This is the slide deck that Mr. Shivaji Sengupta presented in the 27th CIO Vietnam offline event.

1. Outsourcing
Business
from
USA
Is
Viet
Nam
a
sleeping
9ger?
By
Shivaji
(Sam)
Sengupta
me@shivaji.info
www.shivaji.info
www.LinkedIn.com/in/shivaji
www.Twi@er.com/ShivajiSengupta

2. Worldwide
and
U.S.
Business
Process
Outsourcing
Services
2012-­‐2016
Forecast
IDC
expects
the
worldwide
BPO
market
to
reach
$202.6
billion
in
2016,
represenQng
a
five-­‐year
CAGR
of
5.3%.
The
U.S.
market
is
expected
to
grow
at
a
five-­‐year
CAGR
of
4.2%,
reaching
$92
billion
in
2016.
IDC
concludes
that
BPO
services
vendors
are
beginning
to
assist
the
transforma9on
efforts
of
their
customers.
Evidence
is
now
seen
in
case
studies
from
providers
that
describe
case
studies
where
they
have
leveraged
their
automated
sub-­‐process
solu9ons,
big
data,
business
analy9cs,
mobility,
cloud
delivery,
and
so
forth,
and
as
a
result,
customers
are
not
only
reducing
errors/defects
in
their
processes
but
beginning
to
standardize
processes
globally,
analyze
business
performance
(oLen
in
real
9me),
and
gain
more
insight
and
control
over
their
business
operaQons.
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved

3. Latest
Trends
affecQng
the
USA
Outsourcing
Model
Here
are
few
trends
which
give
idea
of
what
is
stored
in
future
for
this
outsourcing
industry:-­‐
1. Client
will
ask
for
increased
standardized
solu9ons
from
their
outsourcing
contracts,
so
the
vendor
will
have
to
differenQate
their
services
through
performance
rather
than
pricing.
2. Industry
leaders
and
analysts
predict
that
industry
will
face
cost
pressure,
though
short
term,
and
Vendors/service
providers,
will
be
under
pressure
for
more
flexible
pricing
contracts.
3. Smaller
alliances,
which
have
focus
on
opera9onal
efficiencies,
good
quality
control,
lesser
back
office
costs,
will
have
rising
trend.
4. The
rising
energy
cost
will
pressure
companies
to
look
for
areas
where
cost
reducQon
can
be
done.
Taking
advantage
of
technology
and
outsourced
work
to
save
cost
will
be
on
the
priority
list
of
the
companies.
5. Cloud
based
technologies
will
grow,
as
they
are
cost
effecQve.
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved

4. BPO
Maturity
Scale
Integrated
y
rit
u
at
ing
s
a
re
c
In
Ad Hoc
PO
B
M
✪
Defined
Linked
Functional and
Process strong
Functional strong,
Process strong but
with gaps
Functional strong,
Process boundaries
visible
Key:
Functional strong,
Process barely visible
- Process orientation
- Functional orientation

5. Types
of
BPO
★
★
★
★
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved
★

6. Finance
and
AccounQng
BPO
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved

7. Outsourcing
advances
in
Publishing
Business
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved

8. Insurance
Processing
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved

9. Three
Tenets
of
BPO
Flexible
&
Stable
★
Clients
★
Human
Capital
Sub
Contract
Technical
Specialist
Technology
BPO
ConQnuous
Incremental
Training
&
Mentoring
People
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved
Process
Standardize
d
and
Repeatable

10. Top
IT
Outsourcing
DesQnaQons
✪
Ireland
7%
✪
India
51%
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved
China
✪
3%
✪
Philippines
21%

