U.S. Business Process As A Service In Healthcare Payers Market To Reach $9.6 Billion By 2030

U.S. Business Process As A Service in Healthcare Payers Market Growth & Trends

The U.S. business process as a service in healthcare payers market size is expected to reach USD 9.6 billion by 2030, registering a CAGR of 5.62% from 2024 to 2030, according to a new report by Grand View Research, Inc. Business process as a service (BPaaS) engagements contributed significantly to healthcare payer business process outsourcing revenue, and this percentage is likely to rise as the market for payer BPaaS expands due to the move toward value-based care, which has been hastened by COVID-19.

The adoption of BPaaS in the U.S. providers industry is growing quickly. Although providers have been around for a while, the Affordable Care Act made them more common and significant, which makes them well-suited to take advantage of BPaaS opportunity. The U.S. healthcare system is shifting from a fee-for-service to a value-based care model, which emphasizes quality of care and patient outcomes over volume of services provided. Growing pressure on the health system as a result of a constant increase in healthcare costs is contributing to rising penetration of value-based healthcare services in industry. BPaaS can help in delivering value-based care by providing healthcare organizations access to advanced analytics and data management tools.

The industry-specific regulatory compliances specify a range of compliance requirements for various industrial verticals. Health Insurance Portability and Accountability Act (HIPAA), Health Information Technology for Economic and Clinical Health (HITECH), and Payment Card Industry Data Security Standard (PCI DSS) are a few legislations that have impacted industry. In many instances, the market now supports compliance management as an administrative activity rather than a regulatory one. BPaaS providers could implement BPaaS solutions that can bridge compliance gaps between verticals and adapt to changes in existing regulations, leading to industry’s growth with a rise in adoption throughout the forecast period as all compliance adherence difficulties can be managed with their assistance.

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U.S. Business Process As A Service In Healthcare Payers Market Report Highlights

• Based on solution coverage, the market has been segmented into traditional and best-of-breed. Traditional BPaaS segment has accounted for the largest market share of over 75% in 2023, owing to lower cost of service and higher customer satisfaction

• Based on buyer type, the government buyers segment held the majority of revenue share of over 73% in 2023. Government insurance companies have historically been main buyers for BPaaS due to modular implementations of medicaid management information systems (MMIS)

• Small and medium-sized payers make up more than 70% of all payers in 2023 and have shown a stronger preference for the BPaaS model. In terms of plan types, medicare advantage and managed Medicaid have emerged as viable business cases, with MA accounting for a significant share percentage of the market

• Based on value chain processes, administrative processes such as care management have seen the most BPaaS adoption. Payers are, however, progressively becoming aware of BPaaS's potential in processes such as claims management, population health management, and member engagement as well as in reducing medical expenses

U.S. Business Process As A Service In Healthcare Payers Market Segmentation

Grand View Research has segmented the U.S. business process as a service (BPaaS) in healthcare payers market based on solution coverage, buyer type, value chain processes, and buyer size:

U.S. BPaaS In Healthcare Payers Solution Coverage Outlook (Revenue, USD Billion, 2018 - 2030)

• Traditional BPaaS

  • End-to-end Traditional BPaaS

  • Process-specific Traditional BPaaS

• Best-of-breed BPaaS

  • End-to-end Best-of-breed BPaaS

  • Process-specific Best-of-breed BPaaS

U.S. BPaaS In Healthcare Payers Buyer Type Outlook (Revenue, USD Billion, 2018 - 2030)

• Government Buyers

  • Medicare Advantage

  • Managed Medicaid

• Commercial Buyers

  • Individual Health Plan

  • Employer-sponsored Health Plan

U.S. BPaaS In Healthcare Payers Value Chain Processes Outlook (Revenue, USD Billion, 2018 - 2030)

• Claims Management

• Member Engagement

• Care Management

• Others

U.S. BPaaS In Healthcare Payers Buyer Size Outlook (Revenue, USD Billion, 2018 - 2030)

• Small Buyers

• Midsized Buyers

• Large Buyers

List of Key Players in the U.S. Business Process As A Service In Healthcare Payers Market

• Accenture

• Cognizant

• HCL Technologies Limited

• IBM

• Infosys Limited

• NTT DATA Corporation

• Optum

• TATA Consultancy Services Limited

• UST

• Wipro

• EXL

• Softheon, Inc.

• Genpact

• Change Healthcare

• Firstsource

• Celegence

• Highmark Health