Healthcare Payer BPO – Annual Report: Value-Based Sourcing Helping Payers Stay Afloat in an Era of Uncertainty

31 Mar 2017
by Ankur Verma, Manu Aggarwal, Naman Sharma

Healthcare payer BPO market grew strongly during 2013-2015, reaching US$9.1 billion (including government business) in 2016. Obamacare contributed to a large extent in this growth story. However, with the election of Donald Trump as the President of the United States, this market is likely to witness a downturn in short-term, owing to the anti-ACA stand of the new President and uncertainty surrounding the changes he could bring in the market. The market grew at ~9% in 2016 reaching US$9.9 billion.

In 2016, some of the key themes that dominated the market revolved around industry shift towards value-based care models, payer-provider convergence, and withdrawal of several payers from health insurance exchanges; who cited rising losses as the main reason for this move.

On the technology side, payers are increasingly demanding new-age solutions such as RPA, BPaaS, and predictive analytics. Whatever path the market takes, in terms of changes that the Republicans want to enforce, technology is the one thing that is here to stay.

Scope and Methodology

  • Proprietary database of over 350 healthcare payer BPO contracts (updated annually)
  • Service provider market success
  • Coverage across 20 healthcare payer BPO service providers including Accenture, Capgemini, Conduent, Cognizant, Concentrix, CGI, EXL, Firstsource, HCL, HGS, Genpact, hexaware, HPE, Infosys, Intelenet, NTT DATA, Shearwater Health, Syntel, Sutherland, and Wipro


This report provides comprehensive coverage of the global healthcare payer BPO market, including adoption trends across geographies, key solution characteristics, drivers & challenges, and service provider landscape. It will assist key stakeholders (buyers, service providers, and technology providers) to understand the changing dynamics of the healthcare payer BPO market and identify the upcoming trends. Some of the findings in this report are:

  • Election of Donald Trump as the President of the United States and his subsequent stand on the healthcare policies is creating uncertainty in the market, in terms of the changes that the new policies could bring in the healthcare market
  • Healthcare payer BPO market grew at a CAGR of ~11% during 2013-2015. However, prevalent uncertainty in the market is likely to result in slower growth in next one to two years
  • In terms of adoption characteristics, cost reduction continues to be the most important purchase driver for buyers; however, their focus on technology (automation, analytics, etc.) and expertise is increasing
  • Buyers’ preference for short contract length continues to rise, as it gives them the flexibility to replace a service provider in case of non-compliance
  • Claims management – with a share of 60% – continues to be the most outsourced process in the healthcare payer BPO market
  • New-age solutions, such as BPaaS, RPA, and predictive analytics, continue to witness increasing adoption
  • The market continues to remain consolidated at the top, with Accenture, Cognizant, Conduent, and HPE, together accounting for over 60% of the market by revenue

Membership (s)

Healthcare & Life Sciences Business Process Outsourcing


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