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Healthcare Payer Services Market

Healthcare Payer Services Market Size, Share & Segment By Service Type (BPO Services, ITO Services, KPO Services), By Application (Claims management services, Integrated front office service and back-office operations, Member management services, Provider management services, Billing and accounts management services, Analytics and fraud management services, HR Services), By End User (Private Payers, Public Payers), by Regions and Global Forecast 2022-2028

Report Id: SNS/HC/2299 | July 2022 | Region: Global | 131 Pages

Healthcare Payer Services Market Size was valued at USD 58.3 billion in 2021, and is expected to reach USD 96.8 billion by 2028, and grow at a CAGR of 7.5% over the forecast period 2022-2028.

 

Healthcare insurance payers contract out healthcare payer services. Payers are intrigued by the shifting dynamics of the healthcare industry and are redesigning their business models and procedures to compete in the market while offering better patient care by streamlining the process, cutting costs, and enhancing customer relations. Healthcare insurance payers and providers are using a variety of outsourcing solutions to improve customer experience and optimize internal operations. A profitable company strategy that reduces the workload of administrative, accounting, purchasing, shipping, and other responsibilities while creating efficient corporate procedures is outsourcing.

Healthcare Payer Services Market

MARKET DYNAMICS

DRIVERS

  • Outsourcing: A Practical Choice for Healthcare Payers

  • Federal Requirements in the United States Increasing Payer Workload

  • The prevalence of healthcare fraud

  • The Adaptiveness of Health Benefit Plan Designs

  • Lack of Skilled Personnel Within the Company

 

RESTRAINTS

  • Data breaches and confidentiality breaches are becoming more common.

  • Costs of Outsourcing That We Didn't Expect

  • Abandonment of Managerial Control

 

OPPORTUNITIES

  • sophisticated data analytics

  • Implementing Icd-10 Standards

  • Increased Service Portfolio

 

CHALLENGES

  • The replacement of legacy systems

  • Language disparities and cultural differences

 

IMPACT OF COVID-19

Healthcare services have had a major impact due to Covid-19. According to an article by the National Academy of Medicine entitled "COVID-19 Payment Impact Assessment: Lessons Learned and Compulsory Needs" from May 2021, payers have taken steps to increase access to COVID-19 health care and non-COVID-19 spring-based issues. controls and recommendations (e.g., withdrawal of administrative requirements, telehealth recovery). Many payers also independently send financial and financial assistance to assist providers in sustainability, and use their technical and social media resources to assist with outbreak activities such as arranging non-medical services and assisting with vaccination campaigns.

 

By Service Type

The market is divided into the BPO services, ITO services, and KPO services categories. According to estimates, the BPO services segment holds the greatest market share for healthcare payer services globally. The main reason for this high proportion is that BPO services help in important administrative areas. In turn, this helps payers cut costs and shorten time to market, which is primarily what payer groups are aiming for.

 

By Application

The claims management services, provider management services, integrated front office services & back-office operations, member management services, analytics & fraud management services, billing & accounts management services, and HR services are the different market segments for healthcare payer services.

 

By End User

The worldwide healthcare payer services market is anticipated to be dominated by claims management services. End users anticipate that private payers will dominate the market.

 

COMPETITIVE LANDSCAPE

Some of the major key players are as follows: Accenture, Cognizant, Genpact, HGS Ltd, Concentric Corporation, EXL, HCL Technologies, WIPRO Ltd., Xerox Corporation.

 

MARKET SEGMENTS:

By Service Type

  • BPO Services

  • ITO Services

  • KPO Services

 

By Application

  • Claims management services

  • Integrated front office service and back-office operations

  • Member management services

  • Provider management services

  • Billing and accounts management services

  • Analytics and fraud management services

  • HR Services

 

By End User

  • Private Payers

  • Public Payers

Healthcare Payer Services Market

REGIONAL ANALYSIS

Due to the presence of large providers of healthcare payer solutions in the region as well as the substantial demand for these products, North America captured a sizable portion of the market. However, Asia-Pacific is anticipated to expand at the highest rate over the course of the projection period due to increased use of healthcare IT solutions and the region's sizable uninsured population, which presents considerable market expansion prospects. In addition, attractive commercial expansion opportunities are provided by growing markets for providers of healthcare payment solutions.

 

