U.S. Business Process As A Service In Healthcare Payers Market Size, Share & Trends Analysis Report By Solution Coverage (Traditional BPaaS, Best-of-breed BPaaS), By Buyer Type, By Value Chain Processes, By Buyer Size, & Segment Forecasts, 2024-2030

The U.S. business process as a service in healthcare payers market size is expected to reach USD 9.6 billion by 2030, registering a CAGR of 5.62% from 2024 to 2030, according to a new report by Grand View Research, Inc. Business process as a service (BPaaS) engagements contributed significantly to healthcare payer business process outsourcing revenue, and this percentage is likely to rise as the market for payer BPaaS expands due to the move toward value-based care, which has been hastened by COVID-19.

The adoption of BPaaS in the U.S. providers industry is growing quickly. Although providers have been around for a while, the Affordable Care Act made them more common and significant, which makes them well-suited to take advantage of BPaaS opportunity. The U.S. healthcare system is shifting from a fee-for-service to a value-based care model, which emphasizes quality of care and patient outcomes over volume of services provided. Growing pressure on the health system as a result of a constant increase in healthcare costs is contributing to rising penetration of value-based healthcare services in industry. BPaaS can help in delivering value-based care by providing healthcare organizations access to advanced analytics and data management tools.

The industry-specific regulatory compliances specify a range of compliance requirements for various industrial verticals. Health Insurance Portability and Accountability Act (HIPAA), Health Information Technology for Economic and Clinical Health (HITECH), and Payment Card Industry Data Security Standard (PCI DSS) are a few legislations that have impacted industry. In many instances, the market now supports compliance management as an administrative activity rather than a regulatory one. BPaaS providers could implement BPaaS solutions that can bridge compliance gaps between verticals and adapt to changes in existing regulations, leading to industry's growth with a rise in adoption throughout the forecast period as all compliance adherence difficulties can be managed with their assistance.

U.S. Business Process As A Service In Healthcare Payers Market Report Highlights:

Based on solution coverage, the market has been segmented into traditional and best-of-breed. Traditional BPaaS segment has accounted for the largest market share of over 75% in 2023, owing to lower cost of service and higher customer satisfaction
Based on buyer type, the government buyers segment held the majority of revenue share of over 73% in 2023. Government insurance companies have historically been main buyers for BPaaS due to modular implementations of medicaid management information systems (MMIS)
Small and medium-sized payers make up more than 70% of all payers in 2023 and have shown a stronger preference for the BPaaS model. In terms of plan types, medicare advantage and managed Medicaid have emerged as viable business cases, with MA accounting for a significant share percentage of the market
Based on value chain processes, administrative processes such as care management have seen the most BPaaS adoption. Payers are, however, progressively becoming aware of BPaaS's potential in processes such as claims management, population health management, and member engagement as well as in reducing medical expenses

Product Code: GVR-4-68039-988-7

Chapter 1 Methodology and Scope

1.1 Market Segmentation & Scope
- 1.1.1 Segment Definition
  - 1.1.1.1 Solution coverage
  - 1.1.1.2 Buyer type
  - 1.1.1.3 Value chain processes
  - 1.1.1.4 Buyer size
1.2 Research Methodology
- 1.2.1 Information procurement
  - 1.2.1.1 Purchased database
  - 1.2.1.2 GVR'S internal database
  - 1.2.1.3 Secondary sources
  - 1.2.1.4 Primary research
1.3 Information or Data Analysis
- 1.3.1 Data Analysis Models
1.4 Market Formulation & Validation
1.5 Model Details
1.6 List of Secondary Sources
1.7 List of Abbreviations
1.8 Objectives
- 1.8.1 Objective - 1
- 1.8.2 Objective - 2
- 1.8.3 Objective - 3

Chapter 2 Executive Summary

2.1 Market Outlook
2.2 Segment Snapshot
2.3 Competitive Landscape

Chapter 3 Market Variables, Trends & Scope

3.1 Market Lineage Outlook
- 3.1.1 Parent Market Outlook
- 3.1.2 Related/Ancillary Market Outlook
3.2 Market Dynamics
- 3.2.1 Market Driver Analysis
  - 3.2.1.1 Changing regulations
  - 3.2.1.2 Expanding healthcare consumerism
  - 3.2.1.3 Shift towards value-based healthcare
- 3.2.2 Market Restraint Analysis
  - 3.2.2.1 Risk Concerns Regarding Data Security
  - 3.2.2.2 High costs
3.3 Business Environment Analysis Tools
- 3.3.1 Porter's Five Forces Analysis
- 3.3.2 PESTLE Analysis
3.4 Impact of COVID-19 on U.S. Business Process as a Service (BPaaS) in Healthcare Payer Market
3.5 Regulatory Framework

