines: Smart pills with ingestible sensors can be used to track and collect patients’ health data, which can be used to run analytics for Adverse Event (AE) detection.

Mobile apps: These apps can enable pharma companies to collect ADR data much more quickly.

Cloud-based solutions: Cloud-based databases can enable pharma companies to collect data from multiple stakeholders to build an integrated ADR repository – even at a global level.

Artificial intelligence (AI): AI can help pharma companies to move beyond basic automation by identifying patterns in unstructured data.

Automation: RPA solutions can help pharma companies process structured data much more rapidly than via manual efforts.

Big data analytics: Analytics can help pharma companies use the vast amount of digital data available on the Internet (e.g., on Facebook and Twitter, and in patient forums such as Doctissimo) to supplement traditional data sources such as primary calls, EHR data, and claims data for AE detection.

Proactive PV: Robust IT solutions and advanced systems can help pharma companies monitor drug safety during the research and trials process and post-launch.

 

How Pharma companies capitalize on technology?

To fully capitalize on the benefits technology can deliver to the PV process, pharma companies must begin with establishing a clear and robust strategy for what they want to achieve and how they should progress along the technological curve. For instance, if their end-goal is to implement an AI-based solution, they should first invest in basic automation, analytics, and cloud. As pharma companies tend to lag behind those in other industries in terms of adopting new and innovative methods, they may find it valuable to partner with a third-party advisor to assist in the development of their strategy.

Next, they should proactively identify opportunities and partner with specialized technology vendors to fill technology gaps. For example, while many pharma companies are investing in the development of mobile-based adverse event reporting apps, they will not be able to realize their full potential until all the apps are connected with a common platform that precludes patients from having to download apps for each drug.

Finally, they should strongly consider partnering with outsourcing service providers that have a proven history of supporting the delivery, technology, and regulatory reporting requirements of the PV process. Call center, case entry, literature review and insights mining, aggregate reporting, and PV quality assurance are some of the areas in which outsourcing service providers can of great help.

Pharma companies have long been slow to adopt technology in PV. However, the time has come for technology to play a greater role in delivering solutions, with technology vendors and outsourcing service providers serving as force multipliers.

For detailed insights on new technological innovations in the PV market, please refer to Everest Group’s viewpoint: Innovation in Pharmacovigilance (PV): How to Spend Smarter Not Higher?

The Wide-Ranging Impacts of a Single Payer Healthcare System | Sherpas in Blue Shirts

By | Blog, Healthcare & Life Sciences, Outsourcing

On June 1, 2017, the California state senate passed the “Healthy California Act (HCA.)” The bill (SB 562), which is now in the state assembly for further action, aims to replace all private/government insurance plans in the state with a single, government-run insurance plan.

There are numerous reasons the bill will likely not pass. For example, the California state government would need to spend US$400 billion per year (more than twice the current spend) to fund the proposals in the bill, in turn requiring a massive increase in taxes, including a 15 percent payroll tax increase (source: California Senate Appropriations Committee). There’s limited political support for the bill, even among Democrats. There’s also minimal popular support, per a Pew Research Center poll, which concluded that only 30 percent of California residents prefer having the government be the sole payer. Previous similar attempts at a single, state-run payer system have failed due to the expense involved.

On the other hand, there are voices of support for a single payer system, including Bernie Sanders, the longest serving independent in U.S. congressional history, and Mark Bertolini, Aetna’s CEO, who in May 2017 asked the nation to ponder such an arrangement.

If a single payer system were ever implemented, sweeping changes would impact multiple parties.

How would a single payer system look if it were ever implemented?

Healthcare Payers:

  • If the government was the sole provider of health insurance, commercial payers would get absorbed into the government-run business
  • If the government expanded Medicare coverage to all citizens, commercial payers would die out due to strong competition from government plans
  • If the government sublet to a single commercial payer to handle the insurance market, there would be large-scale consolidation in the payer market

While there are many ways in which this could play out, a move to a single payer system would in most cases be a bane for the payers.

Healthcare Providers:

  • A commercial payer-controlled single payer system would severely undermine providers’ negotiating power. However, a government-controlled single payer system would give them some negotiating leverage
  • They would experience significantly reduced administration costs, as everything would be sponsored by the single payer

Thus, healthcare providers would experience positives as well as negatives in a single payer system.

Outsourcing Service Providers:

A single payer system would bring many opportunities to outsourcing service providers. For example:

  • Payer consolidation would require third-party support across system integration, consulting, process expertise, BPO, and many other areas
  • A government-run consolidation would lead to new areas of investments, similar to the Medicaid Management Information System (MMIS) that the states currently run
  • Integration of everything, including clinical data, under one umbrella payer would enable service providers to develop much more powerful analytics and insights

Single payer system’s governmental requirement for service providers

Of course, not all would be rosy. As a single payer system would require service providers to work with the government instead of commercial entities, they would likely face slower processing, a smaller appetite for innovation, and bureaucratic red tape. Additionally, payer consolidation would lead to outsourcing industry consolidation, likely putting some service providers out of business.

