Table of Content




1 INTRODUCTION 12
1.1 OBJECTIVES OF THE STUDY 12
1.2 MARKET DEFINITION 12
1.3 OVERVIEW OF NORTH AMERICA HEALTHCARE BPO MARKET 12
1.4 CURRENCY AND PRICING 13
1.5 LIMITATIONS 13
1.6 MARKETS COVERED 14

2 MARKET SEGMENTATION 16
2.1 MARKETS COVERED 16
2.2 GEOGRAPHIC SCOPE 17
2.3 YEARS CONSIDERED FOR THE STUDY 18
2.4 CURRENCY AND PRICING 18
2.5 RESEARCH METHODOLOGY 19
2.6 PRIMARY INTERVIEWS WITH KEY OPINION LEADERS 22
2.7 DBMR MARKET CHALLENGE MATRIX 23
2.8 DBMR MARKET POSITION GRID 24
2.9 MULTIVARIATE MODELING 25
2.10 SERVICE LIFELINE CURVE 25
2.11 SECONDARY SOURCES 26
2.12 ASSUMPTIONS 26

3 EXECUTIVE SUMMARY 27

4 PREMIUM INSIGHTS 29

5 MARKET OVERVIEW 31
5.1 DRIVERS 33
5.1.1 REGULATORY CHANGES IN THE U.S. 33
5.1.2 PRESSURE TO REDUCE RISING HEALTHCARE COSTS 34
5.1.3 DEMAND FOR NICHE SERVICES 35
5.2 RESTRAINTS 35
5.2.1 HIDDEN COSTS OF OUTSOURCING 35
5.2.2 FEAR OF LOSING VISIBILITY AND CONTROL OVER THE BUSINESS PROCESS 36
5.3 OPPORTUNITIES 36
5.3.1 SHIFT TO ICD-10 CODING STANDARDS AND UPCOMING ICD-11 36
5.3.2 BIG DATA ANALYTICS IN HEALTHCARE 37
5.4 CHALLENGE 38
5.4.1 DEARTH OF SKILLED WORKFORCE 38

6 NORTH AMERICA HEALTHCARE BPO MARKET, BY COMPONENT 39
6.1 OVERVIEW 40
6.2 PAYER SERVICES 42
6.2.1 CLAIMS MANAGEMENT 42
6.2.2 PRODUCT DEVELOPMENT 43
6.2.3 CUSTOMER RELATIONSHIP MANAGEMENT 43
6.2.4 OPERATIONAL AND ADMINISTRATIVE MANAGEMENT 43
6.2.5 CARE MANAGEMENT 43
6.2.6 PROVIDER MANAGEMENT 43
6.2.7 INTEGRATED FRONT END SERVICES AND BACK OFFICE OPERATIONS 43
6.2.8 HUMAN RESOURCE MANAGEMENT 43
6.2.9 BILLING AND ACCOUNTS MANAGEMENT 43
6.3 PROVIDER SERVICES 44
6.3.1 REVENUE CYCLE MANAGEMENT 44
6.3.2 FINANCE AND ACCOUNTS 44
6.3.3 MEDICAL BILLING 45
6.3.4 MEDICAL CODING 45
6.3.5 MEDICAL TRANSCRIPTION 45
6.3.6 PATIENT ENROLLMENT AND STRATEGIC PLANNING 45
6.3.7 DEVICE MONITORING 45
6.4 PHARMACEUTICAL SERVICES 46
6.4.1 CLINICAL DATA MANAGEMENT 46
6.4.2 NON-CLINICAL SERVICES 46
6.4.3 OTHER NON-CLINICAL FUNCTIONS 47
6.4.4 RESEARCH AND DEVELOPMENT 47
6.4.5 PHARMACOVIGILANCE SERVICES 47
6.4.6 MANUFACTURING OUTSOURCING 47
6.4.7 SALES AND MARKETING 47
6.4.8 SUPPLY CHAIN MANAGEMENT AND LOGISTICS 47
6.4.9 OTHERS 47

