North America Healthcare BPO Market: By Provider Services (Medical Billing, Medical Coding, Medical Transcription, Finance & Account), By Payer Services ((Claims Management (Claims Adjudication. Claims Settlement, Information Management, Claims Repricing, Claims Investigation, Claims Indexing, Litigation Management), Integrated Front-end Services and Back-office Operations, Member Management, Provider Management, Billing and Accounts Management, Analytics and Fraud Management, HR), By Pharmaceutical Service (Research and Development, Manufacturing, Non-clinical Services, Supply Chain Management (SCM) and Logistics, Sales and Marketing, (Performance Reporting (Forecasting, Research, Analytics, Marketing), (Other Non-clinical Functions (Finance and Accounts, HR, IT)), By End users (Hospital, Dental Clinics, Public Service, Others) and Country  

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North America Healthcare BPO Market size was valued at USD 112.99 billion in 2023 and is poised to grow at a CAGR of 8.9% from 2024-2030. Business Process Outsourcing (BPO) is a process in which healthcare providers select the most suited third-party vendor for some specific business process. It allows the hospitals and medical professionals to spend their energy and valuable time on patient care rather than doing some paperwork in the office.  Healthcare BPO is a solution for clients to adopt intelligent approaches that will support the organization by reducing the cost pressures and increasing the overall productivity. Healthcare BPO market provides various solutions, such as customer account setup, front-end services, billing and account receivables, enrollment services, provider network services, claims services, membership services, Medicare services, and pharmacy benefits management.

The major factor that drives the growth of North American healthcare BPO is the increasing development in healthcare IT. Furthermore, new business models & processes and the increasing use of digital technologies in healthcare are increasing the market for healthcare BPO. North America Healthcare BPO Market is expected to grow at the rate of about Good CAGR from 2016 to 2027. The rising geriatric population is anticipated to be the major issue, due to susceptibility to numerous health issues including cardiovascular diseases (CVD), respiratory disorders, cancers, eye care problems, orthopedic disorders, etc. The increasing prevalence of these diseases has led to a growing amount of work for insurance companies. To handle such a large volume of patients and claims data, and to assure rapid turnaround time, the payer companies need to invest in infrastructure, technology, and skilled personnel, leading to higher operational costs which is expected to accelerate the healthcare payer BPO market. The shift from ICD-9 to ICD-10 coding system generated a huge workload for the payers to upgrade their systems, train staff, and thereby increase their financial burden. The ICD-9 code system had 13,000 codes, while the ICD-10 code system had nearly 68,000 codes. This variation has augmented the need for medical coding, HR, accounting, skilled personnel, and other technical operations, thus estimated to positively strengthen industry growth during the forecast timeframe.

North America Healthcare BPO Market Key Developments:
  • In October 2016, Quintiles IMS Holdings has completed its merger of Equal's transaction between IMS Health Holdings, Inc. and Quintiles Transnational Holdings Inc.  
 

North America Healthcare BPO Market Dynamics

North America Healthcare BPO Market is primarily driven by a few key factors such as lack of in-house trained professionals for specific processes, cost-effective availability of workforce, and lack of industry knowledge. The pressure to reduce healthcare delivery costs, increasing number of people seeking insurance, pharmaceutical companies facing patent cliffs, consolidation of healthcare systems and mandatory implementation of ICD-10 codes and lower cost of manufacturing in developing countries are the major drivers for the North America Healthcare BPO Market. However, with the ongoing trends in the Healthcare BPO, the customers face challenges in data security & reliability, increasing regulatory compliance, and handling huge amount of healthcare data, fear of losing control over the outsourced process, probability of reduced service/product quality, and threat to data security are factors expected to restrain the growth of North America Healthcare BPO Market.

Key Features of the Reports

  • The report provides granular level information about the market size, regional market share, historic market (2019-2023), and forecast (2024-2030)
  • The report covers in-detail insights about the competitor’s overview, company share analysis, key market developments, and their key strategies
  • The report outlines drivers, restraints, unmet needs, and trends that are currently affecting the market
  • The report tracks recent innovations, key developments, and start-up details that are actively working in the market
  • The report provides a plethora of information about market entry strategies, regulatory framework, and reimbursement scenario

