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Report Overview

The United States healthcare BPO market value reached around USD 152.33 Billion in 2023. As organizations seek to reduce operational costs, outsourcing non-core functions such as medical billing, claims processing, and administrative tasks to specialised BPO providers has become a strategic priority. Companies like Cognizant and TCS offer comprehensive medical billing services that help healthcare providers streamline their revenue cycle management. As a result, the industry is expected to grow at a CAGR of 8.00% during the forecast period of 2024-2032 to attain a value of USD 304.51 Billion by 2032. The growing complexity of healthcare regulations and the need for compliance further fuel the demand for outsourced services. Firms like Optum provide regulatory compliance solutions to ensure adherence to changing laws.

2023

Base Year

2018-2023

Historical Year

2024-2032

Forecast Year

  • The Biden administration proposed a USD 6.1 trillion budget for FY 2024, which includes USD 1.9 trillion in discretionary spending aimed at enhancing healthcare services. This substantial investment is expected to significantly contribute to the growth of healthcare BPO (Business Process Outsourcing) services. With increased funding directed towards healthcare initiatives, there will be a greater demand for outsourced services that can help streamline operations, reduce costs, and improve service delivery, leading to United States healthcare BPO market expansion.
  • In February 2022, the Department of Health and Human Services (HHS) allocated nearly USD 55 million to 29 health centers funded by the Health Resources and Services Administration (HRSA), which boosted the demand for healthcare BPO. This funding supports initiatives aimed at expanding access to healthcare services, particularly in underserved areas. As these health centers enhance their capabilities, they will likely seek outsourced solutions for administrative tasks, patient management, and billing processes to focus more on direct patient care.
  • The Biden-Harris Administration announced a significant investment of USD 52 million in November 2024, aimed at enhancing healthcare services for individuals re-entering the community after incarceration. This funding is expected to support 54 health centers across the country and further aid the deployment of BPO services, contributing to United States healthcare BPO market size. By addressing the unique healthcare needs of this population, these investments will create additional opportunities for BPO providers specialising in areas such as case management, mental health services, and substance abuse treatment. The integration of BPO services into these initiatives will not only improve access to care but also enhance the quality of services provided to vulnerable populations.

United States Healthcare BPO Market Growth

Healthcare BPO plays an important role in reducing the administrative burden of employees and improving patient care. As healthcare expenses continue to escalate, organisations are increasingly compelled to find cost-effective solutions. Outsourcing non-core functions such as medical billing, claims processing, and administrative tasks to specialised BPO providers allows healthcare organisations to achieve significant cost savings. The changing preferences of the healthcare industry towards embracing a patient-centric approach also impact the growth of the United States healthcare BPO market. Outsourcing supports various functions that enable healthcare organisations to concentrate on essential patient care aspects. The United States market growth can be attributed to the increasing focus on improving operational efficiency and streamlining administrative processes within the healthcare industry. BPO also enables healthcare organisations to improve efficiency and offer accessible and convenient services.

Compound Annual Growth Rate

Value in USD Billion

8%

2024-2032


United States Healthcare BPO Market Outlook

*this image is indicative*

Key Trends and Developments

United States Healthcare BPO Market Trends

As healthcare organisations adopt RPA, there is a growing emphasis on improving patient experience. By automating administrative tasks, healthcare professionals can dedicate more time to patient care. Additionally, conversational AI is being utilised to create virtual assistants that provide 24/7 support for patients, enhancing overall service delivery and increasing United States healthcare BPO market value. For example, Cleveland Clinic has integrated conversational AI to enhance its appointment scheduling and follow-up processes. This AI-powered system allows patients to easily book, reschedule, or cancel appointments through a user-friendly interface, significantly reducing the administrative burden on staff. Additionally, it ensures timely reminders for medications and follow-up visits, enhancing patient engagement and care continuity.

Meanwhile, Kaiser Permanente has implemented a virtual assistant within their mobile app that provides personalised health coaching for patients with chronic conditions. This assistant offers daily medication reminders and lifestyle tips tailored to individual needs, helping patients manage their health more effectively while reducing the workload on healthcare providers.

