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Next Generation Healthcare Payer BPS

Market Analysis

by Sven Lohse

published on Mar 05, 2019

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Report Overview:

NelsonHall's market analysis "Next Generation Healthcare Payer BPS" details the current state of the market and analyzes the ramifications of the most significant trends for both the buyers and vendors of BPS.

Ramifications of trends in the commercial payer market:

  • Unsustainable economic and demographic trends make it likely that the U.S. health insurance market (and associated BPS vendors) will be significantly disrupted during the medium to long term.
  • Commercial payers are now more receptive to outsourcing provider services; care management; and quality/compliance.
  • Payers will value highly BPS vendor adaptability in face of market disruption.
  • Commercial payers and their BPS vendors are experimenting with digital transformation in BPS settings, but thus far seem disinterested in large scale BPaaS offerings.

Ramifications of trends in the public payer market:

  • Secular and technology trends resemble those in the commercial health insurance market, but they tend to drive change at slower rates.
  • Public agency efforts to restructure contracts and competition will not affect dominance of DXC or Conduent substantially. BPS vendors will spearhead automation, but progress will be moderate.

Who is this Report for:

NelsonHall’s “Next Generation Healthcare Payer BPS” report is a comprehensive market assessment report designed for:

  • Sourcing managers investigating sourcing developments within the healthcare payer services market
  • Vendor marketing, sales and business managers developing strategies to target service opportunities within the healthcare payer services market
  • Financial analysts and investors specializing in the healthcare payer services sector.

Scope of this Report:

The report analyzes the U.S. market for outsourced healthcare payer services and addresses the following questions:

  • What is the current and future market for outsourced healthcare payer services, including both commercial payers and public sector payers?
  • What is the size and growth of the U.S. outsourced healthcare payer services market?
  • Within outsourced healthcare payer services, which service segments are emerging strongly?
  • What are the market segments for outsourced healthcare payer services and their characteristics? What are the issues, drivers and benefits for each segment? What are vendor capabilities by segment?
  • What are vendor challenges and critical success factors by market segment?
  • How are vendor offerings and delivery capabilities changing to meet emerging market needs?
  • How are vendors positioned within each outsourced healthcare payer services market segment?

Key Findings & Highlights:

NelsonHall analyzes the U.S. healthcare payer business process service (BPS) market for buyers and vendors of business process services. The report details the commercial and public payer sectors in terms of size, scope, trends, and customer requirements; BPS vendor competitor market shares, offerings, delivery, and success factors. Commercial and public market sectors are broken out in further detail:

Highlights about the U.S. commercial market BPS sector:

  • Market size in 2018: $4.9bn. CAGR 2018-2022: 5.5%
  • The largest and most important BPS vendors in the sector, with detail by payer function: claims admin services; payment integrity/FWA; customer service
  • Payer functions where BPS services will grow more quickly are customer experience and care management
  • BPS vendor offerings in consumerization, digital transformation (including RPA) and business process as a service offerings (BPaaS).

Highlights about the U.S. public market BPS sector:

  • Key findings for the buyers and vendors of U.S. public market BPS:
  • Market size in 2018: $5.9bn. CAGR 2018-2022: 3.6%
  • The largest and most important BPS vendors in the sector, with detail by payer function.
  • Competitors from adjacent IT and BPS service sectors may compete more aggressively for contracts that are broken up or modularized.
  • “Piggy-backing” where states/territories use BPS vendors as intermediaries to manage their MMIS systems on the backs of larger states’ systems.
  • Automation and the slow introduction of RPA, with BPS vendors servings as the main vectors for introduction to the sector

Table of contents:

Table of contents:

  • 1. Introduction
  • 2. Changing Shape of the Healthcare Payer BPS Market
  • 3. Customer Requirements
  • 4. Market Size and Growth
  • 5. Vendor Market Shares
  • 6. Vendor Offerings and Targeting
  • 7. Delivery in Healthcare Payer BPS
  • 8. Critical Success Factors
  • Appendix I: Vendors Researched

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Healthcare Commercial Payer BPS

published 2019-05-01 | Project by Sven Lohse

This NelsonHall Vendor Evaluation & Assessment Tool (NEAT) analyzes the performance of vendors offering healthcare commercial payer services. The NEAT tool allows strategic sourcing managers to assess the capability of vendors across a range of criteria and business situations and identify the best performing vendors overall. Vendors evaluated are: Accenture, Capgemini, CGI, Cognizant, Concentrix, Conduent, Cotiviti, DXC Technology, EXL, Firstsource, Genpact, Hexaware, HGS, Infosys, NTT Data, Optum, Sutherland, TCS, Tech Mahindra, and WNS. To find out more, contact Keith MacLean at [email protected]
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