Healthcare Payer Services Market Analysis by Outsourcing services (BPO, ITO, KPO), 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 Use (Private Payers, Public Payers), and Segment Forecasts to 2024

Published: Aug, 2016 | Pages: 74 | Publisher: Grand View Research
Industry: Healthcare | Report Format: Electronic (PDF)

The global healthcare payer services market is anticipated to reach USD 69.2 billion by 2024, according to a new report by Grand View Research. The key factors driving the market include the increasing demand for streamlined business processes and better customer services through the adoption of cost effective strategies.

The growing usage of advanced technologies to deliver economical business process services, rising adoption of digital technology, increasing focus on consumerism, and the presence of stringent healthcare regulatory policies are certain crucial factors boosting the healthcare payer services market in the coming years. Some of the key participants, such as Accenture, Cognizant, EXL, HP Development Company, L.P., Concentrix Corporation, and others, are primarily focusing on incorporating mobility technology with health plans to engage enrolled members.

Moreover, the growing private healthcare insurance exchanges, increasing IT investments, and with the Affordable Care Act (ACA) in effect, the market is set to grow. The increasing demand to curb the overall administrative costs of member management services, increasing demand for cost effective solutions for the healthcare payer services, and the growing number of healthcare fraud cases are few determinants that are expected to propel the market growth over the forecast period.

Some established players including United Healthcare, Inc., Anthem, Inc., Aetna, Inc., Accenture, Cognizant, Dell, HP Development Company, L.P., and Xerox Corporation are expanding their footprint through the implementation of various technologies such as digital technology and contract models. The technological advancements in the overall healthcare payer services system are anticipated to positively reinforce the market growth.

Further key findings from the study suggest:

In 2015, the BPO segment accounted for the maximum revenue share of 51.7%. The growing number of people enrolling for the insurance program, increasing pressure to bend the healthcare cost curve, and the rising implementation of ICD-10 codes are driving this segment's growth. However, the KPO segment is expected to emerge as the fastest growing with a CAGR of 17.9%. Increasing demand for accurate claim resolution and the reduction of fraud incidences are some of the factors that are expected to drive the market over the forecast period.

In 2015, North America was a clear leader with a revenue share of 77.31%. The growing insurance enrollment, lack of low-cost skilled professionals, and the increasing demand for an integrated healthcare system are accountable for the large market share captured by this segment.

Asia Pacific is expected to emerge as the fastest growing region with a CAGR of 10.8% during the forecast period. The Southeast Asian region is one of the major outsourcing destinations in the world. The region includes Malaysia, Singapore, Vietnam, Philippines, India, China, and many more, which are predominately involved in carrying out outsourcing activities. The presence of skilled workforce to provide high-end process services, such as software development and application development management, is one of the prominent factors driving the Asia Pacific healthcare payer services market in the coming years.

The healthcare payer services market is presently dominated by few key participants, such as United Healthcare, Inc., Anthem, Inc., Aetna, Inc., Cigna, Humana, Inc., Accenture, Xerox Corporation, Genpact, IBM Corporation, and Cognizant. The healthcare payer services players initiate merger & acquisition and corporate development strategies primarily to further expand their reach in various other verticals. For instance, Wipro Limited had acquired HealthPlan Services for approximately USD 460 million to diversify its health insurance product portfolio.

 Table of Contents

Chapter 1 Executive Summary

Chapter 2 Market Snapshot

Chapter 3 Market Variables, Trends & Scope
                     3.1 Market Segmentation & Scope
                        3.1.1 Market Driver Analysis
                              3.1.1.1 Growing demand for smart health plan selector tools 
                              3.1.1.2 Lack of in-house skilled professionals
                        3.1.2 Market Restraint Analysis
                              3.1.2.1 Loss of confidentiality and increasing number of data breaches
                     3.2 Penetration & Growth Prospect Mapping
                     3.3 Healthcare Payer - SWOT Analysis, By Factor (political & legal, economic and technological)
                     3.4 Industry Analysis - Porter's

