The global healthcare payer services market was valued at $40.6 bn in 2016 and is forecast to grow at a CAGR of 11.1% between 2017 and 2024, culminating in 2024 global market size of $106 bn.
BPO services represent 45% of total services, followed by IT Outsourcing and KPO services. There is a lot of automation going on to streamline the services. Hence the demand for work around machine learning, AI will further boost the IT and IT-enabled services. Lack of adequate resources in U.S. market and cost arbitrage will further boost the outsourcing.
We have segmented the market on the basis of services, applications and end use. On the basis of applications, it is segmented into 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. Within applications, claim management, billing and account management services and analytics will lead the market. From end-user perspective, we have segmented the service market from public and private insurance players.
The journey towards value-based reimbursement: The major disruptive force shaping the commercial payer’s space is the transition to value-based reimbursement from the traditional fee for service payment model. To achieve the same, they are using predictive analytics, advanced software and machine learning.
“Optimal Price Point (OPP) for Healthcare Payer Services”
Estimated Average Healthcare Payer services cost – $ xx globally. However, with improving access and availability of options, OPP and range of acceptable Prices (RAP) are going to change. We at Ameri Research continuously track these prices with our proprietary pricing model.
Our report will provide major services outsourced by payers to IT and ITES companies and cost of execution by services. We will also map the market to previous projects and fees for services
The key regions analyzed in the study include North America, Europe, Asia-Pacific, Latin America and the Middle East and Africa. In 2016, North America dominated the market with a revenue share of over 75%. Increasing health insurance enrolment, presence of robust framework like ACA (Affordable Care Act), HIPPA (Health Insurance Portability and Accountability Act of 1996), ICD-10 reporting will drive the need for more and more advanced software and business process.
With changing landscape, Asia-Pacific is expected to emerge as the fastest growing region with a CAGR of 8.5% over the forecast period. Growing demand for health insurance, availability of trained resources and demand for customized insurance products will further drive the market for solutions.
Merger and Acquisition Insight
Revenue cycle management technology companies Navicure and ZirMed merge together to bring efficiency into their offering while financial terms of the deal have not been disclosed. This will be finalized before the end of the year, said ZirMed Chairman and CEO Tom Butts.
The Advisory Board Company (Healthcare research, technology and consulting firm) sell its healthcare business to Optum and its education division to Vista Equity Partners in a duo of deals worth $2.58 billion. Our report tracks all such merger and acquisition in this space.
Top Players & Company Share
As of 2016, major players in the market include United HealthCare Services Inc., Anthem Inc., Aetna Inc., Accenture, Cognizant, Xerox Corporation, EXL, Concentrix Corporation, HP Development Company, L.P., HGS Limited, Dell, HCL Technologies Ltd., Wipro Limited, United Healthcare, CIGNA Corp. and Genpact.
Healthcare Payer Services (Outsourcing) Market, by Service Type (Revenue, USD Million, 2014- 2024)
Healthcare Payer Services Market, by Application (Revenue, USD Million, 20124- 2024)
- 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
Healthcare Payer Services Market, by End User (Revenue, USD Million, 20124- 2024)
- Private Payers
- Public Payers
Healthcare Payer Services Market, Regional Outlook (Revenue, USD Million, 20124- 2024)
- North America
- Latin America
- Asia pacific
- Middle East & Africa
- Saudi Arabia
- South Africa