Global Healthcare Payer Services Market

Healthcare Payer Services Market Size, Share, Growth Analysis, By Service(BPO Services, ITO Services, and KPO Services), By Application(Claims Management Services, Integrated Front Office Service and Back Office Operations, Member Management Services, Provider Management Services), By End-use(Private Payers, and Public Payers), By Region - Industry Forecast 2024-2031


Report ID: SQMIG35A2352 | Region: Global | Published Date: February, 2024
Pages: 157 |Tables: 93 |Figures: 76

Healthcare Payer Services Market Insights

Healthcare Payer Services Market size was valued at USD 57.3 Billion in 2021 and is poised to grow from USD 61.9 Billion in 2022 to USD 111.9 Billion by 2030, at a CAGR of 7.7% during the forecast period (2023-2030).

The global healthcare payer services market is expected to witness new growth opportunities in the coming years due to the overall cost of the healthcare supply chain business process outsourcing falling. Additionally, as a result of inventory control, there is an increasing requirement for the healthcare supply chain outsourcing of business processes. As a result, it is predicted that the market would grow throughout the projection period. The healthcare supply chain BPO business is growing as a result of a decrease in healthcare delivery costs, the implementation of ICD-10 codes, and the patent cliffs that pharmaceutical companies have to deal against.

The resulting firms' adoption of cutting-edge technology like AI, analytics, and a cloud-based service portfolio fuels fierce market competition. Accenture's cloud-based solutions, for instance, for the healthcare supply chain save logistics costs, increase service revenue, and increase service accessibility. As a result, it is anticipated that the market will expand significantly for this reason. During the forecast period, technological development and the integration of outsourced procedures with SCM are anticipated to continue to be the primary market drivers.

The COVID-19 epidemic caused issues for healthcare payers. Numerous health insurers fared better financially during the epidemic as a result of the reduction in healthcare funding. The payers have been quite supportive of the healthcare providers. They have created web portals that give real-time and accurate information about the epidemic, launched community programmes for health equity, expanded eligibility to let patients continue receiving medical care, and provided advance payments. The important parties are participating in strategic alliances for upcoming initiatives that address systemic health disparities.

US Healthcare Payer Services Market is poised to grow at a sustainable CAGR for the next forecast year.

Market Snapshot - 2024-2031

Global Market Size

USD 57.3 Billion

Largest Segment

ITO Services

Fastest Growth

ITO Services

Growth Rate

7.7% CAGR

Global Healthcare Payer Services Market ($ Bn)
Country Share for North America Region (%)

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Healthcare Payer Services Market Segmental Analysis

The global healthcare payer services market is categorized on the basis of service, application, end-use, and region. Based on service, the market is segmented into BPO Services, ITO Services, and KPO Services. Based on Application, the market is segmented into 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, and HR Services. Based on End-use, the market is segmented into Private Payers, Public Payers. Based on region the global Healthcare Payer Services Market is segmented into North America, Europe, Asia-Pacific, South America, and MEA.

Healthcare Payer Services Market Analysis by Service

ITO services led the market for healthcare payer services, accounting for 51.1% of total revenue. The main drivers of growth are rising demand for cutting-edge and innovative technologies, an increase in investments in AI technology, conveniently accessible information, and greater involvement of patients in healthcare decisions.

The demand for highly qualified workers is on the rise, and there is a cost advantage to outsourcing high-end procedures to emerging nations at cheap cost. As a result, the healthcare provider KPO category is predicted to grow at a profitable CAGR of 12.2%. The rising demand in emerging countries for low-cost, highly qualified workers for domain-dependent core & non-core aspects of the payer vertical is another important element anticipated to fuel the sector's expansion in the ensuing years.

Healthcare Payer Services Market Analysis by Application

The claims management services maintained a market share of more than 29.9% in 2022. Among other important reasons that are influencing the number of people enrolled in the Centers for Medicaid and Medicare are the existence of the Affordable Care Act and rising overall healthcare spending. Claims processing services, categorized as the most data-intensive processes, make up the majority of a payer's load. Claims from the providers are checked for eligibility compliance, authenticity, and the specific amount that needs to be reimbursed. The process has been streamlined & turnaround times have greatly increased as a result of the advent of the digital era.

