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Healthcare Payer Solution Market by Type, Stakeholders and Application: Global Opportunity Analysis and Industry Forecast, 2020-2027

  • ID: 5157240
  • Report
  • August 2020
  • Region: Global
  • 274 pages
  • Allied Analytics LLP

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The global healthcare payer services market was valued at $19,409.52 million in 2019, and is projected to reach $41,906.64 million by 2027, registering a CAGR of 10.6% from 2020 to 2027. Healthcare payer refers Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMOs), healthcare service contracts, state insurance agencies, and claim handlers. Healthcare payer solution providers help such public and private payers as well as healthcare insurers to manage the claims, member engagement, audits, medical documents, and customer relations. These businesses have dedicated units that help to improve overall health system performance through optimizing care quality; reducing costs & improving consumer experience & care provider performance; and leveraging distinctive capabilities in data & analytics, pharmacy care services, population health, healthcare delivery, & healthcare operations. Through all these services, healthcare payer solution providers help their clients to improve their operational efficiency and reduce their operational cost.

The growth of the global healthcare payer solution market is majorly driven by rise in cost of healthcare systems and urge to decrease wasteful spending. Moreover, surge in risk of healthcare frauds and increase in demand for streamlined business processes drive the growth of the healthcare payer solution market. Furthermore, rise in health insurance enrolment, an increase in adoption of healthcare IT solutions, and implementation of various healthcare reforms such as Patient Protection and Affordable Care Act fuel the growth of the healthcare payer solution market.

However, surge in incidence of data breaches and loss of confidentiality and cultural & language barriers are anticipated to restrict the growth of the market. On the contrary, high growth potential offered by emerging economies and increase in adoption of AI & analytics are expected to offer lucrative opportunities for the market expansion during the forecast period. The global healthcare payer solution market is segmented into service, application, end user, and region. On the basis of service, the market is fragmented into business process outsourcing (BPO) services, information technology outsourcing (ITO) services, and knowledge process outsourcing (KPO) services. By application, it is categorized into pharmacy audit & analysis systems, claims management services, fraud management services, computer-assisted coding (CAC) systems, member eligibility management services, provider network management services, payment management services, customer relationship management services, medical document management services, and general ledger & payroll management. Depending on end user, it is differentiated into private and public end user. Region wise, it is analyzed across North America (U.S., Canada, and Mexico), Europe (Germany, the UK, Italy, Spain, France, and rest of Europe), Asia-Pacific (Japan, China, India, and rest of Asia-Pacific), and LAMEA (Brazil, South Africa, Saudi Arabia, and rest of LAMEA).

Major players operating in the market include UnitedHealth Group Incorporated, McKesson Corporation, HMS Holdings Corp, International Business Machines Corporation, Change Healthcare, Inc., Accenture plc, Cognizant Technology Solutions Corporation, Hinduja Global Solutions Limited, Inovalon Holdings, Inc., and Wipro Limited.

Key Benefits for Stakeholders
  • This report entails a detailed quantitative analysis of the current market trends from 2019 to 2027 to identify the prevailing opportunities along with strategic assessment of the global healthcare payer solution market.
  • Market size and estimations are based on a comprehensive analysis of the end users, developments, and services in the industry.
  • An in-depth analysis based on region assists to understand the regional market and facilitate the strategic business planning.
  • The development strategies adopted by the key market players are enlisted to understand the competitive scenario of the market.
Key Market Segments

By Services
  • Business Process Outsourcing Services
  • Information Technology Outsourcing Services
  • Knowledge Process Outsourcing Services
By Application
  • Pharmacy Audit & Analysis Systems
  • Claims Management Services
  • Fraud Management Services
  • Computer-assisted Coding (CAC) Systems
  • Member Eligibility Management Services
  • Provider Network Management Services
  • Payment Management Services
  • Customer Relationship Management Services
  • Medical Document Management Services
  • General Ledger & Payroll Management
By End User
  • Private Provider
  • Public Provider
By Region
  • North America
  • U.S.
  • Canada
  • Mexico
  • Europe
  • Germany
  • UK
  • Italy
  • Spain
  • France
  • Rest of Europe
  • Asia-Pacific
  • Japan
  • China
  • India
  • Rest of Asia-Pacific
  • LAMEA
  • Brazil
  • Saudi Arabia
  • South Africa
  • Rest of Middle East
List of key players profiled in the report
  • Accenture Plc.
  • Change Healthcare, Inc.
  • Cognizant Technology Solutions Corporation
  • Hinduja Global Solutions Limited
  • HMS Holdings Corp.
  • Inovalon Holdings, Inc.
  • International Business Machines Corporation Technology
  • McKesson Corporation
  • UnitedHealth Group Incorporated
  • Wipro Limited
LIST OF OTHER PLAYERS IN THE VALUE CHAIN (These players are not profiled in the report. The same will be included on request.)
  • HCL Technologies Limited
  • Synnex Corporation (Concentrix Corporation)
  • Genpact Ltd.
  • Sutherland Global Services
  • Hexaware Technologies Limited
Note: Product cover images may vary from those shown
Chapter 1: Introduction
1.1. Report Description
1.2. Key Benefits for Stakeholders
1.3. Key Market Segments
1.3.1. List of Key Players Profiled in the Report
1.4. Research Methodology
1.4.1. Secondary Research
1.4.2. Primary Research
1.4.3. Analyst Tools and Models

