As patient expectations rise and healthcare delivery becomes more complex, access functions face increasing strain. Legacy systems and fragmented workflows can no longer handle real-time scheduling, eligibility verification, and financial clearance. Despite growing investments in AI, several organizations fail to achieve meaningful gains due to the absence of cohesive orchestration across access processes. This report introduces Systems of Execution (SoE) as healthcare enterprises’ next critical capability layer. Positioned between core systems and AI applications, SoE platforms enable coordinated, intelligent execution across patient access touchpoints. The report outlines key effective SoE tenets, including embedded AI, adaptive learning, and API-driven interoperability, and illustrates how they can transform critical touchpoints across the revenue cycle. It also profiles the evolving vendor landscape and offers strategic considerations for healthcare stakeholders seeking to optimize patient access with SoE-driven approaches.

As US healthcare providers grapple with a turbulent economic and regulatory landscape, new tariffs and evolving policies are reshaping operational and financial realities across the sector. In response, providers are reassessing spending, delaying technology investments, and seeking more cost-effective operations. This report explores how Revenue Cycle Management (RCM) providers can strategically help healthcare organizations navigate this disruption. It highlights key actions such as adopting flexible pricing, enhancing operational agility, and deploying targeted AI to improve efficiency and safeguard revenue. Designed for RCM leaders and healthcare stakeholders, the report offers practical guidance on turning disruption into opportunity by aligning solutions with shifting provider needs. Scope Industry: healthcare Geography: North America Contents This report covers the impact of tariffs and regulations on healthcare providers and outlines strategic and portfolio-specific actions RCM providers can take to mitigate risk, enhance value, and drive growth. Memberships Healthcare Payer and Provider Business Process Revenue Cycle Management Sourcing and Vendor Management

Generative AI can potentially revolutionize the healthcare payer industry, driving innovation across critical areas like claims processing, member engagement, and care management. By enhancing operational efficiency and improving outcomes for both payers and members, it is becoming a key enabler for transformation. However, adoption is not without its challenges, including concerns about data privacy, model accuracy, ethical considerations, and the resource demands of training AI models. Providers are addressing these hurdles through technologies such as encryption, anonymization, federated learning, and scalable cloud infrastructures, ensuring secure and seamless integration into existing workflows. As generative AI becomes a key driver of industry innovation, providers are gradually transitioning from experimental pilot projects to large-scale implementations. In this report, we analyze the value promise of generative AI across the healthcare payer value chain, highlighting the problems it addresses and the adoption of generative AI in the healthcare payer market. We also examine 13 leading providers, highlighting their capabilities, partnerships, and generative AI roadmap. Scope Industry: Healthcare payer Geography: North America The assessment is based on Everest Group’s annual RFI process for the calendar year 2024, interactions with leading healthcare payer service providers, client references, and Everest Group’s ongoing analysis of the payer market Contents In this report, we examine: The value promise of generative AI across different segments of the healthcare payer value chain Generative AI market adoption in healthcare payer Service provider capabilities Membership(s) Healthcare Payer and Provider Business Process Sourcing and Vendor Management

Generative AI can potentially revolutionize the life sciences industry, driving innovation across key areas of the value chain. By streamlining drug discovery, optimizing clinical trials, and enhancing decision-making, it can significantly reduce the time and cost required to bring new medicines to market, setting a new benchmark for industry efficiency and innovation. However, adopting generative AI presents challenges including concerns about data privacy, model accuracy, training resource demands, and ethical implications. As providers work toward addressing these challenges and generative AI becomes a key industry innovation driver, the focus is slowly moving beyond experimental pilot projects to full-scale implementations. This report examines generative AI’s value promise across the life sciences value chain, its market adoption within the industry, and the capabilities of 15 leading providers driving this innovation from pilots to scaled deployment. Scope Industry: life sciences Geography: global The assessment is based on Everest Group’s annual RFI process for the calendar year 2024, interactions with leading life sciences providers, client references, and Everest Group’s ongoing analysis of the life sciences market Contents In this report, we examine Generative AI’s value promise across different segments of the life sciences value chain Its market adoption in the life sciences industry 15 leading providers’ profiles Membership(s) Life Sciences Business Process Life Sciences Information Technology Sourcing and Vendor Management

