Healthcare services company Carelon Global Solutions Philippines is assembling a pool of niche talent in the Philippines that can compete in the global market and meet the changing health care demands internationally.
Nora Terrado, chief country executive of Carelon Global Solutions Philippines, is putting together 1,500 talents as part of the expansion of the company over an 18-month period starting 2023, its fifth year in operations.
According to Terrado, with the fast pace with which technology and medicine are changing, the ability of talent to deliver health care services speedily and accurately has never been more crucial.
Terrado believes technology and artificial intelligence (AI) can help close the gap.
While the pandemic has taught many to do telemedicine, such behavior has evolved even as online consultations are back. Even the priorities of patients have shifted to health and wellness.
“ In addition to more people preferring to do digital engagement, such as telehealth, telemedicine, even the prescription management services (are now) done digitally or done using the cellphone. We see that rising. We’re also seeing the rise of chat versus voice.
There seems to be more people who are more inclined to do those kinds of engagements where they see the conversation (on their phone) rather than (talking on) the phone.
That’s the reason why you hear the words omnichannel services because it could be a combination of voice and chat, or pure chat, or sometimes, human beings and technology,” Terrado said.
In fact Carelon since the start had included bots to work with its human resources.
“AI has helped us in the very beginning wherein our contact center agents have been assisted by bots (for questions with) easy answers, such as member ID, ID number, the names. Technology is evolving but what I can say is that it has definitely helped us reduce the amount of repetitive tasks… (such that) the average handling time (of) transactions (has been reduced). Consumers nowadays are very demanding—they want speed, they want accuracy,” Terrado said.
Terrado said technology can help clinicians because some of the tasks can be done by a third party like Carelon.
Terrado added Carelon is watching closely developments in the Philippines where 7,000 staff members are currently catering to the to the US market.
“We’re interested in the development in the Philippines because we work in an ecosystem.
Any industry would work in the ecosystem where the supply and demand sides get connected. A lot of it will impact talent. The reason why we want to assemble up to 1,500 (talents) is we want to be sure that we’ll build a set of resources that would cater to this kind of service. They have to be taught healthcare informatics. We are investing in people—in upskilling, reskilling people. It would entail more investment in time rather than money,” she said.
For niche talents, Carelon is on the lookout for those who knows the healthcare domain, has a bit of knowledge of technology, specifically and in data.
Terrado stressed Carelon wants talent who can deliver good customer experience.
“That’s our business. We want to bring together the technology expertise, insights… as they engage with our customers,” she said. Carelon’s customers are the healthcare providers, which are the hospitals, doctors, clinics and also the members or those who hold the health plans.
“We want to have talents or resources who can keep up with the pace of our talents in Ireland, Puerto Rico, India, and even in the US,” Terrado said.
Focusing on prevention in the Philippines, Terrado said, would ease the pressure on the healthcare system.
“Hence, the talent required in the hospital will not be that stressful. Right now, the reality is after the pandemic, a lot of clinicians have been burnt out. They’re overworked and some of them left the system and (are) doing other jobs. It’s important to consider that locally and we’re interested in that because we live in the Philippines and we want to develop more talent,” she added.
Providing end-to-end service necessitates clinicians like nurses who analyze the disease, especially during the pandemic where Carelon had to ramp up its staff.
“During the pandemic, we grew. At that time, we needed to ramp up due to a surge of requirements. During the pandemic, there were more responses about prevention.
Sometimes, they’re showing symptoms. Our people have to analyze the case to see if it’s covered by the plan or they can use the ambulance, and the like,” Terrado said.
In the face of shortage of nurses in the country, Terrado said the future of healthcare offers a myriad of opportunities around the practice of nursing.
“A career in nursing, for instance, is not necessarily all bedside. People in the nursing profession would want to grow, there’s nursing informatics, health finance, (and) health insurance technology or health IT. It’s technology-driven—it’s the reason why AI will be one of the biggest change makers in healthcare practice,” Terrado said.
Providing member engagement, like authorization of services for benefits around the health maintenance organizations is just one one aspect of Carelon’s offerings.
“What we do is the healthcare services in health management and the health administration. That’s the clinical support process around the delivery of care. So that’s the kind of work [we do]. There’s the administrative side where we receive calls or we transact with customers. It could be the frontend or at the backend. Frontend may be a member wanting to seek an appointment with a doctor based on his health situation, whether it’s wellness, curative, or preventive. Coding and billing is part of the backend because as a provider, let’s say doctors, hospitals, clinics would have to claim from the payer. We’re the payer because we’re a health benefits insurance company. So, we pay. We’re in healthcare insurance and we’re also in the ASO (administrative service only).
Local staff members also provide risk and compliance services because insurance a highly regulated industry in the US. Irma Isip
