Tag: IT-BPO

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

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.

The Battle over Healthcare: Round One Ends with a Whimper and Uncertainty | Sherpas in Blue Shirts

Healthcare reform has become a political slugfest, casting a spell of ambiguity as the world’s largest healthcare economy attempts to fundamentally transform itself.

Consequently, the global services industry is waiting with baited breath to see how this upheaval pans out. For context, healthcare has been a saving grace, growing at three times the rate of the overall IT-BPO market, which is facing challenging times of its own.

On March 6, Republicans unveiled their plan to repeal the Affordable Care Act, or ACA, popularly known as Obamacare. The ACA, which was signed in March 2010 and came into effect during latter half of 2013, was the most significant regulatory overhaul to expand coverage since the passage of Medicare and Medicaid (Social Security Amendments) in 1965. One of the key highlights of President Trump’s campaign was to repeal and replace the ACA, which he dubbed “broken.” Soon after he took over the Oval Office, he realized that complete overhaul of the law would be a lengthy and complex process, contrary to his promise of quickly instituting a completely new health law. Despite the significant advantage of Republicans controlling both House and Senate, President Trump’s bid to replace the ACA with the American Health Care Act, or AHCA, (essentially a variant of Speaker of the House Paul Ryan’s health plan), failed to see the light of day, with Ryan conceding defeat on March 24.

What went wrong with the American Health Care Act

The principal problem with the AHCA was that it was nowhere close to the promised repeal and replacement of the ACA, but essentially a stop gap plan. It was a contentious bill, which lacked widespread appeal. Key stakeholders and their objections included:

  • Almost all the large payers (except Anthem) were opposed to this law, as it would significantly reduce their enrollment base and, in turn, impact their top-line
  • Healthcare provider associations (such as the AHA, AMA, and American Nurses Association) also opposed AHCA, as it would put extra pressure on providers who are already reeling with bottom-line and revenue problems
  • Various consumer groups, including the American Association of Retired Persons (AARP), expressed concerns as the bill was not in favor of the sick and older populations that require healthcare services the most
  • Conservative Republican lawmakers (i.e., The Freedom Caucus) dubbed it Obamacare-lite.

The uncertain future for healthcare payers, providers, consumers, and IT-BPO service providers

The currently regulatory limbo has a cascading impact on each stakeholder group.

Healthcare payers

Health insurance companies are left with little clarity on their participation in the healthcare exchanges, which have become value-dilutive, and appear even shakier given the current administration’s disdain of the ACA. Large payers, including such as Aetna, Anthem, Cigna, Humana, and UnitedHealth have threatened to pull out of the exchange markets if the uncertainty is not resolved soon. There are theories that the executive branch could act independently of Congress to improve functionality of the individual insurance exchanges.

Healthcare providers

Failure of passage of the AHCA resulted in an increase in some of the leading hospital networks’ stock prices. This was primarily driven by the fact that the decline in enrollment, especially around Medicaid patients, has been delayed. Most of these hospitals improved their bad debt when their respective states expanded Medicaid, as hospitals became eligible for payments for patients who could not afford healthcare. While providers are relieved right now, uncertainty remains. They have struggled with high operating costs, thin margins, and talent issues, and these are only going to intensify.

Healthcare consumers

With the June deadline for submittal of initial rates for exchange plan fast approaching, some consumers may be left with limited health plan options, as some of large payers are hedging on exchange participation. At the same time, ACA plans have witnessed a resurgence in popularity.

Healthcare IT-BPO service providers

Service providers will have to deal with spending decision delays from both payers and providers as they look towards the new healthcare bill. We have already seen leading vendors face revenue headwinds. For example, Cognizant’s healthcare revenue grew by just a mid-single digit in CY2016 after a stellar performance in CY2015. Any new decisions around outsourcing will most certainly be deferred for now, whereas existing keeping-the-lights-on spend is expected to continue. Deal renewals are expected to be for shorter duration as buyers (both payers and providers) wait for veil of uncertainty to be lifted.

The road ahead for healthcare and global services

After this initial bruising, the Republicans are unlikely to give up without a fight. Speaker Paul Ryan recently mentioned that House Republicans will resume work on healthcare reform, but offered no timeline. This will be easier said than done, as GOP leaders need to overcome the deep divisions that ultimately led to the failure of the bill.

Healthcare policy requires hard work, and rushing through a half-baked plan such as the AHCA just won’t cut it. Obama spent over a year on garnering support for the ACA, and the new administration’s heavy handed attempt reiterates that there are no real shortcuts to the process. The GOP should regroup and take a fresh look at the problem statement.

