Healthcare Payer Services Market Size, Share, Analysis, Trends, Growth Report, 2030

Healthcare payer services Market Industry Perspective:

The global healthcare payer services market size was worth USD 56.8 billion in 2021 and is estimated to grow to USD 87.7 billion by 2028, with a compound annual growth rate (CAGR) of approximately 7.50% over the forecast period.

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The report analyzes the healthcare payer services market's drivers, restraints/challenges, and their effect on the demands during the projection period. In addition, the report explores emerging opportunities in the healthcare payer services market.

Healthcare payer services Market: Overview

The vendors of the Global healthcare payer services market assist healthcare insurers, public & private payers, as well as members in managing claims, member engagement, audits, medical records, and customer relations. These companies have specialized divisions that enhance the performance of the entire healthcare system by optimizing care quality, cutting costs, enhancing patient satisfaction and care provider effectiveness, utilizing unique competencies in data & analytics, pharmacy care services, population health, healthcare delivery, and healthcare operations.

Healthcare payer services providers assist their clients in increasing operational effectiveness and lowering operational costs by offering all these services. Healthcare insurance payers and providers employ a variety of outsourcing options to streamline their operations and provide better customer service.

Outsourcing has become a feasible business strategy to reduce administrative, logistical, procurement & other obligations, and create cost-effective company operations. The rise in healthcare system costs and the desire to reduce wasteful expenditure are the main reasons driving the market growth for healthcare payer services. However, it is projected that the rise in data breaches, loss of confidentiality, and linguistic and cultural obstacles will restrain the market's expansion.

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Key Insights

• As per the analysis shared by our research analyst, the global healthcare payer services market value is expected to grow at a CAGR of 7.50% over the forecast period.
• In terms of value, the global healthcare market size was valued at around USD 56.8 billion in 2021 and is projected to reach USD 87.7 billion by 2028.
• The rise in healthcare system costs and the desire to reduce wasteful expenditure is the main reasons driving the growth of the global healthcare payer services market.
• By service, the ITO category dominated the market in 2021.
• By end-use, the private payer's category dominated the market in 2021.
• North America dominated the global healthcare payer services market in 2021.

COVID-19 Impact:

Due to the alarming increase in individuals being diagnosed with COVID-19, the recent COVID-19 pandemic has disturbed the healthcare systems of all the countries which are most severely impacted. It is anticipated that COVID-19's excessive burden on the healthcare system will result in significant losses in administrative operations. The payers in the market should expect assistance from outsourcing partners who have a history of increasing efficiency in claim operations, provider network management, medical document management, fraud control, and all other applications.

Healthcare Payer Services Market: Growth Drivers

An increase in insurance coverage among the population is likely to pave the way for market growth

The global population's rising insurance coverage is driving the demand for healthcare payer services. Due to favorable government policies, it is also projected that developing nations like India will see a rise in health insurance coverage. For instance, the FDI cap in insurance was raised from 49 to 74 % as part of the Union Budget of 2021, and state-owned general insurance businesses received an infusion of USD 413.13 million to help them become more financially stable. Additionally, the substantial losses from the rise in healthcare frauds enhance the demand for healthcare payer services, fueling the global market expansion. A noticeable increase in health insurance enrollment has been noted, which benefits the global healthcare payer services market's development.

Healthcare Payer Services Market: Restraints

The hidden cost of healthcare payer services may hamper the global market growth

The market's main obstacle is the unadvertised expenses of outsourcing healthcare payer services. Healthcare businesses might overestimate the amount of work done by BPO providers, which could lead to greater overall expenditures than anticipated. Additionally, if there are any issues between the healthcare provider and the service provider, the likelihood of legal fees for using BPO services increases. Other factors include variations in the caliber of the work and excessive reliance on the provider of healthcare payer services.

