Technology Solutions in U.S. Healthcare Payer Market – Solution Type (Integrated, Standalone), Payer Type (Commercial, Government), Application (Analytics, Claim, Provider, Revenue, Data Management and Billing, CRM) – Global Forecast (2024 – 2032)

Technology Solutions in U.S. Healthcare Payer Market – Solution Type (Integrated, Standalone), Payer Type (Commercial, Government), Application (Analytics, Claim, Provider, Revenue, Data Management and Billing, CRM) – Global Forecast (2024 – 2032)

Technology Solutions in U.S. Healthcare Payer Market Size

Technology Solutions in U.S. Healthcare Payer Market size was valued at USD 7.6 billion in 2023 and is anticipated to showcase growth at 7.2% CAGR from 2024 – 2032. Increasing demand for streamlining operational workflow and reducing administrative expenses, shift towards value-based care approaches, and modernization of billing and claim settlement approaches are driving the adoption of technology solutions among payers, contributing to the overall market growth in the US.

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Furthermore, growing adoption of telehealth services among payers and providers is also positively impacting the revenue growth in the market. In the U.S. healthcare payer industry, technology solutions encompass a diverse array of software and digital tools. These solutions are designed to support various aspects of health insurance companies' operations, including administrative tasks, financial management, clinical processes, and regulatory compliance.

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Technology Solutions in U.S. Healthcare Payer Market Trends

• Healthcare payers are utilizing advanced healthcare analytics techniques such as predictive analytics, machine learning algorithms, and data visualization tools to extract valuable insights from the vast amounts of healthcare data available. These data-driven insights are enabling the healthcare payers to enhance patient outcomes and optimize costs by tailoring their strategies based on the unique needs and characteristics of each individual.
• The widespread occurrence of fraudulent activities in claim management has become a pressing concern for healthcare payers. Vendors are increasingly preferring to integrate generative AI in their existing solutions to detect patterns in fraudulent activities. Such integrations have enabled the healthcare payers to analyze datasets and detect the subtle patterns that indicate and alarm for any fraudulent activities.
• For instance, according to an article published by HealthEdge Software, Inc. in March 2024, healthcare payers are using core administration processing systems (CAPS) to improve auto adjudication rates and detect fraud. Such advanced integrations are expected to drive the adoption of technology solutions among healthcare payers in the U.S.

Technology Solutions in U.S. Healthcare Payer Market Analysis

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Based on solution type, the market is segmented into integrated and standalone solutions. The integrated segment held the majority of market share in 2023 and is anticipated to grow at CAGR of 7.5% over the coming years.

• Leading share of integrated segment can be attributed to their capability to offer multiple functionalities into a single platform, that helps in streamlining processes and reduce the need for disparate systems. The integrated solutions help in minimizing data silos and simplifying workflow for healthcare payers, thereby driving their adoption.
• Growing demand for user experience through offering personalized solutions is also leading towards growing use of integrated solution platforms. Integrated solutions are facilitating seamless and personalized payer services through coordinated and proactive communication, and customized interventions that can align with individual preferences and requirements.

Based on payer type, the technology solutions in U.S. healthcare payer market is classified into commercial and government. The commercial segment dominated the market with a revenue of about USD 5.4 billion in 2023.

• Leading share of commercial segment can be attributed to employer sponsored healthcare insurance. According to an October 2023 article published by Kaiser Family Foundation, about 153 million non-elderlies are covered through employer sponsored healthcare insurance. Moreover, availability of diverse range of employer-sponsored health insurance plans that covers significant number of employees and their families across various industries and demographics also helps to contribute to the overall growth of the segment.
• Presence of large number of private insurance companies competing to gain employers contracts is driving innovation in policies, service differentiation, and competition in pricing, thereby attracting significant share of population relying on employer sponsored insurance, that contributes to a leading share of commercial segment. 

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Based on application, the technology solutions in U.S. healthcare payer market is classified into claims management, enrolment and member management, provider management, revenue management and billing, analytics, data management and authorization, personalized/CRM, value based payments, clinical decision support, and other applications. The claims management segment secured a leading share of about 31.5% in 2023 and is anticipated to grow at 7.4% CAGR during the forecast period.

• Rapid technological advancements such as digital engagement, automation, AI and advanced analytics together with growing availability of claims data is driving the use of technology solutions in claims management, which has contributed to a dominating share of this segment.
• Increasing demand for timely reimbursement, cost reduction, and fraud prevention among healthcare payers has also driven the demand for claim management solutions in the US. According to the Council for Affordable Quality Healthcare (CAHQ) index report of 2019, the U.S. medical industry spends approximately $4.5 billion each year on processing and submitting insurance claims. As a result, the demand for reducing claim management cost has surged the adoption of claim management solutions among healthcare payers, driving the revenue growth in the segment.

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Technology Solutions in U.S. Healthcare Payer Market Share

The market is fragmented due to the presence of large number of solution providers in the country, each addressing specific needs and functions within the payer ecosystem. Smaller players are focusing towards offering innovative solutions to healthcare payers only within specific segments such as claim management, and analytics. Lower entry barriers such as requirements for low capital investments is also driving large number of smaller players into the market. However, established vendors are using inorganic growth strategies such as acquisition and merger to gain competitive edge in the market.

Technology Solutions in U.S. Healthcare Payer Market Companies

Prominent players operating in the technology solutions in U.S. healthcare payer industry include

• Cognizant Technology Solutions Corporation 
• HCL Technologies Limited
• HealthEdge Software, Inc.
• Hyland Software, Inc.
• KMS Healthcare
• Medecision
• MedHOK, Inc.
• Open Text Corporation
• Oracle Corporation
• OSP
• Pegasystems Inc.
• System Soft Technologies LLC
• Virtusa Corp.
• ZeOmega, Inc.
• Zyter, Inc.

Technology Solutions in U.S. Healthcare Payer Industry News

• In March 2024, Cognizant Technology Solutions Corporation announced its collaboration with Microsoft Corporation for their TriZetto platform, powered by Azure OpenAI Service, to infuse generative AI into healthcare administration. The collaboration aims to enhance productivity and efficiency for healthcare payers and providers, ensuring prompt responses and better care for patients.
• In August 2023, HealthEdge Software, Inc. announced the launch of web-based configuration management tool HealthRules Promote for HealthRules Payers. The solution will provide an easy-to-use interface and will help payers to run health plans faster.

The technology solutions in U.S. healthcare payer market research report includes an in-depth coverage of the industry with estimates & forecast in terms of revenue in USD Million from 2021 - 2032 for the following segments

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Market, By Solution type

• Integrated
• Standalone

Market, By Payer type

• Commercial
• Government

Market, By Application

• Claims management
• Enrolment and member management
• Provider management
• Revenue management and billing
• Analytics
• Data management and authorization
• Personalized/CRM
• Value based payments
• Clinical decision support
• Other applications