The Utilization Management (UM) healthcare market faces challenges such as administrative burdens in prior authorization and inconsistent clinical criteria, causing delays and inefficiencies. To overcome these issues, payers are partnering with specialized UM service providers, integrating generative AI, automation, and clinical expertise to streamline workflows and enhance decision-making. Payers are increasingly adopting outcome-based pricing models, linking payments to patient health outcomes rather than service volume. These collaborations improve operational efficiency, accelerate care delivery, reduce costs, and ensure high-quality, evidence-based patient care, ultimately boosting provider alignment and patient satisfaction. In this report, we analyze 18 providers featured on the Utilization Management Operations 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 from competitors. Scope Industry: healthcare Geography: US This assessment is based on Everest Group’s annual RFI process for the calendar year 2024, interactions with leading UM operations providers, client reference checks, and an ongoing analysis of the UM operations market Contents In this report, we examine: The Utilization Management Operations PEAK Matrix® Assessment 2025 The UM operations provider landscape Providers’ key strengths and limitations Membership(s) Healthcare Payer and Provider Business Process 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

In 2023, US healthcare providers faced formidable challenges. Although patient volumes have started to recover, increased labor expense and talent shortage caused administrative burdens and workflow issues to become more pronounced. Despite slight improvements in hospital margins, denial rates continue to increase, putting pressure on revenue cycle performance and financial stability. Furthermore, being able to access and leverage clean data has become critical given medical coding’s rising complexity and the dynamic regulatory environment. Additionally, the increase in patient responsibility has underscored third-party Revenue Cycle Management (RCM) service providers’ need to provide effective support. As healthcare providers strive to future-proof their revenue cycle operations, the focus remains on enhancing efficiency and mitigating current obstacles. Service providers are responding by scaling their talent pools, enhancing their technology portfolios with automation and analytics, and pursuing mergers and acquisitions to deepen their value chain coverage and remain competitive in the dynamic revenue cycle market. In this report, we assess 29 providers featured on the RCM Operations PEAK Matrix® Assessment 2024. 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 Contents In this report, we examine: The RCM Operations PEAK Matrix® Assessment 2024 Key insights into PEAK Matrix® dimensions The RCM business process services provider landscape Providers’ key strengths, limitations, capabilities, and market shares Memberships Healthcare Payer and Provider Business Process Revenue Cycle Management 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

Over the past year, enterprises have faced significant macroeconomic and geopolitical challenges. The potential uncertainties surrounding the implementation of the Inflation Reduction Act (IRA), the escalation in federal interest rates aimed at curbing inflation, and the ongoing conflicts leading to the relocation of clinical trials from regions such as Russia and Ukraine, have prompted enterprises to reassess their strategies. Moreover, the introduction of generative AI technologies, such as ChatGPT, empowers biopharmaceutical and MedTech companies to revamp their offerings and deliver state-of-the-art technology and cost efficiencies. In response to enterprises’ evolving demands, providers are enhancing their capabilities across the life sciences operations value chain. They have directed investments into various avenues, including Decentralized Clinical Trials (DCT), with numerous IT / Business Process Outsourcing (BPO) firms forging partnerships with DCT providers. Furthermore, additional investments encompass analytics-driven tools for precision Healthcare Professional (HCP) profiling and targeting, as well as the adoption of automation tools in areas such as Adverse Events (AE) intake to swiftly adapt to market demands. In this report, we assess 28 life sciences operations service providers featured on the life sciences operations PEAK Matrix®. The study will enable life sciences enterprises to identify suitable providers to transform their business processes and differentiate themselves. Scope Industry: life sciences business process services Geography: global The assessment is based on Everest Group’s annual RFI process for the calendar year 2023, interactions with leading life sciences operations service providers, client reference checks, and an ongoing analysis of the life sciences operations market Contents In this report, we: Examine 28 life sciences operations service providers featured on the life sciences operations PEAK Matrix® Assess providers’ capabilities and market shares Membership(s) Life Sciences Business Process Outsourcing Excellence

The payment integrity market is dynamically transforming, continuously adapting and enhancing fundamental capabilities within the healthcare industry. The growing emphasis on ensuring accurate and efficient payment processes is creating various opportunities. Key trends gaining prominence include advances in fraud detection and prevention technologies, using sophisticated data analytics for claims validation, integrating AI to identify irregularities, and implementing predictive modeling to forecast potential risks. The industry is experiencing a surge in collaborations and partnerships among payment integrity solution providers, healthcare organizations, and regulatory bodies to create robust ecosystems that foster innovation. Additionally, there is a notable shift toward leveraging next-generation technologies, such as generative AI, to enhance payment accuracy. This evolution underscores the industry’s commitment to refining payment integrity practices through technology innovation and strategic collaborations. In this report, we analyze 18 payment integrity solutions providers featured on the Payment Integrity Solutions PEAK Matrix®. The report positions providers’ market shares 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: global The assessment is based on Everest Group’s annual RFI process for the calendar year 2023, interactions with leading payment integrity solutions providers, client references, and Everest Group’s ongoing analysis of the payment integrity solutions market Contents This report analyzes 18 payment integrity solutions providers and includes: Providers’ relative positioning on Everest Group’s PEAK Matrix® for Payment Integrity Solutions Providers’ capabilities and market shares Key strengths and limitations Membership(s) Healthcare Payer and Provider Business Process 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

The healthcare industry faces challenges such as a shortage of clinical talent, a growing elderly population, and disparities in care access. Chronic diseases are on the rise, influenced by lifestyle choices and air quality. According to the CDC, chronic diseases chronic diseases contribute significantly to increased healthcare spending and mortality. To bridge this gap, healthcare organizations must deliver cost-effective care, expand infrastructure, and address Social Determinants of Health (SDoH) to improve access. Proactively identifying high-risk patients is essential for efficient resource allocation and cost reduction. Innovations in care delivery, targeted interventions, and investments are required to enhance care quality and outcomes. In this viewpoint, we discuss the trends driving care management policies’ adoption, outsourcing opportunities, and the evolution of care delivery. It also highlights challenges in delivering quality care and suggests ways for providers to support enterprises in overcoming these obstacles, with the ultimate goal of achieving superior patient care outcomes. Scope Industry: healthcare Geography: North America Contents In this report, we examine: Key market trends driving the increased outsourcing of care management operations A look into the past, present, and future dynamics of healthcare models Key challenges that enterprises face in handling care management operations and the solutions providers offer to support them Membership(s) Healthcare Payer and Provider Business Process Sourcing and Vendor Management

The life sciences sales and marketing industry is undergoing a profound transformation, driven by factors such as technology advances, changing regulatory landscape, and evolving patient expectations. As pharmaceutical and MedTech companies embrace innovation and patient centricity, outsourcing becomes a strategic imperative, enabling them to remain competitive, compliant, and responsive to the evolving needs of patients, payers, and healthcare systems. In this report, we examine key trends such as Healthcare Practitioner (HCP) engagement, patient centricity, evolving market access strategies, and efficient hybrid sales models. Furthermore, we analyze outsourcing implications, empowering providers to align with evolving market dynamics. This report will serve as a guide for stakeholders, both enterprises and providers, in navigating the complexities of an industry in constant flux. It equips them with essential insights to adapt, grow, and thrive in a rapidly evolving healthcare ecosystem. Scope Industry: life sciences Geography: global Contents In this report, we examine: Key trends impacting the life sciences sales and marketing operations market Outsourcing dynamics and deal trends in the life sciences sales and marketing operations market Provider landscape in the life sciences sales and marketing operations market Membership(s) Life Sciences Business Process Sourcing and Vendor Management