Healthcare Payer BPO Market: Rapidly Evolving Industry…… COVID-19….
Global healthcare
payer BPO market is expected to reach
over USD 34.2 billion by 2022
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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Further key findings from the study
suggest:
·
In 2014, claims processing
services accounted for the maximum share of approximately 55%. Key reasons
attributed are growth in new member enrolments due to ObamaCare, increase in
disease burden. For instance, as per data published by ObamaCare and CMS, in 2013
nearly 8 million people enrolled through the marketplace and nearly 11.7
million people were enrolled in 2015.
·
However, Asia Pacific is
expected to be the fastest growing market over the forecast period owing to
high economic development in the region, favorable government initiatives and
growth in insurance penetration across urban and rural centers. For instance,
the Indian government’s initiatives such as Pradhan Mantri Suraksha Bima Yojana
and Pradhan Mantri Jeevan Jyoti Bima Yojana, are expected to benefit millions
of people seeking life insurance and personal accident coverage and as
consequence is expected to contribute to the healthcare payer BPO market
expansion over the forecast period.
·
Some key players operating in
the market include, Xerox Corporation, Genpact Limited, Wipro Limited,
Capgemini, Hinduja Global Solutions, HCL Technologies Ltd, Cognizant Technology
Solutions, EXLService Holdings Inc., and Accenture. These players dominate the
market owing to their strong product and service delivery portfolio, and
presence of large customer base in the U.S and European markets.
Global
healthcare payer BPO market size was valued at USD 15,084.6 million in 2014 and
is expected to grow at CAGR of over 10% over the forecast period. Key drivers attributing
to the growth of the market include increasing global geriatric population,
regulatory changes, rising healthcare costs, and the need to improve payer’s
operational efficiency and customer satisfaction.
According
to estimates published by the United Nations, in 2012, the global geriatric
population was estimated to be nearly 809 million and is expected to reach
nearly 2 billion by 2050. The constantly rising geriatric population is
expected to serve as a high-impact rendering factor for market growth as the
segment is prone to various health conditions such as cardiovascular diseases,
cancers, respiratory diseases, orthopedic problems, eye care problems, and
others.
Rising
incidences of such diseases lead to increased workload for the insurance companies.
To handle high volume claim records, patient records, and to ensure quick
turnaround time, the payer companies need to invest resources in technology,
infrastructure, and in acquiring skilled talent pool, leading to very high
operational costs which is expected to drive market growth over the forecast
period.
In
2013, as per data published by the Centers for Medicare and Medicaid Services,
nearly 950,000 healthcare providers were collectively paid USD 89 billion as
Medicare Payments. This amount includes USD 72 billion for medical and health
services, and USD 17 billion for drugs administered.
Private
and public organizations are outsourcing the payer administrative functions to
significantly reduce the costs, improve operational efficiency, and streamline
the overall service delivery to the clients. The outsourcing vendors deploy
full-time resources to provide round-the-clock customer support to providers,
patients, and other stakeholders.
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Grand View Research has segmented the
Healthcare payer BPO market on the basis of services:
Global Healthcare Payer BPO Services Outlook (USD
Million, 2015 - 2022)
·
Claims Processing Services
·
Member Services
·
HR Services
·
Finance And Accounts
Based
on services offered, the healthcare payer BPO market is segmented into claims
processing services, member services, HR services, finance and accounting
services. The impact of regulatory changes and key policy initiatives are key
factors boosting the healthcare payer BPO market.
In
2014, claims processing services segment accounted for the maximum share of
nearly 55%. Key factors attributed are increasing penetration of insurance
coverage across the developed and developing nations. The Affordable Care Act
is a very high-impacting rendering driver for the overall healthcare payer BPO
market. This act provides healthcare and Medicare access to millions of
Americans, and as per CMS and ObamaCare data published in 2013, nearly eight
million people enrolled through the marketplace and nearly 11.7 million people
enrolled in 2015. The increase in these numbers is a direct indicator of
growing burden of the healthcare payer services, and as a consequence, it is
expected to positively reinforce the healthcare payer BPO market over the forecast
period.
About Grand View Research
Grand View Research, Inc. is a U.S.
based market research and consulting company, registered in the State of
California and headquartered in San Francisco. The company provides syndicated
research reports, customized research reports, and consulting services. To help
clients make informed business decisions, we offer market intelligence studies
ensuring relevant and fact-based research across a range of industries, from
technology to chemicals, materials and healthcare.
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