Global Healthcare Payer Solutions Market – Industry Trends and Forecast to 2030

Global Healthcare Payer Solutions Market, By Service Type (Business Process Outsourcing, Information Technology Outsourcing, Knowledge Process Outsourcing), 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, Payment Management Services, Audit and Analysis Systems), End-User (Private Payers, Public Payers) – Industry Trends and Forecast to 2030.

 Healthcare Payer Solutions Market Analysis and Size

Healthcare insurance providers and payers use a variety of outsourcing solutions to improve their business processes and provide better service to their customers. Outsourcing has emerged as a viable business strategy for reducing administrative, logistical, and procurement responsibilities while developing cost-effective business processes. During the forecast period, the healthcare payer solutions market is likely to be driven by rising insurance enrolments, an increase in healthcare fraud, and an increased use of analytics in healthcare.

Data Bridge Market Research analyses that the healthcare payer solutions market which was USD 61.90 billion in 2022, is expected to reach USD 114.57 billion by 2030, at a CAGR of 8.0% during the forecast period 2023 to 2030. In addition to the insights on market scenarios such as market value, growth rate, segmentation, geographical coverage, and major players, the market reports curated by the Data Bridge Market Research also include depth expert analysis, patient epidemiology, pipeline analysis, pricing analysis, and regulatory framework.

Healthcare Payer Solutions Market Scope and Segmentation  

Market Definition

A healthcare payer solution is software that assists insurance companies and other healthcare providers with financial management. It may include billing, claims management, customer service, and other financial operations features. Healthcare payer solutions are essential because they assist these organizations in keeping track of their money and ensuring that patients are correctly billed.

Global Healthcare Payer Solutions Market Dynamics

Drivers

• Growing healthcare payer services

The healthcare payer solutions market is expected to grow during the forecast period due to the growing number of healthcare payer service providers and the increasing demand to reduce costs. Outsourcing healthcare payer services is less expensive than in-house payer services. The number of clients is growing due to the technological advancements and increased acceptance of analytics in healthcare, as well as an increasing number of people opting for healthcare insurance. During the forecast period, all of these factors are likely to drive the growth of the healthcare payer solutions market.

• Digitization of software

Healthcare providers and medical offices adopted digitization at a rapid rate. A lot of information about the patients who receive services each day is being gathered. An adequate system is required for health services to organise, manage, and carry out plans efficiently. The ‘Administrative Errors: Technical Series on Safer Primary Care 2016’ report published by the World Health Organization (WHO) estimated that about 5–50% of medical errors in primary care are administrative errors, further prompting the need for digitization. As a result, the market is growing.

Opportunities

• Rising duplicate insurance claims

The use of software facilitates communication across various domains and subdomains of hospitals. The programme uses cutting-edge approaches to ensure seamless interoperability between insurance companies and hospitals while managing patient data and information about their treatment. The identical claims and a lack of transparency, the insurance firms reportedly reject about one out of every five claims. Thus, the use of advanced methodologies and interoperability between these domains of hospitals will aid in reducing the number of fraudulent claims, further boosting the market growth.

Restraints/Challenges

• Threat of cyber crimes

Concerns over the privacy of the patient's medical history and other personal information have grown as a result of the rise in cybercrime over the past few years. The Indiana Attorney General reported in 2015 that a cyberattack on the Indiana-based company Medical Informatics Engineering compromised the data of more than four million patients from 230 institutions (MIE). Malware, phishing, Man in the Middle attacks, Trojans, and other rising cyber threats are among those limiting market expansion to some extent.

This healthcare payer solutions market report provides details of new recent developments, trade regulations, import-export analysis, production analysis, value chain optimization, market share, impact of domestic and localized market players, analyses opportunities in terms of emerging revenue pockets, changes in market regulations, strategic market growth analysis, market size, category market growths, application niches and dominance, product approvals, product launches, geographic expansions, technological innovations in the market. To gain more info on the healthcare payer solutions market contact Data Bridge Market Research for an Analyst Brief, our team will help you take an informed market decision to achieve market growth.

COVID-19 Impact on the Healthcare Payer Solutions Market

COVID-19 struck during a period of renovation to the architecture of the United States' health-care system. The public health emergency, which is still ongoing as of the publication of this paper, has had enormous consequences for the health of American society as well as the financial stability of the American health-care system.

In addition, rise in the demand for health coverage in emerging markets due to the COVID-19 and increase in healthcare system or insurance awareness among uninsured patients are expected to grow the market.

