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United States Healthcare BPO Market - Growth, Trends, and Forecast (2019-2024)

The United States Healthcare BPO Market is segmented by Payer Service, Provider Service (Patient Enrolment and Strategic Planning, Patient Care Service, and Revenue Cycle Management), Pharmaceutical Service, and End User.

Market Snapshot

United States Healthcare BPO Market_1
Study Period:

2016-2024

Base Year:

2018

Market Value (2018):

109.84 billion

Market Value (2024):

174.59 billion

Key Players:

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Market Overview

The United States Healthcare BPO Market was valued at USD 109.84 billion in 2018, and it is expected to reach USD 174.59 million by 2024, with an anticipated CAGR of 8.11% during the forecast period, 2019-2024. 

  • According to the US federal government reports, around USD 3.65 trillion was spent on the healthcare sector in 2018, which means that the spending was around USD 11,212 per person, with 59% of the spending was on hospitals, clinical services, and doctors. The National healthcare expenditure (NHE) grew by 4.4%, when compared to 2017. As per the National Health Expenditure Projections 2018-2027, the projected growth of the national health spending is around at an average rate of 5.5% per year for 2018-27, which is anticipated to reach nearly USD 6.0 trillion by 2027. The health share of GDP is expected to increase from 17.9% in 2017 to 19.4% by 2027. The healthcare spending by the payer is expected to rise with faster growth rates, for example, Medicare spending growth was projected to have an accelerated growth to 5.9% in 2018, from 4.2%, and Medicaid spending was witnessing growth more slowly in 2018, at 2.2% from 2.9% in 2017. A similar trend has been observed in national health expenditures by sector, prescription drug spending is projected to have grown 3.3%, hospital spending is projected to have grown 4.4%, and physician and clinical services spending is projected to have grown more rapidly at 4.9%, in 2018.
  • With increasing healthcare costs, people seem to be skipping physician visits, skipping medical care, and delaying care, which ultimately impact the quality of care and lead to an increased cost of care. The main function of healthcare is diagnosing and treating patients, which are achieved by healthcare organizations by focusing on is increasing staff efficiency and delivering proper patient care. There is a need to balance the number of non-care responsibilities, in order to improve quality patient care, and in turn, the overall cost of the revisits and re-treatment can be controlled. This can be achieved by proper implementation of the outsourcing for non-core activities, the healthcare BPO can lower the costs through outsourcing the professionals on behalf of the healthcare company. The money can be saved on both acquiring additional staff and training them. Similarly, outsourcing can provide access to specialists, which enhances the availability of skilled healthcare professionals. Their expertise and experience can complete a complex task in a short period of time and save a lot of labor costs.
  • With increasing regulatory compliance and rise in healthcare costs, healthcare BPO may witness exponential growth, due to more healthcare facilities and hospitals outsourcing non-core activities for better operational benefits, such as improved patient care, predictable cash flow, and increased net revenue.

Scope of the Report

The healthcare BPO (business process outsourcing) refers to a process, in which the healthcare providers select the most suited third-party vendor for specific business processes. It allows the hospitals and medical professionals to spend their energy and valuable time on patient care.

By Payer Service
Human Resource Management
Claims Management
Customer Relationship Management (CRM)
Operational/Administrative Management
Care Management
Provider Management
Other Payer Services
By Provider Service
Patient Enrollment and Strategic Planning
Patient Care Service
Revenue Cycle Management
By Pharmaceutical Service
Research and Development
Manufacturing
Non-clinical Services
Supply Chain Management and Logistics
Sales and Marketing Services
Other Non-clinical Services
By End User
Biotechnology and Pharmaceutical Companies
Academic and Government Research Institutes
Other End Users