11. Advantage
India
As
the
markets
in
outsourcing
have
become
Knowledge
intensive,
India
has
become
the
most
preferred
global
hub
for
outsourcing
for
knowledge
services
(KPO).
India
has
large
pool
of
skilled
manpower
resources
such
as
Chartered
Accountants,
MBAs,
Doctors,
Lawyers,
Research
Analysts,
Sogware
engineers,
which
is
necessary
for
growth
of
KPO.
The
areas
of
KPO
are,
where
India
has
edge
over
other
desQnaQons,
are
:-­‐
1.
Finance
and
AccounQng
outsourcing
2.
Legal
Outsourcing
3.
Services
that
require
advanced
English
like
Content
and
Medicine
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved

12. China
Challenges
Undertaking
any
form
of
business
transacQon
in
china
presents
unique
challenges
as
a
result
of
both
cultural
and
regulatory
factors.
High
levels
of
employee
churn
amongst
outsourced
service
providers
coupled
with
limited
cultural
awareness
of
the
importance
of
proprietary
informaQon.
It
is
important
to
note
that
the
PRC
IPR
enforcement
regime
is
focused
heavily
upon
registered
rights,
so
local
registraQon
of
IPR
within
china
can
be
helpful.
There
are
several
key
challenges
which
need
to
be
addressed
in
a
china
outsourcing,
including:
• Language
• Due
Diligence
• Regulatory
• ProtecQng
IP
• Contractual
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved

13. Advantage
Philippines
From
an
outsourcing
perspecQve,
the
Philippines
is
one
of
the
global
Qtans.
Ranked
2nd
ager
India
as
a
business
process
offshoring
market
by
desQnaQon,
the
Philippines
has
emerged
as
a
power-­‐player
that
has
aggressively
taken
advantage
of
the
outsourcing
trends
over
the
past
decade.
Choosing
the
Philippines
for
your
BPO
requirements
presents
disQnct
advantages:
• Lifestyle,
language
and
professional
skills
that
are
culturally
specific
to
Western
partners
• A
mature,
funcQonal
democracy
operaQng
in
a
free-­‐trade
environment
• A
steady
supply
of
highly
qualified
and
skilled
manpower
• Well
organized
and
workable
labour
laws
• English
speaking
populaQon
• A
'value
added'
and
pro-­‐acQve
work
ethic
• Access
to
state-­‐of-­‐the-­‐art
technology
• Deregulated
financial
systems
• U.S.
based
legal
system
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved

14. Country
Snap
Shot
–
BPO
PerspecQve
NegaQves
PosiQves
India
China
Philippines
Ireland
High
End
BPO
Process
Maturity
Technology
Competence
Scale
Project
funding
High
End
BPO
Language
Process
Maturity
High
end
BPO
Quality
Technology
Competence
Rising
Costs
Quality
Issues
Rising
Costs
Language
Low
end
BPO
Labor
Shortage
High
Cost
Tax
Benefits
Gone
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved

15. Viet
Nam
SWOT
DEVELOP
Business
Friendly
Clients
Looking
for
AlternaQves
Geography
Value
BPO
Processes
Young
Workforce
Opportunity
Domain
Experience
Stable
Government
Labor
Costs
Sub
ContracQng
ConnecQvity
Focused
Delivery
Teams
Language
InflaQon
AccounQng
Standards
Threats
Weakness
Technology
Skill
Sets
ENVISION
RECOGNIZE
Strengths
Regional
Business
Technology
Infrastructure
Real
Estate
costs
REDUCE
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved
SCALE
OF
IMPACT
25%
50%
100%

16. Vietnam
Plan
of
AcQon
Market
–
USA
Market
–
India
BPO Capability
Core
Team
-­‐
Trainer
Workflows
&
Technology
Partnerships
&
Alliances
Business
Development
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved
Market
–
EMEA

