Healthcare Payer Services Market by Service Type (BPO, ITO, KPO), By Application (Claims, Provider, Member management, HR services, Analytics & Fraud, Billing & Accounts) & by End Users (Public & Private Payers) - Analysis and Global Forecast to 2020

ヘルスケア・ペイヤー・サービスの世界市場:BPO、ITO、KPO

◆タイトル:Healthcare Payer Services Market by Service Type (BPO, ITO, KPO), By Application (Claims, Provider, Member management, HR services, Analytics & Fraud, Billing & Accounts) & by End Users (Public & Private Payers) - Analysis and Global Forecast to 2020
◆商品コード:MAM-HIT-3877
◆調査・発行会社:MarketsandMarkets
◆発行日:2015年11月10日
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【レポートの概要】

当調査レポートでは、ヘルスケア・ペイヤー・サービスの世界市場について調査・分析し、エグゼクティブサマリー、市場インサイト、市場概観/市場動向、サービス別分析、用途別分析、需要先別分析、地域別分析、市場規模及び予測、市場動向、競争状況、関連企業分析などの情報をお届けいたします。

The healthcare payer services market includes the services that are outsourced by healthcare insurance providers/payers. These outsourcing solutions help the payers to streamline their business processes and deliver better services to their customers.

The healthcare payer services market is segmented on the basis of service type, application, and end users. On the basis of service type, the market is segmented into three segments namely BPO services, ITO services, and KPO services. The BPO services segment is estimated to account for the largest share of the global healthcare payer services market, by service type, in 2015. This large share is primarily attributed to the fact that BPO services provide assistance in key administrative areas. This, in turn enables the payers to achieve cost reductions and to speed time-to-market which is majorly the prime target of the payer organizations.

On the basis application, the healthcare payer services market is segmented into claims management services, member management services, provider management services, integrated front office services & back office operations, billing & accounts management services, analytics & fraud management services, and HR services. In 2015, claims management services are expected to command the largest share of the global healthcare payer services market. Private payers are expected to dominate the market, by end users.

The key factors expected to spur the growth of the global healthcare payer services market are federal mandates in the U.S., rising insurance enrolments, increasing healthcare frauds, rising cost of healthcare, and in-house shortage of skilled personnel. However, factors like rising incidences of data breach & loss of confidentiality, unforeseen costs associated with outsourcing along with the loss of managerial control in outsourced projects are expected to restrain the growth of the healthcare payer services market. In addition to this, migration from legacy systems is posing as a major challenge for the global healthcare payer services market.

On the basis of region, healthcare payer services market is categorized into North America, Europe, Asia-Pacific, and the Rest of the World (RoW).

Source: International Association of Outsourcing Professionals (IAOP), Association of Health Information Outsourcing Services (AHIOS), Healthcare Information and Management System Society (HIMSS), National Outsourcing association, The National Association of Software and Services Companies (India), U.S. Department of Health and Human Services, Healthcare Information Management Outsourcing Association of Philippines (HIMOAP), Healthcare Information and Management Systems Society (HIMSS), National Association of Healthcare Quality, Centers for Medicare and Medicaid Services (CMS), U.S. Department of Labor, The Economist Intelligence Unit, American Health Information Management Association (AHIMA), Healthcare IT News, Healthcare Payer News, World Health Organization (WHO), Annual Reports, SEC Filings, Press Releases, Company Websites, Investor Presentations, Expert Interviews, and MarketsandMarkets Analysis

The healthcare payer services (outsourcing) market is expected to reach USD 21.1 Billion by 2020 from USD 11.8 Billion in 2015, at a CAGR of 12.2% during the forecast period. The healthcare payer services market is dominated by North America, followed by Europe, Asia-Pacific, and the Rest of the World (RoW). North America is expected to grow at the fastest rate during the forecast period.

