As Obamacare continues to bring about changes in the market, healthcare payer market remains in a dynamic state. The impending decision about top payer consolation has added to the uncertainty in the market. Some of the key changes observed in the market include loss recorded in exchange health plans, increase in drug prices & healthcare costs, decline in private physician practice, surge in the sale of High Deductible Health Plans (HDHPs) being sold, preference for narrow provider network, and rise of Accountable Care Organizations (ACOs).
Such a scenario accentuates the role of BPO service providers and the value they bring to the table. Service providers can help payers reduce administrative costs, streamline claims operations, and handle increased volumes, especially during the enrollment season. Improving care management (including care coordination), enhancing customer experience, and reducing errors while keeping costs in check are some of the other key areas where service providers can add value to payers’ operations. Payers have shown increased interest in analytics-driven solutions for key areas, such as population health management, FWA, utilization management, and payment integrity.
In this study we analyze the healthcare payer BPO market. We focus on:
This report will assist key stakeholders (healthcare payer institutions, service providers, and technology providers) understand the changing dynamics of the healthcare payer BPO service provider landscape. It will also help them identify Leaders, Major Contenders, and Aspirants for 2017. The report provides detailed analysis of the service provider market share, relative position on the Everest Group PEAK Matrix, capability assessment, and Everest Group’s remarks on service providers highlighting their key strengths and development areas.
Some of the findings in the report are:
Everest Group has a complimentary four-page PEAK Matrix preview document for this service provider landscape report.