U.S. Business Process As A Service (BPaaS) In Healthcare Payers Market Size, Share & Trends Analysis Report By Solution Coverage (Traditional BPaaS, Best-of-breed BPaaS), Buyer Type, Value Chain Processes, Buyer Size, And Segment - Industry Analysis, Share, Growth, Regional Outlook and Forecasts, 2023-2032

The U.S. business process as a service (BPaaS) in healthcare payers market size was exhibited at USD 6.9 billion in 2022 and is projected to hit around USD 12.15 billion by 2032, growing at a CAGR of 5.82% during the forecast period 2023 to 2032.

U.S. Business Process As A Service (BPaaS) In Healthcare Payers Market Size, 2023 to 2032

Key Takeaways:

  • The healthcare industry has advanced significantly over the last few years. The rise of digital health, the shift to value-based care, and rising consumerism have all altered how payers operate. The traditional BPS outsourcing model is quickly giving way to a platform-led BPaaS model, which has brought about advantages such as access to better technology and human capital, the promise of digital transformation at a lower cost, and a lower cost of ownership. As a consequence, BPaaS usage is anticipated to increase moderately
  • Small and medium-sized payers, make up more than 71% of all payers in 2022 and have shown a stronger preference for the BPaaS model. In terms of plan types, medicare advantage, and managed medicaid have emerged as viable business cases, with MA accounting for a significant share percentage of the market.
  • In terms of value chain processes, administrative processes such as care management have seen the most BPaaS adoption. Payers are, however, progressively becoming aware of BPaaS's potential in processes such as claims management, population health management, and member engagement as well as in reducing medical expenses

U.S. Business Process As A Service (BPaaS) In Healthcare Payers Market Report Scope

Report Attribute Details
Market Size in 2023 USD 7.3 Billion
Market Size by 2032 USD 12.15 Billion
Growth Rate From 2023 to 2032 CAGR of 5.82%
Base Year 2022
Forecast Period 2023 to 2032
Segments Covered Solution coverage, Buyer Size, Buyer type, Value chain processes
Market Analysis (Terms Used) Value (US$ Million/Billion) or (Volume/Units)
Report Coverage Revenue forecast, company ranking, competitive landscape, growth factors, and trends
Key Companies Profiled Accenture; Cognizant; HCL Technologies Limited; IBM; Infosys; NTT DATA Corporation; Optum; TATA Consultancy Services Limited; UST; Wipro; EXL; Softheon Inc.; Genpact; Change Healthcare; Firstsource; Celegence; Highmark Health

 

The U.S. spends over USD 3.8 trillion on healthcare, which is roughly twice as much as any other major international economy, as a result of the complexity and inefficiency of its healthcare system. BPaaS engagements contribute significantly to payer business process outsourcing revenue, which is likely to drive the industry’s growth.

The U.S. healthcare industry is highly regulated. Healthcare payers are subjected to a complex web of regulations. The payer burden is also being exacerbated by the rapidly shifting regulatory environment and changing member demands. In addition, the Affordable Care Act and the Centers for Medicare and Medicaid are establishing regulations and payment/reimbursement practices, causing more and more conversations. These pressures, combined with the possibility of margins contracting, make this the ideal time for payers to assess options for profitable growth and improved agility. Many healthcare payers are thus switching to the BPaaS model for planning administration, back-office functions, and others to focus on core activities.

The market is likely to be impacted by the COVID-19 pandemic, expanding healthcare consumerism, changing regulations, and the shift to value-based care. Due to these challenges and declining margins, healthcare providers are being compelled to think about different game plans, such as BPaaS, to improve the patient experience, which is eventually driving the market's revenue growth due to the rise in demand and acceptance of the BPaaS system.

The COVID-19 pandemic has greatly increased the financial, regulatory, and technology challenges that healthcare payers currently confront. The pandemic has improved payers' cash flow in the short term, but it has also brought about major operational and market changes for which payers must get prepared. For instance, as per the Kaiser Family Foundation, enrollees under Medicaid grew by 32.6% from February 2020 to December 2022. The market is also anticipated to expand as a result of payers including United Healthcare, Anthem, Centene, and Oscar Health reviving their interest in this market due to changes in COVID-19's enrollment patterns.

