Report: Payer business process outsourcing market growing steadily

ACA implementation played key role in growth

The healthcare payer business process outsourcing (BPO) market grew at a rate of 14 percent, according to a recent report from the Everest Group. This growth rate is likely to continue over the next few years.

The research looked at more than 180 active payer BPO contracts signed as of December 2013. This included coverage across 15 healthcare payer BPO service providers, such as Accenture, Genpact and Xerox.

Due to a surge in enrollment thanks to the Affordable Care Act, as well as an increase in both high-risk consumers and the size of the aging population, payers must process more claims than ever. Additionally, aligning payers and service providers can help ensure smoother claims processing and reduce overall operational costs, according to the report.

Other key insights include the following:

  • Control of healthcare fraud, waste and abuse likely will impact the future of the BPO industry, as well as more payer-provider collaborations.
  • Technology solutions will drive the majority of BPO adoption.
  • The adoption of more complex pricing models will affect BPO adoption as well.

"Federal and state-level regulations are playing an increased role in healthcare payer BPO, as are measures to control fraud, waste and abuse," Rajesh Ranjan, partner at Everest Group, said in the report. "The result is wide windows of opportunity for BPO service providers to help payers who want to streamline operations, reduce costs, speed their time to market with new service plans, and use data analytics to reduce risk."

Since the early days of ACA implementation, states have used BPO services to address the requirements and deadlines for rolling out their insurance exchanges. For instance, Policy Studies Inc. created a BPO service that enabled states to speed up implementation while controlling costs should they build or transfer and operate exchanges on their own, FierceHealthPayer previously reported.

For more:
- here's the report (.pdf)

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