미국 의료비 지불자용 기술 솔루션 시장 - 시장 규모, 점유율, 동향 분석 보고서 : 용도별, 솔루션 유형별, 지불자 유형별, 부문 예측(2024-2030년)

Technology Solutions In The U.S. Healthcare Payer Market Growth & Trends:

The technology solutions in the U.S. healthcare payer market size is anticipated to reach USD 12.6 billion by 2030, according to a new report by Grand View Research, Inc. The market is expected to expand at a notable CAGR of 7.3% from 2024 to 2030. Major factors driving the market growth include enrollment and billing modernization, growing acquisition by market leaders, growing interest of investors and venture capitalists, and revolutionizing healthcare using innovative technologies.

The interest of investors and venture capitalists in the healthcare payer sector is growing as technology startups focusing on this industry draw substantial attention. This increased attention is driven by several factors, such as digital transformation, value-based care, telehealth, data analytics, and consumer-centric care, highlighting the significant potential for innovation and expansion in the healthcare payer domain. The healthcare industry is undergoing rapid transformation, driven by evolving patient expectations, the shift toward value-based care, and the increasing demand for more accessible & personalized healthcare experiences. These changes have created a competitive environment for startups to introduce innovative technologies and solutions, with the potential to improve and enhance various aspects of the healthcare payer ecosystem.

The initial phase of the pandemic required a strong emphasis on ensuring business continuity, member communication, and support, and these priorities remained important for the future. As the pandemic progressed from a remote concern to a global crisis, marked by extensive closure of schools and businesses for social distancing, payers found engaging with diverse stakeholders to manage the response measures collectively imperative. Healthcare payers adopted several response measures, such as establishing collaborative forums with providers and government response teams, proactive identification of high-risk members, and preparation for supply and demand imbalances.

Moreover, key players in the market are engaging in strategic initiatives such as partnerships, collaborations, new product launches, acquisitions, and expansions to strengthen their market position and expand their customer base. For instance, in March 2023, Pegasystems Inc. announced enhancements to the Pega Foundation for Healthcare. The platform will include intelligent AI-powered decision-making, personalized & responsive benefits, and expanded interoperability to help payers, care providers, & customers. Moreover, in April 2023, Cognizant and Microsoft announced an expansion of their long-standing healthcare collaboration to provide healthcare providers and payers with access to streamlined claims management, advanced technology solutions, and improved interoperability to provide better patient and member experiences and optimize business operations. Microsoft and Cognizant are expected to work collaboratively to develop an integration roadmap between Cognizant's TriZetto healthcare technologies and Microsoft Cloud for Healthcare.

Technology Solutions In The U.S. Healthcare Payer Market Report Highlights:

• Based on application, the claims management segment held the majority of the market share of 32.2% in the application segment in 2023. As the population of insured individuals and the demand for healthcare services continue to increase, insurance claims are also rising
• Based on solution type, the integrated segment held most of the market share of 64.4% in the solution-type segment in 2023 and is e xpected to witness the fastest growth at a CAGR of 7.5% during the forecast period. The rising emphasis on value-based care & population health management contributes to market growth
• Based on payer type, the commercial segment held the largest market share of 67.1 % in 2023 and is anticipated to witness the fastest growth at a CAGR of 7.5% over the forecast period. The growth is attributed to the increasing adoption of health insurance among the population

Table of Contents

Chapter 1 Methodology And Scope

• 1.1 Market Segmentation & Scope
  • 1.1.1 Estimates & Forecast Timeline
• 1.2 Research Methodology
• 1.3 Information Procurement
  • 1.3.1 Purchased Database:
  • 1.3.2 GVR's Internal Database
  • 1.3.3 Secondary Sources
  • 1.3.4 Primary Research:
  • 1.3.5 Details Of Primary Research
• 1.4 Information Or Data Analysis
  • 1.4.1 Data Analysis Models
• 1.5 Market Formulation & Validation
• 1.6 Model Details
  • 1.6.1 Commodity Flow Analysis
  • 1.6.2 Segment Level Market Estimation
• 1.7 List Of Secondary Sources
• 1.8 Objectives
  • 1.8.1 Objective 1:
  • 1.8.2 Objective 2:

