The global healthcare BPO market is projected to reach USD 468.5 billion by 2026 from USD 296.4 billion in 2021, at a CAGR of 9.6% during the forecast period. Healthcare BPO is a practice in which healthcare organizations outsource their business operations to third-party organizations. The aim of healthcare business process outsourcing services is to reduce administration costs for healthcare providers and enhance patient satisfaction.
The healthcare BPO sector handles a variety of activities ranging from data entry to medical claims processing services. The major factors driving the growth of this market include the need to curtail the escalating healthcare costs, rising demand for niche services, growing outsourcing in the life science industries, and lack of in-house expertise in the end-use industries.
On the other hand, hidden costs associated with outsourcing services and concerns related to losing visibility and control over the business process are expected to hamper the market growth to a certain extent in the coming years.
Claims management services to hold the largest share of the payer services market
Based on type, the payer services market is segmented into claims management, integrated front-end services and back-office operations, member management, product development & business acquisition, provider management, care management, billing & accounts management services and HR services.
The claims management segment is projected to grow at a CAGR of 10.8%, from USD 11.7 billion in 2021 to USD 19.5 billion by 2026. Claims processing is an integral part of the healthcare payer industry, and outsourcing of claims management provides the payer company with an opportunity to establish a long-term relationship with customers.
R&D services to be the fastest-growing segment in the life science services market
Based on type, the life science services market is segmented into manufacturing, R&D and non-clinical services. R&D services are expected to grow at a CAGR of 9.8% between 2021 to 2026. Rising R&D expenditure and the increasing need to reduce drug costs are a matter of concern for various pharmaceutical companies across the globe. Increasing competition, escalating cost of drug development, the complexity of discovery research, and the increasing need to speed up the rate of new product launches are some of the major factors driving the increased demand for R&D outsourcing.
The US to be the largest source geography for healthcare BPO services in North America
North America is expected to account for the largest share of 49.0% of the global healthcare BPO market in 2021, followed by Europe (30.6%) and the RoW (20.3%). Factors such as growing pressure to curb the increasing cost of care, demand for dedicated customer care professionals to create new insurance exchanges, manage workload of processing claims, account maintenance, and catering to the expanded customer base are some of the major factors driving the growth of healthcare BPO market in the US.
Key Topics Covered:
2 Research Methodology
3 Executive Summary
4 Premium Insights 4.1 Healthcare BPO Market Overview 4.2 North America: Healthcare BPO Market, by Provider Service (2020) 4.3 Healthcare BPO Market Share, by Life Science Service, 2021 Vs. 2026 4.4 Non-Clinical Services Market Share, by Type, 2021 Vs. 2026 4.5 Sales & Marketing Services Market Share, by Type, 2021 Vs. 2026 4.6 Healthcare BPO Market, by Destination Geography
5 Market Overview 5.1 Introduction 5.2 Market Dynamics 5.2.1 Drivers 18.104.22.168 Shift to Icd-10 coding standards and upcoming Icd-11 standards 22.214.171.124 Pressure to reduce the rising healthcare costs 126.96.36.199 Loss of revenue due to billing errors 188.8.131.52 Demand for niche services 184.108.40.206 Need for structured processes and documentation 220.127.116.11 Lack of in-house expertise in end-use industries 18.104.22.168 Growing outsourcing in the pharma and biopharma industries 5.2.2 Restraints 22.214.171.124 Hidden outsourcing costs 126.96.36.199 Concerns related to losing visibility and control over the business process 5.2.3 Challenges 188.8.131.52 Limitations in the data capturing process in Medicaid services 184.108.40.206 Data security concerns 5.2.4 Opportunities 220.127.116.11 Advanced data analytics 18.104.22.168 Growing adoption of artificial intelligence-based tools for drug discovery 5.3 Outsourcing Approaches 5.4 Outsourcing Models 5.5 Impact of COVID-19 On the Healthcare BPO Market 5.6 Porter's Five forces Analysis 5.7 Pricing Analysis 5.8 Technology Analysis 5.8.1 Machine Learning 5.8.2 Artificial Intelligence 5.8.3 Internet of Things 5.8.4 Blockchain 5.8.5 Augmented Reality 5.9 Regulatory Analysis 5.10 Ecosystem 5.11 Value Chain Analysis 5.12 Case Study Analysis