The segment providing analytics & fraud management services is anticipated to experience the largest CAGR growth, at 9.1%. One of the key elements anticipated to propel the industry in the upcoming years is the rising demand for predictive modeling and claim analytics. During the forecast period, this segment's growth is anticipated to be positively reinforced by the rising demand in low-cost skilled workers in developed economies who can help with workload distribution and high-end healthcare payers’ analytical applications, as well as by the expanding outsourcing of infrastructure management, management of applications, and data architecture.

Global Healthcare Payer Services Market By Service, 2023 (%)

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Healthcare Payer Services Market Regional Insights

North America led the market and took home 76.1% of the total revenue in 2022. Due to the growing demand for health IT services, the market for outsourcing business processes in the healthcare supply chain is anticipated to grow throughout the forecast period. The demand for healthcare supply chain outsourcing of business processes is projected to rise as a result of evolving regulatory environments and mounting pressure on the healthcare sector to reduce service costs. Consequently, it is predicted that the regional market will significantly expand during the projection period.

Asia Pacific is expected to experience the fastest CAGR over the forecast period, coming in at 9.6%. This predicted expansion is influenced by reasons such as the rise in long-term illness incidence, rising healthcare expenses, and greater demand for resources in developing countries like China and India. BPO service providers have a concentration of delivery centers in countries including Philippines, China, Singapore, India, & Vietnam, which suggests higher activity from these regions throughout the anticipated time frame.

Global Healthcare Payer Services Market By Geography, 2024-2031
  • Largest
  • Fastest

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Healthcare Payer Services Market Dynamics

Healthcare Payer Services Market Drivers

Increasing Complexity of Payer Operations

  • Payer organizations face complex challenges related to claims processing, member enrollment, billing, and customer service. Payer services providers offer specialized expertise, technology solutions, and operational support to address these complexities and enhance efficiency.

Advancements in Technology

  • Technological advancements, such as artificial intelligence (AI), big data analytics, and robotic process automation (RPA), are transforming the healthcare payer industry. Payer services providers leverage these technologies to streamline processes, improve data management, enhance decision-making, and drive operational efficiency.

Healthcare Payer Services Market Restraints

Cost Constraints and Pricing Pressure

  • Payer organizations often face cost constraints and pricing pressure due to the rising healthcare costs and efforts to manage premiums for their members. Payer services providers need to demonstrate cost savings and offer competitive pricing models to remain viable in the market.

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Healthcare Payer Services Market Competitive Landscape

In order to introduce technologically improved products and acquire a competitive edge, businesses are putting a lot of effort into research and development. Companies are also forming alliances, merging, and buying other businesses in an effort to broaden their product offerings, increase their manufacturing capabilities, and create competitive difference. For instance, in 2021, Holy Cross Health, Memory Healthcare System, and Oscar worked up to offer the Medicare Advantage plan, which offers cheap, virtual care from a connected care team and a dependable doctor.

Healthcare Payer Services Market Top Player’s Company Profiles

  • CVS Health
  • Aetna Inc. (a subsidiary of CVS Health)
  • Humana Inc.
  • Centene Corporation
  • Molina Healthcare, Inc.
  • WellCare Health Plans, Inc. (now part of Centene Corporation)
  • Optum (part of UnitedHealth Group)
  • Blue Cross Blue Shield Association (BCBS)
  • Kaiser Permanente
  • Magellan Health, Inc.
  • Change Healthcare
  • HMS Holdings Corp.
  • MultiPlan, Inc.
  • Evolent Health
  • Health Net, Inc. (a subsidiary of Centene Corporation)
  • Medecision Inc.
  • Conduent Inc.

Healthcare Payer Services Market Recent Developments

  • In March 2022, IMAT Solutions, a pioneer in population health reporting and real-time healthcare data management, introduced a new product that addresses the gathering, aggregation, dissemination, and analysis of healthcare data. Its new clustering and SaaS-based solutions, together with the business's new Data Aggregator Validation (DAV) certification by the Nationwide Committee for Quality Assurance (NCQA), will be advantageous to payers, state-wide organizations, or health information exchanges (HIEs).
  • In March 2022, for healthcare providers, the Icertis launched Icertis Contracts Intelligence (ICI). By modernizing complicated agreements including payer, supplier, and contract services, a contract life cycle management (CLM) solution assists healthcare organizations in accelerating digital transformation.

