Building a strong foundation for growth: how a leading dental plan transformed operations with strategic partnership

Overview

A prominent dental plan faced a critical challenge in managing its administrative costs, with high overheads and lack of cost predictability, making it difficult for the organization to realize economies of scale and to forecast finances as it grows. The organization partnered with Firstsource to implement a strategic transformation initiative designed to optimize operations through a phased, global delivery model while maintaining service excellence for members and providers.

The Challenge

• Operational Efficiency: Following the completion of a major technology platform transition in 2021, the dental plan had stabilized its operations but reached a performance ceiling. Administrative costs per member per month (PMPM) increased to unsustainable levels, preventing the organization from achieving necessary economies of scale. Speed to answer provider calls often stretched to nearly 8 minutes (478 seconds of Average Speed of Answer), leading to dissatisfaction and increased administrative costs.
• Market Pressures and Rising Costs: The client was under mounting market pressures and cost challenges, such as:
  • Higher than desired administrative expenses tied to hiring and turnover.
  • The operating model lacked an AI and automation roadmap.
  • Rising competition among member companies demanding operational excellence.
  • No predictable financial model as membership scaled, creating strategic risk for sustainable growth.
• Limitations: The dental plan faced several limitations that directly impacted efficiency, scalability, and member experience, including:
  • Lack of cost predictability with scale in membership volume variations
  • Risk of continued operational inefficiencies hindering competitive positioning
  • Legacy systems limited the ability to provide an omnichannel customer experience, such as web and chat, which members increasingly expected.
• Strategic Risk: Without immediate action, the organization risked falling behind in an increasingly competitive and cost-sensitive healthcare market, potentially losing market position and growth opportunities

How We Made It Happen

• Land-Safe Model: Our outcome-driven approach mitigated the client's primary concern about outsourcing risks. By implementing guaranteed service levels and a gradual transition methodology, we ensured business continuity with a soft landing for the operations.
• Unified Operational Excellence Strategy: Rather than treating member and provider calls separately, we focused on creating tighter benchmarks for speed to answer, speed to resolution, and overall service delivery metrics across all interactions. For example, average speed to answer provider calls improved from 478 seconds to just 5.9 seconds, a significant improvement. This approach enhances member and provider experience, delivering improvements in CSAT and overall provider satisfaction.
• Hybrid Global Delivery Model: To drive sustainable cost efficiency without compromising service quality, the hybrid model balanced offshore and onshore operations while establishing robust governance for long-term partnership management. The right-shoring model ensured leveraging the healthcare calls CoE (center of excellence) in the Philippines for provider call operations, while maintaining 100% onshore member calls. This strategy ensured optimal staffing coverage and resulted in calls answered jumping from 86% to 99%.
• Risk-Free Implementation: Our carefully orchestrated approach streamlined the transition process, while sustaining business continuity through comprehensive planning and proactive risk management.
• AI-First Approach: We designed the program with a clear roadmap for AI tools, automation, and an omnichannel experience design across web, email, chat, and calls. The transformation vision is aimed at improving external and internal experience with AI and GenAI to empower frontline staff, while simplifying journeys for members and providers through intuitive digital channels. This creates the foundation for a scalable operational model with predictable costs, reducing fixed overheads and enabling business growth reinvestment.

Conclusion

The dental plan took decisive action through its strategic partnership with Firstsource, successfully transitioning from a cost-intensive operating model to a scalable, predictable, performance-driven framework. By leveraging intelligent automation, a hybrid global delivery model, and robust governance, they achieved 35-40% administrative cost savings, >~35% CSAT improvement, enhanced member and provider experience, and substantial service efficiency gains.

These operational improvements now equip the organization with financial predictability, superior member/provider experiences, and the agility to reinvest savings into its strategic priorities - positioning them to compete effectively, scale membership growth sustainably, and thrive in the evolving healthcare market.