Cognizant Technology Solutions (U.S.), Accenture plc (Ireland), Concentrix Corporation (U.S.), ExlService Holdings, Inc. (U.S.), Xerox Corporation (U.S.), (Ireland), Genpact Limited (U.S.), Hewlett-Packard (U.S.), Hexaware Technologies Limited (India), FirstSource Solutions Limited (India). HCL Technologies Ltd. (India), Teleperformance Group (France), Hinduja Global Solutions Ltd. (India), SourceHOV (India), Sutherland Global Services (U.S.), and Wipro Limited (India) are some of the key players involved in providing healthcare payer outsourcing services worldwide.

【レポートの目次】

1 Introduction (Page No. – 16)
1.1 Objectives of the Study
1.2 Market Definition
1.3 Market Scope
1.3.1 Markets Covered
1.3.2 Years Considered for the Study
1.4 Currency
1.5 Limitations
1.6 Stakeholders

2 Research Methodology (Page No. – 19)
2.1 Research Methodology Steps
2.2 Secondary and Primary Research Methodology
2.2.1 Secondary Research
2.3 Key Data From Secondary Sources
2.3.1 Primary Research
2.3.2 Key Industry Insights
2.4 Key Data From Primary Sources
2.5 Key Insights From Primary Sources
2.6 Market Size Estimation Methodology
2.7 Market Forecast Methodology
2.8 Market Data Validation and Triangulation
2.9 Assumptions

3 Executive Summary (Page No. – 28)
3.1 Introduction
3.2 Current Scenario
3.3 Future Outlook
3.4 Conclusion

4 Premium Insights (Page No. – 32)
4.1 Global healthcare payer services Market
4.2 healthcare payer services Market, By Service Type and Region
4.3 healthcare payer services Market, By Service Type (2015 vs 2020)

5 Market Overview (Page No. – 36)
5.1 Introduction
5.2 Market Segmentation
5.3 Market Dynamics
5.3.1 Drivers
5.3.1.1 Outsourcing: A Cost-Effective Solution for Healthcare Payers
5.3.1.2 Federal Mandates in the U.S. Increasing Payer Workload
5.3.1.3 Increasing Healthcare Fraud
5.3.1.4 Dynamic Nature of Health Benefit Plan Designs
5.3.1.5 In-House Shortage of Skilled Personnel
5.3.2 Restraints
5.3.2.1 Rising Incidences of Data Breaches and Loss of Confidentiality
5.3.2.2 Unforeseen Costs Associated With Outsourcing
5.3.2.3 Loss of Managerial Control
5.3.3 Opportunities
5.3.3.1 Advanced Data Analytics
5.3.3.2 Switching to Icd-10 Standards
5.3.3.3 Service Portfolio Expansion
5.3.4 Challenges
5.3.4.1 Migration From Legacy Systems
5.3.4.2 Cultural Differences and Language Barriers

6 Healthcare Payer Outsourcing Market, By Service Type (Page No. – 48)
6.1 Introduction
6.2 Business Process Outsourcing Services
6.3 Information Technology Outsourcing Services
6.4 Knowledge Process Outsourcing Services

7 Healthcare Payer Outsourcing Market, By Application (Page No. – 55)
7.1 Introduction
7.2 Claims Management Services
7.2.1 Claims Adjudication Services
7.2.2 Claims Settlement
7.2.3 Information Management Services
7.2.4 Claims Repricing
7.2.5 Claims Investigation Services
7.2.6 Claims Indexing Services
7.2.7 Litigation Management
7.3 Integrated Front-End Services and Back-Office Operations
7.4 Member Management Services
7.5 Provider Management Services
7.6 Billing and Accounts Management Services
7.7 Analytics and Fraud Management Services
7.8 Hr Services

