Salient improving back-office processes in India

BANGALORE, INDIA: Salient provides business process solutions to clients around the world in diverse vertical and horizontal streams such as finance and accounts, health care, financial services, human resource and knowledge process outsourcing. The company enables its clients' businesses to grow by improving their back-office processes, while significantly reducing costs.

Due to a combination of domain, technology and process expertise, Salient is able to offer end-to-end processing services that reduce costs, increase productivity, ensure compliance and augment the quality of employee services.

Salient is backed by sophisticated IT systems and telecommunications network, including independent IPLC and sound internal networking, which ensure uninterrupted communication. The company focuses on stringent service delivery standards, continuous value addition to make the process more efficient, and a robust delivery and implementation strategy.

Manoj Malhotra, CEO, Salient Business Solutions Ltd, Pyramid Health Solutions, USA; and president, The Business Process Industry Association of India (BPIAI) shares his thoughts on the inefficiency of revenue cycle management in Indian healthcare provider systems, Indian retail paradigm shift from offline to online as well as towards customer centricity, the role Salient plays and more.

CIOL: How is the revenue cycle management in Indian healthcare provider systems inefficient? How can Salient help?

Manoj Malhotra: Indian healthcare industry is expected to touch US $ 40 BN in 2012-13 with annual growth rate of 15-20 percent and GDP share of 5-6 percent. Given the population driven additional demand of almost 1.5 - 2 million beds by 2025 from the current 1-1.25 million, the industry size is expected to continue to grow at a rapid pace.

Akin to the US healthcare industry, a lion's share (almost 80 percent) of this growth will be provided by the private sector where a typical revenue cycle management workflow is mostly managed in house and with limited use of technology and process. There are some other reasons for an inefficient RCM system that exists in Indian hospitals today.

* There is a lack of a coherent and sustainable plan that addresses the healthcare needs of the masses. There are no national standards by which physicians, nurses, pharmacists and hospitals are trained.

* Financial incentives between specialists and hospitals from referring doctors govern the way a substantial proportion of patients are treated. Guidelines and protocols for the management of disease, including the length of stay, are virtually non-existent and so is the ability of hospitals to determine the appropriateness of medical and surgical therapy seems years away.

* Further, lack of an Electronic Health Record (EHR) prevents the development of transparency throughout the healthcare system. Above all, there is not enough historical evidence of what it costs for the treatment of a particular condition for insurers to adequately set their premiums.

Few suggestions, if implemented, can improve the overall scenario of healthcare industry and specifically, the revenue cycle management within hospital:

* Develop and implement national standards for examination by which doctors, nurses and pharmacists are able to practice and get employment.

* Rapidly develop and implement national accreditation of hospitals; those that do not comply would not get paid by insurance companies. However, a performance incentive plan that targets specific treatment parameters would be a useful adjunct.

* Obtain proposals from private insurance companies and the government on ways to provide medical insurance coverage to the population at large and execute the strategy. It is healthy to have competition in healthcare, and provide health insurance to the millions who cannot afford it.

* Utilize and apply medical information systems that encourage the use of evidence-based medicine, guidelines and protocols as well as electronic prescribing in inpatient and outpatient settings. This is possible though the implementation of the EHR; this will, in time, encourage healthcare data collection, transparency, quality management, patient safety, efficiency, efficacy and appropriateness of care.

* Given our expertise in working across the revenue cycle for large healthcare providers in US, we can assist the regulatory bodies in creating a medical coding and billing protocol. This will help regulate and standardize the way in which healthcare providers charge for treatment and reduce ambiguity in the way billing is carried out presently.

Some areas in which Salient can help improve RCM for medical care providers in the country:

Patient intake registration: Intake/admission services, if efficiently performed, lead to reduction of bad debts as well as generation of critical data repositories for the providers based on its expertise in performing these functions for US hospitals, Salient can assist in onsite/remotely managing the intake and registration process.

Medical records management: Diligently maintaining the patient records and digitizing them for usage during the billing process will be a key process augmentation for Indian hospitals. Salient can provide these services using a mix of onsite and remote services.

Customer service: Salient provides an integrated CRM platform bundled with services to its hospital clients and offers services like

* Appointment Scheduling

* Ambulance Services

* Complaint Registration

* Billing Query Handling.

Billing services: Salient is using billing expertise generated by working in a highly regulated and process driven by the US healthcare industry, can reduce typical billing related revenue leakages in a hospital environment, inpatient and outpatient. These services are provided by trained medical representatives with knowledge of medical treatment and diagnosis.

Supply chain management (SCM): Salient can provide SCM services for all the inventories that are used in a hospital (Medicines, Hospital Supplies). These services will ensure usage of optimal processes for procurement, storage, issue and disposal of such inventories.

