Showing 149 results
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Provider Compendium
Payment Integrity Solutions – Provider Compendium 2025
June 30, 2025The payment integrity market is shifting from post-payment recovery to a proactive focus on pre-payment accuracy, aiming to reduce costs and improve efficiencies. AI is enhancing fraud detection, real-time claims validation, and predictive risk modeling. Simultaneously, blockchain is helping boost transparency, while cloud adoption supports automation and operational agility. Collaboration among payers, providers, and regulators is also strengthening, helping develop more integrated and effective ecosystems. This report assesses 24 payment integrity providers, analyzing key aspects such as revenue scales, client bases, delivery models, value chain coverages, service segmentations, plan sizes and types, notable clients, and proprietary tools. It is designed to help healthcare payers identify the right partners to support operational transformation and gain a competitive edge in a rapidly evolving payment integrity environment.
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Viewpoint
The Health Plan Renaissance: How Next-generation BPaaS is Ushering a New Era of Efficiency
June 27, 2025US health insurance carriers face escalating pressures, from soaring costs and workforce shortages to rising member expectations and complex compliance demands. In this environment, traditional administrative processes and outdated systems are proving inadequate. To address these challenges, health plans are embracing next-generation Business-Process-as-a-Service (BPaaS) as a strategic transformation enabler. Unlike earlier models, next-generation BPaaS integrates cloud-based platforms, generative and agentic AI, digital twins, and robust data strategies into unified, scalable service ecosystems. This report explores how next-generation BPaaS helps healthcare payers drive outcomes such as higher auto-adjudication, reduced total cost of ownership, improved regulatory readiness, and enhanced member experiences. It also introduces a 4D transition framework – Discover, Decide, Drive, and Deepen – to guide payers through readiness assessment, provider selection, and continuous optimization. With intelligent platforms, multi-shore delivery, and AI-led decision-making at the core, next-generation BPaaS is enabling health plans to shift from transactional efficiency to strategic transformation.
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June 10, 2025Life sciences enterprises are under increasing pressure to accelerate innovation, optimize costs, and embrace emerging technologies like AI. These priorities are reshaping how and where organizations source capabilities, prompting a fresh look at the roles of Global Capability Centers (GCCs) and service providers. GCCs are gaining renewed focus as enterprises invest in internal talent and domain expertise, while service providers continue to play a critical role in delivering flexibility, scale, and specialized capabilities. However, very few conversations bring both sides of the sourcing story to the table. Watch Everest Group’s experts as they explored how life sciences sourcing strategies are evolving in an AI-first world and where enterprises are choosing to build vs. buy capabilities. What questions did the webinar answer? How are life sciences enterprise priorities changing, and what is the impact on the sourcing strategy? What capabilities are companies increasingly looking to bring in-house through GCCs, and which are they turning to service providers to deliver? In an AI-first world, how is the value proposition evolving for both models?
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June 04, 2025Healthcare enterprises are increasingly recognizing the strategic value of Data, Analytics, and AI (DAAI) as data-driven decision-making becomes central to achieving business and clinical outcomes. While DAAI initiatives have traditionally focused on cost containment and operational efficiencies, there is now a clear shift toward enhancing patient experiences and driving improved health outcomes. This evolving focus is prompting organizations to invest in robust data integration capabilities and advanced analytics, with particular emphasis on data privacy, value-based care, and population health management. Although payers have historically led DAAI adoption, providers are rapidly advancing their capabilities. They are essential in shaping enterprise DAAI strategies and roadmaps, modernizing infrastructure, and delivering actionable insights that support high-impact decision-making. As a result, healthcare organizations are realizing measurable improvements in performance, care delivery, and patient engagement. In this report, we assess 32 healthcare DAAI providers featured on the Healthcare Data, Analytics, and AI Services PEAK Matrix® Assessment 2025. The report analyzes the healthcare DAAI services market size, DAAI service themes for healthcare enterprises, and providers’ capabilities and market success. The research will enable enterprises to select the best-fit provider for their sourcing needs. Scope Industry: healthcare Service: healthcare DAAI services Geography: global Contents In this report, we assess: Healthcare DAAI services market trends Each provider’s capabilities and market success Providers’ key strengths and limitations
