Healthcare Payer BPO Market To Reach $52.0 Billion By 2030

Healthcare Payer BPO Market Growth & Trends

The global healthcare payer BPO market size is expected to reach USD 52.0 billion by 2030, registering a CAGR of 6.9%, according to a new report by Grand View Research Inc. Key drivers attributing to the growth are ObamaCare, shift to ICD-10 coding system, growing geriatric population, increasing disease burden and penetration of insurance coverage in emerging economies. 

In 2013, as per estimates published by the America’s Health Insurance Plans (AHIP), which is the national trade association representing the health insurance industry, one-sixth of the U.S. economy or nearly USD 2.7 trillion is dedicated to healthcare spending and the number is expected to increase year on year. However, the healthcare system is not able to reap the benefits of such expenditure due to process inefficiencies and use of redundant systems. The estimated loss due to such inefficiencies is nearly 800 billion or approximately 20 to 30 percent of the overall expenditure. 

Increasing healthcare expenditure is a major concern for the U.S. and all the other major economies. In order to reduce the economic burden and provide universal access to healthcare, governments are encouraging outsourcing of payer services to onshore or offshore locations. 

The shift from ICD-9 coding system to ICD-10 coding has created huge work load for the payers to upgrade their systems, train their staff and has significantly increased the financial burden. The ICD-9 code system had 13,000 codes, where as the ICD-10 code system has nearly 68,000 codes. This shift from the legacy system to the latest system has significantly increased the need for medical coding, accounting, HR, and other technical professionals, thereby is expected to positively reinforce the healthcare payer BPO outsourcing market growth in the next seven years. 

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Healthcare Payer BPO Market Report Highlights

• Claims management services dominated the market and accounted for 32.3% in 2023. It involves verifying and approving medical claims from providers. Automation and AI are revolutionizing this process.

• North America healthcare payer BPO market dominated the global market in 2023. Major factors contributing to the growth of this region include the increasing geriatric population, the growing burden of diabetes due to lifestyle changes, the increasing penetration of health insurance in emerging economies, and the increasing use of technology for operational efficiency.

• The provider management services segment is expected to grow at the fastest CAGR of 8.66% over the forecast period owing to the increasing number of healthcare providers and the constant rise in customers, claims, etc.

Healthcare Payer BPO Market Segmentation

Grand View Research has segmented the global healthcare payer BPO market report based on services, and region:

Healthcare Payer BPO Services Outlook (Revenue, USD Million, 2018 - 2030)

• Claims Management Services

• Integrated Front Office Service & Back Office Operations

• Member Management Services

• Provider Management Services

• Billing & Accounts Management Services

• Analytics & Fraud Management Services

• HR Services

Healthcare Payer BPO Regional Outlook (Revenue, USD Million, 2018 - 2030)

• North America

  • U.S.

  • Canada

  • Mexico

• Europe

  • UK

  • Germany

  • France

  • Italy

  • Spain

  • Denmark

  • Sweden

  • Norway

• Asia Pacific

  • Japan

  • China

  • India

  • Australia

  • South Korea

  • Thailand

• Latin America

  • Brazil

  • Argentina

• Middle East and Africa (MEA)

  • South Africa

  • Saudi Arabia

  • UAE

  • Kuwait

List of Key Players in Healthcare Payer BPO Market

• Cognizant

• Xerox Corporation

• Hinduja Global Solution Limited

• ExlService Holdings, Inc. 

• Hewlett Packard Enterprise Development LP

• Accenture

• Genpact

• HCL Technologies Limited

• Wipro

• Capgemini