The outcomes might have even greater implications on the global services market. Until then, buyers are likely to twiddle their thumbs and delay key decisions amidst the tremendous uncertainty.

Genpact Pharmalink Acquisition Echoes Other Providers’ Efforts to Deepen Life Sciences Expertise | Sherpas in Blue Shirts

On April 23, Genpact announced it had signed an agreement to acquire Pharmalink Consulting, a global provider of regulatory services to the life sciences industry. The move brings Genpact valuable expertise in supporting life sciences research and development functions including regulatory strategy, filing submissions, complex compliance services, and post-licensing activities management. And it well complements Genpact’s traditional stronghold in FAO BPO for major pharma clients.

This strategic play is in line with a wider move by generalist IT-BPO service providers to compete with life sciences technology and process majors such as Accenture and Cognizant. These generalists are ramping up their capabilities in domain-specific areas including drug safety, regulatory services, pharmacovigilance, and clinical data management, to enable more broad-based engagement with pharma customers.

Life Sciences Regulatory Imperatives

Life Sciences Regulatory Imperatives

The already complex life sciences regulatory landscape is further compounded by stringent quality measures, new drug approval regulations, restricted sales force access to physicians, increasing scrutiny of manufacturing processes, improving collaboration among regulatory agencies, and enhanced pharmacovigilance legislation. We estimate that compliance-related IT spending amounts to nearly 15 percent of the total IT budget of life sciences firms, with three to five percent annual increment.

Recent European data protection regulations call for greater control of personal data. Newer provisions include use of health data for only “absolutely necessary” purposes, as well as an additional onus on data controllers to formulate methodologies to adhere to “data minimization” practices. Pharmacovigilance, drug safety, and clinical data management have become key imperatives in this scenario. New technologies and systems can enable organizations to tackle the regulatory puzzle. 

The Inorganic Route to Enabling Domain Expertise

Inorganic Route to Enabling Domain Expertise

In a significant change and recognition of new market realities, nearly all IT majors have separate business verticals specifically targeting clinical data management and pharmacovigilance. In 2011, Accenture even tied up with the Institute of Clinical Research in India (ICRI) to jointly develop a pharmacovigilance and clinical research program for the Indian market.

And in the last couple of years, there has been an increasing impetus on behalf of service providers to look at M&As to acquire these specific areas of expertise in the life sciences domain. For example, the Accenture/Octagon deal in 2012 signalled an important shift in focus as Accenture attempted to combine its life sciences offerings by adding elements of regulatory management and SI/consulting to have a more integrated portfolio with a cross-functional view. This is based on the belief that the marriage of functional expertise in conventional process-oriented outsourcing services with industry expertise across regulatory, drug safety and clinical trials, make for a very compelling business case. Additionally, regulatory work has been largely project-based, and typically short-term. The enhanced value players bring to the table can translate into longer and more meaningful IT-BPO engagements.

The moves by Accenture and Genpact herald the transformation of life sciences customers’ expectations for greater consolidation and efficiency in the aspects of regulatory activities management, bringing together different tenets such as clinical data management and pharmacovigilance. Service providers that seek to explore, leverage, and consolidate adjacencies in current scope of work, and assume a consolidated and integrated approach to IT-BPO services, will end up with a greater share of the life sciences pie.

Service Providers Versus GICs: the Age-old Debate | Sherpas in Blue Shirts

The debate on whether outsourcing or global in-house centers (GICs) is the better service delivery option for today’s enterprises has again been ignited by multiple divestitures in 2012. While there are solid arguments in favor of both models, the truth is that companies have to change their sourcing decisions from time-to-time to maximize value from global services.

Let us examine how the market has moved over the last few years. For a long while, Everest Group has affirmed that GICs are here to stay and we still maintain that view. However, GICs have become more mature in terms of their services portfolios and have upshifted toward delivery of more complex work such as analytics. Buyers have become more intentional about what work to source from which model, e.g., complex work from GICs and transactional work from service providers.

The chart below is an analysis from Everest Group’s GIC database, and is a testimony to the above stated scenario. During 2009-2011, the GIC market continued to witness new set-ups on a sustained basis. The model’s stability was evident in the decreasing number of divestitures in that period. And the stark shift from business processes and IT to R&D/engineering was clear.

