Healthcare Payer Services Market

The global healthcare payer services market in terms of revenue was estimated to be worth $69.9 billion in 2022 and is poised to reach $118.2 billion by 2027, growing at a CAGR of 11.1% from 2022 to 2027. The new research study consists of an industry trend analysis of the market. The new research study consists of industry trends, pricing analysis, patent analysis, conference and webinar materials, key stakeholders, and buying behaviour in the market. Increased health insurance enrollment, rising incidences of healthcare fraud, increased usage of outsourcing, federal mandates, and rising cases of chronic diseases are driving growth in this market. However, the risks of data breaches, loss of managerial control, cultural and linguistic hurdles, and high outsourcing costs are projected to limit the market's growth to some extent.

Healthcare Payer Services Market Trends

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Healthcare Payer Services Market Dynamics

Driver: Outsourcing of services to reduce costs and increase efficiency

Over the past few decades, healthcare costs have been extremely increasing. Rising health insurance costs fuel the rising cost of healthcare, the increasing need for healthcare services, the rising geriatric population worldwide, and the subsequent increase in chronic conditions. Additional factors contributing to healthcare expenses include wasteful use of resources, inflated claims, and administrative costs. Due to the increasing costs associated with healthcare, payers are focusing on leveraging the advantages of outsourcing. The need of outsourcing services to reduce costs and increase efficiency is one of the key growth drivers for the global market.

Restraint: Data breaches and loss of confidentiality

Working with healthcare payer servicing firms increases the danger of security breaches and data leaks. Extremely sensitive and legally protected information such as patient contact information, medical history, insurance plans, and illnesses can significantly impact demand. The healthcare provider could be extremely impacted due to a breach or leak of this data, as it would undermine patient confidence. Additionally, it can result in legal actions, costing the business more losses. Incidents of healthcare data breaches rose by 55% in 2020 over 2019. In 2020, there were around 600 breaches that affected over 26 million people.

Opportunity: Adoption of advanced data analytics

The increasing volume of patient data created by electronic records and various other sources, including connected technologies and devices, has also fueled the expansion of this industry. Since the data is unstructured and raw, analytics is necessary to draw useful conclusions. Business intelligence (BI) tools are used more frequently to interpret this data. Pharma companies, healthcare providers, payers, and patients, continuously produce digital data; using BI technologies not only suggests the best course of action to follow throughout the treatment process but also helps reduce the risk of disease. With a focus on managing medical loss ratios, payers must use data analytics to retain current members and implement effective care management programs. Many payers have started using analytics that extensively uses data, enables statistical and quantitative analysis, and uses predictive models to drive better fact-based decision-making. Due to the benefits of advanced data analytics and its applications, its adoption can be expected to increase; this provides major growth opportunities for the healthcare payer outsourcing market.

Challenge: Migration from legacy systems

A legacy system is an old method, technology, or application program that continues to be used, typically because it still caters to users’ needs, even though newer technologies and more efficient methods are available. Nearly all companies in the insurance sector offer the same goods. Therefore, one of the most crucial market differentiators is customer service. Bringing consumers closer to the business, providing facilities for easy information and transaction access, and ensuring continuous distributor support are new trends driving this market. Since these platforms are intrinsically limited and unable to support business simplicity and enterprise-wide data interpretation, the legacy landscape is rapidly shifting to support this business change. Legacy systems present difficulties since the application software is typically built in out-of-date programming languages and is typically mainframe-based. Moreover, there also exists a lack of resources with the knowledge of these systems.

The BPO services segment accounted for the largest share of the healthcare payer services industry, by type of service.

On the basis of service type, the healthcare payer services market is bifurcated into ITO services, BPO services, and KPO services. The BPO services segment accounted for the largest market share. The large share of this segment is primarily attributed to the lower costs, higher efficiency, and ability to concentrate on essential business operations provided by BPO services. This greatly contributes to the fact that BPO services offer administration in important administrative domains. This thus makes it possible for payers to cut costs and accelerate time to market, which is primarily the target of any payer organisation.

The private payer segment is expected to grow at the highest CAGR in the healthcare payer services industry during the forecast period, by end user.

On the basis of the end user, the healthcare payer services market is bifurcated into private payers and public payers. During the forecast period, the private payer segment is expected to grow at the highest CAGR. The high growth of this segment is attributed to the rising competitiveness among private payers, the rising demand for private health insurance due to increasing healthcare costs, and the growing prevalence of chronic diseases.

North America was the most populous region in the healthcare payer services industry.

On the basis of region, the healthcare payer services market is bifurcated into North America, Europe, Asia Pacific, and the Rest of the World (RoW). North America dominated the global market, followed by Asia Pacific. However, Asia Pacific is expected to grow at the highest CAGR during the forecast period. This highest growth in Asia Pacific can be attributed to the implementation of new ICT guidelines in Japan, investments and reforms to modernize China’s healthcare infrastructure, and the rapidly growing healthcare industry in India.

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Prominent players in the healthcare payer services market include Accenture (Ireland), Cognizant (US), Tata Consultancy Services (India), XEROX Corporation (US), WNS (Holdings) Limited (India), NTT Data Corporation (Japan), IQVIA Inc. (US), Mphasis (India), Genpact (US), Wipro (India), Infosys BPM (India), Firstsource Solutions (India), IBM Corporation (US), HCL Technologies (India), Solutions (US), Lonza (Switzerland), Omega Healthcare (India), R1 RCM, INC. (US), Invensis Technologies (India), UnitedHealth Group (US), Paraxel Corporation International (US),

Scope of the Healthcare Payer Services Industry

The research report categorizes the healthcare payer services market to forecast revenue and analyze trends in each of the following submarkets:

By Service Type

• BPO Services
  • Claims Management Services
  • Integrated Front-End Services and Back-Office Operations
  • Member Management Services
  • Product Development and Business Acquisition Services
  • Provider Management Services
  • Care Management Services
  • Billing And Accounts Management Services
  • HR Services
• ITO Services
  • Claims Management Services
  • Provider Network Management
  • Billing and Accounts Management Services
  • Fraud Management Analytics Services
  • Other ITO Services
• KPO Services

By End User

• Private Payers
• Public Payers

Recent Developments of Healthcare Payer Services Industry

• In July 2021, Cognizant (US) collaborated with Royal Philips (Netherlands) to create Philips HealthSuite, a cloud-based platform, to deliver and maintain leading-edge digital health solutions, providing advanced connectivity and using big data to create actionable insights.
• In April 2021, Xerox Corporation (US) acquired Groupe CT (Canada), an independent document management provider in Eastern Canada, to accelerate a digital transformation roadmap by combining its document management services expertise and leadership with Xerox’s portfolio of workplace solutions to expand its reach in the North American market.
• In December 2020, Accenture (Ireland) acquired OpusLine (France) to help clients innovate and deliver digital innovation across their organizations.
• In June 2018, WNS (Holdings) Limited (India) entered into a global shared services partnership with Hyperion Insurance Group (UK), which enabled WNS to highlight its position as an industry leader in high-end global insurance BPM.

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