The new report from Markets and Markets, The ”U.S. Healthcare BPO Market - Payer (Claims Processing, HR Services, and Finance and Accounts), Provider (Medical Billing and Coding), and Pharmaceutical (Clinical Trials, Contract Manufacturing, and Non-Clinical Services) - Trends and Global Forecasts to 2018 ”, analyzes and studies the major market drivers, restraints, and opportunities in the U.S for healthcare BPO for the forecast period 2013 – 2018.
With the ever-changing landscape of the U.S. healthcare system, the U.S. healthcare BPO market is undergoing a significant transformation. The U.S. healthcare payer, provider, and pharmaceutical outsourcing markets are valued at $11.1 billion, $6.8 billion, and $65.6 billion, respectively, in the year 2013.
However, the U.S. healthcare payer market has been greatly impacted by the introduction of the Patient Protection and Affordable Care Act (PPACA). This market is particularly driven by claims processing services. As the act expanded insurance access to more than 30 million U.S. citizens, the increased claims processing workload led to large-scale outsourcing of these services by payers.
Healthcare process in BPO
Other factors that have led to the growth of the market include developments and innovation in IT and regulatory changes. Approximately 75% of U.S. healthcare companies outsource their work to external locations. This is due to the shortage of qualified staff in key positions, such as nurses and coders, and due to the new set of rules and regulations that they need to comply with. Some services that are commonly outsourced are insurance claims processing, adjudication and receivables management, billing and coding services, radiology reporting, transcription services, and clinical outsourcing, among others.
Implementation of various reforms such as the American Recovery and Reinvestment Act of 2009 and the Health Information Technology for Economic and Clinical Health Act (HITECH) as well as the conversion from the ICD-9 coding system to the ICD-10 coding system (to be implemented by October 2014) has created an upward growth trend. Furthermore, constant improvements in the quality of work from destination countries have reinforced the confidence of various healthcare payers, providers, and pharmaceutical companies in outsourcing. This is considered as the key driver of the healthcare process outsourcing market. On the other hand, data security and confidentiality concerns are the restraints for the growth of the market.
In this report, the U.S. healthcare BPO market is categorized into three segments, namely, payer outsourcing, provider outsourcing, and pharmaceutical outsourcing. Each segment is further sub-segmented on the basis of services provided. Payer services consist of claims processing, HR services, member services/customer care, and finance and accounts. Provider services include medical billing, medical coding, medical transcription, and finance and accounts. Pharmaceutical services comprise clinical research organizations (CROs), contract manufacturing organizations (CMOs), and non-clinical services. An exhaustive value analysis for all these markets is provided for 2011, 2012, and 2013, with forecast till 2018.
US healthcare BPO market
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