As Obamacare continues to bring about changes in the market, healthcare payer market remains in a dynamic state. The impending decision about top payer consolation has added to the uncertainty in the market. Some of the key changes observed in the market include loss recorded in exchange health plans, increase in drug prices & healthcare costs, decline in private physician practice, surge in the sale of High Deductible Health Plans (HDHPs) being sold, preference for narrow provider network, and rise of Accountable Care Organizations (ACOs).

Such a scenario accentuates the role of BPO service providers and the value they bring to the table. Service providers can help payers reduce administrative costs, streamline claims operations, and handle increased volumes, especially during the enrollment season. Improving care management (including care coordination), enhancing customer experience, and reducing errors while keeping costs in check are some of the other key areas where service providers can add value to payers’ operations. Payers have shown increased interest in analytics-driven solutions for key areas, such as population health management, FWA, utilization management, and payment integrity.

In this study we analyze the healthcare payer BPO market. We focus on:

• Relative positioning of 20 service providers on the Everest Group PEAK Matrix for healthcare payer BPO
• Analysis of service providers’ market shares
• Key strengths and development areas for service providers

Scope of analysis

• Third-party healthcare payer BPO contracts; it does not include shared services or Global In-House centers (GICs)
• Over 350 active healthcare payer BPO contracts signed as of June 2016
• Coverage across 20 healthcare payer BPO service providers: Accenture, Capgemini, CGI, Cognizant, Concentrix, Conduent, EXL, Firstsource, Genpact, HCL, Hexaware, HGS, HPE, Infosys, Intelenet, NTT DATA, Shearwater Health, Sutherland Global Services, Syntel, and Wipro

Content

This report will assist key stakeholders (healthcare payer institutions, service providers, and technology providers) understand the changing dynamics of the healthcare payer BPO service provider landscape. It will also help them identify Leaders, Major Contenders, and Aspirants for 2017. The report provides detailed analysis of the service provider market share, relative position on the Everest Group PEAK Matrix, capability assessment, and Everest Group’s remarks on service providers highlighting their key strengths and development areas.

Some of the findings in the report are:

• Accenture, Cognizant, Conduent, NTT DATA, and Wipro emerged as Leaders
• Capgemini, CGI, Concentrix, EXL, Firstsource, Genpact, HCL, HGS, HPE, Shearwater Health, and Sutherland Global Services emerged as Major Contenders
• Hexaware, Infosys, Intelenet, and Syntel are Aspirants on the PEAK Matrix for healthcare payer BPO
• Cognizant, EXL, and Wipro have been identified as “Star Performers” on the healthcare payer BPO PEAK Matrix, based on their strong performance during the last 12 months ended June 2016
• Accenture, Conduent, and HPE are the top three largest healthcare payer BPO service providers by revenue
• CGI, Cognizant, Conduent, and HPE account for over 50% of the healthcare payer BPO clients
• Accenture, Cognizant, Conduent, HGS, and HPE have a dominating presence across most healthcare payer BPO processes. Claims management continues to represent the largest share of healthcare payer BPO market and is the most crowded space in terms of number of players

Everest Group has a complimentary four-page PEAK Matrix preview document for this service provider landscape report.

Membership(s)

Healthcare & Life Sciences Business Process Outsourcing