Chapter 4 Market Categorization 1: Outsourcing Services Estimates & Trend Analysis
                     4.1 Healthcare Payer market: Outsourcing Services Movement Analysis
                     4.2 BPO
                        4.2.1 BPO market estimates and forecasts, 2013 - 2024 (USD Billion)
                     4.3 ITO
                        4.3.1 ITO market estimates and forecasts, 2013 - 2024 (USD Billion)
                     4.4 KPO
                        4.4.1 KPO market estimates and forecasts, 2013 - 2024 (USD Billion)


Chapter 5 Market Categorization 2: Application Estimates & Trend Analysis
                     5.1 Healthcare Payer Market: Application Movement Analysis
                     5.2 Claims Management Services
                        5.2.1 Claims management services market estimates and forecasts, 2013 - 2024 (USD Billion)
                     5.3 Integrated Front Office Service and Back Office operations
                        5.3.1 Integrated front office service and back office operations market estimates and forecasts, 2013 - 2024 (USD Billion)
                     5.4 Member Management Services
                        5.4.1 Member management services market estimates and forecasts, 2013 - 2024 (USD Billion)
                     5.5 Provider Management Services
                        5.5.1 Provider management services market estimates and forecasts, 2013 - 2024 (USD Billion)
                     5.6 Billing and Accounts Management Services
                        5.6.1 Billing and accounts management services market estimates and forecasts, 2013 - 2024 (USD Billion)
                     5.7 Analytics and Fraud Management Services
                        5.7.1 Analytics and fraud management services market estimates and forecasts, 2013 - 2024 (USD Billion)
                     5.8 HR Services
                        5.8.1 HR services market estimates and forecasts, 2013 - 2024 (USD Billion)

Chapter 6 Market Categorization 3: End-Use Estimates & Trend Analysis
                     6.1 Healthcare Payer Market: End-Use Movement Analysis
                     6.2 Private Payers
                        6.2.1 Private payers market estimates and forecasts, 2013 - 2024 (USD Billion)
                     6.3 Public Payers
                        6.3.1 Public payers market estimates and forecasts, 2013 - 2024 (USD Billion)