Solution Coverage Insights 

On the basis of solution coverage, the market has been segmented into traditional and best-of-breed. The traditional BPaaS segment has accounted for the largest market in 2022, owing to the lower cost of service and higher customer satisfaction. Traditional business process outsourcing models are gradually shifting to a BPaaS model, an approach that focuses on the total cost of ownership and pushes vendors to provide higher-value business outcomes. BPaaS alters the focus and nature of engagement, resulting in more flexible and collaborative business partnerships focused on common goals. 

The best-of-breed segment is anticipated to witness the fastest growth rate during the forecast period. Best-of-breed technology offers more data security for patient information and gives organizations an option to choose a tool for specific services. Best-of-breed BPaaS models would be made possible by factors including expanding the availability of a BPS partner ecosystem for technological platforms and advancements in data security and compliance standards. 

Buyer Type Insights

In terms of buyer type, the government buyers segment held the majority of revenue share in 2022. Government insurance companies have historically been the main buyers for BPaaS due to the modular implementations of Medicaid Management Information Systems (MMIS). U.S. states have entrusted service providers with the design, development, and implementation of MMIS platforms as well as the use and maintenance of such platforms. As CMS advances the modularity agenda, more states are modernizing their outdated monolithic systems and progressively moving to the as-a-service paradigm. 

Following COVID-19, the already increasing MA and Managed Medicaid enrollment received an additional boost. According to a survey by MedicareAdvantagePlans.org, 45% of Medicare recipients transfer from an original Medicare plan to an MA plan in 2021. Additionally, the 21st Century Cures Act is anticipated to result in a significant increase of ESRD patients in MA plans The commercial buyers segment is anticipated to witness considerable growth during the forecast period owing to the increasing number of people taking commercial insurance plans, which provide value-based services to beneficiaries. 

Value Chain Processes Insights

Based on value chain processes, the market has been segmented into claims management, member engagement, care management, and others. The care management segment held the majority share of 32.3% in 2022 and is expected to retain its position during the forecast period. Care management enhances the efficiency of healthcare functioning while maximizing the benefits for the healthcare institute and patient.Care management is a proven way to increase the efficiency of healthcare operations while maximizing the advantages for both the patient and the healthcare institution.

The others segment is anticipated to register maximum CAGR during the forecast period. The segment includes product development, network management, and risk & compliance.The insights gained from the data make it easier for payers to enhance the network and better serve patients and providers. Moreover, risk and compliance services in the insurance industry are increasingly aiming on adding value and utilizing technology to conduct activities more effectively and to drive efficiency.

Buyer Size Insights

On the basis of buyer size, the small buyers segment is estimated to dominate the market throughout the forecast period. Small buyers always have the scope for innovations and help smaller insurers find niche opportunities for growth. The major benefit of midsized health plans is the provision of member-centric services. Any size payer can succeed if the health insurance enrollment and claims processes are efficient.

The large buyers segment is expected to witness the fastest growth over the forecast period, as they can offer tactical administrative processes for achieving process efficiencies and enable major cost savings.Large health plans are closely monitoring developments, and increased adoption is expected in the long term as BPaaS solutions mature & more successful use cases emerge in the market.

Key Companies & Market Share Insights

Companies are stepping up their efforts to maintain their position in the competitively escalating market by introducing new products. For instance, Cognizant, which has a dominant position in the market for service providers to U.S. healthcare payers due to its industry knowledge, tools, cloud, and digital portfolio, invested USD 120 million in platform R&D in 2020 to support its BPaaS solutions. Additionally, Legato Health Technologies introduced a product business process as a service offering in 2021, enhancing its current portfolio of business process and technology services better to serve the requirements of health plans of all sizes. 

