North America Healthcare BPO Market


Market Outline: 

Business Process Outsourcing (BPO) is a process in which health care 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 paper work 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.


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.


Market Scope:

North America Healthcare BPO Market is segmented on the basis of Provider Services, Payer Services, Pharmaceutical Services, End users, and Geographical Regions.

By Provider Services, North America Market is segmented as:

  • Medical Billing
  • Medical Coding
  • Medical Transcription
  • Finance & Accounts

By Payer Services, North America Market is segmented as:

  • 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, North America Market is segmented as:

  • 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, North America Market is segmented as:

  • Hospital
  • Dental Clinics
  • Public Service
  • Others

Based on Country, North America Market is segmented as

  • US
  • Canada


Market Summary: 

The major factor that drives the growth of North America Healthcare BPO is the increasing development in healthcare IT. Furthermore, new business models & processes and 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.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. Increasing prevalence of these diseases has led to growing amount of work for the insurance companies. In order to handle such 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 the higher operational cost which is expected to accelerate the healthcare payer BPO market. The shift from ICD-9 to ICD-10 coding system generated huge workload for the payers to upgrade their systems, train staff and thereby increased their financial burden. The ICD-9 code system had 13,000 codes, while ICD-10 code system has 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.


Regional Analysis:  

Geographically North America Healthcare Biometrics Market is segmented as US and Canada. North America Healthcare BPO Market is dominated by US. Most of the market players are are highly involved in the introduction of innovative products and technologies to the market. U.S. holds a leading position in North America Healthcare BPO Market. The major driving factors which have driven the growth of the North America Healthcare BPO Market are steadily increasing the prevalence of regulatory scenario, pressure on healthcare institutions to reduce costs and rising trends for healthcare IT, big data and cloud computing.


Competition Assessment: 

Some of the players in the North America market include:

  • Eli Global (USA)
  • Genpact Limited (USA)
  • IBM Corporation (USA)
  • Parexel (USA)
  • QuintilesIMS Inc. (USA)
  • Sutherland (US)
  • Truven Health Analytics (USA)
  • Cognizant Technology Solutions Corporation (USA)
  • Xerox Corporation (USA)
  • Accretive Health, Inc.(USA)


Notable market developments: 

  • In October 2016, Quintiles IMS Holdings has successfully completed its merger of Equal’s transaction between IMS Health Holdings, Inc. and Quintiles Transnational Holdings Inc.


Key Features of the Report:

  • The report provides granular level information about the market size, regional market share, historic market (2013-2017) and forecast (2018-2024)
  • 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 startup’s details that are actively working in the market
  • The report provides plethora of information about market entry strategies, regulatory framework and reimbursement scenario
  • The report analyses the impact of the socio-political environment through PESTLE Analysis and competition through Porter’s Five Force Analysis in addition to recent technology advancements and innovations in the market



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