REGIONAL COVERAGE

  • North America

    • USA

    • Canada

    • Mexico

  • Europe

    • Germany

    • UK

    • France

    • Italy

    • Spain

    • The Netherlands

    • Rest of Europe

  • Asia-Pacific

    • Japan

    • south Korea

    • China

    • India

    • Australia

    • Rest of Asia-Pacific

  • The Middle East & Africa

    • Israel

    • UAE

    • South Africa

    • Rest of Middle East & Africa

  • Latin America

    • Brazil

    • Argentina

    • Rest of Latin America

Healthcare Payer Services Market Report Scope:
Report Attributes Details
Market Size in 2021 US$ 58.3 Billion
Market Size by 2028 US$ 96.8 Billion
CAGR CAGR of 7.5% From 2022 to 2028
Base Year 2021
Forecast Period 2022-2028
Historical Data 2017-2020
Report Scope & Coverage Market Size, Segments Analysis, Competitive  Landscape, Regional Analysis, DROC & SWOT Analysis, Forecast Outlook
Key Segments • By Service Type (BPO Services, ITO Services, KPO Services)
• By Application (Claims management services, Integrated front office service and back-office operations, Member management services, Provider management services, Billing and accounts management services, Analytics and fraud management services, HR Services)
• By End User (Private Payers, Public Payers)
Regional Analysis/Coverage North America (USA, Canada, Mexico), Europe
(Germany, UK, France, Italy, Spain, Netherlands,
Rest of Europe), Asia-Pacific (Japan, South Korea,
China, India, Australia, Rest of Asia-Pacific), The
Middle East & Africa (Israel, UAE, South Africa,
Rest of Middle East & Africa), Latin America (Brazil, Argentina, Rest of Latin America)
Company Profiles Accenture, Cognizant, Genpact, HGS Ltd, Concentric Corporation, EXL, HCL Technologies, WIPRO Ltd., Xerox Corporation.
Key Drivers • Outsourcing: A Practical Choice for Healthcare Payers
• Federal Requirements in the United States Increasing Payer Workload
• The prevalence of healthcare fraud
Restraints • Data breaches and confidentiality breaches are becoming more common.
• Costs of Outsourcing That We Didn't Expect
• Abandonment of Managerial Control


Frequently Asked Questions (FAQ) :

The sub segments of by service type of the Healthcare Payer Services Market is BPO Services, ITO Services, and KPO Services.

North America captured a sizable portion of the market. However, Asia-Pacific is anticipated to expand at the highest rate over the course of the projection period.

 Healthcare Payer Services Market is divided into three segments and they are By Service Type, By Application, and By End User 

 Language disparities and cultural differences are the restraints of the market.

Healthcare Payer Services market is expected to grow at a CAGR of 7.5%.


Table of Content

1. Introduction

1.1 Market Definition

1.2 Scope

1.3 Research Assumptions

 

2. Research Methodology

 

3. Market Dynamics

3.1 Drivers

3.2 Restraints

3.3 Opportunities

3.4 Challenges

 

4. Impact Analysis

4.1 COVID 19 Impact Analysis

4.2 Impact of Ukraine ware

 

5. Value Chain Analysis

 

6. Porter’s 5 forces model

 

7.  PEST Analysis

  

8. Healthcare Payer Services Market Segmentation, By Service Type

8.1 BPO Services

8.2 ITO Services

8.3 KPO Services

 

9. Healthcare Payer Services Market Segmentation, By Application

9.1 Claims management services

9.2 Integrated front office service and back-office operations

9.3 Member management services

9.4 Provider management services

9.5 Billing and accounts management services

9.6 Analytics and fraud management services

9.7 HR Services

 

10. Healthcare Payer Services Market Segmentation, by End User

10.1 Private Payers

10.2 Public Payers

 

11. Regional Analysis

11.1 Introduction

11.2 North America

11.2.1 USA

11.2.2 Canada

11.2.3 Mexico

11.3 Europe

11.3.1 Germany

11.3.2 UK

11.3.3 France

11.3.4 Italy

11.3.5 Spain

11.3.6 The Netherlands

11.3.7 Rest of Europe

11.4 Asia-Pacific

11.4.1 Japan

11.4.2 South Korea

11.4.3 China

11.4.4 India

11.4.5 Australia

11.4.6 Rest of Asia-Pacific

11.5 The Middle East & Africa

11.5.1 Israel

11.5.2 UAE

11.5.3 South Africa

11.5.4 Rest

11.6 Latin America

11.6.1 Brazil

11.6.2 Argentina

11.6.3 Rest of Latin America

 

12.Company Profiles

12.1 Accenture

              12.1.1 Financial

12.1.2 Products/ Services Offered

12.1.3 SWOT Analysis

12.1.4 The SNS view

12.2 Cognizant

12.3 Genpact

12.4 HGS Ltd

12.5 Concentric Corporation

12.6 EXL

12.7 HCL Technologies

12.8 WIPRO Ltd.

12.9 Xerox Corporation

 

13.Competitive Landscape

13.1 Competitive Benchmark

13.2 Market Share analysis

13.3 Recent Developments

 

14.Conclusion

 

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The 5 steps process:

Step 1: Secondary Research:

Secondary Research or Desk Research is as the name suggests is a research process wherein, we collect data through the readily available information. In this process we use various paid and unpaid databases which our team has access to and gather data through the same. This includes examining of listed companies’ annual reports, Journals, SEC filling etc. Apart from this our team has access to various associations across the globe across different industries. Lastly, we have exchange relationships with various university as well as individual libraries.

Secondary Research

Step 2: Primary Research

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This step involves the triangulation of data wherein our team analyses the interview transcripts, online survey responses and observation of on filed participants. The below mentioned chart should give a better understanding of the part 1 of the primary interview.

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