United States Healthcare BPO Market Restraints

Many healthcare organisations underestimate the potential hidden costs associated with outsourcing. These can include expenses related to vendor selection, contract management, and the transition of processes to external providers. If not properly managed, these unforeseen costs can negate the anticipated savings from outsourcing, making it a less attractive option for some healthcare entities and impacting the healthcare BPO demand growth.

The increasing frequency of cyberattacks on healthcare systems raises alarms about patient data security. Ensuring robust security measures while outsourcing functions can be difficult, especially when sensitive information is involved. In February 2024, Change Healthcare experienced a major ransomware attack that resulted in the exposure of over 100 million records. This incident caused widespread disruptions across hospitals and healthcare providers relying on Change Healthcare for critical services, including claims processing and e-prescribing. The attack underscored the vulnerability of healthcare organisations to cyber threats, with the potential impact affecting a substantial portion of the U.S. population.

United States Healthcare BPO Market Dynamics

Hyperautomation, which combines RPA with AI and machine learning, is predicted to see significant growth in the coming years. This trend of United States healthcare BPO market emphasises end-to-end workflow automation across healthcare operations, aiming to enhance productivity and innovation while reducing operational costs. One of the major healthcare companies that have deployed this technology is Emergys which highlights the importance of hyperautomation in addressing inefficiencies within healthcare systems. By combining RPA with other advanced technologies, they aim to enhance operational processes and ensure quality compliance while significantly reducing costs associated with legacy systems. Their focus on agile process automation aligns with the growing demand for efficiency in healthcare operations.

Moreover, UiPath is a leading provider of RPA solutions and has been focusing on hyperautomation across various industries, including healthcare. Their platform enables healthcare organisations to automate repetitive tasks, streamline workflows, and improve patient engagement through intelligent automation.

United States Healthcare BPO Industry Segmentation

“United States Healthcare BPO Market Report and Forecast 2024-2032” offers a detailed analysis of the market based on the following segments:

Market Breakup by Payer Service

  • Claims Management
  • Customer Relationship Management (CRM)
  • Operational/Administrative Management
  • Care Management
  • Human Resource Management
  • Provider Management
  • Others

Market Breakup by Pharmaceutical Service

  • Research and Development
  • Manufacturing
  • Non-clinical Services

Market Breakup by Provider Service

  • Patient Enrollment and Strategic Planning
  • Patient Care Service
  • Revenue Cycle Management

Market Breakup by Region

  • New England
  • Mideast
  • Great Lakes
  • Plains
  • Southeast
  • Southwest
  • Rocky Mountain
  • Far West

United States Healthcare BPO Market Share

Market Insights by Payer Service

Claims management holds a significant portion of the United States healthcare BPO market share as it encompasses the intricate process of claims processing, encompassing submission, validation, and adjudication, through outsourcing. This approach aids healthcare organisations in improving efficiency and accuracy. Specialised BPO providers bring domain expertise, supporting these organisations in navigating the complexities of insurance regulations, coding requirements, and compliance standards.

As a result, this strategy facilitates error mitigation, reduces instances of claim denials, and expedites reimbursement cycles. This allows healthcare providers to reallocate resources and focus on patient care, freeing them from the challenges posed by administrative complexities.

Market Insights by Pharmaceutical Service

The Revenue Cycle Management (RCM) segment holds a significant market share due to factors such as increased government initiatives, a rise in electronic health record adoption, and the need for efficient billing processes to reduce revenue loss due to errors. As per the United States healthcare BPO industry analysis, the integration of electronic health records (EHR) with RCM systems has surged, enhancing workflow efficiency, and reducing errors in billing. Moreover, healthcare providers are increasingly adopting RCM solutions to manage their revenue cycles effectively, which is crucial as patient admissions rise.

Market Insights by Provider Service

Outsourcing of revenue cycle management (RCM) processes, encompassing tasks like medical billing, coding, claims processing, and payment collections, supports healthcare organisations to optimise their financial operations and guarantee precise and prompt reimbursement.

