United States Healthcare BPO Market Size Analysis Report - Market Share, Forecast Trends and Outlook (2025-2034)

The United States healthcare BPO market value reached around USD 164.52 Billion in 2024. As organizations seek to reduce operational costs, outsourcing non-core functions such as medical billing, claims processing, and administrative tasks to specialised BPO providers has become a strategic priority. Companies like Cognizant and TCS offer comprehensive medical billing services that help healthcare providers streamline their revenue cycle management. As a result, the industry is expected to grow at a CAGR of 8.00% during the forecast period of 2025-2034 to attain a value of USD 355.19 Billion by 2034. The growing complexity of healthcare regulations and the need for compliance further fuel the demand for outsourced services. Firms like Optum provide regulatory compliance solutions to ensure adherence to changing laws.

United States Healthcare BPO Market Growth

Healthcare BPO plays an important role in reducing the administrative burden of employees and improving patient care. As healthcare expenses continue to escalate, organisations are increasingly compelled to find cost-effective solutions. Outsourcing non-core functions such as medical billing, claims processing, and administrative tasks to specialised BPO providers allows healthcare organisations to achieve significant cost savings. The changing preferences of the healthcare industry towards embracing a patient-centric approach also impact the growth of the United States healthcare BPO market. Outsourcing supports various functions that enable healthcare organisations to concentrate on essential patient care aspects. The United States market growth can be attributed to the increasing focus on improving operational efficiency and streamlining administrative processes within the healthcare industry. BPO also enables healthcare organisations to improve efficiency and offer accessible and convenient services.

Key Trends and Developments

Evolving regulations in the healthcare market, rapid adoption of advanced technologies, and growing emphasis on improving patient experience are the key trends propelling the market growth.

December 2024

IKS Health, based in Mumbai, has emerged as a significant player in the United States healthcare BPO market, serving over 775 organisations. Following its acquisition of AQuity Solutions, the company expanded its client base by over 800 clients. IKS Health's revenue surged from INR 764 crore in FY22 to INR 1,818 crore in FY24, with a net profit increase of 26% to INR 370 crore. With an implied market cap of INR 22,802 crore, it presents an attractive long-term investment opportunity. The growing trend toward outsourcing administrative tasks in healthcare further enhances its market potential.

November 2024

Midas BPO strategically transitioned its Linden operations to Prochant, a US-based healthcare business process outsourcing (BPO) company that specialises in medical billing and revenue cycle management (RCM). This move is part of Midas BPO's efforts to enhance operational efficiency and leverage Prochant's advanced capabilities in the healthcare sector.

August 2024

GeBBS Healthcare Solutions, a US-based healthcare BPO firm, was set to be acquired by Hillhouse Investment, which made an offer of approximately USD 870 million. This acquisition is significant as it highlights the growing interest in healthcare outsourcing and the increasing value of companies in this sector.

May 2024

Global investment firm KKR announced the acquisition of a significant minority stake in Infinx Healthcare, an AI-driven healthcare business process outsourcing (BPO) company in the USA. This investment, valued at approximately USD 150 million, is part of KKR's strategy to leverage its extensive experience in the healthcare technology sector to accelerate Infinx's growth and expand its network.

Evolving Regulations in the Healthcare Market

Healthcare BPO can support healthcare organisations in reducing the risk of financial and legal penalties and complying with various laws. Hence, evolving regulatory compliances in the country's healthcare industry are also anticipated to propel healthcare BPO demand in the coming years. For instance, the Health Insurance Portability and Accountability Act establishes standards for protecting sensitive patient information and ensures that healthcare providers maintain the privacy and security of health records. Violations can lead to significant fines, ranging from USD 100 to USD 50,000 per violation, with maximum penalties reaching USD 1.5 million per year for repeated violations. Additionally, the Health Information Technology for Economic and Clinical Health Act extends HIPAA provisions by enhancing data security requirements for electronic health information. It imposes stricter penalties for breaches and emphasises the need for Business Associate Agreements (BAAs) between healthcare providers and BPOs that handle electronic Protected Health Information (ePHI).