Chapter 2 Executive Summary

• 2.1 Market Outlook
• 2.2 Market Snapshot
• 2.3 Segmentation Snapshot
• 2.4 Segmentation Snapshot
• 2.5 Competitive Landscape Snapshot

Chapter 3 Technology Solutions In The U.S. Healthcare Payers Market Variables, Trends & Scope

• 3.1 Market Lineage Outlook
  • 3.1.1 Ancillary Market Analysis
• 3.2 Healthcare It Trends/dynamics In U.S. Healthcare Payers Market
  • 3.2.1 Market Driver Analysis
    • 3.2.1.1 Market Leaders
    • 3.2.1.1.1 Modernization Of Enrollment And Billing Processes
    • 3.2.1.1.2 Growing Acquisitions By Market Leaders
    • 3.2.1.2 Emerging Players/startups
    • 3.2.1.2.1 Growing Interest Of Investors And Venture Capitalists
    • 3.2.1.2.2 Revolutionization Of Healthcare Using Innovative Technologies
  • 3.2.2 Market Restraint Analysis
    • 3.2.2.1 Market Leaders
    • 3.2.2.1.1 Demand-supply Gap Of Tech Experts
    • 3.2.2.2 Emerging Players/startups
    • 3.2.2.2.1 Growing Instances Of Data Breaches
  • 3.2.3 Market Challenges Analysis
    • 3.2.3.1 Market Leaders
    • 3.2.3.1.1 Inflation And Rising Cost Of Care
    • 3.2.3.2 Emerging Players/startups
    • 3.2.3.2.1 Increased Competition
  • 3.2.4 Market Opportunity Analysis
    • 3.2.4.1 Market Leaders
    • 3.2.4.1.1 Growing Demand For Innovative Technologies
    • 3.2.4.2 Emerging Players/startups
    • 3.2.4.2.1 Enhanced Communication And Engagement
• 3.3 Industry Analysis Tools: Porter's Analysis
• 3.4 Industry Analysis - Pest
• 3.5 U.S. Healthcare Payers Market Technology Timeline
  • 3.5.1 Secondary Survey Insights Related To Changes In Technology Investments By Healthcare Payers
    • 3.5.1.1 Survey No.1
    • 3.5.1.2 Survey No.2
  • 3.5.2 Emerging Trends
    • 3.5.2.1 Digital Technology Analysis
    • 3.5.2.2 Modernization
    • 3.5.2.2.1 Cloud-based Solutions Analysis
    • 3.5.2.3 Ai-enabled Technology Analysis
• 3.6 Impact Of Covid-19 Pandemic

Chapter 4 U.S. Healthcare Payer Market

Chapter 5 Technology Solutions In The U.S. Healthcare Payers Market: Application Estimates & Trend Analysis

• 5.1 Segment Dashboard
• 5.2 Application Movement Analysis, USD Million, 2023 & 2030
  • 5.2.1 Enrollment And Member Management
    • 5.2.1.1 Enrollment And Member Management Market Estimates And Forecasts, 2018 - 2030 (USD Million)
  • 5.2.2 Provider Management
    • 5.2.2.1 Provider Management Market Estimates And Forecasts, 2018 - 2030 (USD Million)
  • 5.2.3 Claims Management
    • 5.2.3.1 Claims Management Market Estimates And Forecasts, 2018 - 2030 (USD Million)
  • 5.2.4 Value-based Payments
    • 5.2.4.1 Value-based Payments Market Estimates And Forecasts, 2018 - 2030 (USD Million)
  • 5.2.5 Revenue Management And Billing
    • 5.2.5.1 Revenue Management And Billing Market Estimates And Forecasts, 2018 - 2030 (USD Million)
  • 5.2.6 Analytics
    • 5.2.6.1 Analytics Market Estimates And Forecasts, 2018 - 2030 (USD Million)
  • 5.2.7 Personalize /crm
    • 5.2.7.1 Personalize /crm Market Estimates And Forecasts, 2018 - 2030 (USD Million)
  • 5.2.8 Clinical Decision Support
    • 5.2.8.1 Clinical Decision Support Market Estimates And Forecasts, 2018 - 2030 (USD Million)
  • 5.2.9 Data Management And Authorization
    • 5.2.9.1 Data Management And Authorization Market Estimates And Forecasts, 2018 - 2030 (USD Million)
  • 5.2.10 Others
    • 5.2.10.1 Others Market Estimates And Forecasts, 2018 - 2030 (USD Million)