Furthermore, specialised healthcare BPO providers assist in navigating intricate billing codes, insurance regulations, and compliance standards, thereby decreasing billing errors and denials which influences United States healthcare BPO market dynamics and trends. This strategy optimises revenue collection, improves cash flow, and lowers operational costs. By relieving healthcare providers of the administrative burden associated with managing the revenue cycle, it enables them to focus on delivering high-quality patient care and enhancing clinical outcomes.

United States Healthcare BPO Market Regional Insights

New England United States Healthcare BPO Market Trends

New England is recognised for its advanced healthcare systems and high concentration of healthcare organisations. The region benefits from a strong presence of leading hospitals and research institutions, which drive demand for BPO services focused on administrative support, patient management, and compliance solutions, further contributing to the United States healthcare BPO industry revenue. The emphasis on innovative healthcare delivery models further propels the growth of healthcare BPO in this area.

Mideast United States Healthcare BPO Market Outlook

The Mideast region, particularly states like Pennsylvania and Ohio, has a robust healthcare infrastructure that includes numerous hospitals and insurance companies, which can boost the growth of the United States healthcare BPO market. The demand for healthcare BPO services is driven by the need for efficient claims processing, revenue cycle management, and patient engagement solutions. Additionally, the region's focus on integrating technology into healthcare operations supports the growth of outsourcing services.

Southeast United States Healthcare BPO Market Dynamics

The Southeast is experiencing significant growth in the healthcare BPO market due to an expanding population and increasing healthcare needs. States like Florida and Georgia are home to many healthcare providers that seek to reduce operational costs through outsourcing non-core functions and increase United States healthcare BPO market opportunities. The region's investment in telehealth and digital health solutions also enhances the demand for BPO services that support these technologies.

Innovative United States Healthcare BPO Startups

Startups are actively innovating and introducing technology-driven solutions to address various challenges faced by healthcare providers. These companies are focusing on enhancing operational efficiencies, improving patient experiences, and streamlining administrative processes, which can boost the growth of the United States healthcare BPO industry. Some startups are developing platforms that optimise patient engagement and billing transparency and offer data-driven solutions to assist primary care physicians.

Clipboard Health

Founded in 2016 and based in San Francisco, California, Clipboard Health is a healthcare staffing platform that connects healthcare facilities with qualified medical professionals, including nurses and certified nursing assistants. The company utilises a proprietary algorithm to match healthcare professionals with job opportunities tailored to their skills and preferences. This innovative approach aims to improve the efficiency and transparency of staffing solutions in the healthcare sector.

Tomorrow Health

Established in 2018 and located in New York City, Tomorrow Health focuses on providing personalised in-home medical equipment and supplies for patients with chronic conditions. The startup collaborates with healthcare providers and insurance companies to simplify the process of obtaining and managing necessary medical equipment, ensuring that patients receive high-quality care at home.

Competitive Landscape

Companies are adopting advanced technologies, including artificial intelligence and automation, to streamline administrative processes and reduce costs. Additionally, there is a significant push towards enhancing data security and compliance with evolving regulations, which can impact the healthcare BPO demand forecast. Companies are also responding to government initiatives aimed at improving healthcare access and quality, particularly through virtual care solutions.

Accenture Plc

Accenture Plc, founded in 1989, is a prominent management consulting, technology services, and outsourcing company. Offering an extensive range of software products and services, the company caters to various industries, including aerospace and defence, automotive, banking, capital markets, chemicals, communications and media, consumer goods and services, energy, health, technology, industrial, insurance, life sciences, and natural resources, among others.

Genpact Plc

Genpact Plc, founded in 1997, is a renowned global professional services firm in United States healthcare BPO ...

Wipro Limited

Wipro Limited is a consulting and technology service company that is headquartered in Bengaluru, India. It is ...

*Please note that this is only a partial list; the complete list of key players is available in the full report. Additionally, the list of key players can be customized to better suit your needs.*

Other market players operating in the United States healthcare BPO market include Cognizant Technology Solutions Corporation, IQVIA Inc., Infosys Limited, Sutherland Global Services, Inc., Access Healthcare, Global Virtuoso, Inc., and Flatworld Solutions Inc., among others.

