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.

The healthcare payer outsourcing market is rapidly evolving as payers strive to enhance efficiency, control costs, meet member expectations, and navigate complex regulations. With a growing focus on member-centricity and streamlined core administrative processes, Business Process as a Service (BPaaS) has emerged as a key strategic solution. Payers now demand modular, contextualized, and scalable solutions tailored to specific business lines, such as Medicare or Medicaid. In response, providers are innovating with Line-of-Business (LoB)-specific solutions, robust platform partnerships, and comprehensive consulting capabilities to support payers on their BPaaS transformation journeys. In this report, we provide comprehensive, fact-based snapshots of 14 healthcare payer BPaaS solution providers. The report examines the providers’ revenue scale, client base, deployment models, revenue split by offerings, value chain coverage, plan sizes, plan types, key clients, and proprietary solutions and tools. This research enables healthcare payers to identify suitable providers to transform their business processes and achieve differentiation. Scope Industry: healthcare Geography: US Contents In this report, we examine 14 healthcare payer BPaaS solutions providers based on their: Scale of operations including revenue, client base, deployment model, revenue split by offerings, value chain, plan size, and plan type Key clients and proprietary solutions and tools offered Membership(s) Healthcare Payer and Provider Business Process Sourcing and Vendor Management

The healthcare payer outsourcing market is rapidly evolving, driven by healthcare payers' need to enhance efficiency, manage costs, meet member expectations, and navigate complex regulations. As the industry shifts toward member-centricity and robust core administrative processes, an integrated platform and operations play, more commonly referred to as Business Process-as-a Service (BPaaS) solutions have emerged as a strong strategic solution to streamline operations. The healthcare payers are demanding modular, contextualized, and scalable solutions that takes care of their specific needs for different business lines such as Medicare or Medicaid. As a result, providers are developing innovative solutions (such as Line-of-Business (LoB) specific or ‘in-a-box’ solutions), robust platform and digital partnerships, and comprehensive consulting capabilities across the value chain to help chart out the BPaaS transformation journey for payers. In this report, we analyze 14 healthcare payer BPaaS solutions providers featured on the Healthcare Payer BPaaS Solutions PEAK Matrix®. The report positions providers relative to each other and evaluates their strengths and limitations. The study will enable healthcare payers to identify suitable providers to transform their business processes and differentiate themselves. Scope Industry: Healthcare Geography: US The assessment is based on Everest Group’s annual RFI process for the calendar year 2023, interactions with leading healthcare payer BPaaS solutions providers, client references, and Everest Group’s ongoing analysis of the payer BPaaS solutions market Contents The Healthcare Payer BPaaS Solutions PEAK Matrix® Assessment 2024 The payer BPaaS solutions provider landscape Providers’ key strengths, limitations, and capabilities Membership(s) Healthcare Payer and Provider Business Process Sourcing and Vendor Management

The evolving regulatory landscape poses significant challenges for life sciences enterprises. Enterprises struggle to navigate complex compliance frameworks, stay updated with emerging regulations, and manage diverse geographical requirements, all vital for achieving regulatory compliance and securing market access. As a result, enterprises are seeking providers with specialized knowledge and technology expertise to efficiently manage these intricate regulatory landscapes. In response, providers are enhancing their capabilities and offerings by investing significantly in technology. They are expanding their portfolios to include innovate tools and platforms to streamline regulatory processes. Additionally, to provide enhanced value and accessibility, providers are increasing their global presence by establishing localized support networks to cater to the nuanced requirements of diverse markets. In this report, we assess 20 providers featured on the Regulatory and Medical Affairs Operations PEAK Matrix®. Each profile offers a comprehensive picture of the provider’s key strengths and limitations. Scope Industry: life sciences Geography: global This report is based on Everest Group’s annual RFI process for calendar year 2024, interactions with leading regulatory and medical affairs providers, client reference checks, and an ongoing analysis of the regulatory and medical affairs Business Process Services (BPS) market Contents In this report, we: Position the providers on Everest Group’s PEAK Matrix® as Leaders, Major Contenders, and Aspirants Compare providers’ capabilities and market shares Assess providers’ key strengths and limitations Membership(s) Life Sciences Business Process Sourcing and Vendor Management

