PUBLISHER: Grand View Research | PRODUCT CODE: 1511849
PUBLISHER: Grand View Research | PRODUCT CODE: 1511849
U.S. Healthcare Payers Core Administrative Processing Solutions Market Size, Share & Trends Analysis Report By Type (Software, Services), By Deployment (On-premise, Cloud-based), And Segment Forecasts, 2024 - 2030
U.S. Healthcare Payers Core Administrative Processing Solutions Market Growth & Trends:
The U.S. healthcare payers core administrative processing solutions market size is expected to reach USD 2.88 billion by 2030 and is growing at a CAGR of 7.8% from 2024 to 2030, according to a new report by Grand View Research, Inc. The market's growth is attributed to the increasing need for operational optimization. Healthcare payers are adopting technology to enhance administrative workflows, reduce expenses, and boost operational efficiency. Moreover, the market expansion is also driven by the growing need for regulatory compliance in light of strict healthcare regulations, including Medicare Access.
Investor and venture capitalist interest in the healthcare payer sector is increasing, driven by technology startups focusing on innovative solutions. This surge in investment is attributed to various factors, including digital transformation, the adoption of value-based care models, the application of data analytics, and a shift toward consumer-centric care. These elements underscore the healthcare industry's vast potential for innovation and growth. For instance, in August 2023, VBA, a prominent provider of cloud-based software for healthcare payers, completed a majority growth equity transaction valued at USD 156 million with Spectrum Equity, a notable growth equity firm. VBA's objective is to leverage this investment to develop technologically advanced solutions to meet the expanding needs of its customer base.
Furthermore, the healthcare industry is transforming, propelled by changing patient expectations, transitioning to value-based care, and a growing demand for accessible, personalized healthcare services. This evolution fosters a competitive landscape where startups introduce advanced technologies and solutions, aiming to advance the healthcare payer ecosystem in the country. The onset of the COVID-19 pandemic made it critical to maintain business operations, effective member communication, and support. These elements continued to be significant as the situation evolved from an emerging issue to a worldwide emergency, necessitating widespread shutdowns for social distancing. To address these challenges, healthcare payers engaged with various stakeholders, including providers and government bodies. Strategies included forming partnerships, identifying members at elevated risk, and anticipating fluctuations in supply and demand.
Moreover, prominent players in the market are adopting strategic initiatives such as partnerships, new product launches, collaborations, acquisitions, and expansions to strengthen their market position and expand their customer base. For instance, in February 2022, HealthEdge entered a strategic partnership with CitiusTech to offer joint market implementation and consulting services focused on HealthEdge's solutions in care management, core administration, and payment integrity. This collaboration aims at supporting health plans transitioning to value-based care while seeking to optimize their operations.
U.S. Healthcare Payers Core Administrative Processing Solutions Market Report Highlights:
- The market is segmented by type into software and services. Software held the largest market share, 57.56% in 2023. The increasing demand for advanced and integrated solutions to streamline administrative processes, reduce operational costs, and enhance efficiency is fueling the growth
- Based on deployment, cloud-based accounted for a significant market share of 55.42% in 2023, driven by the scalability of cloud-based solutions, which allows healthcare payers to adapt their administrative operations to changing needs efficiently
- Some of the notable companies in the market are HealthEdge Software, Inc., Optum, Cognizant, HealthAxis, Plexis Healthcare Systems, Mphasis, and SS&C Technologies among others.
