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Global Healthcare Payer Services Market- Segmented by Type of Service, Application, End User, and Geography - Growth, Trends, and Forecast (2018 - 2023)

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  • 120 Pages
  • August 2018
  • Region: Global
  • Mordor Intelligence
  • ID: 4622459
UP TO OFF until Sep 30th 2022
The global Healthcare Payer Services market is expected to register a CAGR of nearly 11.5 % during the forecast period, 2018-2023. United States Healthcare Payer Services market will increase due to introduction of Patient Protection and Affordable Care Act (PPACA). North America is expected to retain its dominance over the forecast period primarily owing to Rise in outsourcing supportive services by healthcare payers, Increase in number of individuals seeking insurance, and Increasing Stringency of Regulatory Healthcare Landscape.

Rise in Outsourcing Supportive Services by Healthcare Payers

With significant change in healthcare landscape on account of regulatory amendments and escalating costs most healthcare firms adopted new technologies and outsourcing business models. Large companies are now collaborating with large BPO’s and KPO’s for services such as Health claims, Billing and Accounts, Healthcare IT operations etc. Companies like Conduent have developed an Intelligent Queue (IQ) process that are efficient and eliminates the need for rework on claim documents. These systems when quantified, account for annual cost saving (50%), Improvement in Auto-adjudication, Reduction in turnaround time and overall cycle time.
As population with insurance is on rise, managing the processes efficiently is becoming a lower-value contribution to the bottom line. Having benefited from the cost saving and improved efficiency in Quality, more Payers in industry are outsourcing to large BPO organizations integrated cloud-based platform for claims administration and member lifecycle management.
Other factors that drive this market include Increasing Stringency of Regulatory Landscape, and Rise in Insured Population

High Incidences of Data Breaches

The major concerns in outsourcing payer services to third party providers are health data security and privacy. With these concerns in mind many outsourcing contracts are delayed as clients need assurance that their vendors are safeguarding the privacy of healthcare data.
Health data security is the major challenge when it comes to outsourcing. The changes in health insurance portability and accountability act and technology laws companies have become more cautious. It is estimated that healthcare breaches in United States cost 6.2 billion USD each year. A breach effects the organizations reputation and consequences of financial loss and may impact its sustainability if it cannot create enough confidence clients.
Other factor impeding this market include Unexpected Costs Associated with Outsourcing

US is the Chief Region for Healthcare Payer Services Market

The implementation of Affordable Care Act (ACA) led to coverage of millions of Americans who were uninsured earlier. This has caused increased work load and rise in cost of delivering solutions. The Healthcare Payer Services in United States has undergone major shift owing to new regulatory mandates such as cut in funding of Medicare Plan. With increase in insured people and stringent scrutiny by government, most insurance companies responded by outsourcing their support services such as claims adjudication services, claims repricing and billing and accounts management services etc to countries like India.
In an attempt to reduce the costs while providing better quality patient care, healthcare insurance payers are streamlining the process. The steady growth of people opting insurance and technological advancement has paved the path for increase in Healthcare payer services.
With major Business Process Outsourcing and Knowledge Process Outsourcing service providers such as Accenture, Wipro, Concentrix Corporation etc having established themselves as one stop to cater most services the United States will continue to grow as a major region in the Healthcare Payer Services market.

Key Developments in the Market
  • Jun 2018: Firstsource for its exceptional contributions to the positive reputation of sourcing, and helping shape the current and future state of the global sourcing industry has been named as a “Service Provider Challenger” on the Global Sourcing Association’s annual Top Performers Index


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Table of Contents

1. Introduction
1.1 Market Definition
2. Research Methodology3. Executive Summary4. Key Inferences
5. Market Overview
5.1 Current Market Scenario
5.2 Porter's Five Forces Analysis
5.2.1 Bargaining Power of Suppliers
5.2.2 Bargaining Power of Consumers
5.2.3 Threat of New Entrants
5.2.4 Threat of Substitute Product and Services
5.2.5 Intensity of Competitive Rivalry
6. Market Dynamics
6.1 Market Drivers
6.1.1 Rise in Outsourcing Supportive Services by Healthcare Payers
6.1.2 Shortage of Skilled Healthcare IT Professional
6.1.3 Increasing Stringency of Regulatory Healthcare Landscape
6.1.4 Rise in Insured Population
6.2 Market Restraints
6.2.1 High Incidences of Data Breaches
6.2.2 Unexpected Costs Associated With Outsourcing
6.3 Opportunities
6.4 Challenges
7. Market Segmentation
7.1 By Outsourcing Service
7.1.1 Business Process Outsourcing Services
7.1.2 Knowledge Process Outsourcing Services
7.1.3 Information Technology Outsourcing Services
7.2 By Application
7.2.1 Claims Management Services Claims Adjudication Services Claims Repricing Claims Indexing Services Claims Litigation Management
7.2.2 Billing and Accounts Management Services
7.2.3 Analytics and Fraud Management Services
7.3 By End User
7.3.1 Public Payers
7.3.2 Private Payers
7.4 By Geography
7.4.1 North America United states Canada Mexico
7.4.2 Europe France United Kingdom Germany Spain Italy Rest of Europe
7.4.3 Asia-Pacific India China Japan Australia South Korea Rest of Asia-Pacific
7.4.4 Middle East Africa GCC South Africa Rest of Middle East & Africa
7.4.5 South America Brazil Argentina Rest of South America
8. Company Profiles & Competitive Landscape
8.1 Accenture
8.2 Cognizant
8.3 Concentrix Corporation
8.4 Conduent
8.5 ExlService Holdings, Inc.
8.6 FirstSource Solutions Limited
8.7 Genpact Limited
8.8 HCL Technologies Ltd.
8.9 Hexaware Technologies
8.10 Teleperformance Group
* List Not Exhaustive
9. Future of the Market



Companies Mentioned

A selection of companies mentioned in this report includes:

  • Accenture

  • Cognizant

  • Concentrix Corporation

  • ExlService Holdings Inc

  • Hexaware Technologies

  • Teleperformance Group

  • Genpact

  • HCL Technologies

  • Conduent

  • FirstSource Solutions Limited