We don’t mean to spook outsourcing service providers with our views. Nor are we encouraging them to start investing in expanding their offerings. But we are recommending they keep an eye on the progress of the HCA and other similar acts around the country. Doing so might just save them from the same fate Nokia suffered at the hands of Google and Apple.

What Pain will You Experience if the AHCA Bill Becomes Law? | Sherpas in Blue Shirts

By | Blog, Healthcare & Life Sciences
  • Health insurance lost for 24 million U.S. consumers
  • Billions of dollars of care investment marginalized
  • Providers’ margins eroded by payers
  • And a five-year setback to the healthcare system

These are potential side effects if the U.S. House of Representatives- approved American Health Care Act (AHCA) bill becomes a law. Let’s look at the impact the law would have on the key constituencies.

Healthcare providers

With the most needy (the sick and the elderly) portion of the population left uninsured, the healthcare providers will once again be expected to foot a large part of their healthcare bills due to lack of coverage, non-payments, use of ER services, etc.

Healthcare consumers

With premium increases, credits/subsidies being based on age instead of income level, and states’ ability to change or waive pre-existing health condition coverage, a large percentage of older, lower income, and infirmed consumers would likely opt out of having coverage altogether. Young and healthy people would have less incentive to get insurance coverage.

Healthcare payers

The overall theme of the bill would result in a significant decline in volume of work managed by payers. That said, there would be numerous key operational implications for both private and government payers including:

  • Product development: Payers would end up having state specific plans, leading to increased administrative work around plan design and development activities. This would likely have a cascading effect on downstream processes (policy servicing, network and care management, and claims management) which are expected to become more complex and specialized.
  • Claims: Claims volume would likely dwindle, particularly among the old and ill, as a large percentage would have opted out of coverage.
  • Policy servicing: Payers would likely experience a significant uptick in queries from patients and providers, as uncertainty around topics such as eligibility, verification, and premium collection amplifies. However, demand for certain processes, such as HIX support, would likely be sluggish.
  • Care and network management: Care management programs would likely take a backseat, given their significant cost to enrollees and providers. Additionally, companies that had invested heavily in such programs could see decline in their ROI. Lower patient volumes might drive payers to tighten their provider network, leading to less work around network management activities.
  • Government (Medicaid): Reduced federal spend on Medicaid would likely push states towards a modular approach, and maybe even a shift towards a managed care construct.

With a decline in volume of work, it might not be surprising to see some of the larger payers insource certain processes.

The Healthcare IT and BPO service providers

A lesser volume of work across various value-chain segments would translate into lower revenue for third-party vendors. In fact, even though a law hasn’t yet been enacted, the healthcare business in some of the key players, such as Accenture and Cognizant, is already growing at a slower rate than their overall company growth rate. This impact could extend to the overall outsourcing industry. On the other hand, if states decided to exercise the power granted to them differently, service providers could also expect to see increase in the complexity of work around certain functions such as policy servicing and claims management.

Additionally, the ratified law might just be the impetus that mid-to-large buyers without GICs need to opt for bundled IT and BPO deals, which were traditionally a feature of mid-sized buyers.

Of course, the above-mentioned implications are for the bill in its current form. However, moderate Republican senators might well make massive changes to it, especially after the public outrage over certain parts of the bill.

It is going to be tough time of uncertainty for all stakeholders until a law – in whatever shape and form – is passed. In the meantime, payers and healthcare providers need to work closely with their respective service providers to ensure they stay afloat and come out on the right side of fence when the dust settles.
For a detailed analysis comparing the AHCA and ACA, please see our report titled: Acing Uncertainties in the Payer Market: The Trump Cards.

Pharmaceutical Companies Can Help Support Trump’s Vision of Make America Great Again | Sherpas in Blue Shirts

By | Blog, Healthcare & Life Sciences

When U.S. President Donald Trump met with the CEOs of a host of major pharmaceutical companies in late January 2017, one of his primary declarations was that drug makers should bring manufacturing and production, much of which is done in countries like India and China, back to the United States.

While moving FDA-certified production factories and establishing new supply chains back onshore is an extremely difficult, years-long ordeal, failing to take some type of proactive step to appease the Trump administration could open the door to potentially unfavorable actions for the major pharmaceutical companies. Think patent reforms, price lock-downs, consumer advertisement bans, and import/export tax mandates, all of which could wipe out the lucrative margins from U.S. consumers.