17. Its
not
all
about
wages
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved

18. Healthcare
Outsourcing

19. What
is
Healthcare
Health
insurance
is
designed
to
give
you
peace
of
mind.
It
allows
you
to
focus
on
your
health
-­‐-­‐
instead
of
medical
bills
that
could
pile
up
when
you
are
not
feeling
well.
When
a
individual
buy
health
insurance,
the
health
plan
pays
for
many
of
your
medical
expenses,
whether
you
visit
your
doctor
for
prevenQve
care,
such
as
a
yearly
check-­‐up,
or
you
receive
medical
treatment
for
a
health
concern.
Health
Insurance
can
also
help
cover
your
bills
if
you
need
to
go
to
the
emergency
room.
Your
health
insurance
can
protect
your
family
members
as
well,
and
even
extend
beyond
medical
care:
certain
kinds
of
insurance
can
lower
the
cost
of
prescripQon
drugs,
and
vision
and
dental
care.
You
can
buy
health
insurance
through
your
employer,
a
broker,
and
directly
from
an
experienced,
accredited
insurer
such
as
a
Health
Insurance
Company.
You
pay
a
premium
-­‐-­‐
a
monthly
charge
-­‐-­‐
for
your
insurance
and
if
you
get
insurance
through
your
employer,
your
employer
may
also
pay
some
of
the
cost.
You
ogen
pay
some
other
costs
toward
medical
bills,
too.
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved

20. Healthcare
Programs
• Mailroom/Claims
Capture
• Membership
and
Provider
Eligibility
• Edit
ResoluQon
for
Suspended
Claims
• Provider
/Member
Correspondence/Suspended
Claims
Claims
Processing
• Print
and
Fulfillment
of
Membership
Kits
• Inbound
&
Outbound
Mailroom
OperaQons
• Membership
ApplicaQon
Review
and
Approval
• Premium
Processing
• Membership
Enrollment
Card
ProducQon
and
fulfillment
Enrollment
&
Membership
Management
• Print
and
Le@er
GeneraQon
for
Surveys
• USPS
/
Fax
/
CD-­‐ROM
Processing
• Capturing
of
Survey
Responses
• Repository
/
Workflow
ApplicaQons
• InvesQgaQon
/
Audit
/
QA
• Audit
Trail
Adhering
to
Compliance
Measurements
for
Case
TAT
• Outbound
/
Inbound
Call
Center
Coordina9on
of
Benefits
(Commercial,
RxCOB)
• Integrated
Le@er
GeneraQon
to
Providers
and
Insured
Fraud
&
Abuse,
• Document
ill
Hospital
BFulfillment
• ANSI
837
Receipt
Audit
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved
• Provider
Contract
Fulfillment
• Contract
Approval
and
CredenQaling:
Direct
Access
into
Client’s
ApplicaQons
• Contract
Repository
&
Workflow
• Premiums
/
Provider
Reimbursements
/
PBM
Payments
• EOB
DistribuQon/Processing/
Payments
• Address
Search
Processing
• CredenQaling
File
Conversion
• CMS
Compliance
Trail
Provider
Contract
&
Creden9aling
Management
Payment
Processing
• Complete
InformaQon
Channel
for
Medical
Benefit
RequesQng
• Mailroom
OperaQons
• Instant
NoQficaQon
for
Expedited
Requests
• Integrated
Variable
Content
Management
for
Approval
and
Denial
• Address
Search
Processing
Pre-­‐
Authoriza9on
&
Referrals
• Repository
Workflow
• CMS
Compliance
Trail
• Address
correcQon
and
re-­‐
mail
Return
Mail

21. Payment
Methodology
MEMBER ENROLLS IN AN INSURANCE PLAN THROUGH EMPLOYER
PATIENT GOES TO A PHYSICIAN/HOSPITAL
PHYSICIAN/HOSPITAL PROVIDES SERVICES
PRVOIDER PREPARES AND SUBMITS THE MEDICAL CLAIM TO THE INSURANCE COMPANY.
CLAIM IS RECEIVED AT HEALTH INSURANCE COM. THROUGH FAX/ ELECTTONICALLY, ETC.
CLAIM IS DATA ENTERED
CLAIMS LOADED INTO THE ADJUDICATION SYSTEM
INSURANCE COMPANY VERIFIES THE CLAIM
INSURANCE COMPANY PAY /DENY THE PROVIDER
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved

