Healthcare Payer Mergers Create Opportunity for “Capability Brokers” to Make a Mark

Big players are getting bigger—Anthem/Cigna, Aetna/Humana, Centene/Health Net. As they do, focus on the customer will be critical to winning the end game. As with any merger activity, there are many “personalities,” layers of process and varying states of technology, all posing an opportunity for transformation.

The organizations will have to spend time and attention on finding and executing on synergies that involve driving out cost, protecting current business, and generating new revenues. Adding to the complexity, there are a lot of parties involved because of their siloed business units, previous acquisitions, a shared services organization (Centene) or multiple outsourcing providers (all of the others) who provide business process and technology support. However, they all have experts in their organizations to help make it happen.

These relationships are managed by an operations or governance lead or team who may be thought of as people who are managing contracts and service level agreements, but that is selling them short. Over the past years, as shared services and sourcing has matured in the healthcare industry, these people have developed specialized skills in “brokering,” as explored in our research The BPO Profession in 2015: Today’s Accidental Career Path, Tomorrow’s Capability Broker.

Capability Brokers are the professionals who have the skills, experience, and passion to help shape the definition of the problem or opportunity and then work across internal business units and third parties to shape a solution using the best capabilities available.

HfS has found that people are in these roles because of the opportunity to address a challenge and “hard code” transformation. They are also often disappointed by the lack of career opportunities in their own organization. This is an opportunity for the health plans to tap into relevant expertise and interest, and recognize the value of a role that has been quietly taking shape over the years in shared services and sourcing. It is also an opportunity for career-oriented capability brokers in governance, operations, and similar roles to raise a hand and volunteer to make a mark in shaping a future industry.