Trump’s Anti-Obamacare Stance Depresses Growth of Healthcare Payer Business Process Outsourcing Market—Everest Group

payers are increasingly demanding new-age solutions such as robotic process automation, business process as a service, and predictive analytics as they move towards imbibing value-based care models

The Affordable Care Act contributed to an 11 percent compound annual growth rate (CAGR) in the healthcare payer business process outsourcing (BPO) market from 2013 through 2015, but in 2016, growth declined slightly to 9 percent owing to political and regulatory uncertainty in the U.S. Everest Group expects a further downturn—7 to 9 percent CAGR—through 2018 due to the anti-Affordable Care Act stance of newly elected U.S. President Donald Trump and uncertainty surrounding the changes his administration could bring to the market.

“With the withdrawal of the Republicans’ first attempt to repeal and replace the Affordable Care Act, a great deal of uncertainty remains in the healthcare market, but one thing we can be sure of is the tremendous impact that technology will have on healthcare payer BPO going forward,” said Anupam Jain, practice director at Everest Group. “Payer’s needs are evolving from traditional purchasing drivers, such as cost reduction, to emerging purchasing drivers such as access to better technology and domain expertise. More specifically, payers are increasingly demanding new-age solutions such as robotic process automation, business process as a service, and predictive analytics as they move towards imbibing value-based care models.”

In 2016, other key themes that dominated the healthcare payer BPO market included an industry shift towards value-based reimbursement (VBR) models, payer-provider convergence, and the withdrawal from health insurance exchanges of several payers who cited rising losses as the main reason for this move.

A more detailed discussion about the healthcare payer BPO market is available in “Healthcare Payer BPO – Annual Report: Value-Based Sourcing Helping Payers Stay Afloat in an Era of Uncertainty.” This report provides a detailed analysis of the market size and growth, key drivers and challenges, solution characteristics, and the service provider landscape.

Other key findings:


  • In terms of adoption characteristics, cost reduction continues to be the most important purchase driver for buyers; however, their focus on technology (automation, analytics, etc.) and expertise is increasing
  • Buyers’ preference for short contract length continues to rise, as it gives them the flexibility to replace a service provider in case of non-compliance
  • Claims management continues to be the most outsourced process in the healthcare payer BPO market, with a share of 60 percent
  • The market continues to remain consolidated at the top, with Accenture, Cognizant, Conduent and…

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