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U.S. Business Process As A Service In Healthcare Payers Market Size, Share & Trends Analysis Report By Solution Coverage, By Buyer Type, By Value Chain Processes, By Buyer Size, And Segment Forecasts, 2022 - 2030

October 2022 | 150 pages | ID: UF9B25AE1516EN
Grand View Research, Inc.

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U.S. Business Process As A Service In Healthcare Payers Market Growth & Trends

The U.S. business process as a service in healthcare payers market size is expected to reach USD 9.6 billion by 2030, according to a new report by Grand View Research, Inc. The market is expected to expand at a CAGR of 6.0% from 2022 to 2030. As a result of the fact that BPaaS engagements contributed significantly to healthcare payer business process outsourcing revenue and that this percentage is likely to rise as the industry for payer BPaaS expands due to the move toward value-based care, which has been hastened by COVID-19.

Furthermore, the adoption of BPaaS in the U.S. payviders industry is growing quickly. Although payviders have been around for a while, the Affordable Care Act made them more common and significant, which makes them well-suited to take advantage of the BPaaS opportunity.

In addition, many have not attained considerable scale in terms of members registered, except the majority of large payviders. For instance, according to The Robert Wood Johnson Foundation (RWJF) as of September 2016, just 4 of the 42 Provider Sponsored Health Plans (PSHPs) established since 2010 had between 50,000 and 100,000 covered subscribers, with the remaining 36 having fewer than 50,000. These obstacles could well be solved since BPaaS solutions scale more quickly for the provider and are easier to install without a long lag time.

Additionally, industry-specific regulatory compliances specify a range of compliance requirements for various industrial verticals. The Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health (HITECH), and the Payment Card Industry Data Security Standard (PCI DSS) are a few legislations that have impacted the industry. In many instances, the market now supports compliance management as an administrative activity rather than a regulatory one. A BPaaS provider could implement BPaaS solutions that can bridge compliance gaps between verticals and adapt to changes in the existing regulations, leading to the industry’s growth with the rise in adoption throughout the forecast period—as all compliance adherence difficulties can be managed with their assistance.

U.S. Business Process As A Service In Healthcare Payers Market Report Highlights
  • The healthcare industry has advanced significantly over the last few years. The rise of digital health, the shift to value-based care, and rising consumerism have all altered how payers operate. The traditional BPS outsourcing model is quickly giving way to a platform-led BPaaS model, which has brought about advantages like access to better technology and human capital, the promise of digital transformation at a lower cost, and a lower cost of ownership. As a result, payers' sourcing considerations have also evolved. As a consequence, throughout the forecast period, BPaaS usage is anticipated to increase moderately at a CAGR of 6.0%
  • Small and medium-sized payers, make up more than 70% of all payers in 2021 and have shown a stronger preference for the BPaaS model. In terms of plan types, medicare advantage and managed Medicaid have emerged as viable business cases, with MA accounting for a significant share percentage of about 29% in 2021
  • From a process perspective, administrative processes like claims management have seen the most BPaaS adoption, accounting for over 30% of the revenue share in 2021. Payers are, however, progressively becoming aware of BPaaS's potential in processes like care management, population health management, and member engagement as well as in reducing medical expenses
  • Key players also contribute to the market's expansion through strategic partnerships, mergers, and acquisitions, as well as the introduction of new offerings. For instance, Cognizant announced in 2017 that it had acquired TMG Health, a key national provider of BPaaS to the Medicare Part D, Managed Medicaid, and MA markets in the U.S., which supported 32 health plans offered with more than 4.4 million members across all 50 states. Through the purchase of TMG Health, Cognizant solidifies its position as the leading service provider for management health programs run by the U.S. government
CHAPTER 1 RESEARCH METHODOLOGY & SCOPE

1.1 Market Segmentation & Scope
  1.1.1 Estimates and Forecast Timeline
1.2 Research Methodology
1.3 Information Procurement
  1.3.1 Purchased Database
  1.3.2 GVR’s Internal Database
  1.3.3 Secondary Sources
  1.3.4 Primary Research
  1.3.5 Details of Primary Research
1.4 Information or Data Analysis
  1.4.1 Data Analysis Models
1.5 Market Formulation & Validation
1.6 Model Details
  1.6.1 Mixed Approach Analysis (Model 1)
    1.6.1.1 Approach 1: Mixed Approach
1.7 List of Secondary Sources
1.8 List of Primary Sources
1.9 Report Objectives