8 Healthcare Payer Outsourcing Market, By End User (Page No. – 73)
8.1 Introduction
8.2 Private Payers
8.3 Public Payers

9 Global Healthcare Payer Outsourcing Market, By Region (Page No. – 80)
9.1 Introduction
9.2 North America
9.2.1 U.S.
9.2.1.1 Rise in Insurance Enrolments Triggered By the Patient Protection and Affordable Care Act (PPACA)
9.2.1.2 Federal Healthcare Mandates Driving the Demand for Outsourcing Among Payers
9.2.1.3 Rising Need to Curtail Escalating Healthcare Costs
9.2.2 Canada
9.2.2.1 Outsourcing, A Strategic Solution to Curtail Healthcare Costs in Canada
9.3 Europe
9.3.1 European Union Five (EU5)
9.3.1.1 Insurance Fraud Amounting to Rising Healthcare Costs in Germany and the U.K.
9.3.1.2 Lack of Skilled Personnel in Germany
9.3.2 Rest of Europe
9.3.2.1 Increased Focus of Major Players
9.4 Asia-Pacific
9.4.1 India
9.4.1.1 India, A Low-Cost Destination Coupled With Availability of Highly Skilled It Labor
9.4.2 Rest of APAC
9.4.2.1 High Growth Opportunities and Increased Focus of Major Players in the Philippines
9.4.2.2 Emerging Role of China in Global Outsourcing
9.4.2.3 Rise in the Aging Population in Japan, A Major Workload for Payers
9.5 Rest of the World
9.5.1 Initiatives By Market Players to Enter Emerging Markets Such as Brazil & Colombia

10 Competitive Landscape (Page No. – 117)
10.1 Overview
10.2 Competitive Situation and Trends
10.2.1 Expansion
10.2.2 Agreements/Collaborations/Partnerships/Joint Ventures/Alliances
10.2.3 Acquisitions/Mergers
10.2.4 New Product Launches
10.2.5 Others

11 Company Profiles (Page No. – 125)
11.1 Introduction
11.2 Cognizant Technology Solutions
11.2.1 Business Overview
11.2.2 Cognizant Technology Solutions: Company Snapshot
11.2.3 Service Offerings
11.2.4 Recent Developments
11.2.5 MnM View
11.3 Accenture PLC
11.3.1 Business Overview
11.3.2 Accenture PLC: Company Snapshot
11.3.3 Service Offerings
11.3.4 Recent Developments
11.3.5 MnM View
11.4 Exlservice Holdings, Inc.
11.4.1 Business Overview
11.4.2 Exlservice Holdings, Inc.: Company Snapshot
11.4.3 Service Offerings
11.4.4 Recent Developments
11.4.5 MnM View
11.5 Concentrix Corporation (A Subsidiary of Synnex Corporation)
11.5.1 Business Overview
11.5.2 Synnex Corporation (Parent Company of Concentrix Corporation): Company Snapshot
11.5.3 Service Offerings
11.5.4 Recent Developments
11.5.5 MnM View
11.6 Hewlett-Packard
11.6.1 Business Overview
11.6.2 Hewlett-Packard: Company Snapshot
11.6.3 Services Offerings
11.6.4 Recent Developments
11.7 Hinduja Global Solutions Limited
11.7.1 Business Overview
11.7.2 Hinduja Global Solutions Limited: Company Snapshot
11.7.3 Service Offerings
11.7.4 Recent Developments
11.7.5 MnM View
11.8 Xerox Corporation
11.8.1 Business Overview
11.8.2 Xerox Corporation: Company Snapshot
11.8.3 Service Offerings
11.8.4 Recent Developments
11.9 Dell, Inc.
11.9.1 Business Overview
11.9.2 Dell, Inc.: Company Snapshot
11.9.3 Service Offerings
11.9.4 Recent Developments
11.10 Genpact Limited
11.10.1 Business Overview
11.10.2 Genpact Limited: Company Snapshot
11.10.3 Service Offerings
11.10.4 Recent Developments
11.11 HCL Technologies Ltd.
11.11.1 Business Overview
11.11.2 HCL Technologies: Company Snapshot
11.11.3 Service Offerings
11.11.4 Recent Developments
11.12 Wipro Limited
11.12.1 Business Overview
11.12.2 Wipro Limited: Company Snapshot
11.12.3 Service Offerings
11.12.4 Recent Developments