Table of Contents
Chapter 1. Methodology and Scope
- 1.1. Market Segmentation and Scope
- 1.2. Market Definitions
- 1.3. Research Methodology
- 1.4. Information Procurement
- 1.4.1. Purchased Database
- 1.4.2. GVR's Internal Database
- 1.5. Details of primary research
- 1.6. Market Formulation & Validation
- 1.7. Model Details
- 1.7.1. Commodity flow analysis (Model 1)
- 1.7.1.1. Approach 1: Commodity flow approach
- 1.7.2. Volume price analysis (Model 2)
- 1.7.2.1. Approach 2: Volume price analysis
- 1.7.1. Commodity flow analysis (Model 1)
- 1.8. Research Scope and Assumptions
- 1.8.1. List of Secondary Sources
- 1.8.2. List of Primary Sources
- 1.8.3. Objectives
Chapter 2. Executive Summary
- 2.1. Market Outlook
- 2.2. Segment Outlook
- 2.2.1. Type Outlook
- 2.2.2. Deployment Outlook
- 2.3. Competitive Insights
Chapter 3. U.S. Healthcare Payers Core Administrative Processing Solutions (CAPS) Market Variables, Trends, & Scope
- 3.1. Market Lineage Outlook
- 3.1.1. Parent Market Outlook
- 3.1.2. Related/Ancillary Market Outlook
- 3.2. Pricing Analysis Around the Medical Food Market
- 3.3. Industry Analysis
- 3.3.1. User Perspective Analysis
- 3.3.2. Key Deployments
- 3.4. Technology Outlook
- 3.5. Regulatory Framework
- 3.6. Market Dynamics
- 3.6.1. Market Drivers Analysis
- 3.6.2. Market Restraints Analysis
- 3.6.3. Industry Challenges and Opportunity Analysis
- 3.7. U.S. Healthcare Payers Core Administrative Processing Solutions (CAPS) Market Analysis Tools
- 3.7.1. Porter's Analysis
- 3.7.1.1. Bargaining power of the suppliers
- 3.7.1.2. Bargaining power of the buyers
- 3.7.1.3. Threats of substitution
- 3.7.1.4. Threats from new entrants
- 3.7.1.5. Competitive rivalry
- 3.7.2. PESTEL Analysis
- 3.7.2.1. Political landscape
- 3.7.2.2. Economic and Social landscape
- 3.7.2.3. Technological landscape
- 3.7.2.4. Environmental landscape
- 3.7.2.5. Legal landscape
- 3.7.1. Porter's Analysis
- 3.8. Major Deals & Strategic Alliances Analysis in the U.S. Healthcare Payers Core Administrative Processing Solutions (CAPS) Industry
- 3.9. Impact of COVID-19
- 3.10. Case Study
Chapter 4. U.S. Healthcare Payers Core Administrative Processing Solutions (CAPS) Market: Type Estimates & Trend Analysis
- 4.1. Definition and Scope
- 4.2. Type Market Share Analysis, 2023 & 2030
- 4.3. Segment Dashboard
- 4.4. U.S. Healthcare Payers Core Administrative Processing Solutions (CAPS) Market : By Type, 2018 to 2030
- 4.5. Software
- 4.5.1. Software Market Revenue Estimates and Forecasts, 2018 - 2030 (USD Billion)
- 4.5.2. Standalone
- 4.5.2.1. Standalone Market Revenue Estimates and Forecasts, 2018 - 2030 (USD Billion)
- 4.5.3. Integrated
- 4.5.3.1. Integrated Market Revenue Estimates and Forecasts, 2018 - 2030 (USD Billion)
- 4.6. Services
- 4.6.1. Services Market Revenue Estimates and Forecasts, 2018 - 2030 (USD Billion)
Chapter 5. U.S. Healthcare Payers Core Administrative Processing Solutions (CAPS) Market: Deployment Estimates & Trend Analysis
- 5.1. Definition and Scope
- 5.2. Deployment Market Share Analysis, 2023 & 2030
- 5.3. Segment Dashboard
- 5.4. U.S. Healthcare Payers Core Administrative Processing Solutions (CAPS) Market: By Deployment, 2018 to 2030
- 5.5. On-premise
- 5.5.1. On-premise Market Revenue Estimates and Forecasts, 2018 - 2030 (USD Billion)
- 5.6. Cloud-based
- 5.6.1. Cloud-based Market Revenue Estimates and Forecasts, 2018 - 2030 (USD Billion)
Chapter 6. Competitive Landscape
- 6.1. Recent Developments & Impact Analysis by Key Market Participants
- 6.2. Company Categorization
- 6.3. Company Market Share Analysis
- 6.4. Company Heat Map Analysis
- 6.5. Strategy Mapping
- 6.5.1. Expansion
- 6.5.2. Mergers & Acquisition
- 6.5.3. Partnerships & Collaborations
- 6.5.4. New Type Launches
- 6.5.5. Research And Development
- 6.6. Company Profiles
- 6.6.1. HealthEdge Software, Inc.