Global In-house Center (GIC) set-ups

However, the market saw a bit of a shift from January-September, 2012, with a declining number of new set-ups and rising number of divestitures. There were five major divestitures during that period, (compared to just two in 2011), and the acquirer was a service provider in each case. Four of these key GIC divestitures are listed below:

What is leading this shift? Is the overall market really moving away from the GIC model to an outsourcing model? Our answer is unequivocally NO. Here is why:

  • If you look at the new GIC set-ups during 2012, there is an indication of a dip… but the story is not the same across all industry verticals/functions. For instance, activity picked up during the year within emerging verticals such as professional services. Besides, R&D activity was also largely stable within some verticals such as telecommunications and technology
  • All the divestitures were organization- and situation-specific considerations. For example:
    • ANZ-Capgemini: As part of ANZ’s broad technology roadmap, the bank needed change for ~800 applications and more than 280 projects at a pace it could not achieve alone. So, the bank moved to a hybrid technology delivery model by transferring 360 jobs to Capgemini
    • Hutchison Global Services-Tech Mahindra: This was a part of Hutchison’s broader strategy to exit the Indian market (similar to its exit from India’s telecommunications business). For Tech Mahindra, the acquisition added further capabilities to its already strong telecommunications vertical

Interestingly, some companies have made the reverse decision and are insourcing work that was previously outsourced. An example is the recent in-housing decision made by the new CIO of General Motors (GM), via which the company expects to see long-term cost savings by bringing technology development under its roof. While HP had been GM’s main IT vendor per a US$2 billion contract awarded to the service provider in 2010, it will now provide only a few services to the automaker.

So, which model is better? Which one is winning? Obviously, the decision is complex and dependent on multiple organization-specific factors. Everest Group’s December 12, 2012 webinar, Global In-house Centers vs. Service Providers: Who is Winning?, will provide fact-based insights on this topic, and recommendations on how enterprises can compare and evaluate both options for their own unique requirements. We hope you’ll be able to join us!

Leverage Points in Global Services for India, China, and Philippines | Sherpas in Blue Shirts

India, China, and Philippines are often lumped together in regard to their roles in global services delivery. The reasons are not hard to fathom – these three geographies are consistently featured as leading locations for global services delivery (both new centers and expansions). In addition, their common availability of large talent pools coupled with low-cost operations make them highly relevant in global services delivery discussions.

However, a deeper analysis of the source markets served by these countries reveals some country-specific findings that are relevant for incumbents as well as new players with plans for these geographies. The chart below provides the distribution of IT-BPO services revenue in these countries in terms of source geographies served.

IT BPO Services Revenue

More than four-fifths of the global services delivery in China is focused on the domestic market with a limited scale of global delivery to North America and Europe. The availability of an English-speaking workforce continues to be a concern for global organizations as are perceptions related to IP / data protection regulations. There is a distinct value proposition for China to serve  its regional markets (e.g., Japan and South Korea) given factors such as time zone similarity, cultural affinity, and language availability.

In contrast, the Philippines is almost exclusively leveraged to serve the United States. Voice BPO has been the traditional growth engine for the Philippines, given cultural affinity and a large English-speaking workforce. However, of late, the Philippines market has also seen traction in BPO functions (particularly industry-specific non-voice BPO) and IT services, indicating diversification of service portfolio beyond voice.

And lastly, India has a distinctive value proposition around serving both the domestic and global markets. Leading players have multi-function scaled operations for global delivery to North America and Europe. In addition, India also sees large demand from the domestic market, particularly for technology and voice operation, and players typically leverage multiple cities within the country (including tier-2/3 cities) for serving this demand. However, unlike China, a very small proportion of service delivery from India is targeted towards the Asia Pacific market primarily due to the constraints around East Asian languages.

Global adopters are increasingly accepting a multi-location approach towards building their portfolios. As they think about their location strategy for Asia, they would be wise to consider roles for India, China, and Philippines based on their unique factors related to source markets and functions for delivery.

Helping Pharma Cliff Dive | Sherpas in Blue Shirts

In late November 2011, the world’s largest branded drug by revenue – Lipitor® – went off patent. The forecasted fall in revenues for Pfizer is expected to knock it off the perch of being the world’s largest pharmaceuticals firm. By 2015, industry analysts expect the patent cliff (revenue loss due to patent expiries) to cumulatively knock out more than US$200 billion in pharma industry revenues. For an industry that brings in just under a trillion dollars annually, this is a major revenue hit.