12 Appendix (Page No. – 157)
12.1 Discussion Guide
12.2 Company Developments (2012-2015)
12.2.1 Cognizant Technology Solutions
12.2.2 Accenture PLC
12.2.3 Exlservice Holdings, Inc.
12.2.4 Concentrix Corporation
12.2.5 Hinduja Global Solutions Limited
12.2.6 Xerox Corporation
12.2.7 HCL Technologies Ltd.
12.2.8 Wipro Limited
12.3 Introducing RT: Real-Time Market Intelligence
12.4 Available Customizations
12.5 Related Reports

List of Tables (81 Tables)

Table 1 Increasing Healthcare Costs Driving healthcare payer services Market Growth
Table 2 Rising Incidences of Data Breach Limiting the Adoption of Outsourcing
Table 3 Data Analytics Showcases Growth Opportunities for the healthcare payer services Market
Table 4 Migration From Legacy Systems A Major Challenge in the Healthcare Payer Outsourcing Market
Table 5 Global healthcare payer services Market Size, By Service Type, 2013–2020 (USD Million)
Table 6 Healthcare Payer BPO Services Market Size, By Region, 2013–2020 (USD Million)
Table 7 Healthcare Payer ITO Services Market Size, By Region, 2013–2020 (USD Million)
Table 8 Healthcare Payer KPO Services Market Size, By Region, 2013–2020 (USD Million)
Table 9 Global healthcare payer services Market Size, By Application, 2013–2020 (USD Million)
Table 10 Claims Management Services Market Size, By Type, 2013–2020 (USD Million)
Table 11 Claims Management Services Market Size, By Region, 2013–2020 (USD Million)
Table 12 Claims Adjudication Services Market Size, By Region, 2013–2020 (USD Million)
Table 13 Claims Settlement Services Market Size, By Region, 2013–2020 (USD Million)
Table 14 Information Management Services Market Size, By Region, 2013–2020 (USD Million)
Table 15 Claims Repricing Market Size, By Region, 2013–2020 (USD Million)
Table 16 Claims Investigation Services Market Size, By Region, 2013–2020 (USD Million)
Table 17 Claims Indexing Services Market Size, By Region, 2013–2020 (USD Million)
Table 18 Litigation Management Market Size, By Region, 2013–2020 (USD Million)
Table 19 Integrated Front-End Services and Back-Office Operations Market Size, By Region, 2013–2020 (USD Million)
Table 20 Member Management Services Market Size, By Region, 2013–2020 (USD Million)
Table 21 Provider Management Services Market Size, By Region, 2013–2020 (USD Million)
Table 22 Billing and Accounts Management Services Market Size, By Region, 2013–2020 (USD Million)
Table 23 Analytics and Fraud Management Services Market Size, By Region, 2013–2020 (USD Million)
Table 24 Hr Services Market Size, By Region, 2013–2020 (USD Million)
Table 25 Healthcare Spending Ratios By Major Sources of Funding
Table 26 Global Healthcare Payer Outsourcing Market Size, By End User, 2013–2020 (USD Million)
Table 27 Private Payer Outsourcing Market Size, By Geography, 2013–2020 (USD Million)
Table 28 Private Payer Outsourcing Market Size, By Region, 2013–2020 (USD Million)
Table 29 Public Payer Outsourcing Market Size, By Geography, 2013–2020 (USD Million)
Table 30 Public Payer Outsourcing Market Size, By Region, 2013–2020 (USD Million)
Table 31 Healthcare Payer Services Market Size, By Region, 2013–2020 (USD Million)
Table 32 North America: Healthcare Payer Services Market Size, By Country, 2013–2020 (USD Million)
Table 33 North America: Healthcare Payer Services Market Size, By Service Type, 2013–2020 (USD Million)
Table 34 North America: Healthcare Payer Services Market Size, By Application, 2013–2020 (USD Million)
Table 35 North America: Claims Management Services Market Size, By Type, 2013–2020 (USD Million)
Table 36 North America: Healthcare Payer Services Market Size, By End User, 2013–2020 (USD Million)
Table 37 Macroeconomic Indicators for the Healthcare Market in the U.S.
Table 38 U.S.: Healthcare Payer Services Market Size, By Service Type, 2013–2020 (USD Million)
