Healthcare Payer Services Market Outlook to 2024: In-depth Market view, Key Outsourcing Services (BPO, ITO, KPO), 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), End Use (Private, Public), Regional Segmentation, Competitive Dynamics, Pricing Analysis (OPP, IPP, RAP) And Segment Forecast

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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.

 

Healthcare Payer Services Market

 

Pricing Analysis

 

“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

 

Regional Segmentation

 

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.

 

 

Market Segmentation

Healthcare Payer Services (Outsourcing) Market, by Service Type (Revenue, USD Million, 2014- 2024)

  • BPO
  • ITO
  • KPO

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
    • U.S.
    • Canada
  • Europe
    • UK
    • Germany
    • France
    • Italy
    • Spain
  • Latin America
    • Brazil
    • Mexico
    • Colombia
  • Asia pacific
    • Japan
    • China
    • India
  • Middle East & Africa
    • Saudi Arabia
    • South Africa

Chapter 1 Methodology and Scope

  • Research Methodology
  • Research Scope & Assumptions
  • List of Data Sources

Chapter 2 Executive Summary

Chapter 3 Healthcare Payer Service Market Overview

  • Global payers market
  • Global Service Providers

Chapter 4 Commercial Payers Industry Outlook

  • Market overview
  • Market segmentation
  • Market size and growth prospects
  • Market analysis by type service
  • Market analysis by application type
  • Leading brand dynamics
  • Key Market Drivers
    • Aging population across the globe
    • Rising prevalence of chronic diseases
    • Growing demand for outsourcing
    • Changes in the reimbursement framework and government mandates
  • Key Market Challenges
    • Cyber security
    • Changes in the outsourcing models
  • Major Trends and issues
  • Key events and its impact on future market
  • Key Opportunities Prioritized
  • Industry analysis - Porter’s
  • Commercial Payers Market-PESTEL Analysis

Chapter 5: - Healthcare Payer Services (Outsourcing) Market, by Service Type (Revenue, USD Million)

  • Healthcare Payer Services (Outsourcing) Market Landscape by Service Type- 2016 & 2024
    • BPO (Business Process Outsourcing)
  • Market Landscape Analysis, 2016-2024 (USD Mn)
    • ITO (Information Technology Outsourcing)
  • Market Landscape Analysis, 2016-2024 (USD Mn)
    • KPO (Knowledge Process Outsourcing)
  • Market Landscape Analysis, 2016-2024 (USD Mn)

Chapter 6: - Healthcare Payer Services Market, by Application (Revenue, USD Million, 20124- 2024)

Healthcare Payer Services Market Landscape by Application Type- 2016 & 2024
  • Claims Management Services
    • Market Landscape Analysis, 2016-2024 (USD Mn)
  • Integrated Front Office Service and Back Office Operations
    • Market Landscape Analysis, 2016-2024 (USD Mn)
  • Management Services
    • Market Landscape Analysis, 2016-2024 (USD Mn)
  • Provider Management Services
    • Market Landscape Analysis, 2016-2024 (USD Mn)
  • Billing and Accounts Management Services
    • Market Landscape Analysis, 2016-2024 (USD Mn)
  • Analytics and Fraud Management Services
    • Market Landscape Analysis, 2016-2024 (USD Mn)
  • HR Services
    • Market Landscape Analysis, 2016-2024 (USD Mn)

Chapter 7: - Healthcare Payer Services Market by “End User” (USD Million)

Healthcare Payer Services Market Landscape by End Users- 2016 & 2024
  • Private Payers
    • Market Landscape Analysis, 2016-2024 (USD Mn)
  • Public Payers
    • Market Landscape Analysis, 2016-2024 (USD Mn)

Chapter 8: Regional Market Outlook

Healthcare Payer Service Market Landscape by Region- 2016
  • North America Market Landscape Analysis, 2016-2022 (USD MM)
    • U.S. Market Landscape Analysis, 2016-2022
    • Canada Market Landscape Analysis-2016-2024
  • Europe Market Landscape Analysis, 2016-2022 (USD MM)
    • UK Market Landscape Analysis, 2016-2022
    • Germany Market Landscape Analysis, 2016-2024
    • France Market Landscape Analysis, 2016-2024
    • Italy Market Landscape Analysis, 2016-2024
    • Spain Market Landscape Analysis, 2016-2024
  • Latin America Market Landscape Analysis, 2016-2024 (USD MM)
    • Brazil Market Landscape Analysis, 2016-2024
    • Mexico Market Landscape Analysis, 2016-2024
    • Colombia Market Landscape Analysis, 2016-2024
  • Asia pacific Market Landscape Analysis, 2016-2024 (USD MM)
    • Japan Market Landscape Analysis, 2016-2024
    • China Market Landscape Analysis, 2016-2024
    • India Market Landscape Analysis, 2016-2024