Rapid Adoption of Advanced Technologies

There is a growing trend towards integrating technologies such as AI, robotic process automation (RPA), and data analytics into healthcare BPO services. These technologies enhance operational efficiency, improve patient care, and streamline administrative processes, making them attractive to healthcare organisations seeking cost-effective solutions and contributing to the demand of United States healthcare BPO market. For instance, HealthAxis is leveraging AI and RPA to improve health plan administration. These technologies are being utilised to streamline administrative processes, reduce costs, and enhance member engagement. The integration of conversational AI is particularly noted for improving responsiveness in member support, while RPA automates routine tasks, allowing staff to focus on higher-value activities. Optum, a part of UnitedHealth Group, is utilising advanced data analytics alongside AI to improve healthcare delivery. Their platform analyses vast amounts of health data to identify trends and predict patient needs, which helps providers tailor their services more effectively. This strategy enhances operational efficiency while ensuring that patients receive personalised care.

Increasing Demand for Cost-Effective Solutions

The increasing demand for cost-effective solutions in the United States healthcare BPO market is a significant trend driven by the rising pressure on healthcare providers to manage operational costs while maintaining high-quality patient care. As healthcare expenses continue to escalate, organizations are turning to outsourcing as a viable solution to reduce overhead costs associated with in-house operations. For example, outsourcing medical billing and coding can lead to savings of up to 70% in operational expenses compared to maintaining an in-house team. Companies like Cognizant and Accenture provide services that allow healthcare organisations to focus on core activities, such as patient care, while efficiently managing administrative tasks. Additionally, the shift towards outsourcing enables healthcare providers to access advanced technologies and expertise without the burden of significant upfront investments in infrastructure and staff training. This trend not only enhances operational efficiency but also allows for better allocation of resources towards improving patient outcomes.

Growth of Telehealth Services

The growth of telehealth services has created new opportunities for healthcare BPO providers. The recent pandemic accelerated the adoption of telehealth, with a reported 154% increase in telehealth visits during the early months of 2020 compared to the previous year. This surge necessitated support in managing telehealth services, including appointment scheduling, online customer support, and claims processing for virtual visits. Companies like Omega Healthcare have adapted their offerings to include telehealth support services, helping healthcare organisations efficiently manage remote patient interactions. Furthermore, the integration of telehealth into routine care has led to increased demand for BPO services that can streamline administrative processes related to virtual consultations. By outsourcing these functions, healthcare providers can enhance accessibility to care while focusing on delivering high-quality services, ultimately improving patient satisfaction.

United States Healthcare BPO Market Trends

As healthcare organisations adopt RPA, there is a growing emphasis on improving patient experience. By automating administrative tasks, healthcare professionals can dedicate more time to patient care. Additionally, conversational AI is being utilised to create virtual assistants that provide 24/7 support for patients, enhancing overall service delivery and increasing United States healthcare BPO market value. For example, Cleveland Clinic has integrated conversational AI to enhance its appointment scheduling and follow-up processes. This AI-powered system allows patients to easily book, reschedule, or cancel appointments through a user-friendly interface, significantly reducing the administrative burden on staff. Additionally, it ensures timely reminders for medications and follow-up visits, enhancing patient engagement and care continuity.

Meanwhile, Kaiser Permanente has implemented a virtual assistant within their mobile app that provides personalised health coaching for patients with chronic conditions. This assistant offers daily medication reminders and lifestyle tips tailored to individual needs, helping patients manage their health more effectively while reducing the workload on healthcare providers.

United States Healthcare BPO Market Restraints

Many healthcare organisations underestimate the potential hidden costs associated with outsourcing. These can include expenses related to vendor selection, contract management, and the transition of processes to external providers. If not properly managed, these unforeseen costs can negate the anticipated savings from outsourcing, making it a less attractive option for some healthcare entities and impacting the healthcare BPO demand growth.