- 6.6.1.1. Participant's Overview
- 6.6.1.2. Financial Performance
- 6.6.1.3. Type Benchmarking
- 6.6.1.4. Recent Developments
- 6.6.2. Optum
- 6.6.2.1. Participant's Overview
- 6.6.2.2. Financial Performance
- 6.6.2.3. Type Benchmarking
- 6.6.2.4. Recent Developments
- 6.6.3. Cognizant
- 6.6.3.1. Participant's Overview
- 6.6.3.2. Financial Performance
- 6.6.3.3. Type Benchmarking
- 6.6.3.4. Recent Developments
- 6.6.4. HealthAxis
- 6.6.4.1. Participant's Overview
- 6.6.4.2. Financial Performance
- 6.6.4.3. Type Benchmarking
- 6.6.4.4. Recent Developments
- 6.6.5. Plexis Healthcare Systems
- 6.6.5.1. Participant's Overview
- 6.6.5.2. Financial Performance
- 6.6.5.3. Type Benchmarking
- 6.6.5.4. Recent Developments
- 6.6.6. Mphasis
- 6.6.6.1. Participant's Overview
- 6.6.6.2. Financial Performance
- 6.6.6.3. Type Benchmarking
- 6.6.6.4. Recent Developments
- 6.6.7. SS&C Technologies
- 6.6.7.1. Participant's Overview
- 6.6.7.2. Financial Performance
- 6.6.7.3. Type Benchmarking
- 6.6.7.4. Recent Developments
- 6.6.8. Conduent
- 6.6.8.1. Participant's Overview
- 6.6.8.2. Financial Performance
- 6.6.8.3. Type Benchmarking
- 6.6.8.4. Recent Developments
- 6.6.9. RAM Technologies
- 6.6.9.1. Participant's Overview
- 6.6.9.2. Financial Performance
- 6.6.9.3. Type Benchmarking
- 6.6.9.4. Recent Developments
- 6.6.10. Evolent
- 6.6.10.1. Participant's Overview
- 6.6.10.2. Financial Performance
- 6.6.10.3. Type Benchmarking
- 6.6.10.4. Recent Developments
- 6.6.11. Invidasys
- 6.6.11.1. Participant's Overview
- 6.6.11.2. Financial Performance
- 6.6.11.3. Type Benchmarking
- 6.6.11.4. Recent Developments
- 6.6.12. Advantasure
- 6.6.12.1. Participant's Overview
- 6.6.12.2. Financial Performance
- 6.6.12.3. Type Benchmarking
- 6.6.12.4. Recent Developments
- 6.6.13. VBA solftware
- 6.6.13.1. Participant's Overview
- 6.6.13.2. Financial Performance
- 6.6.13.3. Type Benchmarking
- 6.6.13.4. Recent Developments
- 6.6.14. Advalent Corp
- 6.6.14.1. Participant's Overview
- 6.6.14.2. Financial Performance
- 6.6.14.3. Type Benchmarking
- 6.6.14.4. Recent Developments
- 6.6.1. HealthEdge Software, Inc.
List of Tables
- Table 1 List of secondary sources
- Table 2 List of abbreviation
- Table 3 U.S. Healthcare Payers Core Administrative Processing Solutions (CAPS) Market, by Type, 2018 - 2030 (USD Million)
- Table 4 U.S. Healthcare Payers Core Administrative Processing Solutions (CAPS) Market, by Deployment, 2018 - 2030 (USD Million)
List of Figures
- Fig. 1 List of Figures
- Fig. 2 U.S. Healthcare Payers Core Administrative Processing Solutions (CAPS) Market Segmentation
- Fig. 3 Information Procurement
- Fig. 4 Data Analysis Models
- Fig. 5 Market Formulation and Validation
- Fig. 6 Data Validating & Publishing
- Fig. 7 Market Snapshot
- Fig. 8 Segment Snapshot
- Fig. 9 Competitive Landscape Snapshot
- Fig. 10 U.S. Healthcare Payers Core Administrative Processing Solutions (CAPS) - Market Size and Growth Prospects (USD Billion)
- Fig. 11 U.S. Healthcare Payers Core Administrative Processing Solutions (CAPS) Market : Market Dynamics
- Fig. 12 U.S. Healthcare Payers Core Administrative Processing Solutions (CAPS) Market : PORTER's Analysis
- Fig. 13 U.S. Healthcare Payers Core Administrative Processing Solutions (CAPS) Market : PESTEL Analysis
- Fig. 14 U.S. Healthcare Payers Core Administrative Processing Solutions (CAPS) Market Share by Type: Key Takeaways
- Fig. 15 U.S. Healthcare Payers Core Administrative Processing Solutions (CAPS) Market, by Type: Market Share, 2023 & 2030
- Fig. 16 Software Market Estimates & Forecasts, 2018 - 2030 (USD Million)
- Fig. 17 Standalone Market Estimates & Forecasts, 2018 - 2030 (USD Million)
- Fig. 18 Integrated Market Estimates & Forecasts, 2018 - 2030 (USD Million)
- Fig. 19 Services Market Estimates & Forecasts, 2018 - 2030 (USD Million)
- Fig. 20 U.S. Healthcare Payers Core Administrative Processing Solutions Market, by Deployment: Key Takeaways
- Fig. 21 U.S. Healthcare Payers Core Administrative Processing Solutions Market, by Deployment: Market Share, 2023 & 2030
- Fig. 22 On-premise Market Estimates & Forecasts, 2018 - 2030 (USD Million)
- Fig. 23 Cloud-based Market Estimates & Forecasts, 2018 - 2030 (USD Million)
- Fig. 24 Key Company Categorization
- Fig. 25 Company Market Positioning
- Fig. 26 Key Company Market Share Analysis, 2023
- Fig. 27 Strategic Framework