The year 2022 proved to be a challenging time for healthcare providers in the United States. With patient volumes still lower than pre-pandemic levels, longer average lengths of stay, talent shortages, and rising costs, almost half of the country's hospitals experienced negative margins. To address the mounting revenue pressures, healthcare providers focused on future-proofing their revenue cycle operations and turned to third-party providers to enhance and improve their revenue cycle processes. Revenue Cycle Management (RCM) Operations Provider Compendium 2023 provides accurate, comprehensive, and fact-based snapshots of 31 providers, including their scale of operations, company overview, recent developments, key delivery locations, major clients, technological solutions, and Everest Group’s PEAK Matrix® provider assessment. The compendium also examines the RCM operations service provider landscape. The study will enable providers to benchmark their strengths against their competitors while RCM operations’ buyers will be able to assess the providers on their desired set of capabilities. Scope Industry: healthcare Business Process Services (BPS) Geography: global The assessment is based on Everest Group’s annual RFI process for the calendar year 2023, interactions with leading RCM operations service providers, client reference checks, and an ongoing analysis of the RCM operations market Contents In this report, we assess 31 provider profiles and include: Service suite and scale of operations: key leaders, services suite, FTEs, revenue, recent developments, and partnerships Capabilities and clients: major engagements, revenue split by geography, FTE split by process coverage and location, and revenue split by engagement model Key delivery locations and technology solutions Providers’ key strengths and limitations Membership(s) Healthcare Payer and Provider Business Process Sourcing and Vendor Management

As the global MedTech industry gradually recovers from the disruption caused by COVID-19, it confronts various new challenges, including changing consumer preferences, staffing shortages, supply chain disruptions due to geopolitical tensions, and evolving regulatory frameworks and standards across different markets. Additionally, the surge in interest in generative AI and advanced technologies, such as wearables, digital therapeutics, and medical robots, is compelling providers to expand their digital portfolio. To effectively address the evolving enterprise needs, providers are adopting a personalized approach and revamping their offerings across the MedTech operations value chain. They are investing in numerous avenues, such as providing data-driven insights for manufacturing patient-friendly devices, enhancing their advanced analytics capabilities for supply chain efficiencies, ensuring constant and timely adherence to changing regulations, and developing effective launch strategies amid the competitive environment. These investments aim to keep pace with the rapidly evolving needs of the market. In this report, we assess 15 providers featured on the MedTech Operations PEAK Matrix®. The research will help buyers select the right-fit provider for their needs, while providers will be able to benchmark themselves against each other. Scope Industry: life sciences Business Process Services (BPS) Geography: global The assessment is based on Everest Group’s annual RFI process for the calendar year 2023, interactions with leading MedTech BPS providers, client reference checks, and an ongoing analysis of the MedTech BPS market Contents This report features 15 BPS provider profiles and includes: Everest Group’s PEAK Matrix® for MedTech Operations Providers’ key strengths and limitations Membership(s) Life Sciences Business Process Sourcing and Vendor Management

2022 was a tumultuous year for the US healthcare provider landscape. With patient volumes still below pre-pandemic levels, an increase in the average length of stay, severe talent shortages, and escalating costs, nearly half of the hospitals in the country faced negative margins. As healthcare providers face mounting revenue pressures, they are prioritizing the futureproofing of their revenue cycle operations. To overcome the current challenges, healthcare providers are seeking the support of third-party providers to optimize and streamline their revenue cycle processes. In addition, providers are addressing healthcare providers’ needs by investing in scaling their talent pools, strengthening their technology portfolio to drive value through automation and analytics, and pursuing mergers and acquisitions to expand their value chain coverage and depth in the highly competitive revenue cycle market. In this report, we assess 31 providers featured on the Revenue Cycle Management (RCM) Operations PEAK Matrix® Assessment 2023. Each profile offers a comprehensive picture of the provider’s service focus through a snapshot of its key strengths and limitations. Scope Industry: healthcare Geography: global Service: RCM Business Process Services (BPS) The assessment is based on Everest Group’s annual RFI process for the calendar year 2023, interactions with leading RCM providers, client reference checks, and an ongoing analysis of the RCM services market Contents In this report, we examine: The RCM Operations PEAK Matrix® Assessment 2023 Key insights into PEAK Matrix® dimensions The RCM BPS provider landscape Providers’ capabilities and market shares Providers’ key strengths and limitations Membership(s) Healthcare Payer and Provider Business Process Sourcing and Vendor Management

