USD 2.62 billion
U.S. Healthcare Predictive Payer Market Size, Share, Growth Analysis, By Analytics Type(Descriptive Analytics, Predictive Analytics, Prescriptive Analytics), By Delivery Model(On-Premises, Web-Hosted, Cloud-Based), By Component(Software, Hardware, Services), By Application(Clinical, Financial, Operational & Administrative), By Region - Industry Forecast 2025-2032
Report ID:
SQMIG35G2272 |
Region:
Country |
Published Date: February, 2024
Pages:
224
|Tables:
117
|Figures:
77
U.S. Healthcare Predictive Payer Market Insights
U.S. Healthcare Predictive Payer Market size was valued at USD 3.9 Billion in 2023 and is poised to grow from USD 4.76 Billion in 2024 to USD 23.69 Billion by 2032, growing at a CAGR of 22.1% during the forecast period (2025-2032).
In healthcare, a payor is a person, organization, or entity that pays for the care services administered by a healthcare provider. This term most often refers to private insurance companies, which provide customers with health plans that offer cost coverage and reimbursements for medical treatment and care services. The increasing rate of digitization in the healthcare industry is the primary factor driving growth in the analytics for the payers’ market. The use of electronic medical records has been widespread, more so during COVID-19, the increase in adoption rates of such technologies is propelling growth. The digital records and digital technology being adopted by the health system across the U.S. create a huge amount of data that can be used to derive meaningful results and observations to decrease cost, optimize treatment and mitigate risks.
Increase in the healthcare expenditure has risen over the years, according to the National Health Expenditure for 2020 was $4.1 trillion, accounting for 19.7% of the total GDP. The increase is not only supporting the growing infrastructural needs but is also helping in accommodating the increasing patient volumes. The increase in the incidence of diseases and the growing need for better healthcare solutions are key drivers for the growth of the us healthcare predictive payer market. There has been a shift in the industry since the passing of the Affordable Care Act, under which the hospital systems are now more focused on value-based care rather than the volume of patients being treated. The COVID-19 pandemic generated a huge opportunity for the healthcare payer analytics market. The industry saw an increase in adoption of digital solutions like telemedicine, adoption of EHRs grew, the plethora of data that was generated during the pandemic was overwhelming even for the healthcare analytics industry, the amount of data generated was unprecedented, and there have been improvements in the record-keeping and data analytics and the industry is continuously evolving and improving to accommodate all the challenges that the pandemic is presenting it with.
US Healthcare Predictive Payer Market is poised to grow at a sustainable CAGR for the next forecast.
Market snapshot - 2024-2031
Global Market Size
Largest Segment
Financial
Fastest Growth
Financial
Growth Rate
22.1% CAGR
Global US Healthcare Predictive Payer Market ($ Bn)
Country Share for North America Region (%)
Country Share for Aisa Pacific Region (%)
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U.S. Healthcare Predictive Payer Market Segmental Analysis
US healthcare payer analytics market is segmented based on the analytics type, delivery model, component, and application. Based on analytics type, US healthcare payer analytics market is segmented into descriptive analytics, predictive analytics, and prescriptive analytics. Based on delivery model, the US healthcare payer analytics market is segmented into on-premises, web-hosted, and cloud-based. On the basis component, the US healthcare payer analytics are segmented into software, hardware, and services. Based on application, it is categorized into clinical, financial, and operational & administrative.
US Healthcare Predictive Payer Market Analysis by Analytics Type
The descriptive analytics segment had the largest us healthcare predictive payer market share of 37.4% in 2021. This analytics type is the most widely used in process optimization as well as administrative activities. This method analyzes past as well as present data to bring forth meaningful information or a pattern that can significantly impact future decisions. Specifically, for COVID, it has been used to determine how contagious the virus is by studying the rate of positive COVID tests in a given population over a specific time. Descriptive analytics analyzes data to derive meaningful results and can significantly impact future decisions. The predictive analysis segment is the fastest growing segment during the forecast period. Prescriptive analytics explores several possible actions and suggests actions depending on the results of descriptive and predictive analytics of a given dataset. The rapid growth of the segment is owing to its potential to assist in highlighting strengths, weaknesses, and opportunities in treatment methods and prescribe better business practices, which will ultimately reduce costs while mitigating care and financial risks for all stakeholders. Personalized care has been gaining a lot of momentum and predictive analysis has proved useful to understand the specific treatment needs of each patient and enables providers to offer the best treatment plans.
