Healthcare Payer Services Market - by Service Type (BPO Services, ITO Services, KPO) By Application (Claims Management Services, Analytics & Fraud Management Services, HR Services), By End-use (Private Payers, Public), & Global Forecast 2023

Description

List of Tables

Global Healthcare Payer Services Market will register noteworthy progression from 2023 to 2032. The rising healthcare costs and the increasing complexity of insurance processes have led to a growing demand for outsourcing payer services. According to the Milliman Medical Index (MMI), healthcare costs $31,065 in 2023 for a hypothetical American family of four covered by an average employer-sponsored preferred provider organization (PPO) plan. This depicts a 5.6% rise from 2022. The MMI reflects four family members: a 37-year-old female, a 47-year-old male, a 4-year-old child, and a 1-year-old child.

Healthcare payers seek cost-effective solutions to manage claims processing, billing, and customer support efficiently. The shift towards value-based care and population health management requires advanced data analytics and risk assessment capabilities, driving the need for specialized payer services. Additionally, the focus on improving member engagement and satisfaction fuels the demand for innovative payer services that offer personalized and seamless experiences.

The overall Healthcare Payer Services Market is classified based on service type, application, end-user, and region.

Based on service type, the KPO segment will register a noticeable valuation by 2032. KPO providers offer specialized expertise and in-depth knowledge in areas such as claims adjudication, revenue cycle management, risk assessment, and data analytics. As healthcare payers seek to streamline operations, improve accuracy, and optimize revenue, they turn to KPO services for cost-effective and efficient solutions. The demand for KPO services in the healthcare payer services market is driven by the need for comprehensive and data-driven insights to enhance decision-making and achieve better outcomes in the ever-evolving healthcare landscape.

By application, the healthcare payer services industry from the billing and accounts management services segment will showcase a commendable growth rate from 2023 to 2032. Healthcare payers seek efficient solutions to manage complex billing processes and ensure accurate claims processing. With the increasing volume of claims and the need for timely reimbursements, outsourcing billing and accounts management services has become essential. Specialized providers offer expertise in coding, claims adjudication, and revenue cycle management, streamlining operations and improving financial performance for healthcare payers. The demand for these services in the Healthcare Payer Services Market underscores their importance in ensuring seamless and efficient payment processes.

Regarding the end-user, the public payers segment could capture a decent healthcare payer services market share by 2032. To provide comprehensive coverage to the population, public payers require efficient and cost-effective services to manage claims processing, eligibility verification, and member management. Outsourcing payer services to specialized providers allows public payers to optimize operations, improve member satisfaction, and ensure compliance with regulatory requirements.

Regionally, the Asia-Pacific healthcare payer services industry will amass appreciable revenue throughout 2023-2032 due to the region's growing population and increasing healthcare needs. The rising prevalence of chronic diseases necessitates advanced data analytics and risk assessment capabilities, spurring the need for specialized payer services. Additionally, the growing adoption of digital technologies and telehealth solutions in the Asia-Pacific healthcare sector further fuels the demand for innovative payer services. The focus on improving healthcare access and outcomes propels the growth of the Healthcare Payer Services Market in Asia-Pacific.

Product Code: 5701

Chapter 1 Methodology

1.1 Market definition
1.2 Base estimates & calculations
1.3 Forecast parameters
1.4 COVID-19 impact analysis at global level
1.5 Data validation
1.6 Data Sources
- 1.6.1 Primary
- 1.6.2 Secondary
  - 1.6.2.1 Paid sources
  - 1.6.2.2 Public sources

Chapter 2 Executive Summary

2.1 Healthcare payers services industry 360 degree synopsis, 2018 - 2032
2.2 Business trends
2.3 Regional trends
2.4 Service type trends
2.5 Application trends
2.6 End-use trends

Chapter 3 Healthcare Payer Services Industry Insights

3.1 Industry ecosystem analysis
3.2 Industry impact forces
- 3.2.1 Growth drivers
  - 3.2.1.1 Rising adoption of health insurance policies
  - 3.2.1.2 Increasing outsourcing of services to increase efficiency and reduce cost
  - 3.2.1.3 Growing burden of chronic disease
  - 3.2.1.4 Rise in healthcare fraud cases
- 3.2.2 Industry pitfalls & challenges
  - 3.2.2.1 Risk of data breach and loss of confidentiality
  - 3.2.2.2 High cost associated with outsourcing of services
3.3 Growth potential analysis
- 3.3.1 By services type
- 3.3.2 By application
- 3.3.3 By end-use
3.4 COVID- 19 impact analysis
3.5 Technological advancements
3.6 Regulatory landscape
- 3.6.1 U.S.
- 3.6.2 Europe
3.7 Application potential
3.8 Porter's analysis
3.9 PESTEL analysis

Chapter 4 Competitive Landscape, 2022

4.1 Introduction
4.2 Company matrix analysis, 2022
4.3 Competitive analysis of major market players
4.4 Competitive positioning matrix
4.5 Strategy dashboard
4.6 Strategic outlook matrix

Chapter 5 Healthcare Payers Services Market Size and Forecast, By Service Type (USD Million)

5.1 Key trends, by service type
5.2 BPO Services
5.3 ITO Services
5.4 KPO Services

Chapter 6 Healthcare Payers Services Market Size and Forecast, By Application (USD Million)

6.1 Key trends, by application
6.2 Claims Management Services
6.3 Analytics And Fraud Management Services
6.4 Integrated Front Office Service And Back Office Operations
6.5 Billing And Accounts Management Services
6.6 Member Management Services
6.7 Provider Management Services
6.8 HR Services

Chapter 7 Healthcare Payers Services Market Size and Forecast, By End-use (USD Million)

7.1 Key trends, by end-use
7.2 Private Payers
7.3 Public Payers

Chapter 8 Healthcare Payers Services Market Size and Forecast, By Region (USD Million)

8.1 Key trends, by region
8.2 North America
- 8.2.1 U.S.
- 8.2.2 Canada
8.3 Europe
- 8.3.1 Germany
- 8.3.2 UK
- 8.3.3 France
- 8.3.4 Spain
- 8.3.5 Italy
- 8.3.6 Poland
- 8.3.7 Sweden
- 8.3.8 The Netherlands
- 8.3.9 Rest of Europe
8.4 Asia Pacific
- 8.4.1 Japan
- 8.4.2 China
- 8.4.3 India
- 8.4.4 Australia
- 8.4.5 South Korea
- 8.4.6 Indonesia
- 8.4.7 Philippines
- 8.4.8 Malaysia
- 8.4.9 Rest of Asia Pacific
8.5 Latin America
- 8.5.1 Brazil
- 8.5.2 Mexico
- 8.5.3 Argentina
- 8.5.4 Columbia
- 8.5.5 Chile
- 8.5.6 Peru
- 8.5.7 Rest of Latin America
8.6 MEA
- 8.6.1 South Africa
- 8.6.2 Saudi Arabia
- 8.6.3 UAE
- 8.6.4 Israel
- 8.6.5 Turkey
- 8.6.6 Iran
- 8.6.7 Rest of MEA

Chapter 9 Company Profiles

9.1 Merative (IBM Watson Health)
9.2 Oracle Corporation
9.3 IQVIA Inc
9.4 HGS Ltd.
9.5 Xerox Corporation
9.6 Concentrix Corporation
9.7 Genpact
9.8 HCL Technologies Limited
9.9 Accenture
9.10 Cognizant
9.11 ExlService Holdings, Inc.