Healthcare Payer Services Market - Growth, Trends, Covid-19 Impact, and Forecasts (2022 - 2027)

The Healthcare Payer Services Market is Segmented by Service Type (Business Process Outsourcing, IT Outsourcing Services, Knowledge Process Outsourcing Services), 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, Human Resource Services), End-User (Private Payers, Public Payers), and Geography (North America, Europe, Asia-Pacific, Middle East, and Africa, and South America). The report offers the value (USD million) for the above segments.

Market Snapshot

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Study Period: 2019-2027
Base Year: 2021
Fastest Growing Market: Asia-Pacific
Largest Market: North America
CAGR: 10.1 %

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Market Overview

The Healthcare Payer Services Market is expected to register a CAGR of 10.1 % during the forecast period (2022-2027).

Covid-19 has significantly impacted the healthcare payer services market. For instance, according to the article published in the National Academy of Medicine, titled 'Health Care Payers COVID-19 Impact Assessment: Lessons Learned and Compelling Needs' in May 2021, payers took steps to expand access to health care for COVID-19 and non-COVID-19 health issues in the spring of 2020, based on regulatory requirements and recommendations (e.g., waiving administrative requirements, reimbursing telehealth). Many payers also deployed financial support and capital on their own to help providers stabilize, and they used their technological capabilities and community links to help with outbreak response, from coordinating non-medical services to supporting immunization efforts.

The major factors driving the market growth include the rise in the adoption of health insurance, the rise in healthcare frauds, the growing burden of chronic diseases, and others.

According to the Organisation for Economic Co-operation and Development statistics updated in May 2022, many European Countries, such as the Czech Republic, Denmark, Finland, and Ireland, among others have 100% Government/Social health insurance in 2020. Such adoption of health insurance from the government for its citizens will drive the market due to the adoption of healthcare payer services.

Furthermore, in August 2021, Baring Private Equity Asia (BPEA), one of Asia's major private alternative investment firms, signed formal agreements with Hinduja Global Solutions to buy its Healthcare Services business to funds linked with Such acquisitions will further lead to drive the growth of healthcare payer services market due to growth.

In addition, the rise in chronic diseases will further pave the way for health insurance, leading to the adoption of healthcare payer services and driving the market growth. For instance, according to the International Diabetic Federation 2021, diabetes affects around 537 million persons aged 20 to 79. By 2030, the overall number of diabetics is expected to reach 643 million, and by 2045, it will reach 783 million. Furthermore, according to Globocan 2020, there were 19,292,789 new cancer cases seen in 2020 across the globe, and 9,958,133 deaths were reported globally in 2020. Such a huge burden of chronic diseases will lead to increased adoption of ethical medication, driving the market growth significantly.

However, factors such as high incidences of data breaches, loss of confidentiality, and unpredicted costs associated with outsourcing are expected to hinder the market.

Scope of the Report

As per the scope of the report, the healthcare payer services providers assist payers in actively engaging members, meeting compliance requirements, reducing healthcare costs, and improving overall operational performance. The Healthcare Payer Services Market is Segmented by Service Type (Business Process Outsourcing, IT Outsourcing Services, Knowledge Process Outsourcing Services), 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, Human Resource Services), End-User (Private Payers, Public Payers), and Geography (North America, Europe, Asia-Pacific, Middle-East and Africa, and South America). The market report also covers the estimated market sizes and trends for 17 countries across major global regions. The report offers the value (in USD million) for the above segments.

By Service Type
Business Process Outsourcing
IT Outsourcing Services
Knowledge Process Outsourcing (KPO) Services
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
Human Resource Services
By End User
Private Payers
Public Payers
Geography
North America
United States
Canada
Mexico
Europe
Germany
United Kingdom
France
Italy
Spain
Rest of Europe
Asia-Pacific
China
Japan
India
Australia
South Korea
Rest of Asia-Pacific
Middle-East and Africa
GCC
South Africa
Rest of Middle-East and Africa
South America
Brazil
Argentina
Rest of South America

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Key Market Trends

Claims Management Services Segment Is Expected To Hold A Major Share In The Market.

