Technology Solutions in U.S. Healthcare Payer Market Analysis

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.

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.