MediGain finds its niche in the US healthcare industry

Execution-based work ethics and performance-based promotions are the bywords of US-based BPO MediGain (Pvt.) Ltd. Co-founded by Sri Lankan Mel Gunewardena who is also a Director of the BPO along with Dinesh Butani and Hunter Howard, MediGain has carved out a niche for themselves in the US healthcare industry.

Speaking to the The Sunday Times FT about the company’s workings, Gunewardena who is also the CEO, explained, that unlike in the Sri Lankan healthcare system, in the United States, 90% of collections payable by patients to their doctors are carried out through the patients’ individual insurance companies.

The system boasts close to 300 insurance companies with various internal differentiations, which make the process of haggling for the correct reimbursement time-consuming and difficult. “We process the claim on behalf of the ‘providers’ (hospitals and physicians). Otherwise, because they don’t have the knowledge or competency to process their claims, 20%-25% of the money that they should get, they don’t collect,” Gunewardena said.

MediGain has outsourced the entire operation to Sri Lanka, and according to the CEO, is the only one of its kind to have the complete process off-shore, as opposed to a few other companies which have some parts of their services out-sourced in locations like India.

The objective of the BPO is to increase the revenues of the ‘providers’, who can then concentrate on carrying out their services to the patients.

The US healthcare industry is quite different from their Sri Lankan counterpart in the sense that, when MediGain undertakes services for a hospital, the hospital would be the client. However, Gunewardena says that under some circumstances MediGain approaches physicians independently as well.

“At the moment, we are totally focused on Sri Lanka” was the CEO’s response when being questioned on plans to extend MediGain. Colombo, Sri Lanka is placed 7th best IT and BPO destinations, in a list headed by Chennai, Hyderabad and Pune, India. Born and educated in Sri Lanka, Gunewardena says that he felt it was the best place to start. Also, conducting an off-shore operation in the Indian market is becoming increasingly difficult because of the rise in costs, which in turn has been caused by the appreciation of the Indian Rupee above the US Dollar. Sri Lanka is relatively cheaper to invest in. He also pointed out that for their industry Sri Lanka was best suited; “We’re a niche market and we don’t need to grow from 100 to 3,000 in a short period.”

Worker-wise, mainly school-leavers and graduates are recruited, with special preference given to young people with common sense, fluency in the English language and most importantly, the ability to think out of the box. As each insurance claim is bound to have its own nuances, employees should be able to deal with the differences accordingly. According to the CEO, the difficulty lies in finding people who are competent enough for the job. Courses such as those currently being offered by the ICTA are valuable but he stresses that added to the subject matter, important aspects of decision-making, time-management and shouldering responsibility should be included.

One of the problems the company faces as of now is in fact the loss of productivity during the required 6-month training process of new recruits. Since the BOI-approved MediGain, unlike many other BPOs operates according to ‘execution-based’ US work standards, the newly recruited members are often in for a bit of a culture shock, says the CEO. The Lankan youths’ attitude of complaisance is what needs to be shaken up the most. As Gunewardena puts it, “Our company is like a boat not a ship; everything you (the employee) do impacts the client, impacts the company and impacts us”.

With very flat structure – one without the traditional office hierarchy – MediGain is different from the other BPOs in the country when it comes to administration, ethics and even promotions. According to him, “we promote according to performance until we lose trust, not according to age. So you find younger people who are outstanding being promoted a lot.”

Working on par with US schedules means having to deal with the 12-hour time difference. Subsequently, when this newspaper visited the MediGain HQ on a working day at peak hours, the office was empty. MediGain’s work hours are a bit different.

The usual shift is 8.00pm to 5.00am, and a smaller group come in from 4.00pm to 1.00am to do preparatory work for the next shift. All the clocks are set to US times. Asked if this affects their activities, he reiterates that they are no different from doctors or hoteliers or airport officials carrying out night shifts or night duty; “It’s just that it’s dark outside and the lights are on inside”.

For 2008, Gunewardena has bright prospects in reach. With the expanding of the company, their objective is to have what he refers to as “raving customers” at the end of the day.

Their main competitors are large US companies, but the health insurance market is so fragmented that even the two main companies’ market share is little over 5% and the MediGain market share is close to insignificant. This however has not daunted Gunewardene or his team, as they set out to make the best out of an industry growing at surprising speed.