7 NORTH AMERICA HEALTHCARE BPO MARKET, BY END USER 48
7.1 OVERVIEW 49
7.2 HOSPITAL 51
7.3 LIFE SCIENCES COMPANIES 51
7.4 DENTAL CLINICS 51
7.5 MEDICAL DEVICES COMPANIES 52
7.6 PUBLIC SERVICE 52
7.7 PHARMACY BENEFIT MANAGERS 52
7.8 OTHERS 52

8 NORTH AMERICA HEALTHCARE BPO MARKET, BY COUNTRY 53
8.1 NORTH AMERICA 54
8.1.1 U.S. 60
8.1.2 CANADA 63
8.1.3 MEXICO 66

9 NORTH AMERICA HEALTHCARE BPO MARKET, COMPANY LANDSCAPE 69
9.1 COMPANY SHARE ANALYSIS: NORTH AMERICA 69

10 COMPANY PROFILES 70
10.1 ACCENTURE 70
10.1.1 COMPANY SNAPSHOT 70
10.1.2 SWOT ANALYSIS 71
10.1.3 REVENUE ANALYSIS 72
10.1.4 GEOGRAPHICAL PRESENCE 73
10.1.5 SOLUTION PORTFOLIO 73
10.1.6 RECENT DEVELOPMENTS 74
10.1.7 DATA BRIDGE MARKET RESEARCH ANALYSIS 74
10.2 COGNIZANT 75
10.2.1 COMPANY SNAPSHOT 75
10.2.2 SWOT ANALYSIS 75
10.2.3 REVENUE ANALYSIS 77
10.2.4 GEOGRAPHICAL PRESENCE 78
10.2.5 SOLUTION PORTFOLIO 78
10.2.6 RECENT DEVELOPMENTS 79
10.2.7 DATA BRIDGE MARKET RESEARCH ANALYSIS 79
10.3 GEBBS HEALTHCARE SOLUTIONS 80
10.3.1 COMPANY SNAPSHOT 80
10.3.2 SWOT ANALYSIS 80
10.3.3 GEOGRAPHICAL PRESENCE 81
10.3.4 SOLUTION PORTFOLIO 81
10.3.5 RECENT DEVELOPMENTS 82
10.3.6 DATA BRIDGE MARKET RESEARCH ANALYSIS 82
10.4 UNITEDHEALTH GROUP 83
10.4.1 COMPANY SNAPSHOT 83
10.4.2 SWOT ANALYSIS 83
10.4.3 REVENUE ANALYSIS 84
10.4.4 GEOGRAPHICAL PRESENCE 85
10.4.5 SOLUTION PORTFOLIO 85
10.4.6 RECENT DEVELOPMENT 85
10.4.7 DATA BRIDGE MARKET RESEARCH ANALYSIS 86
10.5 FIRSTSOURCE 87
10.5.1 COMPANY SNAPSHOT 87
10.5.2 SWOT ANALYSIS 87
10.5.3 REVENUE ANALYSIS 88
10.5.4 GEOGRAPHICAL PRSENCE 89
10.5.5 SOLUTION PORTFOLIO 89
10.5.6 RECENT DEVELOPMENTS 90
10.5.7 DATA BRIDGE MARKET RESEARCH ANALYSIS 90
10.6 BOEHRINGER INGELHEIM 91
10.6.1 COMPANY SNAPSHOT 91
10.6.2 REVENUE ANALYSIS 91
10.6.3 GEOGRAPHICAL PRESENCE 92
10.6.4 SOLUTION PORTFOLIO 92
10.6.5 RECENT DEVELOPMENTS 93
10.7 CATALENT, INC 94
10.7.1 COMPANY SNAPSHOT 94
10.7.2 REVENUE ANALYSIS 94
10.7.3 GEOGRAPHICAL PRESENCE 95
10.7.4 SOLUTION PORTFOLIO 95
10.7.5 RECENT DEVELOPMENTS 96
10.8 CHARLES RIVER 97
10.8.1 COMPANY SNAPSHOT 97
10.8.2 REVENUE ANALYSIS 97
10.8.3 GEOGRAPHICAL PRESENCE 98
10.8.4 SOLUTION PORTFOLIO 98