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May 28, 2025US healthcare organizations face operational challenges, including rising chronic disease prevalence, workforce shortages, and growing administrative complexity. In this environment, legacy operating models are proving insufficient, prompting healthcare enterprises to reconsider their long-held hesitancy toward clinical outsourcing. As home health expenditures rise and regulatory scrutiny increases, enterprises must reimagine how they deliver efficient, high-quality, and patient-centered care. This Viewpoint explores how strategic clinical outsourcing can address key pressures by enhancing scalability, operational efficiency, and regulatory readiness. By partnering with providers offering skilled clinical talent, digital platforms, and compliance-aligned workflows, enterprises can streamline utilization management, case management, risk adjustment, and quality improvement efforts. The report also emphasizes the importance of aligning automation and AI tools with human expertise to improve outcomes while managing cost and compliance risk. Scope Geography: US Industry: healthcare Service: healthcare business process services Contents In this report, we examine: Key challenges driving the need for clinical outsourcing Functions best suited for outsourcing in clinical operations Strategic benefits of outsourcing: scalability, efficiency, and compliance Key success factors for implementation The evolving role of digital tools and AI in clinical workflows
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Viewpoint
Navigating Value-based Care (VBC) amid AI and Economic Uncertainty for Healthcare Providers
May 08, 2025The shift from fee-for-service to Value-based Care (VBC) is increasing due to payer mandates and the long-term promise of improved outcomes and lower costs. However, this transformation is unfolding amid economic uncertainty, tariff-driven inflation, and healthcare provider financial strain. Several hospitals lack the capital, operational agility, or data integration required to scale VBC adoption effectively. As Centers for Medicare & Medicaid Services (CMS) expands its adoption through the Alternative Payment Model (APM) framework, healthcare providers struggle to align limited resources with long-term strategic goals. To succeed in this evolving environment, healthcare organizations must invest in automation, analytics, and AI-enabled tools that improve financial and clinical performance. Agentic AI offers the potential to ease documentation burdens, close care gaps, and support compliance in a fragmented data ecosystem. In this report, we highlight how the emerging divide in the VBC landscape, shaped by resource availability, risks exacerbating disparities in care quality and organizational resilience. The report offers actionable strategies to navigate payer demands, optimize contracts, and realign RCM provider partnerships to support value-based models. Scope Industry: healthcare Geography: North America Contents In this report, we: Simply the VBC concept Evaluate systemic barriers slowing VBC adoption Assess VBC adoption trends in the future Analyze the healthcare provider strategy blueprint for VBC’s success
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April 22, 2025As 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
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April 09, 2025In today’s dynamic talent market, organizations must actively monitor key roles and skills, both in-demand and emerging, to enable strategic workforce planning. Higher demand may indicate more significant competition for talent or a higher risk of attrition, making it vital to analyze talent demand trends to anticipate external competition and identify leading industries for talent acquisition. Everest Group’s half-yearly report offers insights into monthly IT services talent demand trends across India, highlighting top industries, roles, and skills based on H2 2024 demand. Leveraging data from our Talent Genius™ tool, this report comprehensively analyzes the current talent market, empowering organizations to stay competitive, plan for future workforce needs, and make informed talent acquisition decisions. Scope Industry: IT services Geography: India Contents In this report, we analyze talent demand trends in India's IT services sector on a national scale. Additionally, we provide detailed profiles of 15 major Tier-1 and Tier-2 cities, offering insights into talent demand trends, top industries, key roles, and essential skills in each location.
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April 03, 2025The payment integrity market is strategically shifting from post-payment recovery to proactive pre-payment accuracy, thereby reducing costs and enhancing efficiency. AI-driven tools are advancing fraud detection, real-time claims validation, and predictive risk modeling, while next-generation technologies, such as blockchain, are being explored for transparency. The industry is also seeing stronger collaborations among solution providers, healthcare organizations, and regulators to build integrated ecosystems. Additionally, cloud-based platforms are gaining traction and reinforcing the drive toward automation, efficiency, and improved payment accuracy in an evolving healthcare landscape. Scope Industry: healthcare Geography: global Contents This report analyzes 24 payment integrity solutions providers and includes their: Relative positioning on Everest Group’s PEAK Matrix® for payment integrity solutions Capabilities and market shares Key strengths and limitations
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March 11, 2025Enterprise spending priorities in traditional areas have largely matured, and they have a playbook on how to optimize it. However, a wave of new pressures – including evolving regulations, geopolitical shifts, supply chain disruptions, tariffs, and rising customer experience (CX) expectations – is forcing executives to rethink how they can do more with less. With the rapid advancement and availability of new technologies, the question now is: What areas of enterprise spend remain untouched, and how can executives optimize these areas while delivering on the promise of AI and CX? What questions did the webinar answer? As an enterprise tech or operations leader, what new ways can I leverage my sourcing options that I haven’t done in the past? As a service or tech provider, what emerging spending opportunities can I pursue that were previously unavailable for outsourcing?