Chapter 9: Pricing Analysis

Optimal Price Points (OPP), Indifference price points (IPP) and Range of Acceptable Prices and (RAP) of leading brands by Region- 2016
  • North America Pricing Analysis (OPP, IPP,and RAP - 2016)
    • U.S. Pricing Analysis-2016
    • Canada Pricing Analysis-2016
  • Europe Pricing Analysis (OPP, IPP,and RAP - 2016)
    • UK Pricing Analysis-2016
    • Germany Pricing Analysis-2016
    • France Pricing Analysis-2016
    • Italy Pricing Analysis-2016
    • Spain Pricing Analysis-2016
  • Latin America Pricing Analysis (OPP, IPP,and RAP - 2016)
    • Brazil Pricing Analysis-2016
    • Mexico Pricing Analysis-2016
    • Colombia Pricing Analysis-2016
  • Asia pacific Pricing Analysis (OPP, IPP,and RAP - 2016)
    • Japan Pricing Analysis-2016
    • China Pricing Analysis-2016
    • India Pricing Analysis-2016

Chapter 10: Competitive Landscape

  • Aetna
    • Company Overview
    • Financial Performance
    • Key Decision Maker
    • Product Pipeline
    • Strategic Initiative
  • Kaiser Permanente
    • Company Overview
    • Financial Performance
    • Key Decision Maker
    • Product Pipeline
    • Strategic Initiative
  • UnitedHealthOne
    • Company Overview
    • Financial Performance
    • Key Decision Maker
    • Product Pipeline
    • Strategic Initiative
  • IHC Group
    • Company Overview
    • Financial Performance
    • Key Decision Maker
    • Product Pipeline
    • Strategic Initiative
  • Assurant Health
    • Company Overview
    • Financial Performance
    • Key Decision Maker
    • Product Pipeline
    • Strategic Initiative
  • Humana
    • Company Overview
    • Financial Performance
    • Key Decision Maker
    • Product Pipeline
    • Strategic Initiative
  • Cigna
    • Company Overview
    • Financial Performance
    • Key Decision Maker
    • Product Pipeline
    • Strategic Initiative
  • Premera Blue Cross
    • Company Overview
    • Financial Performance
    • Key Decision Maker
    • Product Pipeline
    • Strategic Initiative
  • Universal American Corporation
    • Company Overview
    • Financial Performance
    • Key Decision Maker
    • Product Pipeline
    • Strategic Initiative
  • Centene Corporation
    • Company Overview
    • Financial Performance
    • Key Decision Maker
    • Product Pipeline
    • Strategic Initiative
  List of Tables   TABLE 1 Healthcare Payer Service Market - Industry Snapshot & Key Buying Criteria, 2013 - 2024 TABLE 2 Global Commercial Payers Epidemiology, 2013 - 2024 TABLE 3 Global Chronic Wound Care Treatment, 2013 - 2024 TABLE 4 Global Commercial Payers Incidence, 2013 - 2024 TABLE 5 Global Healthcare Payer Service Market Analysis by Product Type-2016 TABLE 6 Global Healthcare Payer Service Market Analysis by Leading Brands-2016 TABLE 7 Healthcare Payer Service Market - Key market driver analysis TABLE 8 Healthcare Payer Service Market - Key market restraint analysis TABLE 9 North America Market Commercial Payers Landscape Analysis, 2016-2024 (USD MM) TABLE 10 U.S. Healthcare Payer Service Market Landscape Analysis, 2016-2024 TABLE 11 Canada Healthcare Payer Service Market Landscape Analysis, 2016-2024 TABLE 12 Europe Healthcare Payer Service Market Landscape Analysis, 2016-2022 (USD MM) TABLE 13 U.K Healthcare Payer Service Market Landscape Analysis, 2016-2022 TABLE 14 Germany Healthcare Payer Service Market Landscape Analysis, 2016-2024 TABLE 15 France Healthcare Payer Service Market Landscape Analysis, 2016-2024 TABLE 16 Italy Healthcare Payer Service Market Landscape Analysis, 2016-2024 TABLE 17 Spain Healthcare Payer Service Market Landscape Analysis, 2016-2024 TABLE 18 Latin America Healthcare Payer Service Market Landscape Analysis, 2016-2024 (USD MM) TABLE 19 Brazil Healthcare Payer Service Market Landscape Analysis, 2016-2024 TABLE 20 Mexico Healthcare Payer Service Market Landscape Analysis, 2016-2024 TABLE 21 Colombia Healthcare Payer Service Market Landscape Analysis, 2016-2024 TABLE 21 Asia pacific Healthcare Payer Service Market Landscape Analysis, 2016-2024 (USD MM) TABLE 22 Japan Healthcare Payer Service Market Landscape Analysis, 2016-2024 TABLE 23 China Healthcare Payer Service Market Landscape Analysis, 2016-2024 TABLE 24 India Healthcare Payer Service Market Landscape Analysis, 2016-2024 TABLE 25 North America Pricing Analysis TABLE 26 North America Pricing Analysis (OPP, IPP,and RAP - 2016) TABLE 27 U.S. Pricing Analysis-2016 TABLE 28 Canada Pricing Analysis-2016 TABLE 29 Europe Pricing Analysis (OPP, IPP,and RAP - 2016) TABLE 30 U.K Pricing Analysis-2016 TABLE 31 Germany Pricing Analysis-2016 TABLE 32 France Pricing Analysis-2016 TABLE 33 Italy Pricing Analysis-2016 TABLE 34 Spain Pricing Analysis-2016 TABLE 35 Latin America Pricing Analysis (OPP, IPP,and RAP - 2016) TABLE 36 Brazil Pricing Analysis-2016 TABLE 37 Mexico Pricing Analysis-2016 TABLE 38 Colombia Pricing Analysis-2016 TABLE 39 Asia pacific Pricing Analysis (OPP, IPP,and RAP - 2016) TABLE 40 Japan Pricing Analysis-2016 TABLE 41 China Pricing Analysis-2016 TABLE 42 India Pricing Analysis-2016TABLE 21 U.S. market, by demographic, 2012 - 2022 (USD Million) TABLE 43 U.S. Commercial Payers Reimbursement Landscape Analysis -2016 TABLE 44 Canada Commercial Payers Reimbursement Landscape Analysis -2016 TABLE 45 Europe Commercial Payers Reimbursement Landscape Analysis -2016 TABLE 46 U.K Commercial Payers Reimbursement Landscape Analysis-2016 TABLE 47 Germany Commercial Payers Reimbursement Landscape Analysis-2016 TABLE 48 France Commercial Payers Reimbursement Landscape Analysis-2016 TABLE 49 Italy Commercial Payers Reimbursement Landscape Analysis-2016 TABLE 50 Spain Commercial Payers Reimbursement Landscape Analysis-2016 TABLE 51 Latin America Commercial Payers Reimbursement Landscape Analysis -2016 TABLE 52 Brazil Commercial Payers Reimbursement Landscape Analysis-2016 TABLE 53 Mexico Commercial Payers Reimbursement Landscape Analysis-2016 TABLE 54 Colombia Commercial Payers Reimbursement Landscape Analysis-2016 TABLE 55 Asia Pacific Commercial Payers Reimbursement Landscape Analysis-2016 TABLE 56 China Commercial Payers Reimbursement Landscape Analysis-2016 TABLE 56 Japan Commercial Payers Reimbursement Landscape Analysis-2016 TABLE 57 India Commercial Payers Reimbursement Landscape Analysis-2016   List of Figures-   FIG. 1 Healthcare Payer Service Market Segmentation FIG. 2 Market Size & Growth Prospects FIG. 3 Leading Brand Dynamics FIG. 4 Penetration & Growth Prospects FIG. 5 Industry Analysis – Porter’s    

