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table of contents
1Introduction...... 16
1.1Objectives of the study...... 16
1.2MARKET DEFINITION...... 16
1.3MARKET SCOPE...... 16
1.3.1markets covered...... 17
1.3.2YEARS CONSIDERED FOR THE STUDY...... 18
1.4CURRENCY...... 18
1.5LIMITATIONS...... 18
1.6stakeholders...... 18
2research methodology...... 19
2.1research methodology steps...... 19
2.2secondary and primary research methodology...... 20
2.2.1Secondary research...... 20
2.3key data from secondary sources...... 20
2.3.1Primary research...... 21
2.3.2Key industry insights...... 22
2.4key data from primary sources...... 23
2.5key Insights from primary sources...... 24
2.6market size estimation methodology...... 24
2.7MARKET FORECAST methodology...... 26
2.8MARKET DATA VALIDATION and TRIANGULATION...... 27
2.9Assumptions...... 27
3executive Summary...... 28
3.1introduction...... 28
3.2Current Scenario...... 28
3.3Future outlook...... 30
3.4conclusion...... 31
4Premium insights...... 32
4.1GLObal HEalthcare payer Outsourcing market...... 32
4.2Healthcare payer outsourcing market, by SErvice TYPE and REgion...... 33
4.3Healthcare payer outsourcing market, by Service tYPE (2015 vs. 2020)...... 35
5Market Overview...... 36
5.1introduction...... 37
5.2Market Segmentation...... 38
5.3market dynamics...... 39
5.3.1DRIVERS...... 39
5.3.1.1Outsourcing: a cost-effective solution for healthcare payers...... 39
5.3.1.2Federal mandates in the U.S. increasing payer workload...... 40
5.3.1.3Increasing healthcare fraud...... 40
5.3.1.4Dynamic nature of health benefit plan designs...... 41
5.3.1.5In-house shortage of skilled personnel...... 41
5.3.2RESTRAINTS...... 43
5.3.2.1Rising incidences of data breaches and loss of confidentiality.....43
5.3.2.2Unforeseen costs associated with outsourcing...... 44
5.3.2.3Loss of managerial control...... 44
5.3.3OPPORTUNITIEs...... 45
5.3.3.1Advanced data analytics...... 45
5.3.3.2Switching to ICD-10 standards...... 45
5.3.3.3Service portfolio expansion...... 46
5.3.4CHALLENGES...... 46
5.3.4.1Migration from legacy systems...... 46
5.3.4.2Cultural differences and language barriers...... 47
6Healthcare PAYER OUTSOURCING market, by service TYPE...... 48
6.1Introduction...... 49
6.2BUSINess process outsourcing services...... 51
6.3INformation technology outsourcing services...... 52
6.4Knowledge process outsourcing services...... 53
7Healthcare PAyer Outsourcing market, by application...... 55
7.1Introduction...... 56
7.2claims management services...... 57
7.2.1Claims Adjudication SERVICES...... 59
7.2.2Claims settlement...... 60
7.2.3Information management SERVICES...... 61
7.2.4Claims repricing...... 61
7.2.5Claims investigation services...... 62
7.2.6Claims indexing SERVICES...... 63
7.2.7Litigation management...... 64
7.3Integrated front-end services and back-office operations...... 65
7.4MEMber management services...... 66
7.5PROVIDER management services...... 68
7.6Billing and accounts MANAGEMENT services...... 69
7.7Analytics and fraud management services...... 70
7.8HR SERVICES...... 71
8Healthcare Payer outsourcing market, by end user...... 73
8.1Introduction...... 74
8.2PRIVATE PAYERS...... 76