*While we strive to always give you current and accurate information, the numbers depicted on the website are indicative and may differ from the actual numbers in the main report. At Expert Market Research, we aim to bring you the latest insights and trends in the market. Using our analyses and forecasts, stakeholders can understand the market dynamics, navigate challenges, and capitalize on opportunities to make data-driven strategic decisions.*

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Key Questions Answered in the Report

In 2023, the market reached an approximate value of USD 152.33 Billion.

The United States healthcare BPO market is assessed to grow at a CAGR of 8.00% between 2024 and 2032.

The market is estimated to witness healthy growth in the forecast period of 2024-2032 to reach a value of around USD 304.51 Billion by 2032.

The major market drivers are the rising demand for operational efficiency and a shift toward cost containment and financial optimisation.

The key trends aiding the market expansion include the rapid adoption of advanced technologies and evolving regulatory compliances in the healthcare industry.

The major regional markets include New England, Mideast, Great Lakes, Plains, Southeast, Southwest, Rocky Mountain, and Far West.

The various provider services of healthcare BPO are patient enrolment and strategic planning, patient care service, and revenue cycle management.

The key players in the market include Accenture Plc, Genpact Plc, Cognizant Technology Solutions Corporation, Wipro Limited, IQVIA Inc., Infosys Limited, Sutherland Global Services, Inc., Access Healthcare, Global Virtuoso, Inc., and Flatworld Solutions Inc., among others.

Report Summary

Explore our key highlights of the report and gain a concise overview of key findings, trends, and actionable insights that will empower your strategic decisions.

Key Highlights of the Report

Please note that the figures mentioned in the description serve as estimates and may vary from the actual figures presented in the final report.

REPORT FEATURES DETAILS
Base Year 2023
Historical Period 2018-2023
Forecast Period 2024-2032
Scope of the Report

Historical and Forecast Trends, Industry Drivers and Constraints, Historical and Forecast Market Analysis by Segment:

  • Payer Service
  • Pharmaceutical Service
  • Provider Service
  • Region
Breakup by Payer Service
  • Claims Management
  • Customer Relationship Management (CRM)
  • Operational/Administrative Management
  • Care Management
  • Human Resource Management
  • Provider Management
  • Others
Breakup by Pharmaceutical Service
  • Research and Development
  • Manufacturing
  • Non-clinical Services
Breakup by Provider Service
  • Patient Enrollment and Strategic Planning
  • Patient Care Service
  • Revenue Cycle Management
Breakup by Region
  • New England
  • Mideast
  • Great Lakes
  • Plains
  • Southeast
  • Southwest
  • Rocky Mountain
  • Far West
Market Dynamics
  • SWOT Analysis
  • Porter's Five Forces Analysis
  • Key Indicators for Demand
  • Key Indicators for Price
Competitive Landscape
  • Market Structure
  • Company Profiles
    • Company Overview
    • Product Portfolio
    • Demographic Reach and Achievements
    • Certifications
Companies Covered
  • Accenture Plc
  • Cognizant Technology Solutions Corporation
  • Genpact Plc
  • Wipro Limited
  • IQVIA Inc.
  • Infosys Limited
  • Sutherland Global Services, Inc.
  • Access Healthcare
  • Global Virtuoso, Inc.
  • Flatworld Solutions Inc.
  • Others

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63 Fiona Drive, Tamworth, NSW

+61-448-061-727

C130 Sector 2 Noida, Uttar Pradesh 201301

+91-858-608-1494

40th Floor, PBCom Tower, 6795 Ayala Avenue Cor V.A Rufino St. Makati City, 1226.

+63-287-899-028, +63-967-048-3306

6 Gardner Place, Becketts Close, Feltham TW14 0BX, Greater London

+44-753-713-2163

193/26/4 St.no.6, Ward Binh Hung Hoa, Binh Tan District, Ho Chi Minh City

+84-865-399-124