Healthcare Payer Services Key Market Trends

  • Shift towards Value-Based Care: There is a growing trend towards value-based care models, which focus on improving patient outcomes and cost-efficiency. Payer services providers are aligning their offerings to support value-based payment models, care coordination, and population health management.
  • Emphasis on Data Analytics and Insights: The healthcare payer services market is increasingly leveraging advanced data analytics and insights to drive decision-making and improve operational efficiency. Payer services providers are utilizing big data, AI, and machine learning to analyze healthcare data, identify trends, manage risks, and enhance member experience.
  • Digital Transformation and Technology Adoption: Digital transformation is reshaping the healthcare payer services landscape. Payer organizations are adopting digital platforms, mobile applications, and telehealth solutions to enhance member engagement, streamline processes, and provide convenient access to healthcare services.
  • Focus on Member Experience and Engagement: Payer services providers are prioritizing member experience and engagement to improve customer satisfaction and retention. Personalized communication, self-service portals, mobile apps, and remote monitoring are being employed to enhance member experience and provide proactive healthcare support.
  • Integration of Care Management and Coordination: Payer services providers are playing an increasing role in care management and coordination. They are implementing care management programs, offering care coordination services, and collaborating with healthcare providers to optimize care delivery and improve health outcomes.

Healthcare Payer Services Market SkyQuest Analysis

SkyQuest’s ABIRAW (Advanced Business Intelligence, Research & Analysis Wing) is our Business Information Services team that Collects, Collates, Co-relates and Analyzes the Data collected by means of Primary Exploratory Research backed by the robust Secondary Desk research.

According to our global healthcare payer services market analysis, the overall cost of the healthcare supply chain business process outsourcing is falling. Additionally, as a result of inventory control, there is an increasing requirement for the healthcare supply chain outsourcing of business processes. As a result, it is predicted that the market would grow throughout the projection period. The healthcare supply chain BPO business is growing as a result of a decrease in healthcare delivery costs, the implementation of ICD-10 codes, and the patent cliffs that pharmaceutical companies have to deal against. However, Asia Pacific is expected to experience the fastest CAGR over the forecast period, coming in at 9.6%. This predicted expansion is influenced by reasons such as the rise in long-term illness incidence, rising healthcare expenses, and greater demand for resources in developing countries like China and India. BPO service providers have a concentration of delivery centers in countries including Philippines, China, Singapore, India, & Vietnam, which suggests higher activity from these regions throughout the anticipated time frame.

Report Metric Details
Market size value in 2023 USD 57.3 Billion
Market size value in 2031 USD 111.9 Billion
Growth Rate 7.7%
Forecast period 2024-2031
Forecast Unit (Value) USD Billion
Segments covered
  • Service
    • BPO Services, ITO Services, and KPO 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, and HR Services
  • End-use
    • Private Payers, and Public Payers
Regions covered North America (US, Canada), Europe (Germany, France, United Kingdom, Italy, Spain, Rest of Europe), Asia Pacific (China, India, Japan, Rest of Asia-Pacific), Latin America (Brazil, Rest of Latin America), Middle East & Africa (South Africa, GCC Countries, Rest of MEA)
Companies covered
  • CVS Health
  • Aetna Inc. (a subsidiary of CVS Health)
  • Humana Inc.
  • Centene Corporation
  • Molina Healthcare, Inc.
  • WellCare Health Plans, Inc. (now part of Centene Corporation)
  • Optum (part of UnitedHealth Group)
  • Blue Cross Blue Shield Association (BCBS)
  • Kaiser Permanente
  • Magellan Health, Inc.
  • Change Healthcare
  • HMS Holdings Corp.
  • MultiPlan, Inc.
  • Evolent Health
  • Health Net, Inc. (a subsidiary of Centene Corporation)
  • Medecision Inc.
  • Conduent Inc.
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Table Of Content

Executive Summary

Market overview

  • Exhibit: Executive Summary – Chart on Market Overview
  • Exhibit: Executive Summary – Data Table on Market Overview
  • Exhibit: Executive Summary – Chart on Healthcare Payer Services Market Characteristics
  • Exhibit: Executive Summary – Chart on Market by Geography
  • Exhibit: Executive Summary – Chart on Market Segmentation
  • Exhibit: Executive Summary – Chart on Incremental Growth
  • Exhibit: Executive Summary – Data Table on Incremental Growth
  • Exhibit: Executive Summary – Chart on Vendor Market Positioning