10.8.5 RECENT DEVELOPMENTS 99
10.9 COVANCE INC. 100
10.9.1 COMPANY SNAPSHOT 100
10.9.2 GEOGRAPHICAL PRESENCE 100
10.9.3 SOLUTION PORTFOLIO 101
10.9.4 RECENT DEVELOPMENT 101
10.10 GENPACT 102
10.10.1 COMPANY SNAPSHOT 102
10.10.2 REVENUE ANALYSIS 102
10.10.3 GEOGRAPHICAL PRESENCE 103
10.10.4 SOLUTION PORTFOLIO 103
10.10.5 RECENT DEVELOPMENTS 103
10.11 HCL TECHNOLOGIES LIMITED 104
10.11.1 COMPANY SNAPSHOT 104
10.11.2 REVENUE ANALYSIS 104
10.11.3 GEOGRAPHICAL PRESENCE 105
10.11.4 SOLUTION PORTFOLIO 106
10.11.5 RECENT DEVELOPMENTS 106
10.12 HGS LTD. 107
10.12.1 COMPANY SNAPSHOT 107
10.12.2 REVENUE ANALYSIS 107
10.12.3 GEOGRAPHICAL PRESENCE 108
10.12.4 SOLUTION PORTFOLIO 108
10.12.5 RECENT DEVELOPMENTS 109
10.13 INVENSIS TECHNOLOGIES PVT LTD 110
10.13.1 COMPANY SNAPSHOT 110
10.13.2 GEOGRAPHICAL PRESENCE 110
10.13.3 SOLUTION PORTFOLIO 111
10.13.4 RECENT DEVELOPMENTS 111
10.14 IQVIA 112
10.14.1 COMPANY SNAPSHOT 112
10.14.2 REVENUE ANALYSIS 112
10.14.3 GEOGRAPHICAL PRESENCE 113
10.14.4 SOLUTION PORTFOLIO 113
10.14.5 RECENT DEVELOPMENTS 114
10.15 LONZA 115
10.15.1 COMPANY SNAPSHOT 115
10.15.2 REVENUE ANALYSIS 115
10.15.3 GEOGRAPHICAL PRESENCE 116
10.15.4 SOLUTION PORTFOLIO 117
10.15.5 RECENT DEVELOPMENTS 117
10.16 PAREXEL 118
10.16.1 COMPANY SNAPSHOT 118
10.16.2 REVENUE ANALYSIS 118
10.16.3 GEOGRAPHICAL PRESENCE 119
10.16.4 SOLUTION PORTFOLIO 119
10.16.5 RECENT DEVELOPMENTS 121
10.17 PHARMACEUTICAL PRODUCT DEVELOPMENT, LLC. 122
10.17.1 COMPANY SNAPSHOT 122
10.17.2 GEOGRAPHICAL PRESENCE 123
10.17.3 SOLUTION PORTFOLIO 123
10.17.4 RECENT DEVELOPMENTS 124
10.18 PREMIER BPO, INC. 125
10.18.1 COMPANY SNAPSHOT 125
10.18.2 GEOGRAPHICAL PRESENCE 125
10.18.3 SOLUTION PORTFOLIO 126
10.18.4 RECENT DEVELOPMENT 127
10.19 SUTHERLAND GLOBAL, INC. 128
10.19.1 COMPANY SNAPSHOT 128
10.19.2 GEOGRAPHICAL PRESENCE 128
10.19.3 SOLUTION PORTFOLIO 129
10.19.4 RECENT DEVELOPMENTS 130
10.20 WNS (HOLDINGS) LTD. 131
10.20.1 COMPANY SNAPSHOT 131
10.20.2 REVENUE ANALYSIS 131
10.20.3 GEOGRAPHICAL PRESENCE 132
10.20.4 SOLUTION PORTFOLIO 133
10.20.5 RECENT DEVELOPMENTS 133
11 QUESTIONNAIRE 134
12 RELATED REPORTS 136