US Healthcare Predictive Payer Market Analysis by Delivery model
On-premises delivery model dominated the us healthcare predictive payer market with a share of 49.4% in 2021. The healthcare industry is evolving in terms of technology, use of on-premise models has largely been adopted by the industry, and it has many benefits like better access to data, reduced chances of theft of data, reduced cost, and ease of maintenance. On-premises storing of data has the biggest downside of storage capacity limitations making it a huge hurdle in the growth of this segment. On-premises installation results in less theft of data and provide easier access and maintenance of data and patient records. Cloud-based storage and improvement in privacy concerns have made the cloud-based delivery model the fastest growing segment. The rapid adoption of this delivery model by healthcare organizations has resulted in the rapid growth of the segment. The biggest hindrance posed by the on-premise storage is easily managed by a cloud-based solution, since there are no capacity limitations, the data that can be stored is huge and requires minimal setup by the organization, which has resulted in the growth of the market.
US Healthcare Predictive Payer Market Analysis by Component
By component, the services segment had the largest us healthcare predictive payer market share of 41.8% in 2021. Outsource of data has been the recent trend in the market, this not only offers the establishments to get the data analyzed from industry experts but also saves the cost of training and educating their staff to do the same. Services segment was recorded to have the fastest growth rate in terms of components; as in 2021, the lack of appropriate staff for analytics in the industry is a major driver for the growth of this segment. Due to this the analytics part is often outsourced and is thus helping the service sector grow, in turn helping the growth of healthcare payer analytics.
US Healthcare Predictive Payer Market Analysis by Application
The financial application segment dominated the us healthcare predictive payer market with a revenue share of 35.7% in 2021, the increased rate of adoption by government and private facilities alike has been the main factor driving the growth of the market. A number of financial applications can save millions in fraudulent claims, claims settlement, and risk analysis for insurance companies. According to National Healthcare Anti-Fraud Association, healthcare frauds in the U.S. amount to nearly $80 billion per year. The use of healthcare analytics can not only reduce incidences of fraud but can also optimize insurance plans and recover losses. The fastest growth was also registered by the financial applications segment; it is expected to grow at a substantial rate during the forecast period. Increased implications related to financial aspects have been a primary driving factor for the growth of the healthcare payer analytics market. With the help of this application payers which includes insurance companies, third-party payers, etc. can optimize their plans for the maximum benefit of patients and also save funds by recognizing fraudulent claims.
Global US Healthcare Predictive Payer Market By Application
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U.S. Healthcare Predictive Payer Market Regional Insights
The digital advancements in the healthcare field, and the digitization of records, are the key factors driving the growth of the us healthcare predictive payer market. Adoption of such technologies is on an upward trend thus propelling the market. Digital data is being used to derive meaningful results, cost reduction, and minimize fraudulent insurance claims. The U.S. government has been increasingly spending on healthcare and focusing on improving digital infrastructure, which is boosting technological advancements in the field. Due to technological advancements, decision-making for payers and healthcare providers has become easier with the help of analytical tools. The overall increase in healthcare expenditure has amounted to more than USD 4 trillion in the year 2020. It is not only helping the healthcare industry develop faster but has also made healthcare more affordable and precise. The healthcare analytical tools are helping administrators and policymakers in determining in turn saving billions of dollars per year. Doctors’ analytical tools have helped to determine the best treatment plans for a particular patient by studying and analysing their history.
