Healthcare Payer Services Market

Market Definition

The Healthcare Payer Services Market size was valued at USD 70.77 billion in 2023 and is predicted to reach USD 130.63 billion by 2030 with a CAGR of 9.2% from 2024-2030. Healthcare payers are the entities that arrange for the payment of any medical or healthcare service, process, or product. The services healthcare payer solutions provide include claims management, billing & accounts management, and member management.

Government entities, health maintenance organizations, and insurance companies outsource these services. These outsourcing solutions help payers to streamline their business procedures, cutting, and improving customer relations to provide better quality patient care and better healthcare plans.

Market Dynamics and Trends

Increasing number of healthcare payer services providers as well as rising number of people opting for healthcare insurance is driving the growth of healthcare payer service market. Also, increasing demand for healthcare payer solutions to be used during certain cases such as falsifying plans of treatment, misrepresenting diagnoses and charges leading to considerable losses boost the growth of the health payer services market. Moreover, increasing use of advanced analytic techniques such as data mining, machine learning & artificial intelligence to make predictions and provide meaningful insights to healthcare payers is further expected to drive the growth of healthcare payer service market during the forecast period.

However, rising privacy concerns and high cost of healthcare insurance are the factors restraining the growth of market during the forecast period. On the contrary, growing use of advanced technologies such as artificial intelligence and internet of things (IoT) to provide consumer easy accessible services is expected to create ample growth opportunities for the healthcare payer service market in the coming years.

Market Segmentations and Scope of the Study

The healthcare payer services market is segmented on the basis of service type, application, end-user and geography. On the basis of service type, the market is divided into information technology outsourcing (ITO), business process outsourcing (BPO), and knowledge process outsourcing (KPO). On the basis of application, the market is classified into claims management services, billing and accounts management services, analytics and fraud management services, member management services, provider management services, integrated front office services, human resource (HR) management services and others. on the basis of end-user, the market is categorized into private payers and public payers. Geographic breakdown and analysis of each of the aforesaid segments includes regions comprising of North America, Europe, Asia-Pacific, and RoW.

Geographical Analysis

North America holds the lion share of healthcare payer services market at present and is expected to continue its dominance during the forecast period. This is attributed to factors such as growing number of enrolments for health insurance as well as growing number of payer services and solution providers that is expected to drive the growth of healthcare payer services market in this region. Also, developed healthcare infrastructure and rising implementation of several codes in the healthcare sector in countries such as U.S and Canada boost the market growth in this region. For instance, ICD-10 (International Classification of Diseases, Tenth Revision) codes, a system used by healthcare providers to provide accurate and complete information. It also allows to track healthcare records, identify medical diagnosis and assist insurance companies for reimbursement decisions.

However, Asia-Pacific is expected to show a steady rise in the healthcare payer service market due to increasing prevalence of chronic diseases such as cancer, heart disease & diabetes. In addition,surging geriatric populations leading to rapid increase in healthcare expenditures is  expected to drive the growth of healthcare payer services in this region.  Also, growing trend of digitization of health records leading to accessing data by providers and payers in the healthcare sector accelerates the growth of the market. Moreover, mandatory provision of healthcare insurance in the workplaces among countries such as China and India are expected to drive the healthcare payer service market in this region.

Competitive Landscape

The healthcare payer services market comprises of various market players such as Dell Technologies Inc., Genpact Limited, HCL Technologies Ltd., Wipro Limited, Change Healthcare Inc., McKesson Corporation, Tata Consultancy Services (TCS), WNS (Holdings) Limited, NTT Data Corporation and Cognizant Technology Solutions Corporation. These market players are adopting various strategies such as product launches, partnerships and planning expansion of business across various regions to maintain their dominance in the healthcare payer service market.

For instance, in June 2022, Accenture was recognized as a leader by Everest Group Peak Matrix amongst digital service providers. Accenture's dedication to advancing its consulting services was acknowledged among the best service providers.   Moreover, in March 2022, Icertis launched Icertis Contract Intelligence (ICI) software for healthcare providers. This software was used for management to digitize contracts, automate workflows, and had an AI model created for the provider experience.
 
Key Benefits

• The healthcare payer services market report provides the quantitative analysis of the current market and estimations through 2022-2030 that assists in identifying the prevailing market opportunities to capitalize on.

• The study comprises a deep dive analysis of the healthcare payer services market trend 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 services market is provided in the report.

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

• The SWOT analysis and Porters Five Forces model is elaborated in the study.

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

Key Market Segments

By Service Type

• Information Technology Outsourcing (ITO)

• Business Process Outsourcing (BPO)

• Knowledge Process Outsourcing (KPO)

By Application

• Claims Management Services

• Billing and Accounts Management Services

• Analytics and Fraud Management Services

• Member Management Services

• Provider Management Services

• Integrated Front Office Services

• HR Management Services 

• Others

By End User

• Private Payers 

• Public Payers

By Geography

• North America

  • U.S.

  • Canada

  • Mexico

• Europe

  • UK

  • Germany

  • France

  • Spain

  • Italy

  • Netherlands    

  • Denmark    

  • Finland    

  • Norway    

  • Sweden    

  • Russia    

  • Rest of Europe

• Asia-Pacific

  • China

  • Japan

  • India

  • South Korea

  • Australia

  • Indonesia

  • Singapore

  • Taiwan

  • Thailand

  • Rest of Asia-Pacific

• Rest of World

  • Latin America    

  • Middle East    

  • Africa

Key Players

• Dell Technologies Inc.

• Genpact Limited

• HCL Technologies Ltd.

• Wipro Limited

• Change Healthcare Inc.

• McKesson Corporation

• Tata Consultancy Services (TCS)

• WNS (Holdings) Limited

• NTT Data Corporation

• Cognizant Technology Solutions Corporation