Chapter 4 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: Solution Coverage Estimates & Trend Analysis

4.1 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market Solution Coverage Type Movement Analysis, 2023 & 2030
4.2 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: Solution Coverage Segment Dashboard
4.3 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market Size & Forecast and Forecasts, By Solution Coverage (USD Billion)
- 4.3.1 Traditional BPaaS
  - 4.3.1.1 Traditional BPaaS market, 2018 - 2030 (USD Billion)
  - 4.3.1.2 End-to-end traditional BPaaS
  - 4.3.1.2.1 End-to-end traditional BPaaS market, 2018 - 2030 (USD Billion)
  - 4.3.1.3 Process-specific traditional BPaaS
  - 4.3.1.3.1 Process-specific traditional BPaaS market, 2018 - 2030 (USD Billion)
- 4.3.2 Best-of-Breed bpaas
  - 4.3.2.1 Best-of-breed bpaas market, 2018 - 2030 (USD Billion)
  - 4.3.2.2 End-to-end best-of-breed BPaaS
  - 4.3.2.2.1 End-to-end best-of-breed BPaaS market, 2018 - 2030 (USD Billion)
  - 4.3.2.3 Process-specific best-of-breed BPaaS
  - 4.3.2.3.1 Process-specific best-of-breed BPaaS market, 2018 - 2030 (USD Billion)

Chapter 5 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: Buyer Type Estimates & Trend Analysis

5.1 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market Buyer Type Movement Analysis, 2023 & 2030
5.2 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: Buyer Type Segment Dashboard
5.3 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market Size & Forecast and Forecasts, By Buyer Type (USD Billion)
- 5.3.1 Government buyers
  - 5.3.1.1 Government Buyers Market, 2018 - 2030 (USD Billion)
  - 5.3.1.2 Medicare advantage
  - 5.3.1.2.1 Medicare Advantage Market, 2018 - 2030 (USD Billion)
  - 5.3.1.3 Managed Medicaid
  - 5.3.1.3.1 Managed Medicaid market, 2018 - 2030 (USD Billion)
- 5.3.2 Commerical buyers
  - 5.3.2.1 Commercial Buyers Market, 2018 - 2030 (USD Billion)
  - 5.3.2.2 Individual Health Plans
  - 5.3.2.2.1 Individual health plans market, 2018 - 2030 (USD Billion)
  - 5.3.2.3 Employer-sponsored health plan
  - 5.3.2.3.1 Employer sponsored health plan market, 2018 - 2030 (USD Billion)

Chapter 6 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: Value Chain Processes Estimates & Trend Analysis

6.1 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market Value Chain Processes Movement Analysis, 2023 & 2030
6.2 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: Value Chain Processes Segment Dashboard
6.3 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market Size & Forecast and Forecasts, By Value Chain Processes (USD Billion)
- 6.3.1 Claims Management
  - 6.3.1.1 Claims Management Market, 2018 - 2030 (USD Billion)
- 6.3.2 Member engagement
  - 6.3.2.1 Member engagement market, 2018 - 2030 (USD Billion)
- 6.3.3 Care management
  - 6.3.3.1 Care management market, 2018 - 2030 (USD Billion)
- 6.3.4 Others
  - 6.3.4.1 Others market, 2018 - 2030 (USD Billion)

Chapter 7 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: Buyer Size Estimates & Trend Analysis

7.1 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market Buyer Size Movement Analysis, 2023 & 2030
7.2 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: Buyer Size Segment Dashboard
7.3 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market Size & Forecast and Forecasts, By Buyer Size (USD Billion)
- 7.3.1 Small buyers
  - 7.3.1.1 Small Buyers Market, 2018 - 2030 (USD Billion)
- 7.3.2 Mid-sized buyers
  - 7.3.2.1 Mid-sized buyers market, 2018 - 2030 (USD Billion)
- 7.3.3 Large buyers
  - 7.3.3.1 Large Buyers Market, 2018 - 2030 (USD Billion)