22. AdjudicaQon
Process
Member
ValidaQon
Provider
ValidaQon
DOS/POS/DX/Procedure
Code/
Modifiers/Billing
Amount
ValidaQon
Edits/Suspend
ValidaQon
Resolve
the
edits
based
on
claims
P&P
End
Process
(File/Deny)
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved

23. Claims
AdjudicaQon
and
Adjustments
MEDICAL–
Professional,
Ins9tu9onal,
Prescrip9on,
Rehabilita9on,
ER,
DMEPOS
DENTAL
–
Oral
Surgery,
Orthodon9cs,
Periodon9cs
Prosthodon9cs,
Endodon9cs
VISION
–
Rou9ne
Vision,
Preven9ve
Vision,
Lens&
Frames,
Lab
order
Entry
Psychiatric–
Psychology,
Mental
Health,
Stress
Management
Fully
Insured/Self-­‐Funded
Plan
Coverage
Commercial/Managed
Care(HMO,
POS)/
Indemnity
(PPO,
OOAPPO)
Product
Coverage
Strong
Project
Management
Team
Mul9ple
Surgery
Reduc9on/CCI/NCD
Proven
Quality
Management
System
Pre-­‐Authoriza9on
&
Penal9es
Capabili9es
Unique
Training
Methodology
Timely
filing/
Provider
Appeals
Buddy
System–Unique
Knowledge
Re-­‐Pricing
Exper9se
sharing
plaiorm
Skilled
Examiners
&
SMEs
• Buddy
System
• Progressive
Evalua9on
• Train-­‐the-­‐Trainer
Approach
• People
Focused
Career
Progression
Methodology
• Six
Sigma
Control
• Best
Prac9ces
Deployment
• Team
Based
Performance
• Web
Interfaced
Dashboard
Services
Delivery
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved
• Quality
Control
Process
• Stra9fied
Internal
Audit
Controls
• QC
Tools
based
Analysis
&
CAPA
• Knowledge
Agreement
Analysis
Quality
• Sta9s9cal
Process
Controls
• Competency
Resource
Mapping
• ISO
Cer9fied
Process
Documenta9on
• Con9nuous
Process
Improvement
Process
Control
• Intranet
Knowledge
Base
Tool
• Web
based
PPM
and
TAT
Controls
• Secured
and
Integrated
Workflow
Model
• Semi-­‐Automa9on
Custom
Developed
Tools
Technology

24. Typical
SoluQon
Client
• Current Work for
Daimler Trucks NA
(Portland, OR)
• Accounts Payable
Workflow Solution
• Just Renewed
Contract for an
Additional 5 Years
• Potential Architecture
Leverage of Existing
Platform for DAG
Services (Moving
Towards One Main
System)
• Potential Ramp Time
Reductions for DAG
Based on Knowledge
Gained from DTNA
Implementation
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved

25. Typical
Project
Team
Program
Management
Team
Technology
Support
Team
Delivery
Head
Account
Manager
Design
Recruitment
Site
Head
Director
PMO
AdministraQon
Development
OperaQons
Training
Quality
Technical
Project
Manager
IT
TesQng
SME
/
Business
Analyst
InformaQon
Security
Release
Management
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved

26.
Typical Team Approach
Solu9on
Analysis
Project
Ini9a9on
Func9onal
Requirements
(Including
Desired
Quality
Levels)
Project
Planning
Build
Vendor
&
Client
Teams
Prepara9on
Implementa9on
Deployment
Planning
Systems
Test
Solu9on
Analysis
©
Shivaji
Sengupta
2013-­‐2015
All
Rights
Reserved
Detail
Design
User
Training
Implementa9on
Stress
Test
Solu9on
Configura9on
&
Prototyping
Produc9on
Documenta9on

27. Q
&
A
THANK
YOU