CHAPTER 2 EXECUTIVE SUMMARY

2.1 Market Outlook
2.2 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market Summary, 2021

CHAPTER 3 U.S. BUSINESS PROCESS AS A SERVICE (BPAAS) IN HEALTHCARE PAYERS MARKET VARIABLES, TRENDS & SCOPE

3.1 Market Lineage Outlook
  3.1.1 Parent Market Outlook
  3.1.2 Ancillary Market Outlook
3.2 Penetration & Growth Prospect Mapping
3.3 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market Dynamics
  3.3.1 Market Driver Analysis
  3.3.2 Market Restraints Analysis
3.4 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market Analysis Tools: Porter’s Five Forces Analysis
  3.4.1 Supplier Power
  3.4.2 Buyer Power
  3.4.3 Threat Of Substitues
  3.4.4 Threat Of New Entrants
  3.4.5 Competitive Rivalry
3.5 PESTEL Analysis
  3.5.1 Political & Legal Landscape
  3.5.2 Social Landscape
  3.5.3 Technology Landscape
  3.5.4 Envirnomental Analysis
3.6 Regulatory Framework
3.7 Covid-19 Impact Analysis
  3.7.1 Current And Future Impact Analysis
  3.7.2 Impact OF Covid-19 On Market Players

CHAPTER 4 COMPETITIVE LANDSCAPE

4.1 Market participation categorization
4.2 Competitive Dashboard Analysis
4.3 Public Companies
  4.3.1 Company Market Position Analysis
  4.3.2 Synergy Analysis: Major Deals & Strategic Alliances
4.4 Detailed list of market players

CHAPTER 5 U.S. BUSINESS PROCESS AS A SERVICE (BPAAS) IN HEALTHCARE PAYERS MARKET: SEGMENT ANALYSIS, BY SOLUTION COVERAGE, 2017 - 2030 (USD BILLION)

5.1 Solution Coverage Movement Analysis, 2021 & 2030
  5.1.1 Traditional BPaaS
    5.1.1.1 Traditional BPaaS market estimates and forecasts, 2017 - 2030 (Billion)
  5.1.2 Best-of-breed BPaaS
    5.1.2.1 Best-of-breed BPaaS market estimates and forecasts, 2017 - 2030 (Billion)

CHAPTER 6 U.S. BUSINESS PROCESS AS A SERVICE (BPAAS) IN HEALTHCARE PAYERS MARKET: SEGMENT ANALYSIS, BY TRADITIONAL BPAAS, 2017 - 2030 (USD BILLION)

6.1 Traditional BPaaS Movement Analysis, 2021 & 2030
  6.1.1 End-to-end (E2E) traditional BPaaS
    6.1.1.1 End-to-end (E2E) traditional BPaaS market estimates and forecasts, 2017 - 2030 (Billion)
  6.1.2 Process-specific traditional BPaaS
    6.1.2.1 Process-specific traditional BPaaS market estimates and forecasts, 2017 - 2030 (Billion)

CHAPTER 7 U.S. BUSINESS PROCESS AS A SERVICE (BPAAS) IN HEALTHCARE PAYERS MARKET: SEGMENT ANALYSIS, BY BEST-OF-BREED BPAAS, 2017 - 2030 (USD BILLION)

7.1 Best-of-breed BPaaS Movement Analysis, 2021 & 2030
  7.1.1 End-to-end best-of-breed BPaaS
    7.1.1.1 End-to-end best-of-breed BPaaS market estimates and forecasts, 2017 - 2030 (Billion)
  7.1.2 Process-specific best-of-breed BPaaS
    7.1.2.1 Process-specific best-of-breed BPaaS market estimates and forecasts, 2017 - 2030 (Billion)

CHAPTER 8 U.S. BUSINESS PROCESS AS A SERVICE (BPAAS) IN HEALTHCARE PAYERS MARKET: SEGMENT ANALYSIS, BY BUYER TYPE, 2017 - 2030 (USD BILLION)

8.1 Buyer type Movement Analysis, 2021 & 2030
  8.1.1 Government buyers
    8.1.1.1 Government buyers’ market estimates and forecasts, 2017 - 2030 (Billion)
  8.1.2 Commercial buyers
    8.1.2.1 Commercial buyers’ market estimates and forecasts, 2017 - 2030 (Billion)

CHAPTER 9 U.S. BUSINESS PROCESS AS A SERVICE (BPAAS) IN HEALTHCARE PAYERS MARKET: SEGMENT ANALYSIS, BY COMMERCIAL BUYERS, 2017 - 2030 (USD BILLION)

