Showing 36 results
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June 25, 2025As 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.
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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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March 06, 2025The evolving landscape of Revenue Cycle Management (RCM) highlights how AI, automation, and outsourcing are transforming financial and operational efficiencies for healthcare providers. Despite persistent challenges such as billing complexities and staffing shortages, healthcare leaders are increasingly prioritizing advanced automation, AI-driven decision-making, and cybersecurity to modernize RCM processes. Generative AI is expected to play a vital role in this modernization, with 85% of RCM leaders believing it will enhance efficiency within the next five years. Key applications include real-time eligibility verification, AI-driven chatbots, and automated medical coding, though organizations must address challenges such as data accuracy, compliance risks, and integration with legacy systems. As RCM continues to evolve, technology-enabled outsourcing models are becoming essential for sustainable growth, enabling providers to optimize workflows, reduce costs, and enhance patient experiences. This report underscores that AI-driven RCM is no longer an option but a necessity for healthcare providers seeking financial resilience and operational excellence. Additionally, it highlights key considerations for selecting the right RCM partner and outlines how third-party providers can enhance RCM workflows for greater efficiency and compliance. Scope Industry: healthcare Geography: North America Contents In this report, we explore: Key RCM challenges healthcare providers face Investment priorities for 2025 through 2030 Current adoption of advanced analytics and intelligent automation, along with priority use cases The emergence of generative AI in RCM, healthcare providers’ readiness, key use cases under consideration, and mitigation strategies for associated risks and barriers An outsourcing strategy for healthcare providers to transition to a technology-powered outsourcing model Membership(s) Healthcare Payer and Provider Business Process Sourcing and Vendor Management
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Feb. 14, 2025In recent years, technology enterprise adoption and digitalization have significantly reshaped Revenue Cycle Management (RCM), transforming how healthcare providers optimize financial performance and patient engagement. To enhance provider reimbursements, streamline claims processing, and accelerate value-based care initiatives, healthcare providers have made digital adoption their RCM strategies’ foundation. To meet growing enterprise demands, RCM platform providers are expanding their capabilities through investments in AI/gen AI-driven automation, strategic partnerships, and acquisitions to drive efficiency and financial sustainability. In this report, we evaluate 22 RCM platform providers mapped on the Everest Group PEAK Matrix® framework. The report analyzes the RCM platform market size, growth trends, and key capabilities, offering insights into market success metrics. It offers enterprises the information they need to make informed sourcing decisions in the evolving RCM landscape. Scope Industry: healthcare Product: revenue cycle management Geography: US Contents In this report, we: Assess healthcare RCM platforms market trends Examine each platform provider’s capability and market success-related dimensions Analyze platform providers’ key strengths and limitations Membership(s) Healthcare Payer and Provider Information Technology Revenue Cycle Management Sourcing and Vendor Management
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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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Sep. 17, 2024In 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
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May 31, 2024Healthcare organizations use Revenue Cycle Management (RCM) to manage the administrative and clinical functions related to processing claims, receiving payments, and generating revenue. The cycle begins with a patient scheduling an appointment and continues until the final payment is received. Due to increasing staff burnout cases, changing regulations, rising costs, and prioritizing improved patient experiences, there is a growing demand for third-party services to assist healthcare providers with their RCM operations. This has led to significant growth in the RCM services market, making it one of the fastest-growing segments in the healthcare industry. Within RCM, managed services and technology products are two key solution types. Both play vital roles in optimizing healthcare financial processes and have unique advantages. In this viewpoint, we explore the collaborative relationship between healthcare enterprises and RCM service providers, particularly examining the contributions of these two partnership models (technology products and managed services). The report examines how these models address challenges and looks ahead to future-proofing RCM in the ever-evolving healthcare landscape. Scope Industry: RCM Geography: global The assessment is based on Everest Group’s proprietary research and transactional intelligence Membership(s) Healthcare Payer and Provider Information Technology Healthcare Payer and Provider Business Process Sourcing and Vendor Management
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Provider Compendium
Revenue Cycle Management (RCM) Platforms – Provider Compendium 2024
April 10, 2024Revenue Cycle Management (RCM) platforms automate financial processes in the healthcare industry, optimizing the revenue cycle from patient registration and appointment scheduling to final bill payment. Healthcare organizations increasingly evaluate RCM platform providers based on the functionalities, features, and technical support they provide. Demand is high for solutions such as patient engagement, denial management, and medical coding, as healthcare providers prioritize solutions that address current challenges and provide flexibility for future developments in the healthcare landscape. In this compendium, we assess 20 RCM platform providers on the RCM Platforms PEAK Matrix®. The study will enable buyers to choose the best-fit providers based on their sourcing considerations, while providers will be able to benchmark their performance against the competition. Scope Industry: healthcare Geography: US The assessment is based on Everest Group’s annual RFI process for calendar year 2023, interactions with leading RCM platform providers, client reference checks, and an ongoing analysis of the RCM platforms market Contents In this report, we examine 20 RCM platform providers for their: Scale of operations: client base overview, revenue, revenue split by value chain and buyer size Key case studies Proprietary solutions and key events Membership(s) Healthcare Payer and Provider Information Technology Sourcing and Vendor Management
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Thematic Report
Talent Demand Trends | India IT Services – H2 2023
Feb. 23, 2024In today’s dynamic talent market, where competition is fierce, organizations must actively monitor key roles and skills, identifying both in-demand and emerging ones, allowing for strategic workforce planning. A higher demand may indicate more significant competition for talent or a higher probability of attrition in the near future. Thus, analyzing talent demand trends is vital for strategizing workforce requirements, predicting external competition, and understanding 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 2023 demand. Leveraging data from our Talent Genius™ tool, the report provides a comprehensive analysis of 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 within the IT services sector in India 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. Membership(s) This Market Report is available to All Memberships
