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2020

Healthcare Payer Solution Market

Healthcare Payer Solution Market Size, Share, Competitive Landscape and Trend Analysis Report by Service, Application and End User : Global Opportunity Analysis and Industry Forecast, 2020-2027

LS : Healthcare

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Author's: Ravi Telugunta| Sahil Sinha | Roshan Deshmukh
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The global healthcare payer solution market was valued at $19,409.52 million in 2019, and is projected to reach $41,906.64 million by 2027, registering a CAGR of 10.6% from 2020 to 2027.

 

The healthcare payer solution providers support the public and private payers as well as healthcare insurers to manage the claims, member engagement, audits, medical documents, and customer relations. These businesses have dedicated units, which improve the overall health system performance through optimizing care quality; reducing costs as well as improving consumer experience & care provider performance; and leveraging distinctive capabilities in data & analytics, pharmacy care services, population health, healthcare delivery, & healthcare operations. Through all these services, healthcare payer solution providers help their clients to improve their operational efficiency and reduce their operational cost.

Healthcare-Payer-Solution-Market-Market-2020-2027

The major factors that contribute toward the growth of the healthcare payer solution market include rise in cost of healthcare system and urge to decrease wasteful spending. In addition, significant losses incurred due to increase in healthcare frauds augments the demand for healthcare payer solutions, thereby contributing toward the growth of the global market. Moreover, notable risehas been witnessed in health insurance enrolment, which positively impacts the growth of the market. Furthermore, increase in use of healthcare IT solutions and implementation of various healthcare reforms fuel the growth of the healthcare payer solution market.

However, surge in incidence of data breaches and loss of confidentiality and cultural & language barriers are anticipated to hamper the growth of the market. Conversely, potential growth opportunities offered by emerging economies and increase in adoption of AI & analytics are expected to offer remunerative opportunities for the healthcare payer solution market growth during the forecast period.

The recent COVID-19 pandemic has disrupted the healthcare system of all the worst affected countries, owing to alarming rise in number of patients diagnosed with COVID-19. It is expected that due to this overburden of COVID-19 on the healthcare system, it will lead to huge losses in administrative operation. The outsourcing partners who are having track record of improved efficiencies in the claim operations, provider network management, medical document management, fraud management, and all other applications are expected to help the payers in the market. In addition, surge in demand for health coverage in emerging markets due to the COVID-19 pandemic and increase in health insurance awareness among previously uninsured patients are expected to boost the growth of the healthcare payer solution market.

Global Healthcare Payer Solution market Segmentation  

The global healthcare payer solution market is segmented into service, application, end user, and region. On the basis of service, the market is segregated into business process outsourcing (BPO) services, information technology outsourcing (ITO) services, and knowledge process outsourcing (KPO) services.The applications covered in the study include pharmacy audit & analysis systems, claims management services, fraud management services, computer-assisted coding (CAC) systems, member eligibility management services, provider network management services, payment management services, customer relationship management services, medical document management services, and general ledger & payroll management. Depending on end user, the market is bifurcated into private and public end user. Region wise, it is analyzed across North America (U.S., Canada, and Mexico), Europe (Germany, the UK, Italy, Spain, France, and rest of Europe), Asia-Pacific (Japan, China, India, and rest of Asia-Pacific), and LAMEA (Brazil, South Africa, Saudi Arabia, and rest of LAMEA).

Healthcare Payer Solution Market
By Service
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Business Process Outsourcing Services segment holds a dominant position in 2019 and would continue to maintain the lead over the forecast period.

Segment review

On the basis of service, the business process outsourcing services segment acquired the major share of the healthcare payer solution market in 2019, and is expected to experience rapid growth during the forecast period, due to high demand of BPO services. Moreover, surge in investment by key players in cloud computing to strengthen their portfolio is another reason that boosts the growth of the healthcare business process outsourcing services market.

By application, the claims management services segment dominated the market, owing to urge in bringing down the wasteful spending in healthcare and increase in demand to streamline the process. However, the computer-assisted coding (CAC) systems segment is expected to grow at the fastest rate during the forecast period, due to increase in implementation of ICD-10 code globally.

Healthcare Payer Solution Market
By Application
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Computer Assisted Coding (CAC) Systems segment is projected as one of the most lucrative segment.

In 2019, North America acquired a major share of the market, owing to presence of key players that offer healthcare payer solutions in the region as well as high demand for healthcare payer solutions. However, Asia-Pacific is expected to grow at the fastest rate during the forecast period, due to increase in adoption of healthcare IT solutions and presence of large uninsured population base that offers significant opportunities for the growth of the market.In addition, emerging economies offer lucrative opportunities for healthcare payer solution providers to expand their business. Furthermore, the constantly evolving healthcare industry drives the growth of the healthcare payer solution market in the developing economies such as India and China

The global healthcare payer solution market is highly competitive, and prominent players have adopted various strategies for garnering maximum market share. These include collaboration, product launch, partnership, and acquisition. Major players operating in the market include UnitedHealth Group Incorporated, McKesson Corporation, HMS Holdings Corp, International Business Machines Corporation, Change Healthcare, Inc., Accenture plc, Cognizant Technology Solutions Corporation, Hinduja Global Solutions Limited, Inovalon Holdings, Inc., and Wipro Limited.

Healthcare Payer Solution Market
By Region
2027
North America 
Europe
Asia-Pacific
LAMEA

Asia-Pacific region would exhibit the highest CAGR of 11.3% during 2019-2026.

