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EXL Service - Healthcare Payer BPS

Vendor Analysis

by Sven Lohse

published on Mar 01, 2019

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Report Overview:

With recent acquisitions EXL Service (EXL) has more than doubled its revenue in the U.S. healthcare payer BPS market. In 2017 the company's healthcare payer BPS revenue was estimated by NelsonHall to be $62m, all in the commercial payer segment. With its acquisitions of Health Integrated and SCIO Health Analytics in late 2017 and mid-2018, respectively, EXL has acquired a beachhead in the U.S. government healthcare sector and EXL's revenue in the U.S. health plan segment now exceeds $120m.

Who is this Report for:

NelsonHall’s profile of EXL Service’s Healthcare Payer Business Process Services (BPS) is a comprehensive assessment of service offerings and capabilities designed for:

  • Sourcing managers monitoring the capabilities of existing suppliers to deliver business process services to healthcare payers
  • Vendor marketing, sales and business managers looking to benchmark themselves against their peers
  • Financial analysts and investors specializing in the support services sector.

Scope of this Report:

The report provides a comprehensive and objective analysis of EXL’s offerings, capabilities, and market presence in support of business process transformation through the application of healthcare payer BPS including the company’s:

  • Offerings and key service components
  • Delivery organization
  • Customer base, including the company’s targeting strategy and examples of current contracts (where available)
  • Revenue estimates for healthcare payer BPS
  • Strategy, emphasis and new developments in support of healthcare payer BPS
  • Strengths, weaknesses and outlook.

Key Findings & Highlights:

NelsonHall estimates that EXL’s 2018 healthcare payer BPS revenue is $137m, all of which was generated by clients in the U.S. The majority of this revenue was generated by commercial sector health insurance clients for care management and payment/program integrity work. With the acquisition of Health Integrated in late 2017 EXL gained a beachhead in U.S. public sector work.

At the end of 2017, EXL had over 2,900 employees serving healthcare clients, the majority of whom served in payer BPS roles. At this time, EXL acquired Health Integrated with approximately $40m in 2017 revenue (and an unknown number of employees). In July 2018, EXL acquired SCIO Health Analytics, with $71.9m in 2017 revenue.  The SCIO acquisition added 1,100 employees to EXL's health practice; 90+% of these acquired personnel serve BPS clients.

EXL is especially focused on those customers with more than $5bn in revenue. Such companies comprise one-third of the current healthcare client list. There is no indication that this focus is changing as a result of recent acquisitions.

In the near future EXL will continue to focus on improving the following capabilities:

  • Domain expertise: EXL's most prominent capabilities lie in care management and payment integrity. Member/patient engagement is an area of growing importance to the company
  • Integration of software with services: EXL has established software at the core of its major offerings in care management and in payment integrity. Before the acquisition of SCIO, EXL classified approximately 25% of its healthcare revenue as generated by analytics.

Particularly due to the acquisition of SCIO EXL has doubled its size and will now compete against a new competitor set with broader resources, partner networks, and more established brands. EXL will need to adapt its strategic aims, branding, and go to market approaches as it evolves from being a niche vendor.

Table of contents:

Table of contents:

  • Background
  • Revenue Summary
  • Key Offerings
  • Delivery Capability and Partnerships
  • Target Markets
  • Strategy
  • Strengths and Challenges
  • Strengths
  • Challenges
  • Outlook

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