Chapter 6 Technology Solutions In The U.S. Healthcare Payers Market: Solution Type Estimates & Trend Analysis

• 6.1 Segment Dashboard
• 6.2 Technology Solutions In The U.S. Healthcare Payers Market: Solution Type Movement Analysis, USD Million, 2023 & 2030
  • 6.2.1 Standalone
    • 6.2.1.1 Standalone Market Estimates And Forecasts, 2018 - 2030 (USD Million)
  • 6.2.2 Integrated
    • 6.2.2.1 Integrated Market Estimates And Forecasts, 2018 - 2030 (USD Million)

Chapter 7 Country Estimates, Technology Solutions In The U.S. Healthcare Payers Market, By Application And Solution Type

• 7.1 U.S.
  • 7.1.1 Competitive Scenario
  • 7.1.2 Regulatory Framework
    • 7.1.2.1 Technology Solutions In The U.S. Healthcare Payer Market Estimates And Forecasts, 2018 - 2030 (USD Million)

Chapter 8 Market Player Analysis

• 8.1 Recent Developments & Impact Analysis By Key Market Participants
  • 8.1.1 Cognizant (Trizetto Business Line)
  • 8.1.2 Zeomega
  • 8.1.3 Pegasystems, Inc.
  • 8.1.4 Hyland Software, Inc.
  • 8.1.5 Medecision
  • 8.1.6 Medhok, Inc. (Mhk)
• 8.2 Company/competition Categorization (Key Innovators, Market Leaders, Emerging Players)
• 8.3 Estimated Dominant Company Market Position Analysis, 2023
• 8.4 Top Technology Solution Providers For Healthcare Payers
• 8.5 Competitive Factors And Strategies Implementation
  • 8.5.1 By Technology Solutions Providers In The U.S. Healthcare Payers Market
  • 8.5.2 Other Related Streams In The U.S. Healthcare Payers Market
• 8.6 Healthcare Payer's Digital Transformation Initiatives
  • 8.6.1 Key Focus Areas For Healthcare Payers
    • 8.6.1.1 Advanced Analytics
    • 8.6.1.2 Member Engagement
    • 8.6.1.3 Cybersecurity:
    • 8.6.1.4 Telehealth:
    • 8.6.1.5 Value-based Care:
    • 8.6.1.6 Population Health Management:
  • 8.6.2 Digital Healthcare Payer's Transformation Use Cases
    • 8.6.2.1 Accelerating Claims Processing
    • 8.6.2.1.1 Gleematic A.i: Cognitive Automation For Claims Processing
    • 8.6.2.2 Enhancing Customer Care
    • 8.6.2.2.1 Virtusa Corp.: 98% Boost In Customer Satisfaction Realized By Top Payer
    • 8.6.2.3 Accelerating New Member Enrollment
    • 8.6.2.3.1 Innova Solutions: Enrollment Management Solution For Leading U.S. Health Insurance Company
    • 8.6.2.4 Enabling Remote Workforce
    • 8.6.2.4.1 Productive Edge: Revolutionizing Primary Care: A Regional Payer's Innovative Virtual Solution For Patient Needs
    • 8.6.2.5 Enhancing Interoperability
    • 8.6.2.5.1 Hyland Software, Inc.: A Complex Regional Health System And Plan Provider Achieves Interoperability And Significant Roi
    • 8.6.2.6 Other Applications
    • 8.6.2.6.1 Hyland Software, Inc.: New York Health Plan Enhances Efficiency And Security By Automating Appeals And Grievances Processes
• 8.7 Analyst Recommendations For Healthcare Payers Regarding Technology Solutions
  • 8.7.1 Potential Growth And Penetration Areas

Chapter 9 Technology Solutions In The U.S. Healthcare Payers Market: Competitive Analysis