Healthcare Payer Services Market: Challenges

Rising data security concerns are likely to limit the global market growth

Working with healthcare payer servicing firms greatly increases the danger of security breaches and data leaks. Extremely sensitive and legally protected information such as patient contact information, medical history, insurance plans, and illnesses can have a significant negative impact on demand. The healthcare provider could suffer significantly due to a breach or leak of this data because it would undermine patient confidence.

Global Healthcare payer services Market: Segmentation

The global healthcare payer services market is segregated on the basis of service, application, end-user, and region.

By service, the market is divided into BPO services, ITO services, and KPO services. Among these, the ITO services segment dominates the market and accounted for 51.1% of the overall revenue share in 2021. The primary growth factors include increased demand for novel and advanced technologies, more investment in AI technology, conveniently accessible information, and increased engagement in healthcare decisions.

By application, the market is divided into claims management services, integrated front office service & back office operations, member management services, provider management services, billing & accounts management services, analytics & fraud management services, and HR services. Over the forecast period, the claims management services segment is expected to grow significantly. It accounted for 29.9% of the overall revenue share in 2021. The presence of the Affordable Care Act (ACA) and rising overall healthcare spending are two critical factors influencing the number of people registered with the Centers for Medicare and Medicaid Services. The most data-intensive procedures are claims processing services, which account for most of the payer’s effort.

By end-use, the market is classified into private payers and public payers. The private payers segment dominates the market and accounts for 52.1% of the overall revenue share. This is due to expanding government assistance to encourage private investment in the healthcare sector and increased private investment in the healthcare payer vertical.

Recent Developments

• In March 2022, the collection, aggregation, dissemination, and reporting of healthcare data became the focus of a new service from IMAT Systems, a pioneer in real-time healthcare data management and population health reporting solutions. Its new clustering and SaaS-based solutions, as well as the business's new Data Aggregator Validation (DAV) designation from the National Committee for Quality Assurance, will help payers, state-wide organizations, and Health Information Exchanges (HIEs) (NCQA).
• In August 2020, Holy Cross Health and Oscar, a tech-based health insurance provider, jointly unveiled a Medicare Advantage Plan. With the help of the new plan, Oscar's highly tailored member experience may be combined with the broad physician network of Holy Cross Health and Memorial Healthcare System. A premier provider of healthcare services, Memorial Healthcare Systems, and Holy Cross Health are institutions conducting research and education.

Healthcare payer services Market: Report Scope

Healthcare payer services Market: Regional Landscape

The rising number of people signing up for health insurance is likely to help North America dominate the global market

North America dominated the global healthcare payer services market in 2021 because significant businesses in the region provide healthcare payer services and a considerable need for healthcare payer solutions. Currently, the United States is the leading driver of healthcare payer services. This is due to the expanding number of people signing up for health insurance, and a useful reimbursement mechanism. High national healthcare spending will result in increased healthcare payer services and fuel market expansion.

Competitive Landscape

Some of the main competitors dominating the global healthcare payer services market include 

• Congziant
• EXL
• HGS Ltd.
• Accenture
• Xerox Corporation
• Concentric Corporation
• HCL Technologies
• Genpact
• WIPRO Ltd.

The global healthcare payer services market is segmented as follows:

By Service

• BPO Services
• ITO Services
• KPO Services

By Application

• Claims Management Services
• Integrated Front Office Service and Back Office Operations
• Member Management Services
• Provider Management Services
• Billing and Accounts Management Services
• Analytics and Fraud Management Services
• HR Services

By End-use

• Private Payers
• Public Payers

By Region

• North America
  • The U.S.
  • Canada
• Europe
  • France 
  • The UK
  • Spain
  • Germany
  • Italy
  • Rest of Europe
• Asia Pacific
  • China
  • Japan
  • India
  • South Korea
  • Southeast Asia
  • Rest of Asia Pacific
• Latin America
  • Brazil
  • Mexico
  • Rest of Latin America
• Middle East & Africa
  • GCC
  • South Africa
  • Rest of Middle East & Africa