Chapter 8 Competitive Analysis

8.1 Participant Categorization
8.2 Company Market Position Analysis
8.3 Strategy Mapping
- 8.3.1 New Launch
- 8.3.2 Mergers & acquisition
- 8.3.3 Partnerships
- 8.3.4 Collaborations
- 8.5.5 Others
8.4 Company Profiles/ Listing
- 8.4.1 Accenture
  - 8.4.1.1 Company overview
  - 8.4.1.2 Financial performance
  - 8.4.1.3 Product benchmarking
  - 8.4.1.4 Strategic initiatives
- 8.4.2 Cognizant
  - 8.4.2.1 Company overview
  - 8.4.2.2 Financial performance
  - 8.4.2.3 Product benchmarking
  - 8.4.2.4 Strategic initiatives
- 8.4.3 HCL Technologies Limited
  - 8.4.3.1 Company overview
  - 8.4.3.2 Financial performance
  - 8.4.3.3 Product benchmarking
  - 8.4.3.4 Strategic initiatives
- 8.4.4 IBM
  - 8.4.4.1 Company overview
  - 8.4.4.2 Financial performance
  - 8.4.4.3 Product benchmarking
  - 8.4.4.4 Strategic initiatives
- 8.4.5 Infosys Limited
  - 8.4.5.1 Company overview
  - 8.4.5.2 Financial performance
  - 8.4.5.3 Product benchmarking
  - 8.4.5.4 Strategic initiatives
- 8.4.6 NTT DATA Corporation
  - 8.4.6.1 Company overview
  - 8.4.6.2 Financial performance
  - 8.4.6.3 Product benchmarking
  - 8.4.6.4 Strategic initiatives
- 8.4.7 Optum
  - 8.4.7.1 Company overview
  - 8.4.7.2 Financial performance
  - 8.4.7.3 Product benchmarking
  - 8.4.7.4 Strategic initiatives
- 8.4.8 TATA Consultancy Services Limited
  - 8.4.8.1 Company overview
  - 8.4.8.2 Financial performance
  - 8.4.8.3 Product benchmarking
  - 8.4.8.4 Strategic initiatives
- 8.4.9 UST
  - 8.4.9.1 Company overview
  - 8.4.9.2 Financial performance
  - 8.4.9.3 Product benchmarking
  - 8.4.9.4 Strategic initiatives
- 8.4.10 Wipro
  - 8.4.10.1 Company overview
  - 8.4.10.2 Financial performance
  - 8.4.10.3 Product benchmarking
  - 8.4.10.4 Strategic initiatives
- 8.4.11 EXL
  - 8.4.11.1 Company overview
  - 8.4.11.2 Financial performance
  - 8.4.11.3 Product benchmarking
  - 8.4.11.4 Strategic initiatives
- 8.4.12 Softheon, Inc.
  - 8.4.12.1 Company overview
  - 8.4.12.2 Financial performance
  - 8.4.12.3 Product benchmarking
  - 8.4.12.4 Strategic initiatives
- 8.4.13 Genpact
  - 8.4.13.1 Company overview
  - 8.4.13.2 Financial performance
  - 8.4.13.3 Product benchmarking
  - 8.4.13.4 Strategic initiatives
- 8.4.14 Change Healthcare
  - 8.4.14.1 Company overview
  - 8.4.14.2 Financial performance
  - 8.4.14.3 Product benchmarking
  - 8.4.14.4 Strategic initiatives
- 8.4.15 Firstsource
  - 8.4.15.1 Company overview
  - 8.4.15.2 Financial performance
  - 8.4.15.3 Product benchmarking
  - 8.4.15.4 Strategic initiatives
- 8.4.16 Celegence
  - 8.4.16.1 Company overview
  - 8.4.16.2 Financial performance
  - 8.4.16.3 Product benchmarking
  - 8.4.16.4 Strategic initiatives
- 8.4.17 Highmark Health
  - 8.4.17.1 Company overview
  - 8.4.17.2 Financial performance
  - 8.4.17.3 Product benchmarking
  - 8.4.17.4 Strategic initiatives

Product Code: GVR-4-68039-988-7

List of Table

Table 1 List of secondary sources

Table 2 List of key companies

Table 3 U.S. Business Process as a Service (BPaaS) in healthcare payers market, by solution coverage, 2018 - 2030 (USD Billion)