Parent Market Analysis

Market overview

Market size

  • Market Dynamics
    • Exhibit: Impact analysis of DROC, 2021
      • Drivers
      • Opportunities
      • Restraints
      • Challenges
  • SWOT Analysis

KEY MARKET INSIGHTS

  • Technology Analysis
    • (Exhibit: Data Table: Name of technology and details)
  • Pricing Analysis
    • (Exhibit: Data Table: Name of technology and pricing details)
  • Supply Chain Analysis
    • (Exhibit: Detailed Supply Chain Presentation)
  • Value Chain Analysis
    • (Exhibit: Detailed Value Chain Presentation)
  • Ecosystem Of the Market
    • Exhibit: Parent Market Ecosystem Market Analysis
    • Exhibit: Market Characteristics of Parent Market
  • IP Analysis
    • (Exhibit: Data Table: Name of product/technology, patents filed, inventor/company name, acquiring firm)
  • Trade Analysis
    • (Exhibit: Data Table: Import and Export data details)
  • Startup Analysis
    • (Exhibit: Data Table: Emerging startups details)
  • Raw Material Analysis
    • (Exhibit: Data Table: Mapping of key raw materials)
  • Innovation Matrix
    • (Exhibit: Positioning Matrix: Mapping of new and existing technologies)
  • Pipeline product Analysis
    • (Exhibit: Data Table: Name of companies and pipeline products, regional mapping)
  • Macroeconomic Indicators

COVID IMPACT

  • Introduction
  • Impact On Economy—scenario Assessment
    • Exhibit: Data on GDP - Year-over-year growth 2016-2022 (%)
  • Revised Market Size
    • Exhibit: Data Table on Healthcare Payer Services Market size and forecast 2021-2027 ($ million)
  • Impact Of COVID On Key Segments
    • Exhibit: Data Table on Segment Market size and forecast 2021-2027 ($ million)
  • COVID Strategies By Company
    • Exhibit: Analysis on key strategies adopted by companies

MARKET DYNAMICS & OUTLOOK

  • Market Dynamics
    • Exhibit: Impact analysis of DROC, 2021
      • Drivers
      • Opportunities
      • Restraints
      • Challenges
  • Regulatory Landscape
    • Exhibit: Data Table on regulation from different region
  • SWOT Analysis
  • Porters Analysis
    • Competitive rivalry
      • Exhibit: Competitive rivalry Impact of key factors, 2021
    • Threat of substitute products
      • Exhibit: Threat of Substitute Products Impact of key factors, 2021
    • Bargaining power of buyers
      • Exhibit: buyers bargaining power Impact of key factors, 2021
    • Threat of new entrants
      • Exhibit: Threat of new entrants Impact of key factors, 2021
    • Bargaining power of suppliers
      • Exhibit: Threat of suppliers bargaining power Impact of key factors, 2021
  • Skyquest special insights on future disruptions
    • Political Impact
    • Economic impact
    • Social Impact
    • Technical Impact
    • Environmental Impact
    • Legal Impact

Market Size by Region

  • Chart on Market share by geography 2021-2027 (%)
  • Data Table on Market share by geography 2021-2027(%)
  • North America
    • Chart on Market share by country 2021-2027 (%)
    • Data Table on Market share by country 2021-2027(%)
    • USA
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Canada
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
  • Europe
    • Chart on Market share by country 2021-2027 (%)
    • Data Table on Market share by country 2021-2027(%)
    • Germany
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Spain
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • France
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • UK
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Rest of Europe
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
  • Asia Pacific
    • Chart on Market share by country 2021-2027 (%)
    • Data Table on Market share by country 2021-2027(%)
    • China
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • India
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Japan
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • South Korea
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Rest of Asia Pacific
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
  • Latin America
    • Chart on Market share by country 2021-2027 (%)
    • Data Table on Market share by country 2021-2027(%)
    • Brazil
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Rest of South America
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
  • Middle East & Africa (MEA)
    • Chart on Market share by country 2021-2027 (%)
    • Data Table on Market share by country 2021-2027(%)
    • GCC Countries
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • South Africa
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Rest of MEA
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)

KEY COMPANY PROFILES

  • Competitive Landscape
    • Total number of companies covered
      • Exhibit: companies covered in the report, 2021
    • Top companies market positioning
      • Exhibit: company positioning matrix, 2021
    • Top companies market Share
      • Exhibit: Pie chart analysis on company market share, 2021(%)

Methodology

For the Healthcare Payer Services Market, our research methodology involved a mixture of primary and secondary data sources. Key steps involved in the research process are listed below:

1. Information Procurement: This stage involved the procurement of Market data or related information via primary and secondary sources. The various secondary sources used included various company websites, annual reports, trade databases, and paid databases such as Hoover's, Bloomberg Business, Factiva, and Avention. Our team did 45 primary interactions Globally which included several stakeholders such as manufacturers, customers, key opinion leaders, etc. Overall, information procurement was one of the most extensive stages in our research process.