Exacerbating the problem is continually dipping R&D productivity that has constrained pharma firms’ capacity to replenish their pipelines. While R&D spend has doubled to nearly US$50 billion annually over the last decade, new drug approvals across the industry have more than halved.

To manage this unprecedented change, pharma firms are taking a re-look at their business profiles and cost structures.

Emerging market expansions are the industry’s new mantra for growth. IMS, a leading provider of information services for the healthcare industry, estimates the industry’s share of revenues from emerging pharma markets to double to nearly 40 percent by 2015. And all players, from the big pharma companies to generic manufacturers, are expanding their footprint in these markets, aggressively building and buying distribution capacity, and expanding sales and marketing networks. For example, Pfizer teamed up with ITC in India last year to leverage its distribution network to sell drugs to rural consumers.

In the face of steep revenue declines, productivity and cost optimization are but a given. The R&D function is being restructured into leaner and more collaborative partnerships, with growing industry-academia interfaces. For example, in 2011, Pfizer aimed to reduce its R&D budget by US$1.5 billion.[1]. And in the commercial function, sales force reductions have become the norm. In December 2011, AstraZeneca announced that it would cut its U.S. pharma sales force by over a quarter (even as it announced plans to scale up its emerging markets sales force).

Further, as the industry tries to manage its risk profile, it has begun to diversify into new consumer-centric business areas including generics, consumer healthcare, diagnostics, nutritionals, health management and animal health. For example, GlaxoSmithKline (GSK) today lists the creation of a ”diversified global business” as its top strategic priority.

In this era of significant change, technology and business service providers have a great opportunity to exhibit leadership and step up to stronger partnerships with the industry by:

  • Helping drive innovation in the pharma industry
    • Bringing in ideas from other industries, not just in R&D, but also in manufacturing, retail, and distribution, e.g., helping pharma improve field-force design based on fast-moving consumer goods (FMCG) principles, and its manufacturing and supply chain per ideas from logistics
    • Enabling a more effective use of technology to drive business results, e.g., through use of collaboration technologies to improve research, and by leveraging digital media more effectively for a more effective consumer presence
  • Helping pharma firms address the myriad of complexities they face as they enter and expand in emerging markets, e.g., establishing local market relationships, navigating regulatory issues, building distribution setups and partnerships, structuring low-cost solutions, etc. Established service providers with significant emerging market presence also have the potential to enable the industry with more holistic propositions to address a number of these complexities end-to-end.
  • Helping the industry optimize its cost structure:
    • Improving field-force effectiveness – where nearly one-third of pharma spend is concentrated – through enabling sales force management tools, data and analytics (in next generation areas such as effectiveness research and digital analytics) and back office services (sales operations)
    • Driving manufacturing and supply chain efficiencies through more integrated technology architectures (e.g., redesigned ERP implementations, and emerging rollouts)
    • Managing regulatory complexity (an area in which pharma firms spend a couple of billion dollars each year) through building validated, compliant technology environments and cost-effective BPO services in areas such as pharmacovigilance
    • Driving R&D efficiencies through collaborative platforms, and helping manage large volume high-throughput data environments
    • Increasing flexibility in the face of rapid change, e.g., through cloud-based models

Today, service providers seem focused on servicing the pharma industry’s IT-BPO requirements largely in a “vendor” capacity. Traditionally, the pharma industry’s cash rich and risk-averse culture often drove this arms-length positioning. However, in this time of massive change, a more proactive approach is called for, and smart technology and business service providers will not miss the opportunity to challenge the industry’s status quo and support its growth through bold, provocative offerings and thought leadership.

 


[1] Source: FiercePharm, “Pfizer top 10 Pharma layoffs 2011

Philippines’ Expanding Role in the Global Services Supply Chain | Sherpas in Blue Shirts

Recently I was in Manila for the Contact Center Association of Philippines (CCAP) annual industry event, which also marked the CCAP’s 10-year anniversary. There was a great deal of enthusiasm about Philippines having reached an important milestone of becoming the world’s leading voice BPO destination. Prominent industry and political speakers emphasized the fact that Philippines had achieved this distinction on the back of a vibrant ecosystem, a natural affinity toward the services and customers in play, and the significant attention the industry is enjoying relative to the political and economic quarters. One of the eminent presenters summarized the upbeat mood by stating that Filipinos had demonstrated that it is possible to be nice and still win!

