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.
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
Data breaches and confidentiality breaches are becoming more common.
Costs of Outsourcing That We Didn't Expect
Abandonment of Managerial Control
sophisticated data analytics
Implementing Icd-10 Standards
Increased Service Portfolio
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.
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.
Some of the major key players are as follows: Accenture, Cognizant, Genpact, HGS Ltd, Concentric Corporation, EXL, HCL Technologies, WIPRO Ltd., Xerox Corporation.
By Service Type
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
By End User
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.
Rest of Europe
Rest of Asia-Pacific
The Middle East & Africa
Rest of Middle East & Africa
Rest of Latin America
|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|
|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
1.1 Market Definition
1.3 Research Assumptions
2. Research Methodology
3. Market Dynamics
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
11.2 North America
11.3.6 The Netherlands
11.3.7 Rest of Europe
11.4.2 South Korea
11.4.6 Rest of Asia-Pacific
11.5 The Middle East & Africa
11.5.3 South Africa
11.6 Latin America
11.6.3 Rest of Latin America
12.1.2 Products/ Services Offered
12.1.3 SWOT Analysis
12.1.4 The SNS view
12.4 HGS Ltd
12.5 Concentric Corporation
12.7 HCL Technologies
12.8 WIPRO Ltd.
12.9 Xerox Corporation
13.1 Competitive Benchmark
13.2 Market Share analysis
13.3 Recent Developments
An accurate research report requires proper strategizing as well as implementation. There are multiple factors involved in the completion of good and accurate research report and selecting the best methodology to compete the research is the toughest part. Since the research reports we provide play a crucial role in any company’s decision-making process, therefore we at SNS Insider always believe that we should choose the best method which gives us results closer to reality. This allows us to reach at a stage wherein we can provide our clients best and accurate investment to output ratio.
Each report that we prepare takes a timeframe of 350-400 business hours for production. Starting from the selection of titles through a couple of in-depth brain storming session to the final QC process before uploading our titles on our website we dedicate around 350 working hours. The titles are selected based on their current market cap and the foreseen CAGR and growth.
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.
Step 2: Primary Research
When we talk about primary research, it is a type of study in which the researchers collect relevant data samples directly, rather than relying on previously collected data. This type of research is focused on gaining content specific facts that can be sued to solve specific problems. Since the collected data is fresh and first hand therefore it makes the study more accurate and genuine.
We at SNS Insider have divided Primary Research into 2 parts.
Part 1 wherein we interview the KOLs of major players as well as the upcoming ones across various geographic regions. This allows us to have their view over the market scenario and acts as an important tool to come closer to the accurate market numbers. As many as 45 paid and unpaid primary interviews are taken from both the demand and supply side of the industry to make sure we land at an accurate judgement and analysis of the market.
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.
Part 2: In this part of primary research the data collected via secondary research and the part 1 of the primary research is validated with the interviews from individual consultants and subject matter experts.
Consultants are those set of people who have at least 12 years of experience and expertise within the industry whereas Subject Matter Experts are those with at least 15 years of experience behind their back within the same space. The data with the help of two main processes i.e., FGDs (Focused Group Discussions) and IDs (Individual Discussions). This gives us a 3rd party nonbiased primary view of the market scenario making it a more dependable one while collation of the data pointers.
Step 3: Data Bank Validation
Once all the information is collected via primary and secondary sources, we run that information for data validation. At our intelligence centre our research heads track a lot of information related to the market which includes the quarterly reports, the daily stock prices, and other relevant information. Our data bank server gets updated every fortnight and that is how the information which we collected using our primary and secondary information is revalidated in real time.
Step 4: QA/QC Process
After all the data collection and validation our team does a final level of quality check and quality assurance to get rid of any unwanted or undesired mistakes. This might include but not limited to getting rid of the any typos, duplication of numbers or missing of any important information. The people involved in this process include technical content writers, research heads and graphics people. Once this process is completed the title gets uploader on our platform for our clients to read it.
Step 5: Final QC/QA Process:
This is the last process and comes when the client has ordered the study. In this process a final QA/QC is done before the study is emailed to the client. Since we believe in giving our clients a good experience of our research studies, therefore, to make sure that we do not lack at our end in any way humanly possible we do a final round of quality check and then dispatch the study to the client.