CIOL: Could you elaborate on the Indian retail paradigm shift from offline to online as well as towards customer centrality? What is the role Salient plays in providing value added, end-to-end services and technology bundled offering?

MM: The size of the Indian e-commerce market has reached $15BN in 2012-13 with expectation to touch $50-60 BN by 2025. However, even at this impressive pace of growth, the Indian e-commerce market is only 0.1 percent of the total retail sales while developed economies like US and UK stand at 5 to 6 percent.

The growth drivers of internal commerce in India, besides the penetration of internet and growth expected there, have been the m-commerce revolution as well as increasing reality driven cost of physical storefront in major cities. Added to these factors is the growing prominence of Tier two and three cities when it comes to online commerce transactions as well as the demographic profile of Indian Internet users.

At 73.9 million home and work internet users, the Indian online population currently ranks as the third largest in the world after China and the US. With 75 percent of its internet users under the age of 35, India has the youngest skewing online population among BRIC countries.

Out of 19.6 million who accessed internet (in the year 2012), for finding details related to a specific product or a service, nearly 73 percent (14.3 million) actually bought a product or a service in the end.

Due to above reasons, the retail paradigm has shifted from a single physical connection point with customers to a multi-pronged approach that crosses both physical and digital channels. The traditional bricks-and-mortar retail store is no longer the dominant medium for purchasing goods.

Instead, it serves as one of many potential connection points between customers and a retailer's brand. While physical stores may have once enjoyed the advantage of crafting cool shopping experiences, the aesthetics of the iPad and all the social sharing surrounding online shopping today are now shifting that advantage to online retailers.

Customer centricity is another offshoot of the growing sophistication and size of the Indian retail industry, offline and online. As Indian customer has more choice, both within local and global brands, it becomes increasingly important for retailers to focus on customer retention and loyalty rather than just acquisition.

Customer care and relationship management, run through both technology and process, is turning out to be a differentiator that provides retailers an edge in the increasingly competitive retail space in India.

In this scenario of multi channel marketing and customer centricity, SBS' E-Commerce platform is a comprehensive feature-rich, "boxed" framework for first time e-retailers in India that not only fits the standard requirements of a front-end/ online portal integrated to the back-end and fulfillment services but also accommodates specific requirements like strategy and design assistance upfront, digital marketing and logistical support. It incorporates best practices and global benchmarks to provide technology enabled value added services like:

* Superior shopping experience

* Merchandising and marketing capabilities

* Order management and fulfillment

* Customer service

* Analytics

* Content management and design

* Order lifecycle management

* Campaign management.

CIOL: Elaborate on the movement of ITES services to tier two and tier three cities.

MM: Tier one or the larger cities in India have witnessed a tremendous growth of IT and ITEs industry in the past few years. Availability of talent, better infrastructure, connectivity, and an evolved ecosystem were some of the major drivers for focusing on these larger cities.

This unprecedented growth was not easy to handle. While the large cities witnessed severe pressure on the civic infrastructure, service providers faced myriad issues around the rising cost of operation, employee attrition, employee work-life imbalance etc.

The tier two and three cities have done extremely well over the years to fulfill the requirements of the IT/ITeS service providers, issues notwithstanding. India will have 68 cities with a population of over one million by 2030, typically called Tier two or three cities.

Many of them have demonstrated strong delivery and development capabilities to be treated as independent delivery centers. In addition to the quality of resource available, most of the tier two cities boast of productivity levels that are at par or sometimes even higher as compared to tier one cities.

High or at par productivity levels are owed to the much lesser commuting time to office and better work-life balance vis-à-vis larger cities. Some of these cities have also started to establish their authority in niche areas (e.g. Thiruvananthapuram has a well developed animation and gaming industry and Jaipur is considered to possess good Finance and Accounting BPO resources).

The service providers have also reported a much lower attrition in tier two cities. Some of the trends showcasing movement of ITeS services to Tier two/three cities.

As per PwC-CII survey, about 50 percent of the IT/ITeS service providers are looking to move or expand to tier two cities for perceived benefits like availability of low-cost skilled resources, lower real estate cost and lower attrition.

Around 58 percent of the IT-BPO workforce today is from Tier two/three cities, with around four million direct employees from these locations. Around 49 delivery centers were set up in Tier two/three locations in the last year, as opposed to 25 in India's Tier one cities.

The IT-BPO sector has purchased office space, amounting to around 20 million square feet. Around 23 per cent of the operational STPI units are in Tier two and three cities, while nearly 40 percent of the notified IT SEZs and 30 percent of operational IT SEZs are in these areas.