Key Benefits For Stakeholders

  • This report entails a detailed quantitative analysis of the current market trends from 2019 to 2027 to identify the prevailing opportunities along with strategic assessment of the global healthcare payer solution market.
  • Healthcare payer solution market size and estimations are based on a comprehensive analysis of the end users, developments, and services in the industry.
  • An in-depth analysis based on region assists to understand the regional healthcare payer solution market and facilitate the strategic business planning.
  • The development strategies adopted by the key market players are enlisted to understand the competitive scenario of the healthcare payer solution market.

Key Market Segments

By Services

  • Business Process Outsourcing Services
  • Information Technology Outsourcing Services
  • Knowledge Process Outsourcing Services

By Application

  • Pharmacy Audit & Analysis Systems
  • Claims Management Services
  • Fraud Management Services
  • Computer-assisted Coding (CAC) Systems
  • Member Eligibility Management Services
  • Provider Network Management Services
  • Payment Management Services
  • Customer Relationship Management Services
  • Medical Document Management Services
  • General Ledger & Payroll Management

By End User

  • Private Provider 
  • Public Provider

By Region

  • North America
    • U.S.
    • Canada
    • Mexico
  • Europe
    • Germany 
    • UK
    • Italy
    • Spain
    • France 
    • Rest of Europe
  • Asia-Pacific
    • Japan 
    • China 
    • India 
    • Rest of Asia-Pacific
  • LAMEA
    • Brazil
    • Saudi Arabia
    • South Africa
    • Rest of Middle East

Healthcare Payer Solution Market Report Highlights

Aspects Details
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By SERVICE
  • Business process outsourcing services
  • Information technology outsourcing services
  • Knowledge process outsourcing services
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By APPLICATION
  • Pharmacy audit & analysis systems
  • Claims management services
  • Fraud management services
  • Computer-assisted coding (CAC) systems
  • Member eligibility management services
  • Provider network management services
  • Payment management services
  • Customer relationship management services
  • Medical document management services
  • General ledger & payroll management
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By END USER
  • Private
  • Public
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By Region
  • North America  (U.S., Canada, Mexico)
  • Europe  (France, Germany, Italy, Spain, UK, Russia, Rest of Europe)
  • Asia-Pacific  (China, Japan, India, South Korea, Australia, Thailand, Malaysia, Indonesia, Rest of Asia-Pacific)
  • LAMEA  (Brazil, South Africa, Saudi Arabia, UAE, Argentina, Rest of LAMEA)
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Key Market Players

UNITEDHEALTH GROUP INCORPORATED (OPTUM), INOVALON HOLDINGS, INC., WIPRO LIMITED, HINDUJA GLOBAL SOLUTIONS LIMITED, COGNIZANT TECHNOLOGY SOLUTIONS CORPORATION, HMS HOLDINGS CORP., INTERNATIONAL BUSINESS MACHINES CORPORATION, MCKESSON CORPORATION, CHANGE HEALTHCARE, INC., ACCENTURE PLC.

Analyst Review

The factors that fuel the growth of the global healthcare payer solution market include the surge in healthcare costs across the globe and the urge to reduce the operational costs associated with it. In addition, the market is exhibiting high growth rate, owing to surge in adoption of AI and analytics. Moreover, increase in health insurance enrolment is another factor that significantly contributes toward the growth of the market. The Asia-Pacific and LAMEA are expected to offer lucrative growth opportunities to the key players. This is majorly attributed to factors such as improvement in healthcare facilities and rapid improvement in economic conditions. 

The healthcare payer solution providers have further focused on expanding their presence in the emerging economies to strengthen their foothold in the market. However, surge in incidences of data breaches and loss of confidentiality hinder the growth of the healthcare payer solution market. 

Author Name(s) : Ravi Telugunta| Sahil Sinha | Roshan Deshmukh
Frequently Asked Questions?

The total market value of healthcare payer solution market is $19,409.52 million in 2019.

The forcast period for healthcare payer solution market is 2020 to 2027

The expected market value of healthcare payer solution market in 2027 is $41,906.64 million.

The base year is 2019 in healthcare payer solution market

Top companies such as, Hinduja Global Solutions Limited, International Business Machines Corporation Technology, McKesson Corporation, UnitedHealth Group Incorporated, and Wipro Limited held a high market position in 2019. These key players held a high market postion owing to the strong geographical foothold in different regions.

Business Process Outsourcing services segment is the most influencing segment owing to high demand of BPO services and surge in investment by key players in cloud computing to strengthen their portfolio for healthcare business process outsourcing services.

The major factor that fuels the growth of the global healthcare payer solution market includes the rising cost of healthcare systems and urge to decrease wasteful spending

Asia-Pacific has the highest growth rate in the market which is growing due to the contribution of the following emerging countries such as India, China, and Japan with a CAGR of 11.3%. This is due to development in healthcare infrastructure, and rise in adoption of healthcare IT solutions.

The healthcare payer solution can be defined as the services provided by the healthcare IT companies to payers, i.e. private and public insurers as well as insurance companies, to help with streamlining the business processes and reduce operational cost.

Healthcare payer solution providers have dedicated units, which improve the overall health system performance through optimizing care quality, reducing costs as well as improving consumer experience & care provider performance, and leveraging distinctive capabilities in data & analytics, pharmacy care services, population health, healthcare delivery, and healthcare operations. Through all these services, healthcare payer solution providers help their clients to improve their operational efficiency and reduce their operational cost.

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Healthcare Payer Solution Market

Global Opportunity Analysis and Industry Forecast, 2020-2027