Chapter 2: Executive Summary
2.1. Key Findings of the Study
2.2. Cxo Perspective

Chapter 3: Market Overview
3.1. Market Definition and Scope
3.2. Key Findings
3.2.1. Top Investment Pockets
3.2.2. Top Winning Strategies
3.3. Porter's Five Forces Analysis
3.3.1. Bargaining Power of Buyers
3.3.2. Bargaining Power of Suppliers
3.3.3. Thereat of New Entrants
3.3.4. Threat of Substitutes
3.3.5. Intensity of Competitive Rivalry
3.4. Top Player Positioning, 2019
3.5. Market Dynamics
3.5.1. Drivers
3.5.1.1. Rise in Cost of Healthcare System and Urge to Decrease Wasteful Spending
3.5.1.2. Increase in Health Insurance Enrolment
3.5.1.3. Surge in Adoption of Healthcare It and Implementation of Various Healthcare Reforms
3.5.1.4. Rise in Healthcare Frauds and Increase in Demand for Streamlined Business Processes
3.5.2. Restraints
3.5.2.1. Surge in Incidences of Data Breach and Loss of Confidentiality
3.5.2.2. Cultural and Language Barriers
3.5.3. Opportunities
3.5.3.1. High Growth Potential in Emerging Economies
3.5.3.2. Increase in Adoption of Ai and Analytics
3.5.4. Impact Analyses
3.6. Impact Analysis of Covid-19 on the Healthcare Payer Solution Market
3.6.1. Positive and Negative Impact of Covid-19 on Healthcare Payers Solution Market
3.6.1.1. Positive Impacts
3.6.1.2. Negative Impacts

Chapter 4: Healthcare Payer Solution Market, by Service
4.1. Overview
4.1.1. Market Size and Forecast
4.2. Business Process Outsourcing Services
4.2.1. Key Market Trends and Growth Opportunities
4.2.2. Market Size and Forecast, by Region
4.2.3. Market Analysis, by Country
4.3. Information Technology Outsourcing Services
4.3.1. Key Market Trends and Growth Opportunities
4.3.2. Market Size and Forecast, by Region
4.3.3. Market Analysis, by Country
4.4. Knowledge Process Outsourcing Services
4.4.1. Key Market Trends and Growth Opportunities
4.4.2. Market Size and Forecast, by Region
4.4.3. Market Analysis, by Country

Chapter 5: Healthcare Payer Solution Market, by Application
5.1. Overview
5.1.1. Market Size and Forecast
5.2. Pharmacy Audit & Analysis Systems
5.2.1. Market Size and Forecast, by Region
5.2.2. Market Analysis, by Country
5.3. Claims Management Services
5.3.1. Market Size and Forecast, by Region
5.3.2. Market Analysis, by Country
5.4. Fraud Management Services
5.4.1. Market Size and Forecast, by Region
5.4.2. Market Analysis, by Country
5.5. Computer-Assisted Coding (Cac) Systems
5.5.1. Market Size and Forecast, by Region
5.5.2. Market Analysis, by Country
5.6. Member Eligibility Management Services
5.6.1. Market Size and Forecast, by Region
5.6.2. Market Analysis, by Country
5.7. Provider Network Management Services
5.7.1. Market Size and Forecast, by Region
5.7.2. Market Analysis, by Country
5.8. Payment Management Services
5.8.1. Market Size and Forecast, by Region
5.8.2. Market Analysis, by Country
5.9. Customer Relationship Management Services
5.9.1. Market Size and Forecast, by Region
5.9.2. Market Analysis, by Country
5.10. Medical Document Management Services
5.10.1. Market Size and Forecast, by Region
5.10.2. Market Analysis, by Country
5.11. General Ledger & Payroll Management
5.11.1. Market Size and Forecast, by Region
5.11.2. Market Analysis, by Country

Chapter 6: Healthcare Payer Solution Market, by End-user
6.1. Overview
6.1.1. Market Size and Forecast
6.2. Private
6.2.1. Market Size and Forecast, by Region
6.2.2. Market Analysis, by Country
6.3. Public
6.3.1. Market Size and Forecast, by Region
6.3.2. Market Analysis, by Country

