Showing 14 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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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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State of the Market
Creating Value with a Purpose: Impact Sourcing State of the Market 2024
Dec. 27, 2024The impact sourcing ecosystem is rapidly expanding due to the growing interest in sustainable and socially responsible business practices. Enterprises and providers are increasingly incorporating diverse and underserved talent into their operations due to cost efficiency, access to specialized talent, and alignment with ESG and SDG objectives. Traditional providers dominate hiring volumes, while specialists see steady growth in revenue and headcount as they refine talent initiatives and partner with NGOs and educational institutions. Buyers recognize the dual value of cost benefits and corporate citizenship, advocating for more robust reporting and impact sourcing policies’ disclosure. In response, providers are investing in enhanced training programs, certifications, and technology upskilling, enabling impact workers to transition to more complex, higher-value roles. Despite generative AI’s disruptive potential concerns, agentic AI emerges as a promising tool to empower the impact workforce. Key market trends include the CXM industry’s increasing contribution to impact sourcing revenue, growing adoption of impact workers in MEA and APAC regions, and alignment with regulatory frameworks promoting fair labor practices. Governments support impact sourcing through incentives and regulations, while providers adopt inclusive hiring strategies and offer tailored employee support to complement workforce diversity and drive social impact. In this report, we explore macroeconomic drivers, buyer feedback, and generative AI’s influence on the impact sourcing space. Africa stands poised to lead the global impact sourcing growth, showing this approach’s transformative potential in fostering a purpose-driven and sustainable business landscape. The report aims to enable enterprises and providers to incorporate impact sourcing and other inclusive talent management strategies in their organizations. Scope Broad industry with a focus on impact sourcing talent strategy Geography: global Impact sourcing programs of both impact sourcing specialists and traditional service providers This report is based on primary and secondary data collection, conversations with market participants (buyers, outsourcing service providers, and impact sourcing specialists), and fact-based research Contents In this report, we analyze: The concept of impact sourcing and the comprehensive impact sourcing market landscape, including market size, trends, and talent portfolio Impact sourcing’s talent management practices across the hire-to-retire cycle Buyers’ take on impact sourcing Impact sourcing engagement case studies Technology’s role on the impact sourcing market and the future of impact sourcing programs Memberships This Market Report is available to All Memberships
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Oct. 08, 2024The payment integrity sector is transforming as the healthcare industry seeks to enhance payment process accuracy and efficiency. With rising financial pressures, the demand for effective payment integrity solutions has intensified, prompting stakeholders to explore innovative strategies to manage administrative waste and payment inaccuracies. This viewpoint focuses on a recent significant merger by New Mountain Capital in the payment integrity space that promises to reshape competitive dynamics within the industry. It highlights key enterprise priorities and trends, including the integration of advanced technologies and strategic partnerships aimed at improving operational effectiveness. As stakeholders navigate this changing landscape, insights into the merger's implications will be important for them in understanding how to adapt and optimize their approaches to payment integrity. By examining the evolving market, this viewpoint equips readers with the knowledge to make informed decisions and improve their operations. Scope Industry: healthcare Geography: global Contents In this viewpoint, we explore: A landmark merger in the payment integrity market How the merger addresses key demands in the payment integrity market The merger’s future implications Membership(s) Healthcare Payer and Provider Business Process Sourcing and Vendor Management
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Thematic Report
Role of Analytics in Claims Management
June 10, 2024In the dynamic healthcare landscape, efficient claims management is vital. Traditionally, the claims management process relies on manual efforts and human judgment. Today, advanced analytics allow healthcare payers to optimize costs, reduce fraudulent claims, ensure regulatory compliance, and lower claims denial rates. Implementing analytics strategically in the healthcare ecosystem has significantly enhanced the claims management life cycle. In this report, we examine the role of analytics in transforming claims management, emphasizing the importance for healthcare payers and providers to prioritize analytics in claims management processes. The report assesses key trends, technologies, and focus areas in claims analytics, offering a comprehensive overview of how these advances lead to more efficient and effective systems. Additionally, it addresses the challenges providers face in adopting and implementing analytical techniques while offering insights into overcoming them. The report also examines the current state of claims management, offering actionable recommendations to use analytics to streamline operations and improve outcomes. It will help stakeholders understand the transformative potential of analytics in healthcare claims management and develop strategies to harness its benefits. Scope Industry: healthcare Geography: global Contents In this report, we: Examine the role of analytics in transforming claims management, highlighting how it can optimize costs, reduce fraudulent claims, ensure regulatory compliance, and lower claims denial rates Identify challenges healthcare payers face in adopting analytics and offer insights to overcome them Assess the current claims management status in the healthcare landscape Recommend best practices for using analytics to enhance efficiency and effectiveness Membership(s) Healthcare Payer and Provider Information Technology Sourcing and Vendor Management