Table 39 U.S.: Healthcare Payer Services Market Size, By Application, 2013–2020 (USD Million)
Table 40 U.S.: Claims Management Services Outsourcing Market Size, By Type, 2013–2020 (USD Million)
Table 41 U.S.: Healthcare Payer Services Market Size, By End Users, 2013–2020 (USD Million)
Table 42 Macroeconomic Indicators for the Healthcare Market in Canada
Table 43 Canada: Healthcare Payer Services Market Size, By Service Type, 2013–2020 (USD Million)
Table 44 Canada: Healthcare Payer Services Market Size, By Application, 2013–2020 (USD Million)
Table 45 Canada: Claims Management Services Market Size, By Type, 2013–2020 (USD Million)
Table 46 Canada: Healthcare Payer Services Market Size, By End User, 2013–2020 (USD Million)
Table 47 Europe: Healthcare Payer Services Market Size, By Region, 2013–2020 (USD Million)
Table 48 Europe: Healthcare Payer Services Market Size, By Service Type, 2013–2020 (USD Million)
Table 49 Europe: Healthcare Payer Analytics Market Size, By Application, 2013–2020 (USD Million)
Table 50 Europe: Claims Management Services Outsourcing Market Size, By Type, 2013–2020 (USD Million)
Table 51 Europe: Healthcare Payer Analytics Market Size, By End User, 2013–2020 (USD Million)
Table 52 EU5: Healthcare Payer Analytics Market Size, By Service Type, 2013–2020 (USD Million)
Table 53 EU5: Healthcare Payer Analytics Market Size, By Application, 2013–2020 (USD Million)
Table 54 EU5: Claims Management Services Outsourcing Market Size, By Type, 2013–2020 (USD Million)
Table 55 EU5: Healthcare Payer Analytics Market Size, By End User, 2013–2020 (USD Million)
Table 56 RoE: Healthcare Payer Analytics Market Size, By Service Type, 2013–2020 (USD Million)
Table 57 RoE: Healthcare Payer Analytics Market Size, By Application, 2013–2020 (USD Million)
Table 58 RoE: Claims Management Services Outsourcing Market Size, By Type, 2013–2020 (USD Million)
Table 59 RoE: Healthcare Payer Analytics Market Size, By End User, 2013–2020 (USD Million)
Table 60 Asia-Pacific: Healthcare Payer Analytics Market Size, By Country, 2013–2020 (USD Million)
Table 61 Asia-Pacific: Healthcare Payer Analytics Market Size, By Service Type, 2013–2020 (USD Million)
Table 62 Asia-Pacific: Healthcare Payer Analytics Market Size, By Application, 2013–2020 (USD Million)
Table 63 Asia-Pacific: Claims Management Services Outsourcing Market Size, By Type, 2013–2020 (USD Million)
Table 64 Asia-Pacific: Healthcare Payer Analytics Market Size, By End User, 2013–2020 (USD Million)
Table 65 India: Healthcare Payer Analytics Market Size, By Service Type, 2013–2020 (USD Million)
Table 66 India: Healthcare Payer Analytics Market Size, By Application, 2013–2020 (USD Million)
Table 67 India: Claims Management Services Outsourcing Market Size, By Type, 2013–2020 (USD Million)
Table 68 India: Healthcare Payer Analytics Market Size, By End User, 2013–2020 (USD Million)
Table 69 Rest of APAC: Healthcare Payer Analytics Market Size, By Service Type, 2013–2020 (USD Million)
Table 70 Rest of APAC: Healthcare Payer Analytics Market Size, By Application, 2013–2020 (USD Million)
Table 71 Rest of APAC: Claims Management Services Market Size, By Type, 2013–2020 (USD Million)
Table 72 Rest of APAC: Healthcare Payer Analytics Market Size, By End User, 2013–2020 (USD Million)
Table 73 RoW: Healthcare Payer Analytics Market Size, By Service Type, 2013–2020 (USD Million)
Table 74 RoW: Healthcare Payer Analytics Market Size, By Application, 2013–2020 (USD Million)
Table 75 RoW: Claims Management Services Market Size, By Type, 2013–2020 (USD Million)
Table 76 RoW: Healthcare Payer Analytics Market Size, By End User, 2013–2020 (USD Million)
Table 77 Expansions, 2012–2015
Table 78 Agreements/Joint Ventures/Partnerships/Collaborations/Alliances, 2012–2015
Table 79 Acquisitions, 2012–2015
Table 80 New Product Launches, 2012–2015
Table 81 Other Strategies, 2012–2015