The claim management services segment is expected to hold a major share in the healthcare payer services market and will do the same over the forecast period.

Traditionally, a healthcare practitioner provides services to a patient, which the payer then confirms and reimburses. The absence of patient involvement raises the possibility of fraud and abuse.

Additionally, in October 2021, Blue Shield of California and Google Cloud collaborated to create a new approach to paying providers that will process claims in real-time for members. To digitize healthcare claims and enhance the quality and timeliness of billing information, the firms would deploy automated processing, artificial intelligence, and machine learning technologies on a cloud platform. Such collaborations will drive market growth due to the rise in the adoption of claim management services.

In addition, according to the study published in the Journal of Medical Internet Research, titled 'Combating Health Care Fraud and Abuse: Conceptualization and Prototyping Study of a Blockchain Antifraud Framework' in September 2020, It is estimated USD 2.6 billion loss is attributed to health care fraud and abuse. Such incidences will lead to increased adoption of claim management services, driving the market growth over the forecast period.

Therefore, this segment is expected to drive market growth owing to the abovementioned factors.

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North America Holds a Major Share and Expected to do Same Over the Forecast Period

North America holds a significant share in the market studied and is expected to do the same over the forecast period. The factors attributed to the significant growth of the healthcare payer services market include the rise in adoption of healthcare policies, the sophisticated healthcare system in this region, and the strong foothold of key market players in this region, among others.

According to the article published by the Congressional Research Service, titled 'The United States Health Care Coverage and Spending,' updated in April 2022, most people had private health insurance or were covered by a government program (such as Medicare or Medicaid) in 2020. Furthermore, according to the same source, in 2020, individuals (including the uninsured), health insurers, and federal and state governments spent USD 3.9 trillion on various types of health consumption expenditures (HCE), accounting for 18.8% of the country's gross domestic product. Such a huge investment in healthcare consumption in this region will lead to driving the growth of this market in this region due to the adoption of healthcare payer services to claim insurance.

Furthermore, in December 2021, according to the United States Centers for Medicare and Medicaid Services, the COVID-19 epidemic, like so many other parts of American society, had a significant impact on the country's health sector in 2020, pushing a 9.7% increase in total national healthcare spending to USD 4.1 trillion. The high investments by national healthcare will lead to higher adoption of healthcare payer services, driving the market growth.

In addition, the strong foothold of major players in this region is also expected to drive the market growth due to the adoption of various services by the end user, driving the market growth. For instance, key players such as Cognizant Technology Solutions, Hewlett-Packard, and Xerox Corporation are headquartered in the United States.

Therefore, the market is expected to propel in this region due to the abovementioned factors.

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Competitive Landscape

The market for healthcare payer services is moderately competitive. The market is driven by the factors such as the strategies opted by the key market players, adoption of services by the end-users, and rise in healthcare policies, among others. Some of the key market players include Cognizant Technology Solutions, Accenture PLC, Hewlett-Packard, Xerox Corporation, Dell, Inc., Genpact Limited, and HCL Technologies Ltd., among others.

Recent Developments

· In March 2022, IMAT Solutions, one of the leaders in real-time healthcare data management and population health reporting solutions, launched a new offering that tackles the collection, aggregation, dissemination, and reporting of healthcare data. Payers, statewide organizations, and Health Information Exchanges (HIEs) will benefit from its new clustering and SaaS-based solutions, as well as the company's new Data Aggregator Validation (DAV) designation from the National Committee for Quality Assurance (NCQA).

· In March 2022, Icertis launched Icertis Contract Intelligence (ICI) for Healthcare Providers. A contract lifecycle management (CLM) solution helps healthcare providers accelerate digital transformation by modernizing complex agreements such as payer, supplier, and contract services.