Chapter 7 Market Categorization 4: Regional Estimates & Trend Analysis
                     7.1 Healthcare Payer Market Share by Region, 2013 & 2024
                     7.2 North America
                        7.2.1 Healthcare payer services market estimates and forecasts, by outsourcing services 2013 - 2024(USD Billion)
                        7.2.2 Healthcare payer services market estimates and forecasts, by application 2013 - 2024(USD Billion)
                        7.2.3 Healthcare payer services market estimates and forecasts, by end use 2013 - 2024(USD Billion)
                        7.2.4 U.S.
                              7.2.4.1 U.S. healthcare payer services market estimates and forecasts, by outsourcing services 2013 - 2024(USD Billion)
                              7.2.4.2 U.S. healthcare payer services market estimates and forecasts, by application 2013 - 2024(USD Billion)
                              7.2.4.3 U.S. healthcare payer services market estimates and forecasts, by end use 2013 - 2024(USD Billion)
                        7.2.5 Canada
                              7.2.5.1 Canada healthcare payer services market estimates and forecasts, by outsourcing services 2013 - 2024(USD Billion)
                              7.2.5.2 Canada healthcare payer services market estimates and forecasts, by application 2013 - 2024(USD Billion)
                              7.2.5.3 Canada healthcare payer services market estimates and forecasts, by end use 2013 - 2024(USD Billion)
                     7.3 Europe
                        7.3.1 Healthcare payer services market estimates and forecasts, by outsourcing services 2013 - 2024(USD Billion)
                        7.3.2 Healthcare payer services market estimates and forecasts, by application 2013 - 2024(USD Billion)
                        7.3.3 Healthcare payer services market estimates and forecasts, by end use 2013 - 2024(USD Billion)
                        7.3.4 Germany
                              7.3.4.1 Germany healthcare payer services market estimates and forecasts, by outsourcing services 2013 - 2024(USD Billion)
                              7.3.4.2 Germany healthcare payer services market estimates and forecasts, by application 2013 - 2024(USD Billion)
                        7.3.4.3 Germany healthcare payer services market estimates and forecasts, by end use 2013 - 2024(USD Billion)
                        7.3.5 UK
                              7.3.5.1 UK healthcare payer services market estimates and forecasts, by outsourcing services 2013 - 2024(USD Billion)
                              7.3.5.2 UK healthcare payer services market estimates and forecasts, by application 2013 - 2024(USD Billion)
                              7.3.5.3 UK healthcare payer services market estimates and forecasts, by end use 2013 - 2024(USD Billion)
                     7.4 Asia Pacific
                        7.4.1 Healthcare payer services market estimates and forecasts, by outsourcing services 2013 - 2024(USD Billion)
                        7.4.2 Healthcare payer services market estimates and forecasts, by application 2013 - 2024(USD Billion)
                        7.4.3 Healthcare payer services market estimates and forecasts, by end use 2013 - 2024(USD Billion)
                        7.4.4 Japan
                              7.4.4.1 Japan healthcare payer services market estimates and forecasts, by outsourcing services 2013 - 2024(USD Billion)
                              7.4.4.2 Japan healthcare payer services market estimates and forecasts, by application 2013 - 2024(USD Billion)
                              7.4.4.3 Japan healthcare payer services market estimates and forecasts, by end use 2013 - 2024(USD Billion)
                        7.4.5 China
                              7.4.5.1 China healthcare payer services market estimates and forecasts, by outsourcing services 2013 - 2024(USD Billion)
                              7.4.5.2 China healthcare payer services market estimates and forecasts, by application 2013 - 2024(USD Billion)
                              7.4.5.2 China healthcare payer services market estimates and forecasts, by end use 2013 - 2024(USD Billion)
                        7.4.6 India
                              7.4.6.1 India healthcare payer services market estimates and forecasts, by outsourcing services 2013 - 2024(USD Billion)
                              7.4.6.2 India healthcare payer services market estimates and forecasts, by application 2013 - 2024(USD Billion)
                              7.4.6.3 India healthcare payer services market estimates and forecasts, by end use 2013 - 2024(USD Billion)
                     7.5 Latin America
                        7.5.1 Healthcare payer services market estimates and forecasts, by outsourcing services 2013 - 2024(USD Billion)
                        7.5.2 Healthcare payer services market estimates and forecasts, by application 2013 - 2024(USD Billion)
                        7.5.3 Healthcare payer services market estimates and forecasts, by end use 2013 - 2024(USD Billion)
                        7.5.4 Brazil
                              7.5.4.1 Brazil healthcare payer services market estimates and forecasts, by outsourcing services 2013 - 2024(USD Billion)
                              7.5.4.2 Brazil healthcare payer services market estimates and forecasts, by application 2013 - 2024(USD Billion)
                              7.5.4.3 Brazil healthcare payer services market estimates and forecasts, by end use 2013 - 2024(USD Billion)
                        7.5.5 Mexico
                              7.5.5.1 Mexico healthcare payer services market estimates and forecasts, by outsourcing services 2013 - 2024(USD Billion)
                              7.5.5.2 Mexico healthcare payer services market estimates and forecasts, by application 2013 - 2024(USD Billion)
                              7.5.5.3 Mexico healthcare payer services market estimates and forecasts, by end use 2013 - 2024(USD Billion)
                     7.6 MEA
                        7.6.1 Healthcare payer services market estimates and forecasts, by outsourcing services 2013 - 2024(USD Billion)
                        7.6.2 Healthcare payer services market estimates and forecasts, by application 2013 - 2024(USD Billion)
                        7.6.3 Healthcare payer services market estimates and forecasts, by end use 2013 - 2024(USD Billion)
                        7.6.4 South Africa
                              7.6.4.1 South Africa healthcare payer services market estimates and forecasts, by outsourcing services 2013 - 2024(USD Billion)
                              7.6.4.2 South Africa healthcare payer services market estimates and forecasts, by application 2013 - 2024(USD Billion)
                              7.6.4.3 South Africa healthcare payer services market estimates and forecasts, by end use 2013 - 2024(USD Billion)