The increasing frequency of cyberattacks on healthcare systems raises alarms about patient data security. Ensuring robust security measures while outsourcing functions can be difficult, especially when sensitive information is involved. In February 2024, Change Healthcare experienced a major ransomware attack that resulted in the exposure of over 100 million records. This incident caused widespread disruptions across hospitals and healthcare providers relying on Change Healthcare for critical services, including claims processing and e-prescribing. The attack underscored the vulnerability of healthcare organisations to cyber threats, with the potential impact affecting a substantial portion of the U.S. population.

United States Healthcare BPO Market Dynamics

Hyperautomation, which combines RPA with AI and machine learning, is predicted to see significant growth in the coming years. This trend of United States healthcare BPO market emphasises end-to-end workflow automation across healthcare operations, aiming to enhance productivity and innovation while reducing operational costs. One of the major healthcare companies that have deployed this technology is Emergys which highlights the importance of hyperautomation in addressing inefficiencies within healthcare systems. By combining RPA with other advanced technologies, they aim to enhance operational processes and ensure quality compliance while significantly reducing costs associated with legacy systems. Their focus on agile process automation aligns with the growing demand for efficiency in healthcare operations.

Moreover, UiPath is a leading provider of RPA solutions and has been focusing on hyperautomation across various industries, including healthcare. Their platform enables healthcare organisations to automate repetitive tasks, streamline workflows, and improve patient engagement through intelligent automation.

United States Healthcare BPO Industry Segmentation

“United States Healthcare BPO Market Report and Forecast 2025-2034” offers a detailed analysis of the market based on the following segments:

Market Breakup by Payer Service

• Claims Management
• Customer Relationship Management (CRM)
• Operational/Administrative Management
• Care Management
• Human Resource Management
• Provider Management
• Others

Market Breakup by Pharmaceutical Service

• Research and Development
• Manufacturing
• Non-clinical Services

Market Breakup by Provider Service

• Patient Enrollment and Strategic Planning
• Patient Care Service
• Revenue Cycle Management

Market Breakup by Region

• New England
• Mideast
• Great Lakes
• Plains
• Southeast
• Southwest
• Rocky Mountain
• Far West

United States Healthcare BPO Market Share

Market Insights by Payer Service

Claims management holds a significant portion of the United States healthcare BPO market share as it encompasses the intricate process of claims processing, encompassing submission, validation, and adjudication, through outsourcing. This approach aids healthcare organisations in improving efficiency and accuracy. Specialised BPO providers bring domain expertise, supporting these organisations in navigating the complexities of insurance regulations, coding requirements, and compliance standards.

As a result, this strategy facilitates error mitigation, reduces instances of claim denials, and expedites reimbursement cycles. This allows healthcare providers to reallocate resources and focus on patient care, freeing them from the challenges posed by administrative complexities.

Market Insights by Pharmaceutical Service

The Revenue Cycle Management (RCM) segment holds a significant market share due to factors such as increased government initiatives, a rise in electronic health record adoption, and the need for efficient billing processes to reduce revenue loss due to errors. As per the United States healthcare BPO industry analysis, the integration of electronic health records (EHR) with RCM systems has surged, enhancing workflow efficiency, and reducing errors in billing. Moreover, healthcare providers are increasingly adopting RCM solutions to manage their revenue cycles effectively, which is crucial as patient admissions rise.

Market Insights by Provider Service

Outsourcing of revenue cycle management (RCM) processes, encompassing tasks like medical billing, coding, claims processing, and payment collections, supports healthcare organisations to optimise their financial operations and guarantee precise and prompt reimbursement.

Furthermore, specialised healthcare BPO providers assist in navigating intricate billing codes, insurance regulations, and compliance standards, thereby decreasing billing errors and denials which influences United States healthcare BPO market dynamics and trends. This strategy optimises revenue collection, improves cash flow, and lowers operational costs. By relieving healthcare providers of the administrative burden associated with managing the revenue cycle, it enables them to focus on delivering high-quality patient care and enhancing clinical outcomes.