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Viewpoint
Revolutionizing Healthcare Operations: Unlocking Transformation with Business Process as a Service
May 02, 2024The 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
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Jan. 10, 2024The 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
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Dec. 15, 2023Healthcare enterprises have made digital adoption the bedrock of their growth strategies to optimize processes, realize cost efficiencies, and enhance member experiences. They are leveraging digital services for value-based care and population health management, and to comply with changing regulations. To support enterprises on their digital transformation journeys, providers are ramping up their capabilities through vertical-specific partnerships and acquisitions, investments in Centers of Excellence (CoEs), and training, among other things. These efforts are, in turn, driving the need for research and market intelligence on demand and supply trends in healthcare payer digital services. In this report, we assess 32 healthcare ITS providers, which are mapped on the Everest Group PEAK Matrix®, a composite index of distinct metrics related to a provider’s capability and market impact. We focus on payer digital services market size and growth, digital service themes for healthcare payers, provider assessments on several capability- and market success-related dimensions, and Everest Group’s independent assessment of the providers to help enterprises make the right sourcing decisions. Scope Industry: healthcare Offering: payer digital services Geography: global (with focus on the US) Contents This report comprises three sections: Healthcare payer digital services market trends Assessment of 32 healthcare payer digital service providers on capability- and market success-related dimensions Enterprise sourcing considerations, highlighting the strengths and limitations of each healthcare payer digital service provider Membership(s) Healthcare Payer and Provider Information Technology Sourcing and Vendor Management
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Provider Compendium
Healthcare Data and Analytics Services – Provider Compendium 2023
Aug. 16, 2023Healthcare Data and Analytics (D&A) Services Provider Compendium provides accurate, comprehensive, and fact-based snapshots of 35 providers, including their scale of revenue, overview of client base, company overview, revenue split by geography, segment, value chain, and buyer size, along with Everest Group’s PEAK Matrix® service provider assessment. The compendium also examines the global healthcare D&A service provider landscape. The report will enable current and potential buyers of payer operations to assess the providers on their strengths and limitations, based on their desired capabilities. Scope Industry: healthcare Geography: global This report is based on Everest Group’s annual RFI process for the calendar year 2023, interactions with leading healthcare D&A services providers, client reference checks, and an ongoing analysis of the healthcare D&A services market Contents Each provider profile captures the following details: Scale of operations: client base overview, revenue, revenue split by segment, value chain, buyer size, and geography Major case studies and consultative frameworks Proprietary solutions and key events Everest Group assessment: providers’ position on Everest Group’s PEAK Matrix® and overall evaluation of provider capabilities with key strengths and limitations Membership (s) Healthcare Payer and Provider Information Technology Healthcare Payer and Provider Business Process Data & Analytics Sourcing and Vendor Management
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June 23, 2023The healthcare industry constantly evolves, requiring organizations to continuously adapt and enhance their capabilities to stay competitive. The shift toward value-based care has presented various opportunities such as telehealth, population data analytics, remote patient monitoring, commercial models based on risk assessment, increased investment in care management, and a greater emphasis on digital initiatives, particularly automation and analytics. To achieve these objectives, healthcare providers are forging robust partnerships within ecosystems, collaborating with top third-party providers, developing innovative technological solutions, and implementing novel approaches such as Business-Process-as-a-Service (BPaaS) and provider solutions for service delivery. In this report, we analyze 29 healthcare payer operations providers featured on the Healthcare Payer Operations PEAK Matrix® . The report positions the 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 healthcare payer operations providers, client reference checks, and an ongoing analysis of the healthcare payer operations market Contents This report analyzes 29 healthcare payer operations providers and includes: Assessment of the providers’ relative positioning on Everest Group’s PEAK Matrix® for Healthcare Payer Operations Comparison of the providers’ capabilities and market shares Providers’ key strengths and limitations Membership(s) Healthcare Payer and Provider Business Process Sourcing and Vendor Management
