Healthcare IT Outsourcing Market Accelerates as Payers Alter Operating Models

Wide-sweeping regulatory reform mandates as well as a new phenomenon of demand consumerization are forcing healthcare payers to alter their operating models and rethink their technology initiatives. The duress they face is driven by a fundamental market shift in which individual consumers exhibit increased ownership of health outcomes.

As a result of these converging forces, the healthcare IT outsourcing (ITO) market is accelerating. The global healthcare ITO market is expected to increase at a 12 percent compound annual growth rate from 2013 to 2020, reaching US$68 billion in 2020.

As in recent years, payers continue to form outsourcing partnerships to address remediation, claims processing and the modernization of legacy systems. Mid-sized providers are leading market activity and are increasingly looking to service providers for cost-effective ways to respond to regulatory demands as well as strategies for shifting from business-to-business to business-to-consumer marketing and service models.

These findings and more are discussed in the report, “IT Outsourcing (ITO) in the Payer Industry – Annual Report 2014: Regulations on Payers’ Mind.” An overview of the ITO market for the healthcare payer industry, this report analyzes market size and growth, forecasts (up to 2020), demand drivers, adoption and scope trends, key areas of investment, and implications for key stakeholders (buyers and service providers). The central theme of the publication focuses on the implications of the regulatory overhaul, which is fundamentally changing payers’ go-to-market strategies, operating models, current systems, interfaces, and vendor portfolios.

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“Two significant forces are fundamentally altering health plan business models, changing payers’ IT needs, and ultimately leading to a surge in adoption of IT and business process outsourcing,” said Jimit Arora, vice president at Everest Group. “First, the healthcare industry is grappling with the uncertainty of reform mandates such as the PPACA (Obamacare) and the transition to ICD-10.

“Secondly, as consumers assume greater ownership, control and responsibility for their health outcomes, payers need to revisit their customer acquisition strategies. They are looking to digital enablers of real-time consumerization—big data, analytics, cloud, and social media—to transform their marketing and customer service approaches to consumer-centric models.”

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High-resolution graphics illustrating the report’s key takeaways can be included in news coverage, with attribution to Everest Group. Graphics include:

• ITO in the payer industry – regulation on payers’ minds
• Healthcare payers, weighed down by regulatory mandates, turn to ITO

 Two converging forces—reforms mandates and consumerization of healthcare—are fundamentally changing payers’ operating models