Affordable Care Act Stimulates Strong Growth in Healthcare Payer Business Process Outsourcing Market—Everest Group Report

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New, smaller buyers are the driving force behind a 14 percent growth in healthcare payer BPO.

Rajesh Ranjan, Vice President, Everest Group

Rajesh Ranjan, Vice President, Everest Group

The Affordable Care Act is having a tremendous impact on the healthcare payer BPO market, but other factors are shaping the market as well.

As the Affordable Care Act boosts healthcare insurance enrollments as well as the number and value of claims, healthcare payers are outsourcing their business processes at a growing rate; in fact, the healthcare payer business process outsourcing (BPO) market grew at a rate of 14 percent in 2013 to cross US$4 billion in size and is likely to continue at a 14 percent compound annual growth rate for the next few years.

The driving force behind this rapid growth is the adoption of BPO by new, smaller buyers who tend to prefer short-term deals. Claims processing, provider management and member management are the most commonly demanded process by the payers.

These findings and more are discussed in a research report recently published by Everest Group—Healthcare Payer BPO – State of market with PEAK Matrix™ Assessment. The report analyzes the healthcare payer BPO service provider landscape, focusing on a market overview and buyer adoption trends.

In addition, the report features the proprietary PEAK Matrix Assessment, which analyzes the capabilities of 15 leading healthcare BPO service providers, which are categorized as Leaders, Major Contenders, Emerging Players and/or Star Performers. The 2015 healthcare payer BPO Market Leaders—based on their market successes and delivery capabilities—are Accenture, Cognizant, Dell and Xerox.

***Download Complimentary Preview Reports***

***Supporting Quotes***

“The Affordable Care Act is having a tremendous impact on the healthcare payer BPO market, but other factors are shaping the market as well,” said Rajesh Ranjan, partner at Everest Group. “Federal and state-level regulations are playing an increased role in healthcare payer BPO, as are measures to control fraud, waste and abuse. The result is wide windows of opportunity for BPO service providers to help payers who want to streamline operations, reduce costs, speed their time to market with new service plans, and use data analytics to reduce risk.”

*** Download Publication-Quality Graphics ***
High-resolution graphics illustrating key takeaways from these reports can be included in news coverage, with attribution to Everest Group. Graphics include:

  • Healthcare provider BPO: One market, two stories
  • Market instability drives down healthcare payer BPO deal lengths
  • Healthcare payer market changes are driving adoption of more strategic use of BPO
  • Increased BPO traction among smaller healthcare payers is driving technology model changes.

About Everest Group
Everest Group, an advisor to business leaders on the next generation of global services, has a worldwide reputation for helping Global 1000 firms improve performance by optimizing back- and middle-office business services. Through practical consulting, original research and industry resource services, Everest Group helps clients maximize value from delivery strategies, talent and sourcing models, technologies and management approaches. Visit http://www.everestgrp.com and research.everestgrp.com.

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