United States Healthcare BPO Market Regional Insights

New England United States Healthcare BPO Market Trends

New England is recognised for its advanced healthcare systems and high concentration of healthcare organisations. The region benefits from a strong presence of leading hospitals and research institutions, which drive demand for BPO services focused on administrative support, patient management, and compliance solutions, further contributing to the United States healthcare BPO industry revenue. The emphasis on innovative healthcare delivery models further propels the growth of healthcare BPO in this area.

Mideast United States Healthcare BPO Market Outlook

The Mideast region, particularly states like Pennsylvania and Ohio, has a robust healthcare infrastructure that includes numerous hospitals and insurance companies, which can boost the growth of the United States healthcare BPO market. The demand for healthcare BPO services is driven by the need for efficient claims processing, revenue cycle management, and patient engagement solutions. Additionally, the region's focus on integrating technology into healthcare operations supports the growth of outsourcing services.

Southeast United States Healthcare BPO Market Dynamics

The Southeast is experiencing significant growth in the healthcare BPO market due to an expanding population and increasing healthcare needs. States like Florida and Georgia are home to many healthcare providers that seek to reduce operational costs through outsourcing non-core functions and increase United States healthcare BPO market opportunities. The region's investment in telehealth and digital health solutions also enhances the demand for BPO services that support these technologies.

Innovative United States Healthcare BPO Startups

Startups are actively innovating and introducing technology-driven solutions to address various challenges faced by healthcare providers. These companies are focusing on enhancing operational efficiencies, improving patient experiences, and streamlining administrative processes, which can boost the growth of the United States healthcare BPO industry. Some startups are developing platforms that optimise patient engagement and billing transparency and offer data-driven solutions to assist primary care physicians.

Clipboard Health

Founded in 2016 and based in San Francisco, California, Clipboard Health is a healthcare staffing platform that connects healthcare facilities with qualified medical professionals, including nurses and certified nursing assistants. The company utilises a proprietary algorithm to match healthcare professionals with job opportunities tailored to their skills and preferences. This innovative approach aims to improve the efficiency and transparency of staffing solutions in the healthcare sector.

Tomorrow Health

Established in 2018 and located in New York City, Tomorrow Health focuses on providing personalised in-home medical equipment and supplies for patients with chronic conditions. The startup collaborates with healthcare providers and insurance companies to simplify the process of obtaining and managing necessary medical equipment, ensuring that patients receive high-quality care at home.

Competitive Landscape

Companies are adopting advanced technologies, including artificial intelligence and automation, to streamline administrative processes and reduce costs. Additionally, there is a significant push towards enhancing data security and compliance with evolving regulations, which can impact the healthcare BPO demand forecast. Companies are also responding to government initiatives aimed at improving healthcare access and quality, particularly through virtual care solutions.

Accenture Plc

Accenture Plc, founded in 1989, is a prominent management consulting, technology services, and outsourcing company. Offering an extensive range of software products and services, the company caters to various industries, including aerospace and defence, automotive, banking, capital markets, chemicals, communications and media, consumer goods and services, energy, health, technology, industrial, insurance, life sciences, and natural resources, among others.

Genpact Plc

Genpact Plc, founded in 1997, is a renowned global professional services firm in United States healthcare BPO market specialising in business process management services. With a robust presence in over 30 countries and a workforce exceeding 115,000 employees, the company delivers its products and services to diverse sectors such as banking and capital markets, consumer goods and retail, healthcare and life sciences, high tech, and insurance, among others.

Wipro Limited

Wipro Limited is a consulting and technology service company that is headquartered in Bengaluru, India. It is focused on creating innovative solutions that address the complex digital transformation requirements of organisations. With business partners across 65 countries, the company aims to leverage its design, consulting, operation, and engineering capabilities to drive sustainability.

Other market players operating in the United States healthcare BPO market include Cognizant Technology Solutions Corporation, IQVIA Inc., Infosys Limited, Sutherland Global Services, Inc., Access Healthcare, Global Virtuoso, Inc., and Flatworld Solutions Inc., among others.