The 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