Table of Contents

  1. 1. INTRODUCTION

    1. 1.1 Study Assumptions and Market Definition

    2. 1.2 Scope of the Study

  2. 2. RESEARCH METHODOLOGY

  3. 3. EXECUTIVE SUMMARY

  4. 4. MARKET DYNAMICS

    1. 4.1 Market Overview

    2. 4.2 Market Drivers

      1. 4.2.1 Rise In Adoption of Health Insurance Policies

      2. 4.2.2 Rise In Healthcare Frauds

      3. 4.2.3 Growing Burden of Chronic Diseases

    3. 4.3 Market Restraints

      1. 4.3.1 High Incidences of Data Breaches and Loss of Confidentiality

      2. 4.3.2 Unpredicted Costs Associated With Outsourcing

    4. 4.4 Porter's Five Forces Analysis

      1. 4.4.1 Threat of New Entrants

      2. 4.4.2 Bargaining Power of Buyers/Consumers

      3. 4.4.3 Bargaining Power of Suppliers

      4. 4.4.4 Threat of Substitute Products

      5. 4.4.5 Intensity of Competitive Rivalry

  5. 5. MARKET SEGMENTATION (Market Size by Value - USD million)

    1. 5.1 By Service Type

      1. 5.1.1 Business Process Outsourcing

      2. 5.1.2 IT Outsourcing Services

      3. 5.1.3 Knowledge Process Outsourcing (KPO) Services

    2. 5.2 By Application

      1. 5.2.1 Claims management services

      2. 5.2.2 Integrated front office service and back office operations

      3. 5.2.3 Member management services

      4. 5.2.4 Provider management services

      5. 5.2.5 Billing and accounts management services

      6. 5.2.6 Analytics and fraud management services

      7. 5.2.7 Human Resource Services

    3. 5.3 By End User

      1. 5.3.1 Private Payers

      2. 5.3.2 Public Payers

    4. 5.4 Geography

      1. 5.4.1 North America

        1. 5.4.1.1 United States

        2. 5.4.1.2 Canada

        3. 5.4.1.3 Mexico

      2. 5.4.2 Europe

        1. 5.4.2.1 Germany

        2. 5.4.2.2 United Kingdom

        3. 5.4.2.3 France

        4. 5.4.2.4 Italy

        5. 5.4.2.5 Spain

        6. 5.4.2.6 Rest of Europe

      3. 5.4.3 Asia-Pacific

        1. 5.4.3.1 China

        2. 5.4.3.2 Japan

        3. 5.4.3.3 India

        4. 5.4.3.4 Australia

        5. 5.4.3.5 South Korea

        6. 5.4.3.6 Rest of Asia-Pacific

      4. 5.4.4 Middle-East and Africa

        1. 5.4.4.1 GCC

        2. 5.4.4.2 South Africa

        3. 5.4.4.3 Rest of Middle-East and Africa

      5. 5.4.5 South America

        1. 5.4.5.1 Brazil

        2. 5.4.5.2 Argentina

        3. 5.4.5.3 Rest of South America

  6. 6. COMPETITIVE LANDSCAPE

    1. 6.1 Company Profiles

      1. 6.1.1 Cognizant Technology Solutions

      2. 6.1.2 Accenture PLC

      3. 6.1.3 Synnex Corporation (Concentrix Corporation)

      4. 6.1.4 Hewlett-Packard

      5. 6.1.5 Xerox Corporation

      6. 6.1.6 Dell, Inc.

      7. 6.1.7 Genpact Limited

      8. 6.1.8 HCL Technologies Ltd.

      9. 6.1.9 Wipro Limited

      10. 6.1.10 Change Healthcare Inc.

      11. 6.1.11 HMS Holding Corp.

      12. 6.1.12 McKESSON Corporation

    2. *List Not Exhaustive
  7. 7. MARKET OPPORTUNITIES AND FUTURE TRENDS

**Competitive Landscape covers- Business Overview, Financials, Products and Strategies and Recent Developments

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Frequently Asked Questions

The Global Healthcare Payer Services Market market is studied from 2019 - 2027.

The Global Healthcare Payer Services Market is growing at a CAGR of 10.1% over the next 5 years.

Asia-Pacific is growing at the highest CAGR over 2021- 2026.

North America holds highest share in 2021.

Cognizant Technology Solutions, Accenture PLC, Hewlett-Packard, Xerox Corporation, Dell, Inc. are the major companies operating in Global Healthcare Payer Services Market.

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