List of Figure (32 Figures)

Figure 1 Global Healthcare Payer Analytics Market: Research Methodology Steps
Figure 2 Sampling Frame: Primary Research
Figure 3 Breakdown of Primary Interviews: By Company Type, Designation, and Region
Figure 4 Market Size Estimation Methodology: Bottom-Up Approach
Figure 5 Market Size Estimation Methodology: Top-Down Approach
Figure 6 Market Forecast Methodology
Figure 7 Data Triangulation Methodology
Figure 8 North America Dominates the Global Healthcare Payer Outsourcing Market in 2015
Figure 9 Analytics and Fraud Management Market to Witness the Highest Growth Rate From 2015 to 2020
Figure 10 North America is Expected to Grow at the Highest CAGR During the Forecast Period
Figure 11 Rising Insurance Enrolment Driving the Market
Figure 12 North America Dominated the Healthcare Payer Outsourcing Market in 2015
Figure 13 North America to Grow at the Highest Rate During the Forecast Period
Figure 14 BPO Services Commanded the Largest Market Share
Figure 15 Healthcare Payer Analytics Market Segmentation
Figure 16 Drivers, Restraints, Opportunities, & Challenges
Figure 17 BPO Services Segment to Account for the Largest Share of Healthcare Payer Analytics Market, in 2015
Figure 18 The Claims Management Services Segment is Expected to Continue to Account for the Highest Share of the Market During the Forecast Period
Figure 19 Private Payers Segment to Account for the Largest Market Share During the Forecast Period
Figure 20 North America is Expected to Command the Largest Share of the Global Healthcare Payer Outsourcing Market in 2015
Figure 21 The U.S. to Witness the Highest Growth in the Healthcare Payer Services Market in North America
Figure 22 BPO Services to Dominate the European Healthcare Payer Services Market
Figure 23 Rest of APAC to Dominate the Asia Pacific Healthcare Payer Services Market
Figure 24 Claims Management Services to Dominate the RoW Healthcare Payer Services Market
Figure 25 Expansion Was the Key Growth Strategy for Market Players
Figure 26 Battle for Market Share: Expansion Was the Key Strategy
Figure 27 Key Players Focusing on Expansion, 2012-2015
Figure 28 Key Players Focusing on Agreements/Collaborations/Joint Ventures/Alliances/Partnerships, 2012-2015
Figure 29 Key Players Focusing on Acquisitions/Mergers, 2012-2015
Figure 30 Key Players Focusing on New Product Launches, 2012-2015
Figure 31 Key Players Focusing on Other Strategies, 2012-2015
Figure 32 Geographic Revenue Mix of Top Market Players

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