List of Figures



FIGURE 1 NORTH AMERICA HEALTHCARE BPO MARKET: SEGMENTATION 16
FIGURE 2 NORTH AMERICA HEALTHCARE BPO MARKET: DATA TRIANGULATION 19
FIGURE 3 NORTH AMERICA HEALTHCARE BPO MARKET: DROC ANALYSIS 20
FIGURE 4 NORTH AMERICA HEALTHCARE BPO MARKET: BOTTOM UP APPROACH 21
FIGURE 5 NORTH AMERICA HEALTHCARE BPO MARKET: TOP DOWN APPROACH 21
FIGURE 6 NORTH AMERICA HEALTHCARE BPO MARKET: INTERVIEW DEMOGRAPHICS 22
FIGURE 7 NORTH AMERICA HEALTHCARE BPO MARKET: THE MARKET CHALLENGE MATRIX 23
FIGURE 8 NORTH AMERICA HEALTHCARE BPO MARKET: DBMR MARKET POSITION GRID 24
FIGURE 9 NORTH AMERICA HEALTHCARE BPO MARKET: SEGMENTATION 28
FIGURE 10 MAJOR FACTOR DRIVING THE GROWTH OF THIS MARKET ARE REGULATORY CHANGES IN THE U.S. PRESSURE TO REDUCE RISING HEALTHCARE COSTS EXPECTED TO DRIVE THE MARKET FOR NORTH AMERICA HEALTHCARE BPO MARKET IN THE FORECAST PERIOD OF 2019 TO 2026 29
FIGURE 11 PROVIDER SERVICES SEGMENT IS EXPECTED TO ACCOUNT FOR THE LARGEST SHARE OF THE NORTH AMERICA HEALTHCARE BPO MARKET IN 2019 & 2026 30
FIGURE 12 DRIVERS, RESTRAINTS, OPPORTUNITIES AND CHALLENGE OF NORTH AMERICA HEALTHCARE BPO MARKET 32
FIGURE 13 TOTAL NATIONAL HEALTH EXPENDITURES IN U.S., USD BILLIONS, 2015-2017 34
FIGURE 14 NORTH AMERICA HEALTHCARE BPO MARKET : BY COMPONENT, 2018 40
FIGURE 15 NORTH AMERICA HEALTHCARE BPO MARKET : BY END USER, 2018 49
FIGURE 16 NORTH AMERICA HEALTHCARE BPO MARKET: SNAPSHOT (2018) 54
FIGURE 17 NORTH AMERICA HEALTHCARE BPO MARKET: BY COUNTRY (2018) 55
FIGURE 18 NORTH AMERICA HEALTHCARE BPO MARKET: BY COUNTRY (2019) 55
FIGURE 19 NORTH AMERICA HEALTHCARE BPO MARKET: BY COUNTRY (2018 & 2026) 56
FIGURE 20 NORTH AMERICA HEALTHCARE BPO MARKET: BY COMPONENT (2019 - 2026) 56
FIGURE 21 NORTH AMERICA HEALTHCARE BPO MARKET: COMPANY SHARE 2018 (%) 69


