Healthcare Payer Services Market is Expected to Reach $118.2 billion | MarketsandMarkets.


Chicago, March 21, 2023 (GLOBE NEWSWIRE) — The healthcare payer services industry is expected to experience rapid growth in the near future. This is due to the increasing demand for managed care services, the expanding use of digital health solutions, and the growing need for data analytics and predictive modelling. As the industry continues to evolve, providers will need to focus on leveraging technology, as well as improving customer service, to remain competitive. In addition, they must ensure compliance with various healthcare regulations and be prepared to comply with the changing demands of the healthcare industry. This will enable them to provide the most cost-effective and efficient services to their customers. As the industry continues to grow and evolve, healthcare payer services will become even more important in providing quality care to patients.

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 latest report published by MarketsandMarkets™. The healthcare payer services market is mainly driven by factors such as 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 likely to restrain the growth of this market.

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Healthcare Payer Services Market Scope:

Report Coverage Details
Market Revenue in 2022 $69.9 billion
Estimated Value by 2027 $118.2 billion
Growth Rate Poised to grow at a CAGR of 11.1%
Market Size Available for 2020–2027
Forecast Period 2022–2027
Forecast Units Value (USD Billion)
Report Coverage Revenue Forecast, Competitive Landscape, Growth Factors, and Trends
Segments Covered Service Type, and End User
Geographies Covered North America (US and Canada), Asia Pacific (Japan, China, India, and RoAPAC), Europe (Germany, UK, France, Italy, Spain and RoE), and the Rest of the World
Report Highlights Updated financial information / product portfolio of players
Key Market Opportunity Adoption of advanced data analytics
Key Market Drivers Outsourcing of services to reduce costs and increase efficiency

Based on service type, the healthcare payer services market is segmented into ITO services, BPO services and KPO services. In 2021, the BPO services segment accounted for the largest market share. This is because BPO services provides lower costs, higher efficiency and makes the companies to be able to concentrate on their business operations. ITO services segment is expected to register the highest growth during the forecast period. This is attributed to the rising integration of healthcare and information technology and increasing use of EHRs and EMRs.

Based on end user, the healthcare payer services market is segmented into private payers & public payers. During the forecast period, the private payers segment accounted for the largest share and is expected to grow at the highest CAGR during the forecast period. The high growth of this segment is attributed to the rising competitiveness among private payers.

Geographically, the healthcare payer services market is segmented into North America, Europe, Asia Pacific, and the Rest of the World (RoW). North America accounted for the largest market share, followed by Asia Pacific in 2021. The market in Asia Pacific is projected to grow at highest CAGR during the forecast period. Factors such as increasing adoption of advanced technologies, increasing pressure to reduce healthcare costs, growing prevalence of chronic disease, presence of large and growing patient population in this region, availability of skilled labor at low costs, high growth opportunities and growing focus of established players on emerging APAC countries are driving the market growth in this region.

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), Paraxel Corporation International (US),

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Hypothetic Challenges of Healthcare Payer Services Market in Near Future:

  • Consolidation of Healthcare Providers: Consolidation of healthcare providers is expected to lead to increased healthcare costs for payers. This will be a challenge for payers to manage the cost of providing medical services.
  • Rising Costs of Medical Services: The cost of providing medical services is expected to rise due to the increasing costs of medical technologies and drugs. This will be a challenge for payers to manage the cost of providing medical services.
  • Increased Regulatory Compliance Requirements: The number of regulatory compliance requirements that payers will have to meet is expected to increase. This will be a challenge for payers to ensure that they meet the regulatory requirements and maintain their competitive advantage.
  • Growing Demand for Transparency: With the emergence of healthcare technology, there is an increasing demand for transparency in the healthcare payer services market. This will be a challenge for payers to ensure that they are providing transparent services to their customers.
  • Cybersecurity: Cybersecurity is a major challenge in the healthcare payer services industry. Payers need to ensure that their systems are secure against cyber-attacks and data breaches.
  • Emergence of New Technologies: The emergence of new technologies such as artificial intelligence and blockchain is expected to disrupt the healthcare payer services market. This will be a challenge for payers to stay ahead of the competition and ensure that they are offering the latest technology to their customers.

Top 3 Use Cases of Healthcare Payer Services Market:

  • Claims Processing & Payment: Healthcare payer services enable medical claims processing and payment for insurance providers. This includes verifying the eligibility of claims, accuracy of patient data, and accuracy of payment amounts.
  • Fraud Detection & Prevention: Healthcare payer services help detect and prevent fraud by monitoring activity such as duplicate billing and coding errors. These services also help identify patterns that could indicate fraudulent activity.
  • Member Engagement & Retention: Healthcare payer services help providers to engage with members, build relationships, and retain them. This can include personalized communication, education on health topics, and access to support services.

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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.

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