美國醫療保健付款人核心管理處理解決方案市場規模、佔有率和趨勢分析報告：按類型、部署和細分市場預測，2024-2030 年

美國醫療保健付款人核心管理處理解決方案市場成長與趨勢：

Grand View Research, Inc.最新報告顯示，到2030年，美國醫療保健付款人核心管理處理解決方案市場規模預計將達到28.8億美元，複合年成長率為7.8%。該市場的成長是由不斷成長的業務最佳化需求所推動的。醫療保健提供者正在部署技術來增強管理工作流程、減少開支並提高業務效率。此外，鑑於嚴格的醫療保健法規（包括醫療保險准入），對監管合規性的需求不斷增加，也是促進市場擴張的因素。

在專注於創新解決方案的科技新興企業的推動下，投資者和創業投資對醫療保健支付領域的興趣不斷成長。投資激增是由於多種因素造成的，包括數位轉型、採用基於價值的護理模式、資料分析的應用以及向以消費者為中心的護理的轉變。這些因素支撐了醫療保健產業創新和成長的巨大潛力。例如，2023 年 8 月，為醫療保健付款人雲端基礎的軟體的著名提供者 VBA 與著名成長型股權公司頻譜 股權達成了 1.56 億美元的多數成長型股權交易。 VBA 的目標是利用這項投資來開發技術先進的解決方案，以滿足其客戶群不斷成長的需求。

此外，由於患者期望的變化、向基於價值的護理的轉變以及對便利和個人化醫療保健服務的需求不斷成長，醫療保健行業正在經歷一場轉型。這種演變將培育一種競爭格局，新興企業將部署先進的技術和解決方案，旨在在該國發展醫療保健支付生態系統。 COVID-19 大流行的爆發使得維持業務運作、有效的會員溝通和支援變得至關重要。隨著局勢從一個新出現的問題演變​​為全球緊急情況，這些因素仍然具有相關性，需要大規模的停工以加強社交距離。為了應對這些挑戰，醫療保健提供者與各種相關人員（包括提供者和政府機構）合作。策略包括建立合作夥伴關係、識別高風險成員以及預測供需波動。

此外，市場主要企業正在採取聯盟、新產品發布、合資、收購和業務擴張等策略性舉措，以鞏固其市場地位並擴大基本客群。例如，2022 年 2 月，HealthEdge 與 CitiusTech 建立策略合作夥伴關係，提供聯合市場開發和諮詢服務，重點關注 HealthEdge 在護理管理、核心管理和支付完整性的解決方案。該合作夥伴關係旨在幫助健康計劃過渡到基於價值的護理，同時最佳化業務。

美國醫療保健付款人核心管理處理解決方案市場報告亮點

• 按類型分類，市場分為軟體和服務。到 2023 年，軟體將佔據最大的市場佔有率，達到 57.56%。對先進整合解決方案的需求不斷成長，以簡化管理流程、降低營運成本並提高效率，從而推動了成長。
• 雲端基礎的解決方案具有擴充性，使醫療保健提供者能夠有效地調整管理業務以適應不斷變化的需求。
• 該市場的著名公司包括 HealthEdge Software, Inc.、Optum、Cognizant、HealthAxis、Plexis Healthcare Systems、Mphasis 和 SS&C Technologies。

目錄

第1章調查方法與範圍

第 2 章執行摘要

第 3 章：美國醫療保健付款人核心行政處理解決方案 (CAPS) 市場變數、趨勢和範圍

• 市場體系展望
  • 母市場展望
  • 相關/輔助市場展望
• 藥用食品市場價格分析
• 產業分析
  • 使用者觀點分析
  • 主要進展
• 技術展望
• 法律規範
• 市場動態
  • 市場促進因素分析
  • 市場限制因素分析
  • 產業挑戰與機會分析
• 適用於美國醫療保健付款人的核心行政處理解決方案 (CAPS) 市場分析工具
  • 波特的分析
  • PESTEL分析
• 美國醫療保險公司核心行政處理解決方案（CAPS）產業重大交易與策略聯盟分析
• COVID-19 的影響
• 案例研究

第4章美國醫療保健支付者核心行政處理解決方案（CAPS）市場：類型估計和趨勢分析

• 定義和範圍
• 2023 年和 2030 年按類型分類的市場佔有率分析
• 細分儀表板
• 2018-2030 年美國醫療保健付款人核心行政處理解決方案 (CAPS) 市場（按類型）
• 軟體
• 服務

第5章美國醫療保健支付者核心行政處理解決方案（CAPS）市場：發展估算與趨勢分析

• 定義和範圍
• 2023 年及 2030 年部署市場佔有率分析
• 細分儀表板
• 美國醫療保健付款人核心行政處理解決方案 (CAPS) 市場：按部署分類，2018-2030 年
• 本地
• 雲端基礎

第6章 競爭狀況

• 主要市場參與企業的最新趨勢和影響分析
• 公司分類
• 公司市場佔有率分析
• 企業熱力圖分析
• 策略規劃
  • 擴張
  • 併購
  • 夥伴關係與協作
  • 新類型發布
  • 研究與開發
• 公司簡介
  • HealthEdge Software, Inc.
  • Optum
  • Cognizant
  • HealthAxis
  • Plexis Healthcare Systems
  • Mphasis
  • SS&C Technologies
  • Conduent
  • RAM Technologies
  • Evolent
  • Invidasys
  • Advantasure
  • VBA solftware
  • Advalent Corp

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
• 1.8. 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
• 3.8. 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

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