Transformative outsourcing
乐鱼（Leyu）体育官网 helped a U.S. regional healthcare payer achieve substantial benefits in a wide-ranging and complex outsourcing initiative.
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Client
A U.S. regional healthcare payer
Sector
Healthcare
Project
Outsourcing contract negotiation and establishment of a transformation management office
Client challenge
Our client is a regional health plan in the United States, providing a full range of plans to its members, including individual, family, employer group, and Medicare Advantage.
Facing declining membership, highly customized tools, and manual processing, this client knew it needed a major upgrade to its core applications to satisfy current members, recruit new ones, and offer new services.
The company was looking for support in developing contract terms and managing the outsourcing provider it had chosen. Importantly, the client wanted to leverage the savings from outsourcing to fund a large-scale transformation of its core legacy applications that had become too costly to maintain and support.
Project at a glance
乐鱼（Leyu）体育官网 advised this company on a major IT and business process outsourcing (BPO) program that included a large-scale聽transformation of all core applications.聽
The breadth of 乐鱼（Leyu）体育官网 enabled us to develop a negotiated outsourcing contract with the appropriate structure and controls. We stood up a transition and transformation organization to manage the execution of the contract and enable our client to effectively execute organizational change聽management and communication鈥攁ll while having the appropriate controls in place to assess new risks and contract governance.聽In the end, we were able to support in the development of a new product.
An estimated savings of $70 million over seven years helps this client reinvest to create a modern, integrated technology infrastructure.
Key 乐鱼（Leyu）体育官网 initiatives
The client initially engaged 乐鱼（Leyu）体育官网 to develop a market-leading IT and BPO agreement that included:
- a modern service level methodology
- statement of work aligning responsibility to expected outcomes
- pricing terms that fluctuate with usage
- mechanisms to add and remove scope, monitor performance, and apply penalties if expected聽outcomes aren鈥檛 achieved.
We ultimately leveraged the breadth of 乐鱼（Leyu）体育官网 to deliver on additional aspects of this engagement:
- Our Outsourcing practice assisted with contract and negotiation support, managed the successful transition of IT and BPO services from the client to its outsourcing provider, established a transformation management office to manage the implementation of all new applications and software, and designed a strong governance framework to oversee provider performance.
- Our People and Change practice conducted change management activities and managed communication across the organization.
- Our Risk Consulting practice assessed controls on outsourced work.
- Our Healthcare practice helped the client launch a new product to increase membership.
Business impact
Over the course of two years, we helped the company聽achieve substantial benefits in a wide-ranging and聽complex outsourcing and transformation initiative,聽including:
- estimated savings of $70 million over seven years聽from outsourcing, which are being reinvested to create聽a modern, integrated technology infrastructure
- a 10 percent increase in new members now that聽the client is certified as a Qualified Health Plan in the聽Federally Facilitated Marketplace
- an improved experience for members, providers, and聽employees, thanks to new self-service capabilities,聽more automated and standardized processes, and聽greater visibility into claims, approvals, and denials.
Looking ahead, the client expects ongoing capability聽enhancements from outsourcing to continue improving聽operational performance, reducing costs, and driving聽new business.
Why 乐鱼（Leyu）体育官网?
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We build strong business cases to power聽major technology and process change
Our approach helps clients prioritize聽investments, sequence initiatives, and聽secure stakeholder buy-in, keeping all parties聽focused on ROI-driven project scopes and聽tangible impact.
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We identify risks and provide mitigation聽strategies before issues occur
We provide insight into upcoming milestones聽and deliverables to reduce the impact of聽program issues and delays.
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We work as one team with deep strategic聽and technical experience
Large, complex enterprises with ambitious聽process and technology aims need journey聽advisers with the bench strength and scale聽to pace with them. We can deliver big-picture聽client priorities on ambitious timelines,聽providing strong continuity of vision and聽execution capabilities.
Meet our team
Shawn Rebocho
Director, Procurement and Outsourcing Advisory, 乐鱼（Leyu）体育官网 LLP
Shawn Rebocho
Director, Procurement and Outsourcing Advisory, 乐鱼（Leyu）体育官网 LLP