Table 4 U.S. Business Process as a Service (BPaaS) in healthcare payers market, by traditional BPaaS, 2018 - 2030 (USD Billion)

Table 5 U.S. Business Process as a Service (BPaaS) in healthcare payers market, best-of-breed BPaaS, 2018 - 2030 (USD Billion)

Table 6 U.S. Business Process as a Service (BPaaS) in healthcare payers market, by buyer type, 2018 - 2030 (USD Billion)

Table 7 U.S. Business Process as a Service (BPaaS) in healthcare payers market, by commercial buyers, 2018 - 2030 (USD Billion)

Table 8 U.S. Business Process as a Service (BPaaS) in healthcare payers market, by value chain processes, 2018 - 2030 (USD Billion)

Table 9 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market, By Buyer Size, 2018 - 2030 (USD Billion)

List of Figures

Fig. 1 U.S. business process as a Service in healthcare payers segmentation
Fig. 2 Market research process
Fig. 3 Data triangulation techniques
Fig. 4 Primary research pattern
Fig. 5 Market research approaches
Fig. 6 Value chain-based sizing & forecasting
Fig. 7 QFD modeling for market share assessment
Fig. 8 Market formulation & validation
Fig. 9 Market snapshot
Fig. 10 Segment outlook
Fig. 11 Segment outlook
Fig. 12 Competitive landscape
Fig. 13 U.S. business process as a service in healthcare payers market lineage
Fig. 14 Parent market outlook
Fig. 15 Related market outlook
Fig. 16 U.S. Business process as a service in Healthcare payers market dynamics
Fig. 17 U.S. business process as a service in healthcare payers market: Porter's analysis
Fig. 18 U.S. business process as a service in healthcare payers market: PESTLE analysis
Fig. 19 U.S. business process as a service in healthcare payers market: Solution coverage movement share analysis, (USD Billion)
Fig. 20 U.S. business process as a service in healthcare payers market: Solution coverage segment dashboard
Fig. 21 Traditional BPaaS market, 2018 - 2030 (USD Billion)
Fig. 22 End-to-end traditional BPaaS market, 2018 - 2030 (USD Billion)
Fig. 23 Process specific traditional BPaaS market, 2018 - 2030 (USD Billion)
Fig. 24 Best-of-breed BPaaS market, 2018 - 2030 (USD Billion)
Fig. 25 End-to-end best-of-breed BPaaS market, 2018 - 2030 (USD Billion)
Fig. 26 Process specific best-of-breed BPaaS market, 2018 - 2030 (USD Billion)
Fig. 27 U.S. business process as a service in healthcare payers market: Buyer type movement share analysis, (USD Billion)
Fig. 28 U.S. business process as a service in healthcare payers market: Buyer type segment dashboard
Fig. 29 Government buyers market, 2018 - 2030 (USD Billion)
Fig. 30 Medicare advantage market, 2018 - 2030 (USD Billion )
Fig. 31 Managed Medicaid market, 2018 - 2030 (USD Billion )
Fig. 32 Commercial buyers market, 2018 - 2030 (USD Billion)
Fig. 33 Individual health plans market, 2018 - 2030 (USD Billion)
Fig. 34 Employer sponsored health plan market, 2018 - 2030 (USD Billion)
Fig. 35 U.S. business process as a service in healthcare payers market: Value chain process movement share analysis, (USD Billion)
Fig. 36 U.S. business process as a service in healthcare payers market: Value chain processes segment dashboard
Fig. 37 Claims management market, 2018 - 2030 (USD Billion)
Fig. 38 Member engagement market, 2018 - 2030 (USD Billion)
Fig. 39 Care management market, 2018 - 2030 (USD Billion)
Fig. 40 Others market, 2018 - 2030 (USD Billion)
Fig. 41 U.S. business process as a service in healthcare payers market: Buyer size movement share analysis, (USD Billion)
Fig. 42 U.S. business process as a service in healthcare payers market: Buyer size segment dashboard
Fig. 43 Small buyers market, 2018 - 2030 (USD Billion)
Fig. 44 Mid-sized buyers market, 2018 - 2030 (USD Billion)
Fig. 45 Large buyers market, 2018 - 2030 (USD Billion)
Fig. 46 Company/competition categorization
Fig. 47 Company market position analysis
Fig. 48 Strategy mapping
Fig. 49 Acquisition mapping