The healthcare industry is transforming rapidly, driven by rising costs, stricter regulations, and a growing emphasis on member experience. This pressure highlights the need for healthcare payers to improve efficiency and effectiveness, especially in light of recent cybersecurity incidents such as the one involving Change Healthcare. Robust information security protocols are essential in this complex environment, where innovative solutions can streamline operations, ensure scalability, and deliver cost-effective care. Amid these challenges, Business Process as a Service (BPaaS) has emerged as a transformative force in healthcare. BPaaS offers a new approach to managing administrative and clinical tasks, leveraging platform-based solutions, deep healthcare expertise, and cutting-edge technology to empower healthcare payers. By embracing BPaaS, organizations can streamline processes, achieve greater scalability, and pursue operational excellence. In this report, we explore the role of BPaaS solutions within the healthcare payer landscape. It provides a comprehensive analysis of the challenges that healthcare enterprises face and demonstrates how BPaaS can effectively address them. The report offers insights into various BPaaS solutions, including their core elements and the outcomes they deliver. Additionally, it examines successful use cases of specialized BPaaS solutions designed to address specific pain points. Furthermore, the report highlights the increasing adoption and potential of BPaaS-led transformation in payviders. Lastly, it provides guidance on evaluating and selecting BPaaS solution providers to navigate the evolving healthcare landscape effectively. Scope Industry: healthcare Geography: global Contents In this report, we examine: The challenges in the enterprise market and how BPaaS can help solve these issues Broad-based BPaaS solutions, including their key elements and the operational efficiency benefits they offer Specialized BPaaS solutions, highlighting successful use cases and targeted approaches to address specific pain points The unique intersection of BPaaS in payviders, including Provider Sponsored Health Plans (PSHPs) BPaaS’ role in navigating the ever-evolving terrain of the healthcare landscape Membership(s) Healthcare Payer and Provider Business Process Outsourcing Excellence

Healthcare payers have long prioritized member experience, investing significantly to improve customer satisfaction. However, their approach has often been incremental, rather than transformative, leading to a notable gap between customer expectations and the actual experience provided. Intensifying competition, regulatory pressures, and evolving consumer standards from industries such as retail and entertainment have heightened the urgency for payers to address this challenge promptly. To bridge this gap, health plans are recognizing the need for embracing technologies such as analytics, automation, cloud, and AI. The emergence of generative AI presents an exciting opportunity to revolutionize member interactions, enabling health plans to make better decisions and deliver personalized healthcare solutions. In this viewpoint, we examine the fundamental challenges impacting member experience within health plans, highlighting the importance of transformative strategies to address these issues. The report also explores the essential digital capabilities required for future member engagement, emphasizing the vital role of technology in meeting the evolving needs of healthcare consumers. Additionally, it examines the role of third-party providers in reshaping member experience and fostering a more connected, customized, and continuous member experience. Enterprises and providers across the healthcare industry can leverage this report to enhance their capabilities and thrive in a digitally enabled future, centered around the needs of members. Scope Industry: healthcare Geography: global Contents In this report, we examine: Foundational customer experience issues in healthcare payer member experiences The defining pillars of next-generation member engagement strategy, employing the 3C approach Key digital capabilities vital for future-proofing member engagement Generative AI’s role in reshaping member experience Third-party providers’ potential contribution in facilitating member journey transformation Membership(s) Healthcare Payer and Provider Business Process Outsourcing Excellence

As the global MedTech industry adapts to the post-COVID-19 landscape, it faces a multitude of challenges including changing consumer preferences, staffing shortages, supply chain disruptions, and evolving regulatory frameworks. Additionally, there is increasing interest in advanced technologies such as generative AI, wearables, digital therapeutics, and medical robots, prompting providers to expand their digital portfolio. To meet these challenges and address evolving enterprise needs, MedTech providers are adopting a personalized approach and enhancing their offerings across the value chain. This includes investments in data-driven insights for manufacturing patient-friendly devices, advanced analytics for supply chain optimization, keeping up with regulations, and effective launch strategies in a competitive environment. Everest Group’s MedTech Operations – Service Provider Compendium 2024 provides comprehensive and fact-based snapshots of 15 MedTech operations service providers. Each provider profile offers a comprehensive picture of its company overview, key leaders, scale of operations, recent developments and investments, partnerships, technology solutions and capabilities, delivery locations, scope of services, and portfolio mix. The compendium will enable providers to benchmark themselves against their competitors, while buyers will be able to assess the providers based on the desired set of capabilities. Scope Industry: MedTech operations Geography: North America Contents In this report, we feature 15 MedTech operations service provider profiles and include: Service suite and scale of operations: key leaders, service suites, FTEs, revenue, recent developments, and partnerships Delivery locations: details of key delivery locations worldwide Capabilities and clients: major client engagements, revenue by process coverage, revenue by geography, revenue by buyer size, and revenue by delivery location Technology solutions and tools: brief descriptions of key MedTech operations technology solutions and tools Membership(s) Life Sciences Business Process Outsourcing Excellence

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