Tired of linear pricing that punishes scale? HEX can help you align your costs with productivity gains, not ticket volume.
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- Advisory Market Lens
- AI
- Benchmarking
- BOT
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- Healthcare
- HEX Index
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23
While analysts may have you believe that deal sizes increase due to vendor consolidation, we as advisors at HEX are assisting clients first-hand with vendor consolidation mandates targeting 20-25% spend reduction via effort elimination, hyper-automation, right-sizing, right-pricing, and 3rd-party Op-model and contractual transformation.
Avoid tacos at 7-Eleven and coffee at Taco Bell. Source matters in everything you consume and that applies to Sourcing and Price Benchmarking trends too.
Don’t ask an advisor what the size of ChatGPT in sourcing deals will be in 2025 and don’t ask a researcher how best to calibrate your multi-million-dollar contracts. You are bound to be misled in either case.
There’s so much broad stroking on IT-BPO Sourcing & Pricing trends going around that I decided not to write a blog post but a MANIFESTO! 🙂
As a result of the increasing complexity of the health plan environment, coordination of payments to multiple parties and a wide range of government and private health plans remains a challenge. Payment Integrity solutions are reducing the rising healthcare waste and fraud to ensure that claims are paid correctly, free of leakages. Using advanced analytics and data mining, patterns are identified across billions of lines of claims to predict errors in claims, thereby helping firms to reduce waste and focus on value-based care for patients.
We see broadly three types of engagement models in the Payment Integrity space:
- Business Process as a Service: Service provider offers Healthcare Payment Integrity to client as a service via a combination of platform (either proprietary or white labelled) and managed operations
- Platform License: Providers license the software to an enterprise who then manage the operation
- Software as a Service: Payment Integrity platform is offered on a SaaS model. The platform can be hosted on customer’s environment or on cloud. The engagement is based on an outcome-based pricing e.g., based on % of validated overpayments of recovery Per Member Per Month along with Fixed annual hosting price (if applicable)
This is an output-based pricing model wherein the fees structure is based on the transactions / Resource Units (RUs) handled. Buyers should consider this model in the following scenarios:
- Fluctuating but predictable volumes with reasonable accuracy (availability of historical data to validate this and baseline is critical)
- Buyer landscape has lower degree of customization, and the processes are largely standardized
- Procurement has a positive experience of using pay-as-you-go models
- There are no restrictions (regulatory or compliance related) in sharing resources as the providers may deploy ‘bubble’ teams across multiple clients
- Relationship with the provider is strong and transparent and the providers have a complete visibility into the buyer’s demand funnel
The heated demand is leading to a drive for talent thereby heating up the salaries in onshore and offshore geographies – thereby increasing the cost to serve for Consulting service providers by as much as 10%-20% on a fully-loaded op-cost per FTE basis depending on the underlying technology type and resource seniority. However, enterprises remain cautious and price sensitive on consulting spend and >80% of consulting engagements have some form or fashion of line-of-sight into tangible outcomes / impact.
Currently, the preferred pricing models for S&C are fixed fee based for clearly ring-fenced scope, outcomes, timelines, and with contractual flexibility to pause and/or terminate. Enterprises are also open to risk-gain share mechanisms BUT should be tread with utmost clarity and thought on scope due-diligence, underlying assumptions, dependencies, and outcome versus risk thresholds, else can be detrimental to an already diminishing margin turf for service providers.
Since the cost to serve for S&C is expected to remain elevated in the near to medium term, this segment of business is expected to see margin pressure. A negative margin scenario is only to be expected if providers do not push for a well-defined scope or outcomes, do not size/solution the effort and staffing accurately, or undercut strategically or competitively for downstream execution-led gains. Opportunistically leveraging the perceived ‘premium and niche skills’ market can offer consulting providers with some margin-cushion at a deal-level.
There is an increased enterprise propensity in the market for committed outsourcing outcomes and the same is manifesting itself in increased instances of outcome-based pricing contracts. However, what construes as “outcome” can vary across contracts. Some points to note:
- “Outcomes” can range from clearly defining tangible end-states, and/or clearly establishing scope, milestones, and deliverables in IT and BPS Strategy & Change contracts, delivering XLAs/BLA targets, self-funded transformation programs that avoid upfront surge in expense and cash outflow
- Enterprises want to ensure more skin in the game for providers till the end of engagement term; equitable risk and reward sharing – typically capped risk and reward as opposed to pure pain/gainshare constructs
- Most enterprises and providers align on a complimentary due-diligence to get a sense of the enterprise environment before engaging in an outcome-based contract so as not to go in “blind” with an unclear view on risk or rewards
Therefore, the definition of “outcome” may vary, but the model is expected to sustain and gain momentum across contract types.
