Introduction

The healthcare payer market is undergoing a rapid transformation. With ObamaCare taking effect and boosting enrollments, several new payers find themselves overwhelmed while handling an unprecedented surge in volume. Also, as a result of the Affordable Care Act and the increase in size of the aging population, a greater number of high-risk individuals are now able to enroll for health plans than ever before. This naturally leads to more claims, in terms of both number and value.

In such a scenario, BPO has a much more relevant role to play in the industry. Service providers can help payers streamline their claims operations and reduce operational costs. They can provide services that help buyers bring out new plans in the market more frequently with minimal overheads. Providers can also help run data analytics that can impact the bottom line by targeting low-risk individuals as well as reducing cases of fraud, waste, and abuse.

In this study we analyze the healthcare payer BPO market. We focus on:

• Relative positioning of 20 service providers on the Everest Group PEAK Matrix for healthcare payer BPO
• Analysis of service providers’ market shares
• Key strengths and development areas for service providers

Scope of analysis

• Third-party healthcare payer BPO contracts; it does not include shared services or Global In-House centers (GICs)
• Over 290 active healthcare payer BPO contracts signed as of June 2015
• Coverage across 20 healthcare payer BPO service providers: Accenture, CGI, Cognizant, Concentrix, Dell, EXL, Firstsource, Genpact, HCCA, HCL, Hexaware, HGS, HP, IGATE, Infosys, Serco, Sutherland Global Services, Wipro, Xchanging, and Xerox

Content

This report will assist key stakeholders (healthcare payer institutions, service providers, and technology providers) understand the changing dynamics of the healthcare payer BPO service provider landscape. It will also help them identify market Leaders, Major Contenders, and Aspirants for 2016. The report provides detailed analysis of the service provider market share, relative position on the Everest Group PEAK Matrix, capability assessment, and Everest Group’s remarks on service providers highlighting their key strengths and development areas.

Some of the findings in the report are:

• Accenture, Cognizant, Dell, and Xerox emerged as Leaders
• CGI, Concentrix, EXL, Firstsource, Genpact, HCL,HGS, HP, IGATE, Sutherland Global Services, Wipro, and Xchangin emerged as Major Contenders
• HCCA, Hexaware, Infosys, and Serco are Aspirants on the PEAK Matrix for banking BPO
• Cognizant, EXL, HCL, and Sutherland Global Services have been identified as “Star Performers” on the healthcare payer BPO PEAK Matrix, based on their strong performance during the preceding 18 months ending June 2015
• Accenture, HP, and Xerox are the top three largest healthcare payer BPO service providers by revenue
• CGI, Cognizant, HP, and Xerox account for over 50% of the healthcare payer BPO clients
• Accenture, Cognizant, HGS, and Xerox have a dominating presence across most healthcare payer BPO processes. Claims management shows the highest level of competitive intensity among all the healthcare payer BPO processes due to its larger size and broader set of requirements

Everest Group has a complimentary four-page PEAK Matrix preview document for this service provider landscape report.