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Key Market Trends

Claims Management is Expected to Grow with High CAGR in the Forecast Period

The United States healthcare system is a trillion-dollar industry, which includes pharmacies, pharmaceutical companies, medical equipment manufacturers, and medical care facilities. This complex infrastructure in this industry relies on a specialized professional who is overseeing these operations. One such process is a medical claim. The claim process is summarized as a dual interaction between two of the largest and the important parts of the healthcare system, namely healthcare providers and medical insurance companies. The relationship between policyholders, healthcare providers, and insurance companies is essential for understanding the details of medical billing and coding process. Medical claims management is the organization, which deals billing, filling and updating, and processing of the medical claims, related to the patient diagnosis, treatments, and medications. Many hospitals and medical facilities outsource these tasks to medical claims management firms, as maintaining patient records, interacting with health insurance agencies, and issuing invoices for medical services are time consuming processes. Medical claims management services process electronic and hard-copy data to determine what the patients owe and what costs insurance companies cover. These services process billing and send invoices to patients and insurance agencies to ensure patients have paid their respective portions of the expenses. In some cases, Medicare, Medicaid, and state sponsored agencies also pay some of the medical expenses. The claims management market is expected to augment in the forecast period, as this market is essential part of the healthcare industry in the United States.

United States Healthcare BPO Market_2

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Competitive Landscape

The United States Healthcare BPO market is competitive and consists of major players and minor players. In terms of the market share, these major players currently dominate the market studied. Some of the major players of the market studied are Accenture PLC, Genpact Limited, IBM Corporation, Parexel International, and Cognizant, among others.

Major Players

  1. Accenture PLC
  2. Genpact Limited
  3. IBM Corporation
  4. Parexel International
  5. Cognizant

* Complete list of players covered available in the table of contents below

United States Healthcare BPO Market_3

Table of Contents

  1. 1. INTRODUCTION

    1. 1.1 Study Deliverables

    2. 1.2 Study Assumptions

    3. 1.3 Scope of the Study

  2. 2. RESEARCH METHODOLOGY

  3. 3. EXECUTIVE SUMMARY

  4. 4. MARKET DYNAMICS

    1. 4.1 Market Overview

    2. 4.2 Market Drivers

      1. 4.2.1 Need to Reduce Rising Healthcare Costs

      2. 4.2.2 Introduction of Medicare Access and Chip Reauthorization Act of 2015 (Macra) and American Recovery and Reinvestment Act of 2009

      3. 4.2.3 Increasing R&D in the Healthcare Industry

    3. 4.3 Market Restraints

      1. 4.3.1 Data Integrity and Confidentiality

    4. 4.4 Porter's Five Forces Analysis

      1. 4.4.1 Threat of New Entrants

      2. 4.4.2 Bargaining Power of Buyers/Consumers

      3. 4.4.3 Bargaining Power of Suppliers

      4. 4.4.4 Threat of Substitute Products

      5. 4.4.5 Intensity of Competitive Rivalry

  5. 5. MARKET SEGMENTATION

    1. 5.1 By Payer Service

      1. 5.1.1 Human Resource Management

      2. 5.1.2 Claims Management

      3. 5.1.3 Customer Relationship Management (CRM)

      4. 5.1.4 Operational/Administrative Management

      5. 5.1.5 Care Management

      6. 5.1.6 Provider Management

      7. 5.1.7 Other Payer Services

    2. 5.2 By Provider Service

      1. 5.2.1 Patient Enrollment and Strategic Planning

      2. 5.2.2 Patient Care Service

      3. 5.2.3 Revenue Cycle Management

    3. 5.3 By Pharmaceutical Service

      1. 5.3.1 Research and Development

      2. 5.3.2 Manufacturing

      3. 5.3.3 Non-clinical Services

        1. 5.3.3.1 Supply Chain Management and Logistics

        2. 5.3.3.2 Sales and Marketing Services

        3. 5.3.3.3 Other Non-clinical Services

    4. 5.4 By End User

      1. 5.4.1 Biotechnology and Pharmaceutical Companies

      2. 5.4.2 Academic and Government Research Institutes

      3. 5.4.3 Other End Users

  6. 6. COMPETITIVE LANDSCAPE

    1. 6.1 Company Profiles

      1. 6.1.1 Accenture PLC

      2. 6.1.2 Capgemini

      3. 6.1.3 Cognizant

      4. 6.1.4 GeBBs Healthcare Solutions

      5. 6.1.5 Genpact Limited

      6. 6.1.6 IBM Corporation

      7. 6.1.7 IQVIA

      8. 6.1.8 Parexel International

      9. 6.1.9 Sutherland Healthcare Solutions

      10. 6.1.10 UnitedHealth Group Incorporated

    2. *List Not Exhaustive
  7. 7. MARKET OPPORTUNITIES AND FUTURE TRENDS

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