-
Categories
- Advisory Market Lens
- AI
- Benchmarking
- BOT
- Case Study
- COLA
- Contract HealthCheck
- Cost & Run Optimization
- CSR
- Digital Workplace Services
- Field Services
- GCC
- GenAI
- Governance
- Healthcare
- HEX Index
- HRO
- L&D Advisory
- Managed Services
- Network
- Outcome based Pricing
- Outsourcing
- Perspectives
- Pricing Models
- Procurement
- RFP
- Security
- Service Desk
- Service Levels
- WAN
Tired of linear pricing that punishes scale? HEX can help you align your costs with productivity gains, not ticket volume.
23
While analysts may have you believe that deal sizes increase due to vendor consolidation, we as advisors at HEX are assisting clients first-hand with vendor consolidation mandates targeting 20-25% spend reduction via effort elimination, hyper-automation, right-sizing, right-pricing, and 3rd-party Op-model and contractual transformation.
Avoid tacos at 7-Eleven and coffee at Taco Bell. Source matters in everything you consume and that applies to Sourcing and Price Benchmarking trends too.
Don’t ask an advisor what the size of ChatGPT in sourcing deals will be in 2025 and don’t ask a researcher how best to calibrate your multi-million-dollar contracts. You are bound to be misled in either case.
There’s so much broad stroking on IT-BPO Sourcing & Pricing trends going around that I decided not to write a blog post but a MANIFESTO! 🙂
As a result of the increasing complexity of the health plan environment, coordination of payments to multiple parties and a wide range of government and private health plans remains a challenge. Payment Integrity solutions are reducing the rising healthcare waste and fraud to ensure that claims are paid correctly, free of leakages. Using advanced analytics and data mining, patterns are identified across billions of lines of claims to predict errors in claims, thereby helping firms to reduce waste and focus on value-based care for patients.
We see broadly three types of engagement models in the Payment Integrity space:
- Business Process as a Service: Service provider offers Healthcare Payment Integrity to client as a service via a combination of platform (either proprietary or white labelled) and managed operations
- Platform License: Providers license the software to an enterprise who then manage the operation
- Software as a Service: Payment Integrity platform is offered on a SaaS model. The platform can be hosted on customer’s environment or on cloud. The engagement is based on an outcome-based pricing e.g., based on % of validated overpayments of recovery Per Member Per Month along with Fixed annual hosting price (if applicable)
This is an output-based pricing model wherein the fees structure is based on the transactions / Resource Units (RUs) handled. Buyers should consider this model in the following scenarios:
- Fluctuating but predictable volumes with reasonable accuracy (availability of historical data to validate this and baseline is critical)
- Buyer landscape has lower degree of customization, and the processes are largely standardized
- Procurement has a positive experience of using pay-as-you-go models
- There are no restrictions (regulatory or compliance related) in sharing resources as the providers may deploy ‘bubble’ teams across multiple clients
- Relationship with the provider is strong and transparent and the providers have a complete visibility into the buyer’s demand funnel
The heated demand is leading to a drive for talent thereby heating up the salaries in onshore and offshore geographies – thereby increasing the cost to serve for Consulting service providers by as much as 10%-20% on a fully-loaded op-cost per FTE basis depending on the underlying technology type and resource seniority. However, enterprises remain cautious and price sensitive on consulting spend and >80% of consulting engagements have some form or fashion of line-of-sight into tangible outcomes / impact.
Currently, the preferred pricing models for S&C are fixed fee based for clearly ring-fenced scope, outcomes, timelines, and with contractual flexibility to pause and/or terminate. Enterprises are also open to risk-gain share mechanisms BUT should be tread with utmost clarity and thought on scope due-diligence, underlying assumptions, dependencies, and outcome versus risk thresholds, else can be detrimental to an already diminishing margin turf for service providers.
Since the cost to serve for S&C is expected to remain elevated in the near to medium term, this segment of business is expected to see margin pressure. A negative margin scenario is only to be expected if providers do not push for a well-defined scope or outcomes, do not size/solution the effort and staffing accurately, or undercut strategically or competitively for downstream execution-led gains. Opportunistically leveraging the perceived ‘premium and niche skills’ market can offer consulting providers with some margin-cushion at a deal-level.
There is an increased enterprise propensity in the market for committed outsourcing outcomes and the same is manifesting itself in increased instances of outcome-based pricing contracts. However, what construes as “outcome” can vary across contracts. Some points to note:
- “Outcomes” can range from clearly defining tangible end-states, and/or clearly establishing scope, milestones, and deliverables in IT and BPS Strategy & Change contracts, delivering XLAs/BLA targets, self-funded transformation programs that avoid upfront surge in expense and cash outflow
- Enterprises want to ensure more skin in the game for providers till the end of engagement term; equitable risk and reward sharing – typically capped risk and reward as opposed to pure pain/gainshare constructs
- Most enterprises and providers align on a complimentary due-diligence to get a sense of the enterprise environment before engaging in an outcome-based contract so as not to go in “blind” with an unclear view on risk or rewards
Therefore, the definition of “outcome” may vary, but the model is expected to sustain and gain momentum across contract types.