Chapter 7: Healthcare Payer Solution Market, by Region
7.1. Overview
7.1.1. Market Size and Forecast
7.2. North America
7.2.1. Key Market Trends and Opportunities
7.2.2. Market Analysis by Country
7.2.2.1. U.S.
7.2.2.1.1. U.S. Market Size and Forecast, by Service
7.2.2.1.2. U.S. Market Size and Forecast, by Application
7.2.2.1.3. U.S. Market Size and Forecast, by End-user
7.2.2.2. Canada
7.2.2.2.1. Canada Market Size and Forecast, by Service
7.2.2.2.2. Canada Market Size and Forecast, by Application
7.2.2.2.3. Canada Market Size and Forecast, by End-user
7.2.2.3. Mexico
7.2.2.3.1. Mexico Market Size and Forecast, by Service
7.2.2.3.2. Mexico Market Size and Forecast, by Application
7.2.2.3.3. Mexico Market Size and Forecast, by End-user
7.2.3. North America Market Size and Forecast, by Service
7.2.4. North America Market Size and Forecast, by Application
7.2.5. North America Market Size and Forecast, by End-user
7.3. Europe
7.3.1. Key Market Trends and Opportunities
7.3.2. Market Analysis by Country
7.3.2.1. Germany
7.3.2.1.1. Germany Market Size and Forecast, by Service
7.3.2.1.2. Germany Market Size and Forecast, by Application
7.3.2.1.3. Germany Market Size and Forecast, by End-user
7.3.2.2. France
7.3.2.2.1. France Market Size and Forecast, by Service
7.3.2.2.2. France Market Size and Forecast, by Application
7.3.2.2.3. France Market Size and Forecast, by End-user
7.3.2.3. UK
7.3.2.3.1. UK Market Size and Forecast, by Service
7.3.2.3.2. UK Market Size and Forecast, by Application
7.3.2.3.3. UK Market Size and Forecast, by End-user
7.3.2.4. Italy
7.3.2.4.1. Italy Market Size and Forecast, by Service
7.3.2.4.2. Italy Market Size and Forecast, by Application
7.3.2.4.3. Italy Market Size and Forecast, by End-user
7.3.2.5. Spain
7.3.2.5.1. Spain Market Size and Forecast, by Service
7.3.2.5.2. Spain Market Size and Forecast, by Application
7.3.2.5.3. Spain Market Size and Forecast, by End-user
7.3.2.6. Rest of Europe
7.3.2.6.1. Rest of Europe Market Size and Forecast, by Service
7.3.2.6.2. Rest of Europe Market Size and Forecast, by Application
7.3.2.6.3. Rest of Europe Market Size and Forecast, by End-user
7.3.3. Europe Market Size and Forecast, by Service
7.3.4. Europe Market Size and Forecast, by Application
7.3.5. Europe Market Size and Forecast, by End-user
7.4. Asia-Pacific
7.4.1. Key Market Trends and Opportunities
7.4.2. Market Analysis by Country
7.4.2.1. Japan
7.4.2.1.1. Japan Market Size and Forecast, by Service
7.4.2.1.2. Japan Market Size and Forecast, by Application
7.4.2.1.3. Japan Market Size and Forecast, by End-user
7.4.2.2. China
7.4.2.2.1. China Market Size and Forecast, by Service
7.4.2.2.2. China Market Size and Forecast, by Application
7.4.2.2.3. China Market Size and Forecast, by End-user
7.4.2.3. India
7.4.2.3.1. India Market Size and Forecast, by Service
7.4.2.3.2. India Market Size and Forecast, by Application
7.4.2.3.3. India Market Size and Forecast, by End-user
7.4.2.4. Rest of Asia-Pacific
7.4.2.4.1. Rest of Asia-Pacific Market Size and Forecast, by Service
7.4.2.4.2. Rest of Asia-Pacific Market Size and Forecast, by Application
7.4.2.4.3. Rest of Asia-Pacific Market Size and Forecast, by End-user
7.4.3. Asia-Pacific Market Size and Forecast, by Service
7.4.4. Asia-Pacific Market Size and Forecast, by Application
7.4.5. Asia-Pacific Market Size and Forecast, by End-user
7.5. LAMEA
7.5.1. Key Market Trends and Opportunities
7.5.2. Market Analysis by Country
7.5.2.1. Brazil
7.5.2.1.1. Brazil Market Size and Forecast, by Service
7.5.2.1.2. Brazil Market Size and Forecast, by Application
7.5.2.1.3. Brazil Market Size and Forecast, by End-user
7.5.2.2. Saudi Arabia
7.5.2.2.1. Saudi Arabia Market Size and Forecast, by Service
7.5.2.2.2. Saudi Arabia Market Size and Forecast, by Application
7.5.2.2.3. Saudi Arabia Market Size and Forecast, by End-user
7.5.2.3. South Africa
7.5.2.3.1. South Africa Market Size and Forecast, by Service
7.5.2.3.2. South Africa Market Size and Forecast, by Application
7.5.2.3.3. South Africa Market Size and Forecast, by End-user
7.5.2.4. Rest of LAMEA
7.5.2.4.1. Rest of LAMEA Market Size and Forecast, by Service
7.5.2.4.2. Rest of LAMEA Market Size and Forecast, by Application
7.5.2.4.3. Rest of LAMEA Market Size and Forecast, by End-user
7.5.3. LAMEA Market Size and Forecast, by Service
7.5.4. LAMEA Market Size and Forecast, by Application
7.5.5. LAMEA Market Size and Forecast, by End-user