Furthermore, companies that are primarily involved in this market and have strong BPaaS product offerings have increased their collaborations with providers in order to maintain their revenue share and support their U.S. operations. These partnerships enable partners to jointly develop cutting-edge programs, solutions, and initiatives for the benefit of patients and the healthcare system. Genpact, for instance, offers payers a strong BPaaS offering that grew out of its BPO legacy, an increasing emphasis on digital transformation skills, and in-depth domain understanding in the healthcare sector. In January 2021, it bought Enquero, a small California-based company that provides services for data engineering and data-led digital transformation, to strengthen its U.S. operations. Some of the prominent players in the U.S. business process as a service (BPaaS) in healthcare payers market include:

  • Accenture
  • Cognizant
  • HCL Technologies Limited
  • IBM
  • Infosys Limited
  • NTT DATA Corporation
  • Optum
  • TATA Consultancy Services Limited
  • UST
  • Wipro
  • EXL
  • Softheon, Inc.
  • Genpact
  • Change Healthcare
  • Firstsource
  • Celegence
  • Highmark Health

Segments Covered in the Report

This report forecasts revenue growth at country levels and provides an analysis of the latest industry trends in each of the sub-segments from 2018 to 2032. For this study, Nova one advisor, Inc. has segmented the U.S. Business Process As A Service (BPaaS) In Healthcare Payers market.

By Solution Coverage 

  • Traditional BPaaS
  • End-to-end Traditional BPaaS
  • Process-specific Traditional BPaaS
  • Best-of-breed BPaaS
  • End-to-end Best-of-breed BPaaS
  • Process-specific Best-of-breed BPaaS

By Buyer Type 

  • Government Buyers
  • Medicare Advantage
  • Managed Medicaid
  • Commercial Buyers
  • Individual Health Plan
  • Employer-sponsored Health Plan

By Value Chain Processes 

  • Claims Management
  • Member Engagement
  • Care Management
  • Others

By Buyer Size 

  • Small Buyers
  • Midsized Buyers
  • Large Buyers

Frequently Asked Questions

The U.S. business process as a service (BPaaS) in healthcare payers market size was exhibited at USD 6.9 billion in 2022 and is projected to hit around USD 12.15 billion by 2032

The U.S. business process as a service (BPaaS) in healthcare payers market is expected to grow at a compound annual growth rate of 5.82% from 2023 to 2032

Some key players operating in the U.S. BPaaS in healthcare payers Market include Accenture; Cognizant; HCL; IBM; Infosys; NTT DATA; Optum; TCS; UST; Wipro; EXL; Softheon; Genpact; Change Healthcare; Firstsource; Celegence.

Key factors that are driving the market growth include the COVID-19 pandemic, expanding healthcare consumerism, changing regulations, and the shift to value-based healthcare.

