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Healthcare Payer Services Market

Healthcare Payer Services Market

Healthcare industry is rapidly changing, where consumer base, government reforms and rising process of technologies are reshaping the industry. However, overcoming challenges to serve the new customer base, along with quality care and service, requires operational efficiency and organizational adaptability to manage new developments. Moreover, changing dynamics of the healthcare sector are creating opportunities for payers to create efficient and smarter healthcare system. Changing dynamics of the healthcare sector compel players to reconsider their business models and process, while considering market competition. Providing better patient care, improving customer interaction and focusing on strategies to lessen healthcare cost are some concern issues that require attention from healthcare players.

The healthcare payer services industry is evolving with introduction of advanced technologies, data-driven software and applications, informative websites and various other related platforms for easy customer accessibility. Healthcare payers or insurance companies are effectively fulfilling the digital demands from customers by availing digital coaches, telehealth services, price comparison tools, mobile apps and many more.

Innovations with technological-driven patient care:

Healthcare Consumerism

In the healthcare payer industry, how consumers are different from patients. Answer is— In the healthcare industry, patients receive treatment and careon the basis ofprovider’s decision, while on the other hand, consumers themselves make choices about their treatment and care in both financial and qualitative terms. Hence, today’s healthcare payer industry is majorly focus upon consumer’s choice and design platforms accordingly.

Mobile Applications

Mobile applications are easy to use online tool, healthcare payers are increasing customer engagement with digital platforms to ease the treatment process and attract the technological driven customers. These patient care tools are equipped with various facilities that include personal healthcare coaches, ease to access UI, competitive pricing models, and many more.

For instance: In Aetna’s iTriage healthcare app, customers can access information in 20 different languages, and locate healthcare providers easily. Along with these features, app provides all information on the basis of database maintained in it, such as personal health record (PHR), electronic health record (EHR) and others.

Fraud Prevention by Data

As per Coalition Against Insurance Fraud, in 2016, 95% of health payers company are using anti-fraud technology, up from 88% in 2012, to prevent any kind of fraud that impacts healthcare data or create data breach among patients and healthcare payers.


The era of virtual visits and telemedicine is eliminating the barriers of quality access to healthcare, especially in rural areas of a region. Some basic healthcare services, such as counselling, dentistry, some kind of therapies, primary diagnosis and management and monitoring of chronic diseases are boosting the usage if telehealth services.

Digital Payments

Along with rising digitalization in almost every sector, the payment sector is also evolving, while supporting a sectoral growth. Rising healthcare consumerismand increasing competition among market players, aid customer’s preference for better healthcare service at low cost, and these all factors are highly supporting the growth of various digital payments platforms. These platforms reduce service charges, travelling expenses and provide easy UI for increasing the usage of these platforms.

Health Analytics

Healthcare industry is friendly platform for Artificial Intelligence and other advanced analytics technologies. These technologies help to increase engagement, cut costs and improve outcomes. Industry's data-driven approach in combination with AI will revolutionize the healthcare payer industry.


The Global Healthcare Payers Market Screenshot:

Moving towards market, in the healthcare industry, payer refers to entities other than the patient that reimburse or finance the healthcare services cost. Healthcare payers include third-party payers, insurance carriers, unions or employers. Additionally, various types of payer services available in the global healthcare payer services market are ITO services, KPO services, and BPO services. Whereas, the application segment of the global healthcare payer services market include integrated front office services and back office operations, provider management services, management services, member management services, HR services and analytics and fraud management services.

On the other side of the market analysis, the private payers present in the market are leading the public payers present in the global healthcare payer market. This lead is due to high amount of investment by private payers in the healthcare industry. While, public payers will grow in the future period, owing to governmental support to increase the participation of public payers in the market.

The global healthcare payerservices market is expected to grow positively in the coming years, and the growth is supported by increasing demand of consumerism and rising adoption of digital technologies in payer operations. Increasing population involvement, beyond back-end and front-end operations drive the efficiency and effectiveness across business processes are also some of the key factors that are supporting the market growth, during the forecast period of market estimation.

Presence of various regulations and acts supported by the government, such as Health Insurance Portability and Accountability Act (HIPAA), International Statistical Classification of Diseases and Related Health Problems (ICD)-10, and the U.S. Patient Protection and Affordable Care Act (ACA)is also acting as key supporting factor, propelling the global healthcare payer market growth, over the forecast period.

On the flip side, market factors such as increasing number of data breaches, rising incidences of cyber theft, i.e., loss of confidential data results in limiting adoption of healthcare payer services and hidden outsourcing cost will hamper the healthcare payer service market growth, during the forecast period.

The global healthcare payer services market is flourished with the presence of some major key players that include, Accenture, Aetna Inc., Anthem Inc.,Cognizant, Genpact, Xerox Corporation, United HealthCare Services Inc. and others.The key players in the global healthcare payer services market are focusing on implementing mobile technology with health plans to capture a large customer base. Companies are adopting various strategies to capture majority of market share and fix a strong foothold in the market. Various strategies adopted by the market players are conglomeration, joint venture, partnership, mergers and acquisitions, product launches, geographical expansion and others. For instance, in 2015, Aetna, Inc. acquired Humana for $37 billion, the acquisition will create a leading pharmacy benefit franchise and healthcare services for over 600 million prescriptions globally, this will increase company’s reach to millions of consumers, and create a strong consumer platform.



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