Chapter 8 Competitive Landscape
                     8.1 Strategy framework
                     8.2 Market Participation Categorization
                     8.3 Company Profiles
                        8.3.1 Cognizant 
                              8.3.1.1 Company overview
                              8.3.1.2 Financial performance
                              8.3.1.3 Product benchmarking
                              8.3.1.4 Strategic initiatives
                        8.3.2 Accenture 
                              8.3.2.1 Company overview
                              8.3.2.2 Financial performance
                              8.3.2.3 Product benchmarking
                              8.3.2.4 Strategic initiatives
                        8.3.3 EXL
                              8.3.3.1 Company overview
                              8.3.3.2 Financial performance
                              8.3.3.3 Product benchmarking
                              8.3.3.4 Strategic initiatives
                        8.3.4 Concentrix Corporation
                              8.3.4.1 Company overview
                              8.3.4.2 Financial performance
                              8.3.4.3 Product benchmarking
                              8.3.4.4 Strategic initiatives
                        8.3.5 HP Development Company, L.P.
                              8.3.5.1 Company overview
                              8.3.5.2 Financial performance
                              8.3.5.3 Product benchmarking
                              8.3.5.4 Strategic initiatives
                        8.3.6 HGS Limited
                              8.3.6.1 Company overview
                              8.3.6.2 Financial performance
                              8.3.6.3 Product benchmarking
                              8.3.6.4 Strategic initiatives
                        8.3.7 Xerox Corporation
                              8.3.7.1 Company overview
                              8.3.7.2 Financial performance
                              8.3.7.3 Product benchmarking
                              8.3.7.4 Strategic initiatives
                        8.3.8 Dell
                              8.3.8.1 Company overview
                              8.3.8.2 Financial performance
                              8.3.8.3 Product benchmarking
                              8.3.8.4 Strategic initiatives
                        8.3.9 Genpact 
                              8.3.9.1 Company overview
                              8.3.9.2 Financial performance
                              8.3.9.3 Product benchmarking
                              8.3.9.4 Strategic initiatives
                        8.3.10 HCL Technologies Ltd.
                              8.3.10.1 Company overview
                              8.3.10.2 Financial performance
                              8.3.10.3 Product benchmarking
                              8.3.10.4 Strategic initiatives
                        8.3.11 Wipro Limited
                              8.3.11.1 Company overview
                              8.3.11.2 Financial performance
                              8.3.11.3 Product benchmarking
                              8.3.11.4 Strategic initiatives
                        8.3.12 United Healthcare
                              8.3.12.1 Company overview
                              8.3.12.2 Financial performance
                              8.3.12.3 Product benchmarking
                              8.3.12.4 Strategic initiatives
                        8.3.13 Anthem Inc.
                              8.3.13.1 Company overview
                              8.3.13.2 Financial performance
                              8.3.13.3 Product benchmarking
                              8.3.12.4 Strategic initiatives
                        8.3.14 Aetna, Inc.
                              8.3.14.1 Company overview
                              8.3.14.2 Financial performance
                              8.3.14.3 Product benchmarking
                              8.3.14.4 Strategic initiatives
                        8.3.15 CIGNA Corp.
                              8.3.15.1 Company overview
                              8.3.15.2 Financial performance
                              8.3.15.3 Product benchmarking
                              8.3.15.4 Strategic initiatives