Chapter 8: Company Profiles
8.1. Accenture plc.
8.1.1. Company Overview
8.1.2. Company Snapshot
8.1.3. Operating Business Segments
8.1.4. Product Portfolio
8.1.5. Business Performance
8.1.6. Key Strategic Moves and Developments
8.2. Change Healthcare, Inc.
8.2.1. Company Overview
8.2.2. Company Snapshot
8.2.3. Operating Business Segments
8.2.4. Product Portfolio
8.2.5. Business Performance
8.2.6. Key Strategic Moves and Developments
8.3. Cognizant Technology Solutions Corporation
8.3.1. Company Overview
8.3.2. Company Snapshot
8.3.3. Operating Business Segments
8.3.4. Product Portfolio
8.3.5. Business Performance
8.3.6. Key Strategic Moves and Developments
8.4. Hinduja Global Solutions Limited
8.4.1. Company Overview
8.4.2. Company Snapshot
8.4.3. Operating Business Segments
8.4.4. Product Portfolio
8.4.5. Business Performance
8.4.6. Key Strategic Moves and Developments
8.5. Hms Holdings Corp.
8.5.1. Company Overview
8.5.2. Company Snapshot
8.5.3. Operating Business Segments
8.5.4. Product Portfolio
8.5.5. Business Performance
8.5.6. Key Strategic Moves and Developments
8.6. International Business Machines Corporation
8.6.1. Company Overview
8.6.2. Company Snapshot
8.6.3. Operating Business Segments
8.6.4. Product Portfolio
8.6.5. Business Performance
8.6.6. Key Strategic Moves and Developments
8.7. Inovalon Holdings, Inc.
8.7.1. Company Overview
8.7.2. Company Snapshot
8.7.3. Operating Business Segments
8.7.4. Product Portfolio
8.7.5. Business Performance
8.7.6. Key Strategic Moves and Developments
8.8. Mckesson Corporation
8.8.1. Company Overview
8.8.2. Company Snapshot
8.8.3. Operating Business Segments
8.8.4. Product Portfolio
8.8.5. Business Performance
8.8.6. Key Strategic Moves and Developments
8.9. Unitedhealth Group Incorporated (Optum)
8.9.1. Company Overview
8.9.2. Company Snapshot
8.9.3. Operating Business Segments
8.9.4. Product Portfolio
8.9.5. Business Performance
8.9.6. Key Strategic Moves and Developments
8.10. Wipro Limited
8.10.1. Company Overview
8.10.2. Company Snapshot
8.10.3. Operating Business Segments
8.10.4. Product Portfolio
8.10.5. Business Performance
8.10.6. Key Strategic Moves and Developments
Note: Product cover images may vary from those shown

The analyst offers exhaustive research and analysis based on a wide variety of factual inputs, which largely include interviews with industry participants, reliable statistics, and regional intelligence. The in-house industry experts play an instrumental role in designing analytic tools and models, tailored to the requirements of a particular industry segment. The primary research efforts include reaching out participants through mail, tele-conversations, referrals, professional networks, and face-to-face interactions.

They are also in professional corporate relations with various companies that allow them greater flexibility for reaching out to industry participants and commentators for interviews and discussions.

They also refer to a broad array of industry sources for their secondary research, which typically include; however, not limited to:

  • Company SEC filings, annual reports, company websites, broker & financial reports, and investor presentations for competitive scenario and shape of the industry
  • Scientific and technical writings for product information and related preemptions
  • Regional government and statistical databases for macro analysis
  • Authentic news articles and other related releases for market evaluation
  • Internal and external proprietary databases, key market indicators, and relevant press releases for market estimates and forecast

Furthermore, the accuracy of the data will be analyzed and validated by conducting additional primaries with various industry experts and KOLs. They also provide robust post-sales support to clients.

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