North America Healthcare Bpo Market Segmentation

By Provider Services
  • Medical Billing
  • Medical Coding
  • Medical Transcription
  • Finance & Accounts
By Payer Services
  • Claims Management
    • Claims Adjudication
    • Claims Settlement
    • Information Management
    • Claims Repricing
    • Claims Investigation
    • Claims Indexing
    • Litigation Management
  • Integrated Front-end Services and Back-office Operations
  • Member Management
  • Provider Management
  • Billing and Accounts Management
  • Analytics and Fraud Management
  • HR
By Pharmaceutical Service
  • Research and Development
  • Manufacturing
  • Non-clinical Services
    • Supply Chain Management (SCM) and Logistics
    • Sales and Marketing
      • Performance Reporting
      • Forecasting
      • Research
      • Analytics
      • Marketing
    • Other Non-clinical Functions
      • Finance and Accounts
      • HR
      • IT
By End users
  • Hospital
  • Dental Clinics
  • Public Service
  • Others

Frequently Asked Questions

The north america healthcare bpo market size was valued at USD 112.99 billion in 2023

The north america healthcare bpo market report covers the market data: United States, Canada

The north america healthcare bpo market key players are Accretive Health, Eli Global, Sutherland, Genpact Limited, IBM Corporation, Truven Health Analytics, Cognizant Technology Solutions Corporation, Xerox Corporation