List of Tables



TABLE 1 MAJOR COMPANIES IN U.S. IN 2017 33
TABLE 2 NAMING CONVENTIONS IN ICD-10 CODING SYSTEMS 37
TABLE 3 NORTH AMERICA HEALTHCARE BPO MARKET, BY COMPONENT, 2017– 2026 (USD MILLION) 41
TABLE 4 NORTH AMERICA PAYER SERVICES IN HEALTHCARE BPO MARKET, BY COMPONENT, 2017– 2026 (USD MILLION) 42
TABLE 5 NORTH AMERICA PROVIDER SERVICES IN HEALTHCARE BPO MARKET, BY COMPONENT, 2017– 2026 (USD MILLION) 44
TABLE 6 NORTH AMERICA PHARMACEUTICAL SERVICES IN HEALTHCARE BPO MARKET, BY COMPONENT, 2017– 2026 (USD MILLION) 46
TABLE 7 NORTH AMERICA HEALTHCARE BPO MARKET, BY END USER, 2017– 2026 (USD MILLION) 50
TABLE 8 NORTH AMERICA HEALTHCARE BPO MARKET, BY COUNTRY, 2017-2026 (USD MILLION) 57
TABLE 9 NORTH AMERICA HEALTHCARE BPO MARKET, BY COMPONENT, 2017-2026 (USD MILLION) 57
TABLE 10 NORTH AMERICA PROVIDER SERVICES IN HEALTHCARE BPO MARKET, BY COMPONENT, 2017-2026 (USD MILLION) 57
TABLE 11 NORTH AMERICA PAYER SERVICES IN HEALTHCARE BPO MARKET, BY COMPONENT, 2017-2026 (USD MILLION) 58
TABLE 12 NORTH AMERICA PHARMACEUTICAL SERVICES IN HEALTHCARE BPO MARKET, BY COMPONENT, 2017-2026 (USD MILLION) 58
TABLE 13 NORTH AMERICA HEALTHCARE BPO MARKET, BY END USER, 2017-2026 (USD MILLION) 59
TABLE 14 U.S. HEALTHCARE BPO MARKET, BY COMPONENT, 2017-2026 (USD MILLION) 60
TABLE 15 U.S. PROVIDER SERVICES IN HEALTHCARE BPO MARKET, BY COMPONENT, 2017-2026 (USD MILLION) 60
TABLE 16 U.S. PAYER SERVICES IN HEALTHCARE BPO MARKET, BY COMPONENT, 2017-2026 (USD MILLION) 61
TABLE 17 U.S. PHARMACEUTICAL SERVICES IN HEALTHCARE BPO MARKET, BY COMPONENT, 2017-2026 (USD MILLION) 61
TABLE 18 U.S. HEALTHCARE BPO MARKET, BY END USER, 2017-2026 (USD MILLION) 62
TABLE 19 CANADA HEALTHCARE BPO MARKET, BY COMPONENT, 2017-2026 (USD MILLION) 63
TABLE 20 CANADA PROVIDER SERVICES IN HEALTHCARE BPO MARKET, BY COMPONENT, 2017-2026 (USD MILLION) 63
TABLE 21 CANADA PAYER SERVICES IN HEALTHCARE BPO MARKET, BY COMPONENT, 2017-2026 (USD MILLION) 64
TABLE 22 CANADA PHARMACEUTICAL SERVICES IN HEALTHCARE BPO MARKET, BY COMPONENT, 2017-2026 (USD MILLION) 64
TABLE 23 CANADA HEALTHCARE BPO MARKET, BY END USER, 2017-2026 (USD MILLION) 65
TABLE 24 MEXICO HEALTHCARE BPO MARKET, BY COMPONENT, 2017-2026 (USD MILLION) 66
TABLE 25 MEXICO PROVIDER SERVICES IN HEALTHCARE BPO MARKET, BY COMPONENT, 2017-2026 (USD MILLION) 66
TABLE 26 MEXICO PAYER SERVICES IN HEALTHCARE BPO MARKET, BY COMPONENT, 2017-2026 (USD MILLION) 67
TABLE 27 MEXICO PHARMACEUTICAL SERVICES IN HEALTHCARE BPO MARKET, BY COMPONENT, 2017-2026 (USD MILLION) 67
TABLE 28 MEXICO HEALTHCARE BPO MARKET, BY END USER, 2017-2026 (USD MILLION) 68