Key Insights Addressed:  

  • Defining market size from 2013 to 2015.
  • Estimating market growth till 2024 and consequence market forecast.
  • Identifying market drivers, restraints & future opportunities and allowing decision-maker with a range of possible outcomes and the probabilities that will occur for any choice of action.
  • Market segments and regions that will drive or lead market growth.
  • Defining Optimal Price Point (OPP) which will be accepted and recommended by maximum customers.
  • A bird’s-eye view of competitive landscape and the key market players.
  • Key strategic growth driver adopted by market players. In-depth analysis of their strategies and implication on competition & growth.
    Key Findings:    
  • The global healthcare payer service 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 lot of automation going on to streamline the services. Hence 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
  • 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.
  • 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.
  • 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.

Ameri Research implies a unique methodology of published information and primary research to bring key insights to customer decision making process. Our analytics model helps us to understand the structured and unstructured information from various sources. Key steps involves in the process are as below-

  1. Analyzing Published Information- Access to large pool of paid and unpaid published information via different sources and analyzing market trend.
  2. Setting Foundation- Input from analysis of secondary sources set our foundation to market analysis and helps in setting the scope for further research. Setting the scope involves Ameri Research proprietary statistical model, discussion with industry leaders, internal brainstorming, key discussion pointers from various forums etc.
  3. Need Gap Analysis- Defining the gap between our scope and availability of information.
  4. KOL Panel Discussion- Focused Group Discussion with a structured discussion guide to fine tune the gap and deriving the factors driving/restraining the market trend.
  5. Quantitative Research- Sampling large number of industry players, Education/Research Institutes, Government bodies, NGOs, Individual acclaimed researchers and conducting the primary interview with a structured questionnaire.
  6. Data Triangulation- We apply bottom-up demand approach or top-down estimation or a combined approach to triangulate the data points.
  7. Analyst Comment- Each of our analysts carries large pool of experience from domain perspective and add their value which is directional in nature
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Description

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.

 

Healthcare Payer Services Market

 

Pricing Analysis

 

“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

 

Regional Segmentation

 

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.

 

 

Market Segmentation

Healthcare Payer Services (Outsourcing) Market, by Service Type (Revenue, USD Million, 2014- 2024)

  • BPO
  • ITO
  • KPO

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
    • U.S.
    • Canada
  • Europe
    • UK
    • Germany
    • France
    • Italy
    • Spain
  • Latin America
    • Brazil
    • Mexico
    • Colombia
  • Asia pacific
    • Japan
    • China
    • India
  • Middle East & Africa
    • Saudi Arabia
    • South Africa

Additional information

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