But there’s one easy step pharma companies can take to mollify the administration’s overarching agenda: start moving services jobs – such as IT, finance, and HR – back to U.S. turf.

Aprrox. 110k to 140k pharma industry services jobs have been offshored, with the majority residing in India

Trump and the pharma industry services jobs

If you look at the dollars, cents, and sense of doing so, it really is win-win. Consider:

  • Services jobs are the least likely to disrupt core business operations if brought back onshore
  • They’re comparatively easy to move, as they’re essentially labor-based and mostly centralized in offshore service centers
  • Doing so would not only provide gainful employment to more U.S. workers, but also signal a commitment to invest in the U.S. workforce and worker productivity
  • Pharma companies could avoid a negative impact to their bottom lines (i.e., a 50-70 percent labor arbitrage) if they effectively leverage digital technologies and capabilities to transform their delivery models as they repatriate the services.

Let’s take a deeper dive look at this last bullet point. True that India’s and other low-cost regions’ skilled workforce and cheaper labor made them attractive locations for offshoring pharmaceutical services jobs. This labor cost advantage has shielded pharma companies from having to take the painful and arduous path towards step-change improvements in workforce productivity, which requires significant investments and service redesigns. After all, why automate if you can get two or three offshore workers for the price of one U.S. worker?

But the world has changed. Digital service models are transforming how services are delivered and consumed. For example, when was the last time you filled out a deposit slip at a bank? Mobile deposits rule the day now. These transformations are happening across the services functions, and are opening the door to operational savings and productivity improvements.

Higher US labor costs can be mitigated by leveraging digital capabilities to transform the service functions being migrated back

Trump and the pharma industry services jobs

By moving and transforming their services, pharma companies wouldn’t bring back all of the jobs they initially offshored, but would create higher paying, higher skilled, and highly productive U.S. services jobs. And, this could be done relatively quickly and on a cost neutral basis with no impact to their bottom- or top-lines, while simultaneously leveraging digital technologies to transform their service delivery models.

It’s true that uncertainty abounds around what levers the Trump administration will pull to entice or force the pharmaceutical industry to align to its core tenant of creating U.S. jobs and “Making America Great Again.” But wait-and-see is a dicey game to play when it comes to the pharmaceutical industry’s most lucrative market.

Everest Group’s advice is to get ahead of the game – starting today. Take a fresh look at your company’s global talent management strategy and shared services construct to identify your degrees of freedom. Then start engaging your technology and services organizations to assess how you can bring some or all of these services jobs back to the U.S., and at the same time offset the higher labor costs with digital technologies and delivery models. It might just save your CEO from seeing an early morning Tweet from President Trump stating, “Horrible company!”

Learn more about the importance of bringing pharma jobs to the United States in Stephen Chen’s executive viewpoint, Will Big Pharma Heed the Call to Bring Jobs Back Home?

Join the Now Generation! | Sherpas in Blue Shirts

By | Blog

Technology sure has advanced since the dawn of the digital era. Remember the early 1960s, when COBOL was developed and the audiocassette was introduced … the early 1970s, when C was invented and the floppy disk hit the market … the early 1980s, when C++ improved on C and the IBM-PC was launched?

No? Nor do we, really.

But you know who does? Many of the world’s largest banks.

In fact, they don’t have to remember the past – they’re still living it. More than 90 of the top 100 banks continue to leverage legacy systems in some shape or form, working with technology platforms they developed in the mid- to late-20th century. In an age when children are programing marketable apps in their teens, the top banks are using systems based on technologies like COBOL, C, and C++.

What’s the problem with living in the past? (I loved the ‘60s / ‘70s / ‘80s!)

Have you seen holiday pictures from those eras? If the clothing and hairstyles aren’t enough to frighten you, these issues should be:

  • Archaic systems – Maintaining these outdated systems is hugely expensive … and that’s if you can find people who understand these programs and can fix problems, a rare and dying breed
  • The M&A jumble – Decades of acquisitions have left major banks with myriad systems that don’t play well together, making them increasingly unreliable in providing innovative services and developing a single view of customers
  • Limited scalability – These systems were developed long before the days of big data; as volumes explode, they can quickly reach the outer limits of space and capability
  • New demands – As technology expands at light speed, consumers expect newer and more convenient ways to conduct business. Because older systems can’t manage these volumes, banks are continuously augmenting with wrappers and shells. Over time, the architecture can become completely unmanageable
  • Regulatory demands – Older systems are incapable of addressing the seemingly endless stream of new regulations piling on every year, leading to significant manual work and/or investment in parallel solutions that must be fed with manual data, all of which increases the risk of error

We get it – it isn’t easy to cut ties with the past. These banks face significant hurdles in ditching the old systems and committing to something new:

  • Cost – New IT doesn’t come cheap; it requires substantial upfront investment, particularly trying in an era when bank profitability is coming under pressure from regulatory fines and other financial stresses
  • Down time – Banks, and arguably more important, their customers, have become completely reliant on technology. The risk of customers being unable to access their accounts or complete transactions – and the potential hit to the bank’s business, reputation, and revenues – is a nightmare worthy of the worst horror movie any banker can imagine
  • Data loss – Possibly second only to down time is the specter of data lost during transition, a phenomenon that could cause huge issues like duplication, redundancy, and fraud, all of which could put a bank’s reputation, customers, and compliance at risk

Ready to join the current generation? Here’s what you need to consider

Banks that are relying on outdated systems must appreciate that when it comes to replacing legacy systems the question is not if, but when. Realistically, these legacy systems simply are not equipped to handle today’s demands – both in terms of the complexity/volume of transactions required by customers, as well as the regulatory demands imposed by financial authorities around the globe.

As a first step toward joining the current generation, we offer the following advice:

  • Because retaining legacy systems is simply not an option, rather than milking the systems for all they can, banks need to determine when is the best time to transition to newer platforms, recognizing that waiting until the final hour may put them at risk of catastrophic failure
  • Given the pace of digital evolution, the best bet for most banks is to try to at least start their new customers and processes on an updated platform, while slowly, but continuously, transitioning existing customers and processes off of the older solutions
  • The cost and complexity of this kind of transition begs for outside expertise. Leveraging third-party service providers – which have experience, expertise, well-developed systems, and trained staff – is a smart play. Use of providers’ SaaS and BPaaS models can reduce investments required to develop a new platform, and they have the knowledge and skill to help smooth the transition process of existing customers, as well

It’s time to join the now generation; as painful as the change process is, the technology (not to mention the hair and clothing styles) really are a vast improvement!

To learn more about where major banks are along the maturity curve–and what they’re doing to update their legacy technologies–take a look at our recent report, Capital Markets BPO Annual Report 2015 – Technology and Analytics Helping Banks Manage Risk and Compliance.

2015 Cap Mkts BPO AR, I2

BPO: Healthcare Payers’ Swiss Army Knife | Sherpas in Blue Shirts

By | Blog

The healthcare payer market continues to experience rapid transformation as efforts to control costs, minimize waste, and root out fraud and abuse collide with the effects of an aging population, the burgeoning insured population brought on by the implementation of the Patient Protection and Affordable Care Act (PPACA), and advances in technology and medicine. Taken alone, any one of these events would have significant impact on healthcare payers; together they’re nothing short of revolutionary.

Faced with such transformation, healthcare insurers are seeking strategies that can help them to manage ever-increasing demands. Among the more impactful tools they can employ is business process outsourcing (BPO). The healthcare payer BPO market, currently estimated at about US$4 billion, is growing at a healthy 14 percent annually. And it’s no surprise, as BPO is more important than ever in helping healthcare payers to streamline their operations and reduce costs. Beyond the basics, BPO can also help providers to research, develop and launch new products; to glean value from the masses of data they capture; and, to identify and reduce cases of fraud, waste, and abuse.

And there appears to be some evidence that payers are tapping into the power of BPO to help address their most significant challenges. While claims processing remains the most commonly outsourced BPO process, other more strategic areas are driving overall growth:

  • Product development & business acquisition (PDBA) – though the smallest segment of all outsourced healthcare payer BPO market, PDBA grew the most, at about 50 percent, between 2012 and 2013. The implementation of PPACA has forced payers to come up with new plans that are comparable to others and easy for members to understand, driving significant activity in this area
  • Member management – increasing by about 35-40 percent from 2012 to 2013, member management is another fast-growth BPO trend being fueled by PPACA. The Act is driving payers’ need not only to manage more, and increasingly diverse members, but also to take advantage of the vast amounts of data generated by the growing insured population
  • Provider management – changes in the healthcare environment are compelling payers to collaborate more with healthcare providers, in turn driving a need for better provider management. The result is that outsourcing in this area grew at about 35-40 percent year-over-year
  • Care management – As payers increase their direct contact with patients, and as part of their attempts to manage costs, healthcare payers are increasingly getting involved in care management activities, driving growth in the area to about 30-35 percent in one year

The changes in the healthcare market are daunting for even the most prepared and best funded healthcare payers. In order to compete in the increasingly challenging and competitive market, payers have to take advantage of every tool available, and BPO is fast becoming the industry’s Swiss Army Knife.

For more insights on the healthcare BPO market, see our just released report, Healthcare Payer BPO – State of market with PEAK Matrix™ Assessment. Log in or register to download a complimentary preview.


Photo credit: Flickr