8.3PUBLIC PAYERS...... 77
9Global healthcare payer outsourcing market, by region...... 80
9.1Introduction...... 81
9.2North America...... 83
9.2.1U.S...... 87
9.2.1.1Rise in insurance enrolments triggered by the Patient Protection and Affordable Care Act (PPACA) 87
9.2.1.2Federal healthcare mandates driving the demand for outsourcing among payers 87
9.2.1.3Rising need to curtail escalating healthcare costs...... 88
9.2.2CANADA...... 91
9.2.2.1Outsourcing, a strategic solution to curtail healthcare costs in Canada 91
9.3europe...... 94
9.3.1European union five (EU5)...... 98
9.3.1.1Insurance fraud amounting to rising healthcare costs in Germany and the U.K. 98
9.3.1.2Lack of skilled personnel in Germany...... 98
9.3.2Rest of Europe...... 101
9.3.2.1Increased focus of major players...... 101
9.4asia-PACIFIC...... 103
9.4.1INDIA...... 107
9.4.1.1India, a low-cost destination coupled with availability of highly skilled IT labor 107
9.4.2REST OF APAC...... 109
9.4.2.1High growth opportunities and increased focus of major players in the Philippines 109
9.4.2.2Emerging role of China in global outsourcing...... 110
9.4.2.3Rise in the aging population in Japan, a major workload for payers110
9.5Rest OF THE WORLD...... 113
9.5.1Initiatives by market players to enter emerging markets such AS Brazil & Colombia 114
10COMPETITIVE LANDSCAPE...... 117
10.1OVERVIEW...... 117
10.2competitive situation and trends...... 118
10.2.1Expansion...... 118
10.2.2AGREEMENTS/collaborations/partnerships/joint ventures/alliances....119
10.2.3ACQUISITIONS/mergers...... 121
10.2.4NEW PRODUCT LAUNCHES...... 122
10.2.5OTHERs...... 123
11Company Profiles...... 125
11.1INTRODUCTION...... 125
11.2COGNIZANT TECHNOLOGY SOLUTIONS...... 126
11.3Accenture plc...... 129
11.4EXLSERVICE HOLDINGS, INC...... 133
11.5CONCENTRIX CORPORATION (A subsidiary of SYNnex Corporation)...... 136
11.6HEWLETT-Packard...... 138
11.7Hinduja global solutions limited...... 141
11.8xerox corporation...... 144
11.9DELL, INC...... 148
11.10Genpact Limited...... 150
11.11HCL Technologies LTD...... 152
11.12WIPRO LIMITED...... 155
*Details On Financials, Products & Services, Key Strategy, & Recent Developments Might Not Be Captured In Case Of Unlisted Companies.
12Appendix...... 157
12.1DISCUSSION GUIDE...... 157
12.2COMPANY DEVELOPMENTS (2012-2015)...... 162
12.2.1Cognizant Technology solutions...... 162
12.2.2Accenture plc...... 162
12.2.3ExlService Holdings, Inc...... 163
12.2.4CONCENTRIX CORPORATION...... 164
12.2.5Hinduja Global solutions limited...... 164
12.2.6Xerox corporation...... 165
12.2.7HCL Technologies LTD...... 166
12.2.8Wipro limited...... 166
12.3INTRODUCING RT: REAL-TIME MARKET INTELLIGENCE...... 167
12.4AVAILABLE CUSTOMIZATIONS...... 168
12.5Related reports...... 169
List of TableS
UU
TABLE 1increasing healthcare costs driving market growth42
TABLE 2Rising incidences of data breach limiting the adoption of OUTSOURCING44
TABLE 3DATA ANALYTICS showcases growth OPPORTUNITIES for the HEALTHCARE PAYER OUTSOURCING market 46
TABLE 4Migration from legacy systems A MAJOR CHALLENGE in THE healthcare payer outsourcing market 47
TABLE 5Global healthcare Payer outsourcing market size, by SERVICE TYPE, 2013–2020 (USD MILLION) 50