List of Tables


TABLE 1 Global healthcare payer services market revenue, by outsourcing services, 2013 - 2024 (USD Billion)
TABLE 2 Global healthcare payer services market revenue, by application, 2013 - 2024 (USD Billion)
TABLE 3 Global healthcare payer services market revenue, by end use, 2013 - 2024 (USD Billion)
TABLE 4 Global healthcare payer services market revenue, by region, 2013 - 2024 (USD Billion)
TABLE 5 North America healthcare payer services market, by outsourcing services, 2013 - 2024 (USD Billion)
TABLE 6 North America healthcare payer services market, by application, 2013 - 2024 (USD Billion)
TABLE 7 North America healthcare payer services market, by end use, 2013 - 2024 (USD Billion)
TABLE 8 U.S. healthcare payer services market, by outsourcing services, 2013 - 2024 (USD Billion)
TABLE 9 U.S. healthcare payer services market, by application, 2013 - 2024 (USD Billion)
TABLE 10 U.S. healthcare payer services market, by end use, 2013 - 2024 (USD Billion)
TABLE 11 Canada healthcare payer services market, by outsourcing services, 2013 - 2024 (USD Billion)
TABLE 12 Canada healthcare payer services market, by application, 2013 - 2024 (USD Billion)
TABLE 13 Canada healthcare payer services market, by end use, 2013 - 2024 (USD Billion)
TABLE 14 Europe healthcare payer services market, by outsourcing services, 2013 - 2024 (USD Billion)
TABLE 15 Europe healthcare payer services market, by application, 2013 - 2024 (USD Billion)
TABLE 16 Europe healthcare payer services market, by end use, 2013 - 2024 (USD Billion)
TABLE 17 Germany healthcare payer services market, by outsourcing services, 2013 - 2024 (USD Billion)
TABLE 18 Germany healthcare payer services market, by application, 2013 - 2024 (USD Billion)
TABLE 19 Germany healthcare payer services market, by end use, 2013 - 2024 (USD Billion)
TABLE 20 UK healthcare payer services market, by outsourcing services, 2013 - 2024 (USD Billion)
TABLE 21 UK healthcare payer services market, by application, 2013 - 2024 (USD Billion)
TABLE 22 UK healthcare payer services market, by end use, 2013 - 2024 (USD Billion)
TABLE 23 Asia Pacific healthcare payer services market, by outsourcing services, 2013 - 2024 (USD Billion)
TABLE 24 Asia Pacific healthcare payer services market, by application, 2013 - 2024 (USD Billion)
TABLE 25 Asia Pacific healthcare payer services market, by end use, 2013 - 2024 (USD Billion)
TABLE 26 Japan healthcare payer services market, by outsourcing services, 2013 - 2024 (USD Billion)
TABLE 27 Japan healthcare payer services market, by application, 2013 - 2024 (USD Billion)
TABLE 28 Japan healthcare payer services market, by end use, 2013 - 2024 (USD Billion)
TABLE 29 China healthcare payer services market, by outsourcing services, 2013 - 2024 (USD Billion)
TABLE 30 China healthcare payer services market, by application, 2013 - 2024 (USD Billion)
TABLE 31 China healthcare payer services market, by end use, 2013 - 2024 (USD Billion)
TABLE 32 India healthcare payer services market, by outsourcing services, 2013 - 2024 (USD Billion)
TABLE 33 India healthcare payer services market, by application, 2013 - 2024 (USD Billion)
TABLE 34 India healthcare payer services market, by end use, 2013 - 2024 (USD Billion)
TABLE 35 Latin America healthcare payer services market, by outsourcing services, 2013 - 2024 (USD Billion)
TABLE 36 Latin America healthcare payer services market, by application, 2013 - 2024 (USD Billion)
TABLE 37 Latin America healthcare payer services market, by end use, 2013 - 2024 (USD Billion)
TABLE 38 Brazil healthcare payer services market, by outsourcing services, 2013 - 2024 (USD Billion)
TABLE 39 Brazil healthcare payer services market, by application, 2013 - 2024 (USD Billion)
TABLE 40 Brazil healthcare payer services market, by end use, 2013 - 2024 (USD Billion)
TABLE 41 Mexico healthcare payer services market, by outsourcing services, 2013 - 2024 (USD Billion)
TABLE 42 Mexico healthcare payer services market, by application, 2013 - 2024 (USD Billion)
TABLE 43 Mexico healthcare payer services market, by end use, 2013 - 2024 (USD Billion)
TABLE 44 MEA healthcare payer services market, by outsourcing services, 2013 - 2024 (USD Billion)
TABLE 45 MEA healthcare payer services market, by application, 2013 - 2024 (USD Billion)
TABLE 46 MEA healthcare payer services market, by end use, 2013 - 2024 (USD Billion)
TABLE 47 South Africa healthcare payer services market, by outsourcing services, 2013 - 2024 (USD Billion)
TABLE 48 South Africa healthcare payer services market, by application, 2013 - 2024 (USD Billion)
TABLE 49 South Africa healthcare payer services market, by end use, 2013 - 2024 (USD Billion)