Payers, Providers,and a Host of Healthcare Companies Use Outsourcing and Offshore Resources

Over the past two decades, many major U.S. companies have moved their non-core business processes offshore, saving precious management time and resources and allowing for a focus on building or extending core competencies. Many in the healthcare sector use outsourcing, including offshore resources, to improve efficiency, turnaround times, and service quality.

Healthplans outsource within the U.S. to:

»	Disease Management Organizations
»	Pharmacy Benefit Managers
»	Peer Review Organizations
»	Technology Vendors
»	Radiology Companies
»	Case Management Organizations
»	Behavioral Health Providers

Healthplans have used offshore outsourcing resources for many years for:

»	Claims Processing
»	DRG unbundling and analysis
»	Customer Service
»	Sales Prospecting and Lead Management
»	Information Technology
»	Underwriting
»	Revenue Cycle Management
»	Legal Services
»	Transcription Activity
»	Provider Contract Loading
»	Data Management
»	Market Research

And healthcare providers have used offshore outsourcing resources for many years for:

»	Medical Transcription
»	Radiology Services
»	Laboratory Processing
»	Clinical Research
»	Medical Tourism

In 2006, Information Week reported that, “Like most other parts of corporate America, the healthcare industry is quickly learning that there are enormous savings to be had through offshore outsourcing,” and cited IDC, a global market intelligence firm, as reporting that nearly $322 million was spent on offshore healthcare services in 2005 and projecting a 79% increase to $575 million in 2008.

A little-known fact is that the users of offshore outsourcing include numerous government programs. A March 2006, report by the U.S. Government Accountability Office (GAO) examined child support enforcement, Food Stamp administration, temporary assistance for needy families and unemployment insurance, and found that offshore outsourcing occurs in one or more of these programs in 43 of 50 states and District of Columbia.

In the healthcare sector, offshore support is commonly used for claims processing, customer service, medical transcription and billing services. However, as certain clinical areas experience talent shortages amidst rising demand, healthcare providers are looking for innovative solutions to meet their needs.

Destination Countries for Offshore Outsourcing of Services Involving the Use of Personal Health Information Reported by Federal Contractors and State Medicaid Agencies, 2005
Country	Number of Reported Data Transfers From Domestic Vendors To An Offshore Location
	Medicare Advantage Contractors	Medicare FFS Contractors	State Medicaid Agencies
India	25		1
Ghana	9
Mexico	6
Canada			2
Jamaica		2
Bermuda	1
Philippines	1

Vendors’ Offshoring Services Involving the Use of Personal Health Information Reported by Federal Contractors and State Medicaid Agencies, 2005
Survey Group	Percentage of Respondents Reporting Offshore Data Transfers By Vendors
Medicare Advantage Contractors	19
Medicare FFS Contractors	4
State Medicaid Agencies	2
TRICMI Contractors	0

Care Management International is the first to apply a comprehensive smart sourcing approach to care management and produce measurable results.

CMI’s products and services are designed to achieve the following for its clients:

Improve Outcomes

»	Clients can receive time-sensitive indications of clinical need with usable data to maximize the impact of their member interventions and interactions.

Improving Effectiveness and Efficiency

»	Clients can receive the benefit of CMI’s 24/7 operation.
»	Clients can receive the benefit of CMI’s operational flexibility.

Freeing-Up Resources

»	Clients can allow for greater attention and focus on clinical activities by freeing staff from performing administrative duties which do not require the level of capabilities achieved through their education and clinical experience.