TABLE 6healthcare payer BPO services market size, by REgion,
2013–2020 (USD MILLION)52
TABLE 7healthcare payer ITO services market size, by REgion,
2013–2020 (USD MILLION)53
TABLE 8healthcare payer KPO Services market size, by REgion,
2013–2020 (USD MILLION)54
TABLE 9Global healthcare payer outsourcing market Size, by Application, 2013–2020 (usd MILLION)57
TABLE 10CLAIMS MANAGEMENT services market Size, by type,
2013–2020 (USD MILLION)58
TABLE 11CLAIMS MANAGEMENT SERVICES market Size, by region,
2013–2020 (USD MILLION)58
TABLE 12clAIMS ADJUDICATION services market Size, by region,
2013–2020 (USD MILLION)59
TABLE 13clAIMS SETTLEMENT services market Size, by region,
2013–2020 (USD MILLION)60
TABLE 14INFORMATION MANAGEMENT SERVICES market Size, by region,
2013–2020 (USD MILLION)61
TABLE 15CLAIMS REPRICING market Size, by region, 2013–2020 (USD MILLION)62
TABLE 16CLAIMS INVESTIGATION services market Size, by region,
2013–2020 (USD MILLION)63
TABLE 17CLAIMS INDEXING services market Size, by region,
2013–2020 (USD MILLION)64
TABLE 18LITIGATION MANAGEMENT market Size, by region, 2013–2020 (USD MILLION)65
TABLE 19INTEGRATED FRONT-end services and back-office operations market Size, by region, 2013–2020 (USD MILLION) 66
TABLE 20MEMBER MANAGEMENT SERVICES market Size, by region,
2013–2020 (USD MILLION)67
TABLE 21PROVIDER MANAGEMENT SERVICES market Size, by region,
2013–2020 (USD MILLION)69
TABLE 22BILLING AND ACCOUNTS Management SERVICES market Size, by region, 2013–2020 (USD MILLION) 70
TABLE 23ANALYTICS AND FRAUD MANAGEMENT SERVICES market Size, by region, 2013–2020 (USD MILLION) 71
TABLE 24HR services market Size, by region, 2013–2020 (USD MILLION)72
TABLE 25Healthcare Spending ratios by Major Sources of Funding74
TABLE 26Global healthcare Payer outsourcing market Size, by end user,
2013–2020 (USD MILLION)75
TABLE 27Private payer outsourcing market Size, by geography,
2013–2020 (USD MILLION)76
TABLE 28Private payer outsourcing market Size, by REgion,
2013–2020 (USD MILLION)77
TABLE 29PUBLIC payer outsourcing market Size, by geography,
2013–2020 (USD MILLION)78
TABLE 30PUBLIC payer outsourcing market Size, by REgion,
2013–2020 (USD MILLION)79
TABLE 31hEALTHCARE PAYER OUTSOURCING MARKET SIZE, by region,
2013–2020 (USD MILLION)81
TABLE 32north america: healthcare PAYER OUTSOURCING market size,
by country, 2013–2020 (USD million)83
TABLE 33north america: healthcare PAYER OUTSOURCING market size,
by SERVICE TYPE, 2013–2020 (USD million)85
TABLE 34north america: healthcare PAYER OUTSOURCING market size,
by APPLICATION, 2013–2020 (USD million)85
TABLE 35north america: Claims management services market size,
by TYPe, 2013–2020 (USD million)86
TABLE 36north america: healthcare PAYER OUTSOURCING market size,
by END USER, 2013–2020 (USD million)86
TABLE 37Macroeconomic indicators for the Healthcare market in the U.S.88
TABLE 38U.S.: healthcare PAYER OUTSOURCING market size, by SERVICE TYPE,
2013–2020 (USD million)89
TABLE 39U.S.: healthcare PAYER OUTSOURCING market size, by APPLICATION, 2013–2020 (USD million) 90
TABLE 40U.S.: Claims management services OUTSOURCING market size, by TYPe, 2013–2020 (USD million) 90
