Healthcare Payer BPO Market

Market Definition:

The Healthcare Payer BPO Market size was valued at USD 320.26 billion in 2023 and is predicted to reach USD 619.76 billion by 2030 with a CAGR of 9.90% from 2022-2030.

Healthcare business process outsourcing (BPO) refers to the activities where the healthcare projects are outsourced to third-party organizations by healthcare organizations such as payers, providers and other life science organizations. 

Healthcare payer solution providers are the organizations such as health insurance providers, Medicare, and Medicaid that enables to set service rates, collect payments, process claims and payment provider bills. The healthcare payer solution enables increase in efficiencies & outcomes, reduces risk and provides cost-effective services to its consumers.

Market Dynamics and Trends:

Increasing demand for numerous healthcare plans due to increasing member base and managing regulatory compliance of the services that lead to management of high healthcare costs by the payer is driving the growth of healthcare payer BPO market. Also, rising burden of chronic diseases such as cancer, heart disease and diabetes that leads to growing penetration of insurance coverage globally is expected to further propel the growth of healthcare payer BPO market. For instance, in 2021, according to World Bank Data, around 10.6% of China’s population and 10.7% of the United States’ population is suffering from diabetes. 

Moreover, factors such as increasing use of healthcare IT solutions and implementation of various healthcare reforms such as public health, hospital reform, health financing, health regulation and local health systems across countries are further expected to drive the growth of healthcare payer BPO market during the forecast period.

However, lack of data security and privacy concern associated with healthcare payer BPO services are the factors that are expected to restrain the growth of market during the forecast period. On the contrary, the growing adoption of artificial intelligence-based tools for streamlining the drug discovery process that efficiently and substantially increases success rates at an early stage of drug discovery for chronic diseases such as cancer. This helps in assisting healthcare BPO service providers in making significant advancements and several pharmaceutical companies are increasingly focusing on forming partnerships with AI-driven businesses, which is expected to create ample growth opportunities for the healthcare BPO market in the coming years.

Market Segmentations and Scope of the Study:

The healthcare payer BPO market is segmented on the basis of service, application, end user, and geography. On the basis of service, the market is divided into business process outsourcing services, information technology outsourcing services, and knowledge process outsourcing services. On the basis of application, the market is classified into 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 and others. On the basis of end user, the market is categorized into private insurance companies, government agencies, employers, and private exchanges. Geographic breakdown and analysis of each of the aforesaid segments include regions comprising North America, Europe, Asia-Pacific, and RoW.

Geographical Analysis:

North America holds the lion share of healthcare payer BPO market at present and is expected to continue its dominance during the forecast period. This is attributed to increase in investment by private and public organizations in healthcare services in this region. For instance, in November 2021, the US government announced investment of USD 1.5 million to address the National health service Crops, Nurse Crops and Substance Use Disorder Treatment and Recovery programs to provide scholarships and debt repayments to health-care students and workers. 

Also, presence of major key major players such as Cognizant Technology Solutions, EXL Service Holdings Inc., Exlservice Holdings Inc. and Hewlett-Packard that are adopting various acquisitions to expand their business that boosts the market growth in this region. For instance, in December 2021, EXL Service Holdings Inc. announced acquisition of Clairvoyant. This acquisition strengthened EXL’s capabilities by adding additional expertise in data engineering and cloud enablement that provides support to clients in insurance and healthcare sectors. 
On the other hand, Asia-Pacific is expected to show a steady rise in the healthcare payer BPO market due to the growing population coupled with increasing prevalence of chronic diseases such as diabetes, cancer and heart diseases in this region.

For instance, according to International Agency for Research on Cancer, Asia-Pacific reported 9, 503,710 new cancer cases and 5,809,431 death due to cancer in 2020. Moreover, rising investments and expenditure in the healthcare sector are expected to drive the healthcare payer BPO market growth in this region. For instance, in June 2022, Healthcare BPO services provider Access Healthcare announced investment of Rs 190 crores to set up its new campus and expand operations in India.

Competitive Landscape:

The healthcare payer BPO market comprising of various market players such as Cognizant Technology Solutions, Exlservice Holdings Inc., Wipro Limited, WNS Global Services, HCL Technologies Ltd., Hinduja Global Solutions, Accenture, Firstsource Solutions Limited , NTT Data Corporation  and Genpact Limited. These market players are adopting various collaboration and launch of new products across various regions to maintain their dominance in the healthcare payer BPO market.

For instance, in March 2022, NTT Data Corporation announced launch of Hackathon for AI innovations in healthcare to focus on using artificial intelligence to improve outcomes of detection and management of diseases. This new hackathon has bought developers and tech enthusiasts from across the world together to create innovative healthcare solutions for the healthcare payers.

Moreover, in February 2022, Accenture announced collaboration with League to increase access to improve outcomes for people, providers, payers and retail pharmacies. This collaboration combined Accenture’s data analytics and systems integration capabilities of League’s healthcare experience platform to implement and innovate to create personalized digital healthcare experiences by the healthcare payers.

Key Benefits

• The healthcare payer BPO market report provides the quantitative analysis of the current market and estimations from 2022 to 2030. This analysis assists in identifying the prevailing market opportunities to capitalize on.

• The study comprises of a detailed analysis of the healthcare payer BPO market trends including the current and future trends for depicting the prevalent investment pockets in the market.

• The information related to key drivers, restraints, and opportunities and their impact on the healthcare payer BPO market is provided in the report.

• The competitive analysis of the market players along with their market share in the healthcare payer BPO market is mentioned.

• The SWOT analysis and Porter’s Five Forces model are elaborated in the study.

• The value chain analysis in the market study provides a clear picture of the stakeholders’ roles.

Key Market Segments

By Service

• Business Process Outsourcing Services

• Information Technology Outsourcing Services

• Knowledge Process Outsourcing Services

By Application

• 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

• Others

By End User

• Private Insurance Companies

• Government Agencies

• Employers and Private Exchanges 

By Geography

• North America

  • U.S

  • Canada

  • Mexico

• Europe

  • Germany

  • France

  • Italy

  • Spain

  • United Kingdom

  • Russia

  • Sweden

  • Rest of Europe

• Asia-Pacific

  • Australia

  • China

  • India

  • Japan

  • South Korea

  • Indonesia

  • Singapore

  • Rest of Asia-Pacific

• RoW

  • UAE

  • Brazil

  • South Africa

  • Israel

  • KSA (Kingdom of Saudi Arabia)

  • Turkey

  • Remaining Countries

Key Players

• Cognizant Technology Solutions

• Exlservice Holdings Inc.

• Wipro Limited

• WNS Global Services

• HCL Technologies Ltd.

• Hinduja Global Solutions

• Accenture

• Firstsource Solutions Limited 

• NTT Data Corporation 

• Genpact Limited