Healthcare Payer Services Market worth $118.2 Billion | MarketsandMarkets

CHICAGO, Feb. 22, 2023 /PRNewswire/ -- The healthcare payer services industry is expected to undergo a dramatic transformation in the near future. Many of the changes will be driven by the increasing demand for greater transparency, accuracy, and cost-effectiveness in healthcare. The widespread adoption of technology such as artificial intelligence, machine learning, and predictive analytics is likely to revolutionize the payer services industry. Additionally, the use of big data analytics, cloud computing, and blockchain technology could enable payers to provide better services and enable organizations to make more informed decisions.

The healthcare payer services industry is also likely to be impacted by the Affordable Care Act (ACA), which has enabled more people to gain access to health insurance. This has resulted in an increased demand for payer services, as healthcare organizations require more resources to manage the influx of new members. Furthermore, the move to value-based care is likely to drive increased demand for payer services as organizations strive to reduce costs by providing higher-quality care.

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 according to a new report by MarketsandMarkets™. The healthcare payer services market is mainly driven by the increasing health insurance enrolments, rising incidences of healthcare frauds, federal mandates, and rising cases of chronic diseases. However, the risk of data breaches, a loss of managerial control, cultural and language barriers, and high costs associated with outsourcing are expected to restrain the growth of this market to a certain extent.

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Healthcare Payer Services Market Scope:

"BPO services type segment is expected to account for the largest share of the healthcare payer services market in 2022"

Based on service type, the healthcare payer services market is bifurcated into ITO services, BPO services and KPO services. In 2022, the BPO services segment is expected to hold the largest market share. The large share of this segment is primarily attributed to the fact that BPO services can help payers reduce operational costs by outsourcing administrative and non-core functions such as claims processing, member enrolment, and customer support to specialized BPO service providers. This allows payers to focus on their core business of providing healthcare coverage and managing risk.

"Private payers segment to grow at the highest CAGR in the healthcare payer services market during the forecast period, by end user"

Based on end user, the healthcare payer services market is bifurcated into private payers & public payers. In 2022, the private payers segment is expected to account for the largest market share of the healthcare payer services market. During the forecast period, the private payers' segment is expected to grow at the highest CAGR. The high growth of this segment is attributed the increasing adoption of private health insurance by individuals and employers, along with advancements in technology and the need for better healthcare services and rising competitiveness among private payers.

"North America is expected to hold the largest share of the healthcare payer services market in 2022"

Based on region, the healthcare payer services market is divided into North America, Europe, Asia Pacific, and the Rest of the World (RoW). Factors such as rise in insurance enrolments due to PPACA, federal healthcare mandates to drive the demand for outsourcing of services, rising healthcare costs, increasing chronic disease prevalence, technological advancements, shifting consumer preferences, and rising need to curb healthcare expenditure are driving the growth in North American market.

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Healthcare Payer Services Market Dynamics:

Drivers:

1. Outsourcing: a cost-effective solution for healthcare payers
2. Federal mandates in the U.S. increasing payer workload
3. Increasing healthcare fraud
4. Dynamic nature of health benefit plan designs
5. In-house shortage of skilled personnel

Restraints:

1. Rising incidences of data breaches and loss of confidentiality
2. Unforeseen costs associated with outsourcing
3. Loss of managerial control

Opportunities:

1. Advanced data analytics
2. Switching to ICD-10 standards
3. Service portfolio expansion

Challenges:

1. Migration from legacy systems
2. Cultural differences and language barriers

Key Market Players:

Prominent players in this 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), Sykes Enterprises (US), Paraxel Corporation International (US), Access Healthcare (US), and Akurate Management Solutions (US).

Recent Developments

• 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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Healthcare Payer Services Market Advantages:

• Increased Efficiency: Healthcare payer services can provide more efficient services through automation and the use of advanced technologies, such as data analysis and machine learning. This can help to improve the accuracy of claims processing, reduce costs, and improve overall administrative efficiency.
• Improved Customer Service: Healthcare payer services can help to improve customer service by providing more comprehensive and accurate customer service. These services can also help to simplify billing and payment processes, as well as providing additional information and support to customers.
• Cost Reduction: Healthcare payer services can help to reduce costs by streamlining processes, reducing paperwork, and automating claims processing. This can help to reduce overhead costs and improve profitability.
• Risk Management: Healthcare payer services can help to reduce risk by providing improved data analysis and fraud detection capabilities. This can help to identify potential risks and take appropriate measures to mitigate them.
• Increased Transparency: Healthcare payer services can help to provide more transparency into the healthcare system. This can help to ensure that the decisions being made are fair and accurate, and that all stakeholders are informed of any changes or updates.

Healthcare Payer Services Market - Report Highlights:

The updated version of the report covers the historical market for the healthcare payer services market for the years 2020 and 2021, the estimated market for 2022, and the forecast for 2027, along with CAGR from 2022 to 2027.

• The new research study consists of industry trends of the market, value chain analysis, and ecosystem analysis.
• The new research study consists of pricing analysis, porters five forces analysis, regulatory analysis, case study analysis, technology analysis
• The new research study consists of conferences and webinars, key stakeholders, and buying behavior in the market
• The new research study consists of the revenue share analysis
• The new research study consists of competitive benchmarking.
• Updated financial information/service portfolio of players: The new edition of the report provides updated financial information in the context of the healthcare payer services market from 2019 to 2021 for each listed company in a graphical representation.
• Updated market developments of profiled players: The current report includes the market developments from 2019 to 2022.
• The competitive landscape chapter has been updated with the market evaluation matrix of major players.

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