Global Healthcare Payer Solutions Market Scope

The healthcare payer solutions market is segmented on the basis of service type, application and end-user. The growth amongst these segments will help you analyze meagre growth segments in the industries and provide the users with a valuable market overview and market insights to help them make strategic decisions for identifying core market applications.

Service Type

• Business Process Outsourcing
• Information Technology Outsourcing
• Knowledge Process Outsourcing

 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
• Payment Management Services
• Audit and Analysis Systems

 End-User

• Private Payers
• Public Payers

Healthcare Payer Solutions Market Regional Analysis/Insights

The healthcare payer solutions market is analyzed and market size insights and trends are provided by country, service type, application and end-user as referenced above.

The countries covered in the healthcare payer solutions market report are U.S., Canada and Mexico in North America, Germany, France, U.K., Netherlands, Switzerland, Belgium, Russia, Italy, Spain, Turkey, Rest of Europe in Europe, China, Japan, India, South Korea, Singapore, Malaysia, Australia, Thailand, Indonesia, Philippines, Rest of Asia-Pacific (APAC) in the Asia-Pacific (APAC), Saudi Arabia, U.A.E, South Africa, Egypt, Israel, Rest of Middle East and Africa (MEA) as a part of Middle East and Africa (MEA), Brazil, Argentina and Rest of South America as part of South America.

North America dominates the healthcare payer solutions market due to strict government regulations and the availability of skilled labour in the region to provide high-end process services such as software and application development and maintenance.

Asia-Pacific is expected to grow at the highest growth rate in the forecast period of 2023 to 2030 owing to the growing healthcare infrastructure.

The country section of the report also provides individual market impacting factors and changes in regulation in the market domestically that impacts the current and future trends of the market. Data points like down-stream and upstream value chain analysis, technical trends and porter's five forces analysis, case studies are some of the pointers used to forecast the market scenario for individual countries. Also, the presence and availability of global brands and their challenges faced due to large or scarce competition from local and domestic brands, impact of domestic tariffs and trade routes are considered while providing forecast analysis of the country data.

Healthcare Infrastructure Growth Installed base and New Technology Penetration

The healthcare payer solutions market also provides you with detailed market analysis for every country growth in healthcare expenditure for capital equipment, installed base of different kind of products for healthcare payer solutions market, impact of technology using life line curves and changes in healthcare regulatory scenarios and their impact on the healthcare payer solutions market. The data is available for historic period 2011-2021.

Competitive Landscape and Healthcare Payer Solutions Market Share Analysis

The healthcare payer solutions market competitive landscape provides details by competitor. Details included are company overview, company financials, revenue generated, market potential, investment in research and development, new market initiatives, global presence, production sites and facilities, production capacities, company strengths and weaknesses, product launch, product width and breadth, application dominance. The above data points provided are only related to the companies' focus related to healthcare payer solutions market.

Some of the major players operating in the healthcare payer solutions market are:

• Zeomega (U.S.)
• Verisk Analytics, Inc. (U.S.)
• UnitedHealth Group (U.S.)
• NXGN Management, LLC (U.S.)
• Mckesson Corporation (U.S.)
• IBM Corporation (U.S.)
• Epic Systems Corporation (U.S.)
• eClinicalWorks, Inc. (U.S.)
• Cerner Corporation (U.S.)
• Allscripts Healthcare Solutions, Inc. (U.S.)
• Aetna, Inc. (U.S.)

Research Methodology: Global Healthcare Payer Solutions Market

Data collection and base year analysis is done using data collection modules with large sample sizes. The market data is analyzed and estimated using market statistical and coherent models. Also market share analysis and key trend analysis are the major success factors in the market report. To know more please request an analyst call or can drop down your inquiry.

The key research methodology used by DBMR research team is data triangulation which involves data mining, analysis of the impact of data variables on the market, and primary (industry expert) validation. Apart from this, data models include Vendor Positioning Grid, Market Time Line Analysis, Market Overview and Guide, Company Positioning Grid, Company Market Share Analysis, Standards of Measurement, Global versus Regional and Vendor Share Analysis. To know more about the research methodology, drop in an inquiry to speak to our industry experts.

Customization Available

Data Bridge Market Research is a leader in advanced formative research. We take pride in servicing our existing and new customers with data and analysis that match and suits their goal. The report can be customized to include price trend analysis of target brands understanding the market for additional countries (ask for the list of countries), clinical trial results data, literature review, refurbished market and product base analysis. Market analysis of target competitors can be analyzed from technology-based analysis to market portfolio strategies. We can add as many competitors that you require data about in the format and data style you are looking for. Our team of analysts can also provide you data in crude raw excel files pivot tables (Factbook) or can assist you in creating presentations from the data sets available in the report.