6 Healthcare BPO Market, by Provider Service 6.1 Introduction 6.2 Revenue Cycle Management 6.2.1 Revenue Cycle Management Segment Held the Largest Share of the Healthcare BPO Provider Services Market 6.3 Patient Enrolment 6.3.1 Outsourcing Patient Enrolment Services Help Prevent Claim Denials and Payment Delays 6.4 Patient Care 6.4.1 Medical Transcription 22.214.171.124 Medical transcription outsourcing offers a quicker, efficient, and streamlined medical transcription process 6.4.2 Device Monitoring 126.96.36.199 Device monitoring centers facilitate health systems to cater to unique patient needs 6.4.3 Medical Imaging 188.8.131.52 Medical imaging outsourcing services provide a multidisciplinary approach to obtain accurate imaging results
7 Healthcare BPO Market, by Payer Service 7.1 Introduction 7.2 Claims Management Services 7.2.1 Claims Adjudication Services 184.108.40.206 The claims adjudication services segment accounted for the largest share of the claims management outsourcing services market in 2020 7.2.2 Claims Settlement Services 220.127.116.11 Streamlined settlement processes offered by outsourcing companies to drive the segment growth 7.2.3 Information Management Services 18.104.22.168 Information management services enable the handling of a large amount of data generated during the claims management process 7.2.4 Claims Repricing 22.214.171.124 Outsourcing claims repricing services to healthcare BPOs reduces the administrative burden on payer firms 7.2.5 Claims Investigation Services 126.96.36.199 Outsourcing claims investigation services help improve fraud detection & recovery 7.2.6 Claims Indexing Services 188.8.131.52 Outsourcing is preferred for the indexing of medical records as it is time-consuming and requires expertise 7.2.7 Fraud Detection & Management 184.108.40.206 Third-party vendors use advanced analytics, technologies, and tools to identify fraudulent activities accurately 7.3 Integrated Front-End Services and Back-Office Operations 7.3.1 Reduction In Overhead Expenses and Improved Efficiency offered by Outsourcing Companies To Support Segment Growth 7.4 Member Management Services 7.4.1 Third-Party Vendors Help Manage Member-Related Eligibility Data More Strategically Across the Enterprise 7.5 Product Development & Business Acquisition Services (PDBA) 7.5.1 Increasing Focus On Customer Engagement and Retention To Support the Segment Growth 7.6 Provider Management Services 7.6.1 Increasing Complexities and Variations In Provider Networks and Health Plans Has Increased the Dependency On Third-Party Vendors 7.7 Care Management Services 7.7.1 Care Management Services Play A Major Role In Clinical Coverage Decisions and Review Systems 7.8 Billing and Accounts Management Services 7.8.1 Outsourcing of these Services Help Check Frauds, Reduce Process Time, and Minimize the Burden On Payer Staff 7.9 Hr Services 7.9.1 Outsourcing Hr Services Ensures Reduced Costs and Attrition Rates While Ensuring Steady Business Growth
8 Healthcare BPO Market, by Life Science Service 8.1 Introduction 8.2 Manufacturing 8.2.1 Benefits of Outsourcing Such As Long-Term Cost Savings and Availability of Expert Personnel To Propel Market Growth 8.3 Research & Development (R&D) 8.3.1 Increasing Demand for Specialized Research and Development Service Providers To Drive Market Growth 8.4 Non-Clinical Services 8.4.1 Sales & Marketing Services 220.127.116.11 Analytics 18.104.22.168.1 Use of analytics to improve customer-facing functions and minimize risks have increased the outsourcing of analytical services 22.214.171.124 Marketing 126.96.36.199.1 Outsourcing marketing services to third parties helps organizations to focus on their core functionalities 188.8.131.52 Research 184.108.40.206.1 Increasing focus on outsourcing research activities for strategic decision-making to drive market growth 220.127.116.11 Forecasting 18.104.22.168.1 Sales, revenue, and demand are the most commonly outsourced forecasting services by the life science industry 22.214.171.124 Performance reporting 126.96.36.199.1 Commonly outsourced performance reporting services include brand performance tracking, sales force performance tracking, and sales tracking 8.4.2 Supply Chain Management & Logistics 188.8.131.52 Outsourcing helps manage complex supply chain operations with more efficiency and flexibility as compared to in-house units 8.4.3 Other Non-Clinical Services
9 Healthcare BPO Market, by Region
10 Competitive Landscape 10.1 Overview 10.2 Market Ranking 10.3 Market Share Analysis 10.4 Company Evaluation Quadrant 10.4.1 Stars 10.4.2 Emerging Leaders 10.4.3 Participants 10.4.4 Pervasive Players 10.5 Company Evaluation Quadrant for Emerging Players 10.5.1 Progressive Companies 10.5.2 Responsive Companies 10.5.3 Starting Blocks 10.5.4 Dynamic Companies 10.6 Competitive Benchmarking 10.6.1 Company Product Footprint 10.6.2 Company Application Footprint 10.6.3 Company Region Footprint 10.7 Competitive Scenario 10.7.1 Product/Service Launches & Approvals 10.7.2 Deals 10.7.3 Other Developments