Scaling in the Nearshore, Through the Eyes of a (Very Large) Healthcare Client

When the pandemic hit, healthcare services in the US went into overdrive. One major US health insurance firm, that sits in the top ten list of Fortune 500 companies, grew their outsourced agent headcount in the Nearshore by over ten times.

A Latin America director of vendor management with the health care provider (who chose not to be named) told Nearshore Americas what the company looks for when hiring vendor services. “Before last year, Latin America was a very small footprint (for the company). Because of the pandemic, the company expanded its hiring in the region. Our headcount went from 300 advocates to over 4,000,” said the source. 

Pandemic Drives Healthcare Expansion

The global pandemic has triggered lasting consequences. On one side, the heavy human toll felt in the US which, as of May 26, has seen over 585,000 Covid-19 related deaths and almost 33 million confirmed cases according to World Health Organization. 

Meanwhile, interest on Nearshore services has been robust. Earlier this year, Nearshore Americas predicted that between 20,000 and 25,000 full-time equivalent positions would migrate from the Philippines to the Americas within 18 months. 

“Our headcount went from 300 advocates to over 4,000” — Vendor managment director

The director is the healthcare provider’s first Latin America-based VM leader, underlining the extent of the company’s growth and the likelihood of its ongoing involvement in the region. But the healthcare provider has clearly taken note of the shortcomings of the Philippine market, and has diversified its footprint across several countries of the region. 

“We opened five countries in the region with nine sites split between them,” said the vendor management director. “In Colombia alone there are four sites with the rest split between Guatemala, Costa Rica, Nicaragua, and Dominican Republic and Colombia.”

Those companies supplying customer contact including Sitel, Concentrix, Teleperformance, and Alorica, as well as an ‘internal’ call center, they explained.

Medicare

Demand peaks caused by annual registration for the US’ national health insurance, Medicare, are one of the major periods of activities for the healthcare provider. 

Medicare is generally targeted at the over 65s, though younger people can be registered to the program in specific cases. The healthcare provider has over 7 million customers that are part of the Medicare program. These are the people that vendors provide customer service to.

“Advocates will be dealing with senior citizens on health matters, so compassion is very important” — Vendor management director

“Advocates work on a variety of products including general billing, reviewing of a customer’s medical benefits, changes of plans or prescriptions. These are the daily call types we deal with,” the director explained.

The type of customers that advocates will be dealing with directs the performance metrics and demands on vendors that the healthcare provider is looking at, says the director: “Advocates will be dealing with senior citizens on health matters, so compassion is very important.”

But metrics do remain, and benchmarks are specific.

“Senior leaders look at performance when it comes to vendor selection. It’s a combination of several things including the improvement of month on month performance,” they said.

“We use different benchmarks for different verticals but for healthcare, most companies want around 70 in NPS. We want see a minimum of 77 because this helps us understand if our members will recommend us to others. CSAT scores must be from 90 to 93,” said the director.

When looking at a site as a whole, the tenure of leaders at a site and the “togetherness” of the team is important, while RPA and AI components are added advantages, said the director.

Data Security

The huge growth of interest that Nearshore service providers including call centers, BPOs, IT outsourcers and others are receiving because of the pandemic has given a boost to many regional companies.

But with the outsourcing boom taking place in verticals like healthcare, questions have also been raised about the processes that health providers take in ensuring their clients’ data remains safe and that they follow legal requirements.

Nearshore Americas spoke with Sonia Baldia, a partner at Kilpatrick Townsend & Stockton LLP, who specializes in technology, privacy, cybersecurity and outsourcing, and works with healthcare providers and insurance companies in the US.

“It all starts with the contract,” Baldia said.

“The outsourcing contract is really key and critical because that is where we spell out all the protections and clauses around issues like any data security breach, liability, how it will be enforced and other similar issues. Vendor contract provisions are strong so that the vendor pays attention to them.”

Because Latin America based agents will be dealing with sensitive data belonging to US citizens, US federal statutes govern details around access and transmission of the data.

“There will be a lot of personal information involved. That’s PII – Personal Identifiable Information and PHI – Personal Health Information. It’s the PHI that is regulated by HIPAA (Health Insurance Portability and Accountability Act),” she said. 

“With data breaches, it’s really more a question of ‘when’ rather than ‘if'” — Sonia Baldia

Vendors should not be able to store nor have direct access the data of customers: “The requirements from a security and operational standpoint are that the vendor delivery service outside of the US is logging onto the customer’s system solely for access. They cannot download, take pictures, replicate the data. There are typically a lot of security around the handling of PHI around these vendors. The support is seamless but all of the servers and the systems that the data travels through will be located in the US. All of this laid out in the contract,” she explained.

Cybersecurity is a growing concern within the outsourcing community. Though the issue has been on the radar for a longtime, recent instances of security breaches like the Colonial Pipeline hack has pushed the security of sensitive data to the forefront of customers’ minds.

“With data breaches, it’s really more a question of ‘when’ rather than ‘if’,” said Baldia. “The question comes down to whether the vendor and buyer are prepared so that when it happens they are not caught off guard. The slower the response is to a data breach, the greater the liability becomes. It is one thing to plan for data security, but planning for breaches is another important element of the medical outsourcing contract.”