The celebrations were well-deserved. The Philippines IT/BPO industry has grown at a healthy clip of ~30 percent annually over the past five years to reach ~US$9 billion in revenues, and is a significant contributor to the country’s GDP, direct and indirect employment, and foreign exchange earnings. Additionally, the industry has catalyzed growth of multiple next-wave cities in the provinces, attracting local talent, entrepreneurs, and governments to participate in the overall economic upswing. Multiple factors, including availability of a robust English-speaking talent pool, relatively neutral accent, cultural similarity with the United States, and a competitive cost environment have contributed to this success.

Yet, one must question whether this success is sustainable and what lies ahead for the industry in the years to come. The global services phenomenon has certainly spawned a new generation of competing destinations beyond India and Philippines. While locations such as China derive strength from regional and domestic market scale and capabilities, countries in Africa are witnessing a significant government-backed push to target the relatively lesser tapped UK and European markets. Other countries such as those in Eastern Europe and Central/Latin America are establishing themselves as the preferred nearshore destinations for Europe and North America, respectively. While it is important for Philippines to protect and enhance its position in the existing strongholds, the competition will be more apparent in the comparatively new markets such as the UK, continental Europe, and Asia Pacific, and in service segments such as non-voice and industry-specific BPO services.

So what must Philippines do to ensure continued growth and success in the emerging global services landscape? Investments in talent capacity and quality are required to meet the industry’s projected entry-level workforce requirements, as are development of specific domain expertise and a steady pool of management/ leadership. The industry’s expansion into next-wave cities needs to be strengthened through adequate physical/social infrastructure development and local government stewardship. Finally, the industry’s stated agenda of further diversification into newer markets and service lines must be supported through renewed and targeted marketing and communication initiatives.

The Philippines IT/BPO industry has set itself an ambitious 20 percent annual growth target over the next five years. Achieving this will require Philippines to proactively shape its destiny and profile, recognizing evolving customer expectations and competitor capabilities. Will there be any surprises?

The Risky Side of Offshore Growth: Operational Challenges with Indian Majors? | Sherpas in Blue Shirts

In my May 3 blog entitled “Size Does Matter – The Real Pecking Order of Indian IT Service Providers” – I commented on the rapid growth achieved by the Top 5 Indian IT majors or WITCH (Wipro, Infosys, TCS, Cognizant, and HCL) in the last few quarters. Last week as we were rounding up our latest service provider risk assessments, I couldn’t but help notice that this very growth has taken its toll on some of these providers, with buyers increasingly highlighting service delivery concerns especially as it relates to the quality (or lack thereof) of resources deployed on their engagements.

Since the Satyam crisis in early 2009, Everest Group has been tracking global and offshore majors across a number of dimensions to analyze patterns that indicate deviation from “ideal” behavior, and thereby highlight risks to service delivery. Based on analysis of 1Q 2011, our risk dashboard for the WITCH majors required a change in operational parameters from “No Risk” to “Marginal Risk.” While individual, provider-specific rating changes are common, this is the first occurrence of a collective group rating change since we started our assessment over two years ago.

WITCH Risk Dashboard

At the core of these operational challenges is the strain on the labor model of the offshore majors that are “blessed” with an environment of hyper growth. With attrition levels at a three-year high, service providers are being forced to meet the commitments for new logos/projects by rotating employees out of existing accounts, especially smaller ones. This practice of robbing Peter to pay Paul is eroding service quality and creating concerns for clients. Further, the hiring freezes and cutbacks at the peak of the economic crisis in late 2008 and most of 2009 created an imbalance in the labor model. Service providers are now having to back-fill for attrition through relatively junior and less-experienced resources than those to which clients were typically accustomed.

Attrition Trend for WITCH

WITCH Attrition Trend

To clarify, this is not a “WITCH hunt” and should not be read as propaganda against offshoring, India, or the WITCH majors. I firmly believe in the fundamentals of offshore growth, India’s delivery competitiveness, and the capabilities of WITCH majors’ management to navigate what we hope are merely short-term hiccups. The issue, however, reinforces the need for a more robust approach to global sourcing risk management in which being proactive is key to staying ahead of the game. While a proactive approach does not guarantee prediction of the next major crisis (e.g., Satyam), our experience suggests that a focused and consistent approach can deliver early warning signals to buyers, who can then use them to potentially undertake mitigation or course correction strategies. After all, as the old saying goes forewarned is forearmed!

In a complimentary Breaking Viewpoint released earlier this week, I shared additional information on this topic, and provide perspectives to better manage the current set of offshore delivery challenges. Download the complimentary Breaking Viewpoint.

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