• 9.1 Strategic Initiatives
• 9.2 Top 5 Consulting Service Lines
  • 9.2.1 Ey
    • 9.2.1.1 Strategic Alliances
  • 9.2.2 Deloitte
    • 9.2.2.1 Strategic Alliances
  • 9.2.3 KPMG
    • 9.2.3.1 Strategic Alliances
  • 9.2.4 Pwc (Pricewaterhousecoopers)
    • 9.2.4.1 Strategic Alliances
  • 9.2.5 Ntt Data
    • 9.2.5.1 Strategic Alliances
• 9.3 Top 5 Indian Advisory Companies
  • 9.3.1 Infosys
    • 9.3.1.1 Strategic Alliances
  • 9.3.2 Tcs
    • 9.3.2.1 Strategic Alliances
  • 9.3.3 Wipro
    • 9.3.3.1 Strategic Alliances
  • 9.3.4 Cognizant
    • 9.3.4.1 Strategic Alliances
  • 9.3.5 Optum
    • 9.3.5.1 Strategic Alliances

Chapter 10 Technology Solutions in the U.S. Healthcare Payers Market: Market Player Landscape

• 10.1 Major Market Player Landscape
  • 10.1.1 HEALTHEDGE
    • 10.1.1.1 Company Overview
    • 10.1.1.2 Partners:
    • 10.1.1.3 Go-To-Market Strategies
  • 10.1.2 ORACLE
    • 10.1.2.1 Company OverVIew
    • 10.1.2.2 Oracle Enterprise Service Bus (ESB)
    • 10.1.2.3 Partners: Accenture, PwC, Cognizant, Deloitte, KPMG, TCS, Infosys, Wipro, EY
    • 10.1.2.4 Go-To-Market Strategies
  • 10.1.3 ORACLE EBS (E-BUSINESS SUITE)
  • 10.1.4 COGNIZANT
    • 10.1.4.1 Company OverVIew
    • 10.1.4.2 Facts of Cognizant digital healthcare payer Solutions
    • 10.1.4.3 Partnership
    • 10.1.4.4 Go-To-Market Strategies
• 10.2 Company Profiles
  • 10.2.1. COGNIZANT (TRIZETTO BUSINESS LINE)
    • 10.2.1.1. Participant's Overview
    • 10.2.1.2. Financial Performance
    • 10.2.1.3. Product Benchmarking
    • 10.2.1.4. Recent Developments
  • 10.2.2. ZEOMEGA
    • 10.2.2.1. Participant's Overview
    • 10.2.2.2. Financial Performance
    • 10.2.2.3. Product Benchmarking
    • 10.2.2.4. Recent Developments
  • 10.2.3. Oracle
    • 10.2.3.1. Participant's Overview
    • 10.2.3.2. Financial Performance
    • 10.2.3.3. Product Benchmarking
    • 10.2.3.4. Recent Developments
  • 10.2.4. HealthEdge Software Inc.
    • 10.2.4.1. Participant's Overview
    • 10.2.4.2. Financial Performance
    • 10.2.4.3. Product Benchmarking
    • 10.2.4.4. Recent Developments
  • 10.2.5. Pegasystems Inc.
    • 10.2.5.1. Participant's Overview
    • 10.2.5.2. Financial Performance
    • 10.2.5.3. Product Benchmarking
    • 10.2.5.4. Recent Developments
  • 10.2.6. Hyland Software Inc.
    • 10.2.6.1. Participant's Overview
    • 10.2.6.2. Financial Performance
    • 10.2.6.3. Product Benchmarking
    • 10.2.6.4. Recent Developments
  • 10.2.7. Zyter (Zyter| TrueCare)
    • 10.2.7.1. Participant's Overview
    • 10.2.7.2. Financial Performance
    • 10.2.7.3. Product Benchmarking
    • 10.2.7.4. Recent Developments
  • 10.2.8. Medecision
    • 10.2.8.1. Participant's Overview
    • 10.2.8.2. Financial Performance
    • 10.2.8.3. Product Benchmarking
    • 10.2.8.4. Recent Developments
  • 10.2.9. OSP
    • 10.2.9.1. Participant's Overview
    • 10.2.9.2. Financial Performance
    • 10.2.9.3. Product Benchmarking
    • 10.2.9.4. Recent Developments
  • 10.2.10. Open Text Corporation
    • 10.2.10.1. Participant's Overview
    • 10.2.10.2. Financial Performance
    • 10.2.10.3. Product Benchmarking
    • 10.2.10.4. Recent Developments
  • 10.2.11. MedHOK, Inc. (MHK)
    • 10.2.11.1. Participant's Overview
    • 10.2.11.2. Financial Performance
    • 10.2.11.3. Product Benchmarking
    • 10.2.11.4. Recent Developments