Chapter 1 Methodology and Scope
                  1.1 Market Segmentation & Scope
                      1.1.1 Segment Definition
                          1.1.1.1 Solution coverage
                          1.1.1.2 Buyer type
                          1.1.1.3 Value chain processes
                          1.1.1.4 Buyer size
                  1.2 Research Methodology
                      1.2.1 Information procurement
                          1.2.1.1 Purchased database
                          1.2.1.2 nova one advisor internal database
                          1.2.1.3 Secondary sources
                          1.2.1.4 Primary research
                  1.3 Information or Data Analysis
                      1.3.1 Data Analysis Models
                  1.4 Market Formulation & Validation
                  1.5 Model Details
                  1.6 List of Secondary Sources
                  1.7 List of Abbreviations
                  1.8 Objectives
                      1.8.1 Objective - 1
                      1.8.2 Objective - 2
                      1.8.3 Objective - 3
Chapter 2 Executive Summary
                  2.1 Market Outlook
                      2.1.1 Segment outlook
                      2.1.2 Competitive landscape
                  2.2 Market Snapshot
                  2.3 Competitive Landscape
Chapter 3 Market Variables, Trends & Scope
                  3.1 Market Lineage Outlook
                      3.1.1 Parent Market Outlook
                      3.1.2 Related/Ancillary Market Outlook
                  3.2 Market Dynamics
                      3.2.1 Market Driver Analysis
                          3.2.1.1 Changing regulations
                          3.2.1.2 Expanding healthcare consumerism
                          3.2.1.3 Shift towards value-based healthcare
                      3.2.2 Market Restraint Analysis
                          3.2.2.1 Risk concerns regarding data security
                          3.2.2.2 High costs
                  3.3 Business Environment Analysis Tools
                      3.3.1 Porter’s Five Forces Analysis
                      3.3.2 PESTLE Analysis
                  3.4 Penetration & Growth Mapping
                  3.5 Impact of COVID-19 on U.S. Business Process as a Service (BPaaS) in Healthcare Payer Market
                      3.5.1 Current and future impact analysis
                      3.5.2 Impact on market players
                  3.6 Regulatory Framework
Chapter 4 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: Solution Coverage Estimates & Trend Analysis
                  4.1 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market Solution Coverage Type Movement Analysis, 2022 & 2032
                  4.2 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: Solution Coverage Segment Dashboard
                  4.3 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market Size & Forecast and Forecasts, By Solution Coverage
                      4.3.1 Traditional BPaaS
                          4.3.1.1 Traditional BPaaS market, 2020 - 2032
                          4.3.1.2 End-to-end traditional BPaaS
                              4.3.1.2.1 End-to-end traditional BPaaS market, 2020 - 2032
                          4.3.1.3 Process-specific traditional BPaaS
                              4.3.1.3.1 Process-specific traditional BPaaS market, 2020 - 2032
                      4.3.2 Best-of-Breed bpaas
                          4.3.2.1 Best-of-breed bpaas market, 2020 - 2032
                          4.3.2.2 End-to-end best-of-breed BPaaS
                              4.3.2.2.1 End-to-end best-of-breed BPaaS market, 2020 - 2032
                          4.3.2.3 Process-specific best-of-breed BPaaS
                              4.3.2.3.1 Process-specific best-of-breed BPaaS market, 2020 - 2032
Chapter 5 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: Buyer Type Estimates & Trend Analysis
                  5.1 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market Buyer Type Movement Analysis, 2022 & 2032
                  5.2 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: Buyer Type Segment Dashboard
                  5.3 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market Size & Forecast and Forecasts, By Buyer Type
                      5.3.1 Government buyers
                          5.3.1.1 Government buyers market, 2020 - 2032
                          5.3.1.2 Medicare advantage
                              5.3.1.2.1 Medicare advantage market, 2020 - 2032
                          5.3.1.3 Managed Medicaid
                              5.3.1.3.1 Managed Medicaid market, 2020 - 2032
                      5.3.2 Commerical buyers
                          5.3.2.1 Commercial Buyers market, 2020 - 2032
                          5.3.2.2 Individual health plans
                              5.3.2.2.1 Individual health plans market, 2020 - 2032
                          5.3.2.3 Employer-sponsored health plan
                              5.3.2.3.1 Employer sponsored health plan market, 2020 - 2032
Chapter 6 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: Value Chain Processes Estimates & Trend Analysis
                  6.1 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market Value Chain Processes Movement Analysis, 2022 & 2032
                  6.2 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: Value Chain Processes Segment Dashboard
                  6.3 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market Size & Forecast and Forecasts, By Value Chain Processes
                      6.3.1 Claims Management
                          6.3.1.1 Claims management market, 2020 - 2032
                      6.3.2 Member engagement
                          6.3.2.1 Member engagement market, 2020 - 2032
                      6.3.3 CARE Management
                          6.3.3.1 Care management market, 2020 - 2032
                      6.3.4 Others
                          6.3.4.1 Others market, 2020 - 2032
Chapter 7 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: Buyer Size Estimates & Trend Analysis
