Every plan pays for admin. We price BPaaS for results.
The full health plan back office, run on PMPM, delivering 35%-40% admin cost reduction with technology migration built in
12 of Top 15
US health plans
3 of Top 5
Blue (BCBS) plans
100M
lives touched across the value chain
Avasant RadarView™
Leader in Healthcare Payer Business Process Transformation
Everest Group PEAK Matrix®
Leader in Healthcare Payer Intelligent Operations
NelsonHall NEAT
Leader in Healthcare Payer Agility & Innovation
Everest Group
Front-runner in the Generative AI Healthcare Payer Market
NelsonHall
Leader in Healthcare Payer Operational Transformation
ISG Provider Lens™
Leader in Payer Transformation on Healthcare Digital Services
Everest Group PEAK Matrix®
Leader in Healthcare Payer Business Process as a Service Solutions (BPaaS)
WHY THIS MATTERS
What's breaking the health plan admin cost model
The ACA MLR cap, rising MA costs, and a $21B automation gap are converging on the same balance sheet.
Capped admin
15-20%
ACA medical loss ratio rules cap administration, marketing, and profit at 15% to 20% of premium, leaving limited room for cost creep. BPaaS can shift fixed overhead into a more variable operating model.
KFF: 2024 Medical Loss Ratio Rebates
MA cost
$50 PMPM
Medicare Advantage payers face combined administrative and medical cost increases of about $50 PMPM in 2025, against rate declines. Margin now depends on administrative efficiency, not just clinical cost.
McKinsey, The future of Medicare Advantage, 2024
Automation gap
$21B
Health plans and payers could still capture $21B in savings through full automation of manual administrative transactions.
CAQH, 2025 CAQH Index, February 2026
PROVEN OUTCOMES
What a PMPM contract actually shifts
Live outcomes from BPaaS engagements across multiple US health plans and lines of business.
~40%
lower admin cost
A leading Blues plan managing 860,000+ member lives moved to a PMPM-priced framework and cut administrative cost by 35% to 40%, with outcome SLAs in the contract.
99.5%
claims financial accuracy
BPaaS claims operations deliver 99.5% financial accuracy and ~90% systemic auto-adjudication across in-scope claims, with accuracy SLAs binding the commercial.
80%
first-call resolution
BPaaS contact center operations hold an 80% first-call resolution rate on a single PMPM with performance SLAs in the contract.
+37%
CSAT improvement
Member satisfaction scores rose and held above 4.7 out of 5 across all service lines, sustained under the BPaaS model.
Bpaas Solutions deep dive
Take the towers you need. Or take all of them.
Five commercial modes: modular, line-of-business, or full-stack. One PMPM. One operating model. Outcomes in the contract.
Take the towers you need
Choose the functions you outsource, claims and enrollment without contact center or provider data, on a per member, per month basis with its own outcome SLAs and domain intelligence from day one. Add towers later with no re-architecture.
A whole line of business, on PMPM
Medicare-in-a-Box and Medicaid-in-a-Box run a full line of business on a per-member-per-month model, from enrollment and claims through member services, provider operations, and compliance, including Stars and risk adjustment. Engagements include state-specific Medicaid reporting.
One capability. Its own commercial.
Payment integrity, prior auth, risk adjustment, or digital mailroom, extracted as a standalone capability with no full-stack commitment. Priced per unit of output with accuracy and TAT floors in the contract.
The operating model, not a bolt-on
Every engagement runs on Kairos OS, integrating copilots, workflow automation, SOP navigation, and process mining into one orchestration layer, with a digital twin to test changes before deployment.
- Integrates HealthRules, QNXT
- Included in the PMPM
Pre-integrated, live from day one
A pre-integrated ecosystem, already live in production: certified core admin, system integration, provider data and credentialing, and member and provider portals, with no CapEx.
WHO WE SERVE
Your plan type determines what the PMPM covers
Admin cost structure, MLR constraints, and line-of-business mix differ across healthcare plans. The PMPM is built around yours.
National plans
Multi-line admin on one PMPM, no rip-and-replace.
National plans carry multi-state, multi-line admin complexity. We operate BPaaS across Medicare, Medicaid, Commercial, and Exchange with 90% auto-adjudication at 99.5% accuracy.
Blues plans
Blues plan transformation, zero production outage.
Blues plans carry multi-platform admin complexity and MLR pressure. Full BPaaS transformation covers claims, enrollment, and member services, including QNXT-to-HealthRules migration, at >99% system availability throughout.
Self-funded
TPA-licensed. PMPM-priced. CapEx-free
Self-funded employers and TPAs need admin certainty at scale. Firstsource is TPA-licensed across 36 states and runs BPaaS with zero CapEx, Kairos OS included, and outcomes in the contract.
PROOF OF DELIVERY
Live BPaaS programs, each proving a different result
Auto-adjudication lift, new-LOB launch speed, and associate ramp. Each from a different live engagement.
~90%
auto-adjudication rate
BPaaS claims operations achieve approximately 90% systemic auto-adjudication at 99.5% financial accuracy across in-scope claims.
2.5X
exchange enrollment vs. target
A public health plan launched a new Covered exchange line as a capability-as-a-service, growing from zero to 30,000 members within months, more than double the initial estimate of 12,000.
20%
faster speed to proficiency
AI-driven training copilots cut speed to proficiency by 20%, so new associates reach performance benchmarks faster under the BPaaS model.
INSIGHTS
Latest from the Firstsource team
Insights from the field, real operations, real outcomes, and perspectives from the people making it work in live operations.
Case Study
Building a strong foundation for growth: how a leading dental plan transformed operations with strategic partnership
Discover how a leading dental plan partnered with Firstsource to transform operations, reduce costs, improve CSAT, and enable scalable growth through AI and a hybrid delivery model.
Contact Us
Admin is a fixed cost today. It doesn’t have to be.
What your back office costs today is where the PMPM and contracted outcomes start.
- Modular, line-of-business, or full-stack, all on a single PMPM.
- Outcomes in the contract: accuracy, turnaround, CMS compliance.
- Zero CapEx, Kairos OS and tools included from day one.