In April 2022, Audax Private Equity (US) invested in Aspen Surgical (US), which will allow Audax to continue to support Aspen as it pursues imminent organic growth and larger-scale acquisition opportunities to expand globally.

Northbrook, IL 60062 -- (SBWire) -- 03/21/2023 --The healthcare payer services industry is expected to undergo a dramatic transformation in the near future. Many of the changes will be driven by the increasing demand for greater transparency, accuracy, and cost-effectiveness in healthcare. The widespread adoption of technology such as artificial intelligence, machine learning, and predictive analytics is likely to revolutionize the payer services industry. Additionally, the use of big data analytics, cloud computing, and blockchain technology could enable payers to provide better services and enable organizations to make more informed decisions.

The healthcare payer services industry is also likely to be impacted by the Affordable Care Act (ACA), which has enabled more people to gain access to health insurance. This has resulted in an increased demand for payer services, as healthcare organizations require more resources to manage the influx of new members. Furthermore, the move to value-based care is likely to drive increased demand for payer services as organizations strive to reduce costs by providing higher-quality care.

Healthcare Payer Services Market in terms of revenue was estimated to be worth $69.9 billion in 2022 and is poised to reach $118.2 Billion by 2027, growing at a CAGR of 11.1% from 2022 to 2027 according to a new report by MarketsandMarkets™. The healthcare payer services market is mainly driven by the increasing health insurance enrolments, rising incidences of healthcare frauds, federal mandates, and rising cases of chronic diseases. However, the risk of data breaches, a loss of managerial control, cultural and language barriers, and high costs associated with outsourcing are expected to restrain the growth of this market to a certain extent.

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"BPO services type segment is expected to account for the largest share of the healthcare payer services market in 2022"

Based on service type, the healthcare payer services market is bifurcated into ITO services, BPO services and KPO services. In 2022, the BPO services segment is expected to hold the largest market share. The large share of this segment is primarily attributed to the fact that BPO services can help payers reduce operational costs by outsourcing administrative and non-core functions such as claims processing, member enrolment, and customer support to specialized BPO service providers. This allows payers to focus on their core business of providing healthcare coverage and managing risk.

"Private payers segment to grow at the highest CAGR in the healthcare payer services market during the forecast period, by end user"

Based on end user, the healthcare payer services market is bifurcated into private payers & public payers. In 2022, the private payers segment is expected to account for the largest market share of the healthcare payer services market. During the forecast period, the private payers' segment is expected to grow at the highest CAGR. The high growth of this segment is attributed the increasing adoption of private health insurance by individuals and employers, along with advancements in technology and the need for better healthcare services and rising competitiveness among private payers.

"North America is expected to hold the largest share of the healthcare payer services market in 2022"

Based on region, the healthcare payer services market is divided into North America, Europe, Asia Pacific, and the Rest of the World (RoW). Factors such as rise in insurance enrolments due to PPACA, federal healthcare mandates to drive the demand for outsourcing of services, rising healthcare costs, increasing chronic disease prevalence, technological advancements, shifting consumer preferences, and rising need to curb healthcare expenditure are driving the growth in North American market.

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Healthcare Payer Services Market Dynamics:

Drivers:

Outsourcing: a cost-effective solution for healthcare payers
Federal mandates in the U.S. increasing payer workload
Increasing healthcare fraud
Dynamic nature of health benefit plan designs
In-house shortage of skilled personnel

Restraints:

Rising incidences of data breaches and loss of confidentiality
Unforeseen costs associated with outsourcing
Loss of managerial control

Opportunities:

Advanced data analytics
Switching to ICD-10 standards
Service portfolio expansion

Challenges:

Migration from legacy systems
Cultural differences and language barriers

Key Market Players:

Prominent players in this market include Accenture (Ireland), Cognizant (US), Tata Consultancy Services (India), XEROX Corporation (US), WNS (Holdings) Limited (India), NTT Data Corporation (Japan), IQVIA Inc. (US), Mphasis (India), Genpact (US), Wipro (India), Infosys BPM (India), Firstsource Solutions (India), IBM Corporation (US), HCL Technologies (India), Solutions (US), Lonza (Switzerland), Omega Healthcare (India), R1 RCM, INC. (US), Invensis Technologies (India), UnitedHealth Group (US), Sykes Enterprises (US), Paraxel Corporation International (US), Access Healthcare (US), and Akurate Management Solutions (US).

Recent Developments

In July 2021, Cognizant (US) collaborated with Royal Philips (Netherlands) to create Philips HealthSuite, a cloud-based platform, to deliver and maintain leading-edge digital health solutions, providing advanced connectivity and using big data to create actionable insights.

In April 2021, Xerox Corporation (US) acquired Groupe CT (Canada), an independent document management provider in Eastern Canada, to accelerate a digital transformation roadmap by combining its document management services expertise and leadership with Xerox's portfolio of workplace solutions to expand its reach in the North American market.

In December 2020, Accenture (Ireland) acquired OpusLine (France) to help clients innovate and deliver digital innovation across their organizations.

In June 2018, WNS (Holdings) Limited (India) entered into a global shared services partnership with Hyperion Insurance Group (UK), which enabled WNS to highlight its position as an industry leader in high-end global insurance BPM.

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