2. Information Analysis: This step involved triangulation of data through bottom-up and top-down approaches to estimate and validate the total size and future estimate of the Healthcare Payer Services Market.

3. Report Formulation: The final step entailed the placement of data points in appropriate Market spaces in an attempt to deduce viable conclusions.

4. Validation & Publishing: Validation is the most important step in the process. Validation & re-validation via an intricately designed process helped us finalize data points to be used for final calculations. The final Market estimates and forecasts were then aligned and sent to our panel of industry experts for validation of data. Once the validation was done the report was sent to our Quality Assurance team to ensure adherence to style guides, consistency & design.

Analyst Support

Customization Options

With the given market data, our dedicated team of analysts can offer you the following customization options are available for the Healthcare Payer Services Market:

Product Analysis: Product matrix, which offers a detailed comparison of the product portfolio of companies.

Regional Analysis: Further analysis of the Healthcare Payer Services Market for additional countries.

Competitive Analysis: Detailed analysis and profiling of additional Market players & comparative analysis of competitive products.

Go to Market Strategy: Find the high-growth channels to invest your marketing efforts and increase your customer base.

Innovation Mapping: Identify racial solutions and innovation, connected to deep ecosystems of innovators, start-ups, academics, and strategic partners.

Category Intelligence: Customized intelligence that is relevant to their supply Markets will enable them to make smarter sourcing decisions and improve their category management.

Public Company Transcript Analysis: To improve the investment performance by generating new alpha and making better-informed decisions.

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FAQs

Healthcare Payer Services Market size was valued at USD 57.3 Billion in 2021 and is poised to grow from USD 61.9 Billion in 2022 to USD 111.9 Billion by 2030, at a CAGR of 7.7% during the forecast period (2023-2030).

In order to introduce technologically improved products and acquire a competitive edge, businesses are putting a lot of effort into research and development. Companies are also forming alliances, merging, and buying other businesses in an effort to broaden their product offerings, increase their manufacturing capabilities, and create competitive difference. For instance, in 2021, Holy Cross Health, Memory Healthcare System, and Oscar worked up to offer the Medicare Advantage plan, which offers cheap, virtual care from a connected care team and a dependable doctor. 'UnitedHealth Group', 'Anthem, Inc.', 'Cigna Corporation', 'CVS Health', 'Aetna Inc. (a subsidiary of CVS Health)', 'Humana Inc.', 'Centene Corporation', 'Molina Healthcare, Inc.', 'WellCare Health Plans, Inc. (now part of Centene Corporation)', 'Optum (part of UnitedHealth Group)', 'Blue Cross Blue Shield Association (BCBS)', 'Kaiser Permanente', 'Magellan Health, Inc.', 'Change Healthcare', 'HMS Holdings Corp.', 'MultiPlan, Inc.', 'Evolent Health', 'Health Net, Inc. (a subsidiary of Centene Corporation)', 'Medecision Inc.', 'Conduent Inc.'

Payer organizations face complex challenges related to claims processing, member enrollment, billing, and customer service. Payer services providers offer specialized expertise, technology solutions, and operational support to address these complexities and enhance efficiency.

Shift towards Value-Based Care: There is a growing trend towards value-based care models, which focus on improving patient outcomes and cost-efficiency. Payer services providers are aligning their offerings to support value-based payment models, care coordination, and population health management.

North America led the market and took home 76.1% of the total revenue in 2022. Due to the growing demand for health IT services, the market for outsourcing business processes in the healthcare supply chain is anticipated to grow throughout the forecast period. The demand for healthcare supply chain outsourcing of business processes is projected to rise as a result of evolving regulatory environments and mounting pressure on the healthcare sector to reduce service costs. Consequently, it is predicted that the regional market will significantly expand during the projection period.

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