                  7.1 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market Buyer Size Movement Analysis, 2022 & 2032
                  7.2 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market: Buyer Size Segment Dashboard
                  7.3 U.S. Business Process as a Service (BPaaS) in Healthcare Payers Market Size & Forecast and Forecasts, By Buyer Size
                      7.3.1 Small Buyers
                          7.3.1.1 Small buyers market, 2020 - 2032
                      7.3.2 Mid-Sized Buyers
                          7.3.2.1 Mid-sized buyers market, 2020 - 2032
                      7.3.3 Large Buyers
                          7.3.3.1 Large buyers market, 2020 - 2032
Chapter 8 Competitive Analysis
                  8.1 Participant Categorization
                  8.2 Company Market Position Analysis
                  8.3 Strategy Mapping
                      8.3.1 New Launch
                      8.3.2 Mergers & acquisition
                      8.3.3 Partnerships
                      8.3.4 Collaborations
                      8.5.5 Others
                  8.4 Company Profiles/ Listing
                      8.4.1 Accenture
                          8.4.1.1 Company overview
                          8.4.1.2 Financial performance
                          8.4.1.3 Product benchmarking
                          8.4.1.4 Strategic initiatives
                      8.4.2 Cognizant
                          8.4.2.1 Company overview
                          8.4.2.2 Financial performance
                          8.4.2.3 Product benchmarking
                          8.4.2.4 Strategic initiatives
                      8.4.3 HCL Technologies Limited
                          8.4.3.1 Company overview
                          8.4.3.2 Financial performance
                          8.4.3.3 Product benchmarking
                          8.4.3.4 Strategic initiatives
                      8.4.4 IBM
                          8.4.4.1 Company overview
                          8.4.4.2 Financial performance
                          8.4.4.3 Product benchmarking
                          8.4.4.4 Strategic initiatives
                      8.4.5 Infosys Limited
                          8.4.5.1 Company overview
                          8.4.5.2 Financial performance
                          8.4.5.3 Product benchmarking
                          8.4.5.4 Strategic initiatives
                      8.4.6 NTT DATA Corporation
                          8.4.6.1 Company overview
                          8.4.6.2 Financial performance
                          8.4.6.3 Product benchmarking
                          8.4.6.4 Strategic initiatives
                      8.4.7 Optum
                          8.4.7.1 Company overview
                          8.4.7.2 Financial performance
                          8.4.7.3 Product benchmarking
                          8.4.7.4 Strategic initiatives
                      8.4.8 TATA Consultancy Services Limited
                          8.4.8.1 Company overview
                          8.4.8.2 Financial performance
                          8.4.8.3 Product benchmarking
                          8.4.8.4 Strategic initiatives
                      8.4.9 UST
                          8.4.9.1 Company overview
                          8.4.9.2 Financial performance
                          8.4.9.3 Product benchmarking
                          8.4.9.4 Strategic initiatives
                      8.4.10 Wipro
                          8.4.10.1 Company overview
                          8.4.10.2 Financial performance
                          8.4.10.3 Product benchmarking
                          8.4.10.4 Strategic initiatives
                      8.4.11 EXL
                          8.4.11.1 Company overview
                          8.4.11.2 Financial performance
                          8.4.11.3 Product benchmarking
                          8.4.11.4 Strategic initiatives
                      8.4.12 Softheon, Inc.
                          8.4.12.1 Company overview
                          8.4.12.2 Financial performance
                          8.4.12.3 Product benchmarking
                          8.4.12.4 Strategic initiatives
                      8.4.13 Genpact
                          8.4.13.1 Company overview
                          8.4.13.2 Financial performance
                          8.4.13.3 Product benchmarking
                          8.4.13.4 Strategic initiatives
                      8.4.14 Change Healthcare
                          8.4.14.1 Company overview
                          8.4.14.2 Financial performance
                          8.4.14.3 Product benchmarking
                          8.4.14.4 Strategic initiatives
                      8.4.15 Firstsource
                          8.4.15.1 Company overview
                          8.4.15.2 Financial performance
                          8.4.15.3 Product benchmarking
                          8.4.15.4 Strategic initiatives
                      8.4.16 Celegence
                          8.4.16.1 Company overview
                          8.4.16.2 Financial performance
                          8.4.16.3 Product benchmarking
                          8.4.16.4 Strategic initiatives
                      8.4.17 Highmark Health
                          8.4.17.1 Company overview
                          8.4.17.2 Financial performance
                          8.4.17.3 Product benchmarking
                          8.4.17.4 Strategic initiatives

Proceed To Buy

USD 3800
USD 1900
USD 1200

Customization Offered

  • check-imgCross-segment Market Size and Analysis for Mentioned Segments
  • check-imgAdditional Company Profiles (Upto 5 With No Cost)
  • check-img Additional Countries (Apart From Mentioned Countries)
  • check-img Country/Region-specific Report
  • check-img Go To Market Strategy
  • check-imgRegion Specific Market Dynamics
  • check-imgRegion Level Market Share
  • check-img Import Export Analysis
  • check-imgProduction Analysis
  • check-imgOthers
Ask To Expert