9.1 Commercial Buyers Movement Analysis, 2021 & 2030
  9.1.1 Medicare advantage
    9.1.1.1 Medicare advantage market estimates and forecasts, 2017 - 2030 (Billion)
  9.1.2 Managed Medicaid
    9.1.2.1 Managed Medicaid market estimates and forecasts, 2017 - 2030 (Billion)
  9.1.3 Individual health plan
    9.1.3.1 Individual health plan market estimates and forecasts, 2017 - 2030 (Billion)
  9.1.4 Employer-sponsored health plan
    9.1.4.1 Employer-sponsored health plan market estimates and forecasts, 2017 - 2030 (Billion)

CHAPTER 10 U.S. BUSINESS PROCESS AS A SERVICE (BPAAS) IN HEALTHCARE PAYERS MARKET: SEGMENT ANALYSIS, BY VALUE CHAIN PROCESSES, 2017 - 2030 (USD BILLION)

10.1 Value Chain Processes Movement Analysis, 2021 & 2030
  10.1.1 Claims Management
    10.1.1.1 Claims Management market estimates and forecasts, 2017 - 2030 (Billion)
  10.1.2 Member Engagement
    10.1.2.1 Member Engagement market estimates and forecasts, 2017 - 2030 (Billion)
  10.1.3 Care Management
    10.1.3.1 Care Management market estimates and forecasts, 2017 - 2030 (Billion)
  10.1.4 Others (Product development, Network Management, Risk & Compliance)
    10.1.4.1 Others market estimates and forecasts, 2017 - 2030 (Billion)

CHAPTER 11 U.S. BUSINESS PROCESS AS A SERVICE (BPAAS) IN HEALTHCARE PAYERS MARKET: SEGMENT ANALYSIS, BY BUYER SIZE, 2017 - 2030 (USD BILLION)

11.1 Buyer Size Movement Analysis, 2021 & 2030
  11.1.1 Small buyers
    11.1.1.1 Small buyers’ market estimates and forecasts, 2017 - 2030 (Billion)
  11.1.2 Midsized buyers
    11.1.2.1 Midsized buyers’ market estimates and forecasts, 2017 - 2030 (Billion)
  11.1.3 Large buyers
    11.1.3.1 Large buyers’ market estimates and forecasts, 2017 - 2030 (Billion)

CHAPTER 12 COMPANY PROFILES

12.1 Accenture
  12.1.1 Company Overview
  12.1.2 Financial Performance
  12.1.3 Product Benchmarking
  12.1.4 Strategic Initiatives
12.2 Cognizant
  12.2.1 Company Overview
  12.2.2 Financial Performance
  12.2.3 Product Benchmarking
  12.2.4 Strategic Initiatives
12.3 HCL
  12.3.1 Company Overview
  12.3.2 Financial Performance
  12.3.3 Product Benchmarking
  12.3.4 Strategic Initiatives
12.4 IBM
  12.4.1 Company Overview
  12.4.2 Financial Performance
  12.4.3 Product Benchmarking
  12.4.4 Strategic Initiatives
12.5 Infosys
  12.5.1 Company Overview
  12.5.2 Financial Performance
  12.5.3 Product Benchmarking
  12.5.4 Strategic Initiatives
12.6 NTT DATA
  12.6.1 Company Overview
  12.6.2 Financial Performance
  12.6.3 Product Benchmarking
  12.6.4 Strategic Initiatives
12.7 Optum
  12.7.1 Company Overview
  12.7.2 Financial Performance
  12.7.3 Product Benchmarking
  12.7.4 Strategic Initiatives
12.8 TCS
  12.8.1 Company Overview
  12.8.2 Financial Performance
  12.8.3 Product Benchmarking
  12.8.4 Strategic Initiatives
12.9 UST
  12.9.1 Company Overview
  12.9.2 Financial Performance
  12.9.3 Product Benchmarking
  12.9.4 Strategic Initiatives
12.10 Wipro
  12.10.1 Company Overview
  12.10.2 Financial Performance
  12.10.3 Product Benchmarking
  12.10.4 Strategic Initiatives
12.11 EXL
  12.11.1 Company Overview
  12.11.2 Financial Performance
  12.11.3 Product Benchmarking
  12.11.4 Strategic Initiatives
12.12 Softheon
  12.12.1 Company Overview
  12.12.2 Financial Performance
  12.12.3 Product Benchmarking
  12.12.4 Strategic Initiatives
12.13 Genpact
  12.13.1 Company Overview
  12.13.2 Financial Performance
  12.13.3 Product Benchmarking
  12.13.4 Strategic Initiatives
12.14 Change Healthcare
  12.14.1 Company Overview
  12.14.2 Financial Performance
  12.14.3 Product Benchmarking
  12.14.4 Strategic Initiatives
12.15 Firstsource
  12.15.1 Company Overview
  12.15.2 Financial Performance
  12.15.3 Product Benchmarking
  12.15.4 Strategic Initiatives
12.16 Celegence
  12.16.1 Company Overview
  12.16.2 Financial Performance
  12.16.3 Product Benchmarking
  12.16.4 Strategic Initiatives
LIST OF TABLES