The Pharmacy Benefits Management (PBM) industry is experiencing significant changes, including increased regulatory scrutiny surrounding pricing transparency and rebate-sharing rules, which are disrupting traditional business models. The rise of specialty drugs is also impacting profitability. Furthermore, the growing adoption of value-based contracting is prompting PBMs to eliminate data silos within their organizations to improve treatment outcomes and detect fraudulent activities. As a result, PBM operating models are shifting and there is a greater emphasis on digitizing operations to improve drug utilization, integrate data, and develop advanced analytical capabilities. In this viewpoint, we examine the evolution of PBMs, their role in the US pharmaceutical industry, and the key trends and controversies surrounding PBM operations. We also explore potential solutions for addressing PBM challenges and how third-party providers can help alleviate them. Scope Industry: healthcare Geography: North America Contents In this report, we: Examine the role of PBMs in the US healthcare ecosystem Discuss the key trends and challenges facing the PBM industry Explore the evolution of the PBM landscape and the role of third-party providers Membership(s) Healthcare Payer and Provider Business Process Sourcing and Vendor Management

Medical coding is one of the most frequently outsourced segments in the Revenue Cycle Management (RCM) value chain. Geriatric population growth and rising incidences of chronic diseases are increasing the demand for skilled medical coders. This, in combination with a shortage of qualified personnel within healthcare providers, is driving growth in the outsourcing of medical coding services. Additionally, the transition from inpatient to home-based care delivery, the adoption of telehealth and remote patient monitoring, and the addition of new code sets have made medical coding processes more complex. These shifts in the medical coding services landscape are compelling healthcare providers to seek support from third-party vendors. This compendium provides detailed and fact-based snapshots of 22 medical coding Business Process Services (BPS) providers. Each profile provides a comprehensive picture of the provider’s strengths and limitations. The compendium will enable providers to benchmark their capabilities against their peers, while buyers will be able to assess the providers based on their sourcing needs. Scope: Industry: healthcare Geography: global Contents: In this report, we feature 22 medical coding BPS provider profiles and include: Scale of operations, key leaders, and recent developments, along with acquisitions, revenues, FTEs, and clients FTE split by certification and revenue split by facility type Technology suite and brief descriptions of key proprietary solutions Key service delivery locations Providers’ strengths and limitations Membership(s) Healthcare Payer and Provider Business Process Sourcing and Vendor Management

Medical coding is one of the most outsourced segments in the Revenue Cycle Management (RCM) value chain. With a growing geriatric population and rising incidence of chronic diseases, the demand for skilled medical coders is on the rise. This increase in demand for qualified coders, combined with shortage of suitable personnel, is driving the growth of outsourced medical coding services. Additionally, the shift from an inpatient to a home-based care delivery model, the adoption of telehealth and remote patient monitoring, and the addition of new code sets have increased the complexity associated with medical coding processes. These gradual shifts in medical coding services are prompting healthcare providers to leverage third-party providers for support. In this research, we present a detailed analysis of 22 operations service providers featured on Everest Group’s Medical Coding Operations PEAK Matrix® Assessment. We provide a relative positioning and analysis of the providers and our evaluation of their strengths and limitations. Scope Industry: healthcare business process Geography: global Contents This report features a detailed analysis of 22 operations service providers and includes: A relative positioning of the providers on Everest Group’s PEAK Matrix® for Medical Coding Operations An analysis of the providers’ capabilities and market shares Everest Group’s analysis of the providers’ strengths and limitations Membership(s) Healthcare Payer and Provider Business Process Sourcing and Vendor Management