1.Executive Summary
2. North America Healthcare BPO Market Introduction 
2.1. North America Healthcare BPO Market  - Taxonomy
2.2. North America Healthcare BPO Market  - Definitions
2.2.1.Provider Services
2.2.2.Payer Services
2.2.3.Pharmaceutical Service
2.2.4.Country
3. North America Healthcare BPO Market Dynamics
3.1. Drivers
3.2. Restraints
3.3. Opportunities/Unmet Needs of the Market
3.4. Trends
3.5. Product Landscape
3.6. New Product Launches
3.7. Impact of COVID 19 on Market
4. North America Healthcare BPO Market Analysis, 2019 - 2023 and Forecast 2024 - 2030
4.1.  Market Analysis, 2019 - 2023 and Forecast, 2024 - 2030, (Sales Value USD Million)
4.2.  Year-Over-Year (Y-o-Y) Growth Analysis (%) 
4.3.  Market Opportunity Analysis 
5. North America Healthcare BPO Market  By Provider Services, 2019 - 2023 and Forecast 2024 - 2030 (Sales Value USD Million)
5.1. Medical Billing
5.1.1. Market Analysis, 2019 - 2023 and Forecast, 2024 - 2030, (Sales Value USD Million)
5.1.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
5.1.3. Market Opportunity Analysis 
5.2. Medical Coding
5.2.1. Market Analysis, 2019 - 2023 and Forecast, 2024 - 2030, (Sales Value USD Million)
5.2.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
5.2.3. Market Opportunity Analysis 
5.3. Medical Transcription
5.3.1. Market Analysis, 2019 - 2023 and Forecast, 2024 - 2030, (Sales Value USD Million)
5.3.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
5.3.3. Market Opportunity Analysis 
5.4. Finance & Accounts
5.4.1. Market Analysis, 2019 - 2023 and Forecast, 2024 - 2030, (Sales Value USD Million)
5.4.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
5.4.3. Market Opportunity Analysis 
6. North America Healthcare BPO Market  By Payer Services, 2019 - 2023 and Forecast 2024 - 2030 (Sales Value USD Million)
6.1. Claims Management
6.1.1. Market Analysis, 2019 - 2023 and Forecast, 2024 - 2030, (Sales Value USD Million)
6.1.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
6.1.3. Market Opportunity Analysis 
6.2. Integrated Front-end Services and Back-office Operations
6.2.1. Market Analysis, 2019 - 2023 and Forecast, 2024 - 2030, (Sales Value USD Million)
6.2.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
6.2.3. Market Opportunity Analysis 
6.3. Member Management
6.3.1. Market Analysis, 2019 - 2023 and Forecast, 2024 - 2030, (Sales Value USD Million)
6.3.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
6.3.3. Market Opportunity Analysis 
6.4. Provider Management
6.4.1. Market Analysis, 2019 - 2023 and Forecast, 2024 - 2030, (Sales Value USD Million)
6.4.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
6.4.3. Market Opportunity Analysis 
6.5. Billing and Accounts Management
6.5.1. Market Analysis, 2019 - 2023 and Forecast, 2024 - 2030, (Sales Value USD Million)
6.5.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
6.5.3. Market Opportunity Analysis 
6.6. Analytics and Fraud Management
6.6.1. Market Analysis, 2019 - 2023 and Forecast, 2024 - 2030, (Sales Value USD Million)
6.6.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
6.6.3. Market Opportunity Analysis 
6.7. HR
6.7.1. Market Analysis, 2019 - 2023 and Forecast, 2024 - 2030, (Sales Value USD Million)
6.7.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
6.7.3. Market Opportunity Analysis 
7. North America Healthcare BPO Market  By Pharmaceutical Service, 2019 - 2023 and Forecast 2024 - 2030 (Sales Value USD Million)
7.1. Research and Development
7.1.1. Market Analysis, 2019 - 2023 and Forecast, 2024 - 2030, (Sales Value USD Million)
7.1.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
7.1.3. Market Opportunity Analysis 
7.2. Manufacturing
7.2.1. Market Analysis, 2019 - 2023 and Forecast, 2024 - 2030, (Sales Value USD Million)
7.2.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
7.2.3. Market Opportunity Analysis 
7.3. Non-clinical Services
7.3.1. Market Analysis, 2019 - 2023 and Forecast, 2024 - 2030, (Sales Value USD Million)
7.3.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
7.3.3. Market Opportunity Analysis 
8. North America Healthcare BPO Market  By Country, 2019 - 2023 and Forecast 2024 - 2030 (Sales Value USD Million)
8.1. United States of America (USA)
8.1.1. Market Analysis, 2019 - 2023 and Forecast, 2024 - 2030, (Sales Value USD Million)
8.1.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
8.1.3. Market Opportunity Analysis 
8.2. Canada
8.2.1. Market Analysis, 2019 - 2023 and Forecast, 2024 - 2030, (Sales Value USD Million)
8.2.2. Year-Over-Year (Y-o-Y) Growth Analysis (%) and Market Share Analysis (%) 
8.2.3. Market Opportunity Analysis 
9.United States of America (USA) Healthcare BPO Market ,2019 - 2023 and Forecast 2024 - 2030 (Sales Value USD Million)
9.1. Provider Services Analysis 2019 - 2023 and Forecast 2024 - 2030 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
9.1.1.Medical Billing
9.1.2.Medical Coding
9.1.3.Medical Transcription
9.1.4.Finance & Accounts
9.2.  Payer Services Analysis 2019 - 2023 and Forecast 2024 - 2030 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
9.2.1.Claims Management
9.2.2.Integrated Front-end Services and Back-office Operations
9.2.3.Member Management
9.2.4.Provider Management
9.2.5.Billing and Accounts Management
9.2.6.Analytics and Fraud Management
9.2.7.HR
9.3.  Pharmaceutical Service Analysis 2019 - 2023 and Forecast 2024 - 2030 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
9.3.1.Research and Development
9.3.2.Manufacturing
9.3.3.Non-clinical Services
10.Canada Healthcare BPO Market ,2019 - 2023 and Forecast 2024 - 2030 (Sales Value USD Million)
10.1. Provider Services Analysis  and Forecast  by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
10.1.1.Medical Billing
10.1.2.Medical Coding
10.1.3.Medical Transcription
10.1.4.Finance & Accounts
10.2.  Payer Services Analysis 2019 - 2023 and Forecast 2024 - 2030 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
10.2.1.Claims Management
10.2.2.Integrated Front-end Services and Back-office Operations
10.2.3.Member Management
10.2.4.Provider Management
10.2.5.Billing and Accounts Management
10.2.6.Analytics and Fraud Management
10.2.7.HR
10.3.  Pharmaceutical Service Analysis 2019 - 2023 and Forecast 2024 - 2030 by Sales Value USD Million, Y-o-Y Growth (%), and Market Share (%) 
10.3.1.Research and Development
10.3.2.Manufacturing
10.3.3.Non-clinical Services
11. Competition Landscape
11.1.  Market Player Profiles (Introduction, Brand/Product Sales, Financial Analysis, Product Offerings, Key Developments, Collaborations, M & A, Strategies, and SWOT Analysis) 
11.2.1.Genpact Limited 
11.2.2.IBM Corporation
11.2.3.Eli 
11.2.4.Parexel
11.2.5.Sutherland
11.2.6.Truven Health Analytics
12. Research Methodology 
13. Appendix and Abbreviations 
  • Accretive Health, Inc.
  • Eli Global
  • Genpact Limited 
  • IBM Corporation
  • Parexel
  • QuintilesIMS Inc
  • Sutherland
  • Truven Health Analytics
  • Cognizant Technology Solutions Corporation
  • Xerox Corporation

Adjacent Markets