TABLE 41U.S.: healthcare PAYER OUTSOURCING market size, by END USERS,
2013–2020 (USD million)91
TABLE 42Macroeconomic indicators for the Healthcare market in Canada91
TABLE 43CANADA: healthcare PAYER OUTSOURCING market size, by SERVICE TYPE, 2013–2020 (USD million) 92
TABLE 44CANADA: healthcare PAYER OUTSOURCING market size, by APPLICATION, 2013–2020 (USD million) 92
TABLE 45CANADA: Claims management services market size, by TYPe,
2013–2020 (USD million)93
TABLE 46CANADA: healthcare PAYER OUTSOURCING market size, by END USER, 2013–2020 (USD million) 93
TABLE 47EUROPE: healthcare PAYER OUTSOURCING market size, by region,
2013–2020 (USD million)94
TABLE 48EUROPE: healthcare PAYER OUTSOURCING market size, by SERVICE TYPE, 2013–2020 (USD million) 96
TABLE 49EUROPE: healthcare PAYER OUTSOURCING market size, by APPLICATION, 2013–2020 (USD million) 96
TABLE 50EUROPE: Claims management services OUTSOURCING market size, by TYPe, 2013–2020 (USD million) 97
TABLE 51EUROPE: healthcare PAYER OUTSOURCING market size, by END USER, 2013–2020 (USD million) 97
TABLE 52EU5: healthcare PAYER OUTSOURCING market size, by SERVICE TYPE,
2013–2020 (USD million)99
TABLE 53EU5: healthcare PAYER OUTSOURCING market size, by APPLICATION,
2013–2020 (USD million)99
TABLE 54EU5: Claims management services OUTSOURCING market size, by TYPe, 2013–2020 (USD million) 100
TABLE 55EU5: healthcare PAYER OUTSOURCING market size, by END USER,
2013–2020 (USD million)100
TABLE 56ROE: healthcare PAYER OUTSOURCING market size, by SERVICE TYPE,
2013–2020 (USD million)101
TABLE 57ROE: healthcare PAYER OUTSOURCING market size, by APPLICATION,
2013–2020 (USD million)102
TABLE 58ROE: Claims management services OUTSOURCING market size, by TYPe, 2013–2020 (USD million) 102
TABLE 59ROE: healthcare PAYER OUTSOURCING market size, by END USER,
2013–2020 (USD million)103
TABLE 60ASIA-PACIFIC: healthcare PAYER OUTSOURCING market size, by country, 2013–2020 (USD million) 103
TABLE 61ASIA-PACIFIC: healthcare PAYER OUTSOURCING market size, by SERVICE TYPE, 2013–2020 (USD million) 105
TABLE 62ASIA-PACIFIC: healthcare PAYER OUTSOURCING market size, by APPLICATION, 2013–2020 (USD million) 105
TABLE 63ASIA-PACIFIC: Claims management services OUTSOURCING market size,
by TYPe, 2013–2020 (USD million)106
TABLE 64ASIA-PACIFIC: healthcare PAYER OUTSOURCING market size, by END USER, 2013–2020 (USD million) 106
TABLE 65INDIA: healthcare PAYER OUTSOURCING market size, by SERVICE TYPE, 2013–2020 (USD million) 107
TABLE 66INDIA: healthcare PAYER OUTSOURCING market size, by APPLICATION, 2013–2020 (USD million) 108
TABLE 67INDIA: Claims management services OUTSOURCING market size, by TYPe, 2013–2020 (USD million) 108
TABLE 68INDIA: healthcare PAYER OUTSOURCING market size, by END USER,
2013–2020 (USD million)109
TABLE 69REST OF APAC: healthcare PAYER OUTSOURCING market size, by SERVICE TYPE, 2013–2020 (USD million) 110
TABLE 70REST OF APAC: healthcare PAYER OUTSOURCING market size, by APPLICATION, 2013–2020 (USD million) 111
TABLE 71REST OF APAC: Claims management services market size, by TYPe,
2013–2020 (USD million)111
TABLE 72REST OF APAC: healthcare PAYER OUTSOURCING market size, by END USER, 2013–2020 (USD million) 112
