December 05, 2025 04:11 pm (IST)
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Healthcare Payer COOs say advanced operating models can positively impact strategic challenges
New York, Dec 10 (IBNS): Genpact Limited, a global leader in designing, transforming, and running intelligent business process operations, has released the healthcare industry findings excerpted from its survey of 920 senior executives.
These insights come from operations leaders at healthcare payer organizations in North America –predominantly large companies with more than 10,000 employees.
This global study reveals how senior leaders across industries are prioritizing key operational initiatives to materially address the critical challenges that their companies face. While 66% of the healthcare executives surveyed see regulatory compliance as a top challenge in an environment of healthcare reform and increased government scrutiny, consumer satisfaction and cost reduction are also among the top enterprise challenges that healthcare COOs must tackle.
The majority of healthcare executives rated claims processing and adjudication as having the highest impact on nearly every enterprise challenge, followed by claims recovery, payment integrity, business intelligence, and analytics.
Business intelligence and analytics, while important to address these strategic challenges, are considered by most as immature and not yet prepared to evolve.
Healthcare executives see the three levers of operating model transformation – technology, process reengineering, and advanced organizational structures such as shared services and outsourcing – as material levers that many use to generate significant positive impact in healthcare operations.
The survey indicates that healthcare executives see advanced organizational structures as more broadly applicable, but technology can generate greater dollar impact. The respondents revealed that advanced operating models have the potential to generate over half a billion dollars in positive per member per month (PMPM) impact every year for healthcare organizations.
“While evolving regulations continue to challenge healthcare organizations, operational efficiencies and consumer satisfaction are now an important focus,” said Jim Mapes, senior vice president and business leader, Healthcare, Genpact.
“The industry sees the greatest value in a pragmatic approach that uses technology judiciously and combines it with shared organizational models to address these challenges," Mapes said.
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