Table 1. List of secondary sources
Table 2. List of key companies
Table 3. U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market, By Solution Coverage, 2017 - 2030 (USD Billion)
Table 4. U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market, By Traditional BPaaS, 2017 - 2030 (USD Billion)
Table 5. U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market, Best-of-breed BPaaS, 2017 - 2030 (USD Billion)
Table 6. U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market, By Buyer Type, 2017 - 2030 (USD Billion)
Table 7. U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market, By Commercial Buyers, 2017 - 2030 (USD Billion)
Table 8. U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market, By Value Chain Processes, 2017 - 2030 (USD Billion)
Table 9. U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market, By Buyer Size, 2017 - 2030 (USD Billion)
LIST OF FIGURES

Fig. 1 Market segmentation
Fig. 2 Market research process
Fig. 3 Data triangulation techniques
Fig. 4 Primary research pattern
Fig. 5 Market research approaches
Fig. 6 Value-chain-based sizing & forecasting
Fig. 7 QFD Modeling for market share assessment
Fig. 8 Market formulation & validation
Fig. 9 Mixed Approach
Fig. 10 Segment-Based Penetration Model
Fig. 11 Market summary (2021, Billion)
Fig. 12 Segment Outlook, By Solution Coverage
Fig. 13 Segment outlook, By Traditional BPaaS
Fig. 14 Segment Outlook, By Best-of-breed BPaaS
Fig. 15 Segment outlook, By Buyer type
Fig. 16 Segment Outlook, By Commercial Buyers
Fig. 17 Segment outlook, By Value Chain Processes
Fig. 18 Segment outlook, By Buyer Size
Fig. 19 Penetration & growth prospect mapping
Fig. 20 Market variable analysis
Fig. 21Market driver relevance analysis (Current & future impact)
Fig. 22 Market restraint relevance analysis (Current & future impact)
Fig. 23 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: By Solution Coverage Movement Analysis, 2021 & 2030
Fig. 24 Traditional BPaaS Market, 2017 - 2030 (Billion)
Fig. 25 Best-of-breed BPaaS market, 2017 - 2030 (Billion)
Fig. 26 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: By Traditional BPaaS Movement Analysis, 2021 & 2030
Fig. 27 End-to-end traditional BPaaS market, 2017 - 2030 (Billion)
Fig. 28 Process-specific traditional BPaaS market, 2017 - 2030 (Billion)
Fig. 29 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: By Best-of-breed BPaaS Movement Analysis, 2021 & 2030
Fig. 30 End-to-end best-of-breed BPaaS market, 2017 - 2030 (Billion)
Fig. 31 Process-specific best-of-breed BPaaS market, 2017 - 2030 (Billion)
Fig. 32 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: By Buyer Type Movement Analysis, 2021 & 2030
Fig. 33 Government buyers’ market, 2017 - 2030 (Billion)
Fig. 34 Commercial buyers’ market, 2017 - 2030 (Billion)
Fig. 35 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: By Commercial Buyers Movement Analysis, 2021 & 2030
Fig. 36 Medicare advantage market, 2017 - 2030 (Billion)
Fig. 37 Managed Medicaid market, 2017 - 2030 (Billion)
Fig. 38 Individual health plan market, 2017 - 2030 (Billion)
Fig. 39 Employer-sponsored health plan market, 2017 - 2030 (Billion)
Fig. 40 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: By Value Chain Processes Movement Analysis, 2021 & 2030
Fig. 41 Claims Management market, 2017 - 2030 (Billion)
Fig. 42 Member Engagement market, 2017 - 2030 (Billion)
Fig. 43 Care Management market, 2017 - 2030 (Billion)
Fig. 44 Others market, 2017 - 2030 (Billion)
Fig. 45 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: By Buyer Size Movement Analysis, 2021 & 2030
Fig. 46 Small buyers’ market, 2017 - 2030 (Billion)
Fig. 47 Midsized buyers’ market, 2017 - 2030 (Billion)
Fig. 48 Large buyers’ market, 2017 - 2030 (Billion)
Fig. 49 Market Participation Categorization
Fig. 50 Company market position analysis?


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