TABLE 73ROW: healthcare PAYER OUTSOURCING market size, by SERVICE TYPE, 2013–2020 (USD million) 114
TABLE 74ROW: healthcare PAYER OUTSOURCING market size, by APPLICATION,
2013–2020 (USD million)115
TABLE 75ROW: Claims management services market size, by TYPe,
2013–2020 (USD million)115
TABLE 76ROW: healthcare PAYER OUTSOURCING market size, by END USER,
2013–2020 (USD million)116
TABLE 77expansions, 2012–2015119
TABLE 78AGREEMENTS/JOINT VENTURES/PARTNERSHIPS/collaborations/alliances, 2012–2015120
TABLE 79acquisitions, 2012–2015121
TABLE 80NEW PRODUCT LAUNCHES, 2012–2015123
TABLE 81other strategies, 2012–2015124
List of FIGURES
FIGURE 1global Healthcare payer outsourcing Market: research methodology steps19
FIGURE 2Sampling Frame: Primary Research22
FIGURE 3BREAKDOWN OF PRIMARY INTERVIEWS: BY COMPANY type, DESIGNATION,
and REGION23
FIGURE 4market size estimation methodology: Bottom-up approach25
FIGURE 5market size estimation methodology: top-down approach25
FIGURE 6MARKET FORECAST methodology26
FIGURE 7DATA TRIANGULATION METHODOLOGY27
FIGURE 8North America dominates the global HEALTHCARE PAYER OUTSOURCING market in 201529
FIGURE 9Analytics and fraud management market to witness the highest growth rate from 2015 to 202030
FIGURE 10NORTH AMERICA is expected to grow at the highest CAGR during the forecast period31
FIGURE 11Rising insurance enrolment Driving the market32
FIGURE 12north america dominated the HEalthcare payer outsourcing Market
in 201533
FIGURE 13North america to GROW AT THE highest rate during the forecast period34
FIGURE 14BPO services commanded the largest MARKET share35
FIGURE 15Healthcare payer outsourcing Market Segmentation38
FIGURE 16drivers, restraints, opportunities, & challenges39
FIGURE 17BPO services segment to account for the largest share of healthcare payer outsourcing market, in 2015 50
FIGURE 18the claims management services segment is expected to continue to account for the highest share of the market during the forecast period 56
FIGURE 19Private PAYERS Segment to Account for the Largest market Share During the forecast period75
FIGURE 20North america is expected to command the largest share of the global healthcare PAYER OUTSOURCING market in 2015 82
FIGURE 21the U.S. to witness the highest growth in the healthcare PAYER OUTSOURCING market in NORTH AMERICA 84
FIGURE 22BPO SERVICES to DOMINATE the european healthcare PAYER OUTSOURCING market95
FIGURE 23Rest OF apac to DOMINATE the ASIA PACIFIC healthcare PAYER OUTSOURCING market104
FIGURE 24CLAIMS MANAGEMENT SERVICES to DOMINATE the ROW healthcare PAYER OUTSOURCING market 113
FIGURE 25Expansion wAS THE KEY GROWTH STRATEGY for market players117
FIGURE 26BATTLE FOR MARKET SHARE: EXPANSION WAS THE KEY STRATEGY118
FIGURE 27key players focusing on expansion, 2012-2015118
FIGURE 28key players focusing on agreements/collaborations/joint ventures/alliances/partnerships, 2012-2015119
FIGURE 29key players focusing on acquisitions/mergers, 2012-2015121
FIGURE 30key players focusing on new product launches, 2012-2015122
FIGURE 31key players focusing on other strategies, 2012-2015123
FIGURE 32GEOGRAPHIC REVENUE MIX OF TOP MARKET PLAYERS125
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