Global US Healthcare Predictive Payer Market By Region
- Largest
- Fastest
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U.S. Healthcare Predictive Payer Market Dynamics
US Healthcare Predictive Payer Market Driver
- Growing demand for cost effective and early treatment applications is expected to spur the overall us healthcare predictive payer market statistics as the adoption of big data in healthcare assists researchers to perform population health data analysis and helps limiting the potential risks of epidemics, treat diseases while lowering the overall costs associated with it. Such big data can include patients’ medical records, information collected by healthcare testing equipment, hospital records, prescription information, family medical history, personal ID as well as insurance details, among others. Doctors and medical professionals use big data analysis to make efficient decisions regarding treatment and services. Thus, it helps doctors to identify illness/disease at early stage which can be treated early and costs less. Such aforementioned factors are expected to boost the adoption rate of healthcare analytics.
US Healthcare Predictive Payer Market Restraint
- Lack of high technical and statistical knowledge among healthcare professionals is expected to restrain the market growth, it is observed that there exists a dearth of skilled professionals in the healthcare sector for the smooth adoption and integration of novel technologies such as big data analytics, machine learning and artificial intelligence, among others. This is one of the major factors hampering the healthcare analytics market demand. These professionals lack high technical and statistical knowledge to operate healthcare analytical solutions. Furthermore, stringent data integrity and compliance regulations affects technology advancements adoption rate in healthcare industry. Hence, it is anticipated to remain one of the prime factors hampering the market growth.
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U.S. Healthcare Predictive Payer Market Competitive Landscape
us healthcare predictive payer market players are focusing on innovating advanced solutions which could help organizations plan their financial budgets efficiently, avoid improper payments & frauds, and effectively assess risk. Healthcare payers comprise insurance companies and health plan sponsors (employers and unions) and they use analytical solutions to expand their business, improve healthcare services, and quality and minimize administrative costs. The increase in the adoption of healthcare analytics across the industry vertical has been the primary factor responsible for the growth of the market. Ease of data understanding, as well as better outcomes, have also contributed significantly to market growth. The market is witnessing a surge in demand for advanced payer analytics owing to the growing healthcare costs and the need for organizations to devise strategies to curb expenditure.
US Healthcare Predictive Payer Market Top Player's Company Profiles
- UnitedHealth Group
- Anthem
- Aetna
- Cigna
- Humana
- Blue Cross Blue Shield Association
- Kaiser Permanente
- Centene Corporation
- Molina Healthcare
- WellCare Health Plans
- Health Net
- CareSource
- Buckeye Health Plan
- Superior HealthPlan
- AultCare
- SummaCare
- Paramount Health Care
- SelectHealth
- Providence Health Plan
- Geisinger Health Plan
US Healthcare Predictive Payer Market Recent Developments
- In September 2022, Lasso and CMI Media Group announced first-to-market partnership with IBM Watson.
- In September 2022, Inovalon, a leading provider of cloud-based software solutions empowering data-driven healthcare, announced that its annual Customer Congress will take place from October 2-4, 2022 in Washington, D.C.
- In May 2021, Apixio (US) Al healthcare analytics firm launched HCC Complete, a risk adjustment solution that has been added to portfolio of HCC, Apixio's HCC Complete supports a full document reviewing experiences with Medicare Advantage (MA) and Affordable Care Act (ACA) enterprises by leveraging the company's industry-leading Al engine. HCC Complete identifies reported earlier acute and chronic illnesses that may have been ignored or overlooked. These identified parameters are offered to coders through an easy-to-use, secure online application. Utilizing technology, coding teams using HCC Complete may complete chart reviews in 80% less time than manual reviews and with considerably greater accuracy.
U.S. Healthcare Predictive Payer Key Market Trends
- Rising insurance enrolments, increasing healthcare frauds, rising cost of healthcare, and in-house shortage of skilled personnel. However, factors like rising incidences of data breach & loss of confidentiality, unforeseen costs associated with outsourcing along with the loss of managerial control in outsourced projects are expected to restrain the growth of the healthcare payer services market. Due to an increase in the use of big data in healthcare organizations to address risks connected with numerous chronic diseases, the healthcare analytics market is predicted to grow. Furthermore, the growing use of telemedicine solutions by various enterprises to lower operational costs and improve service quality is propelling the healthcare analytics market expansion. Furthermore, big data facilitates the preservation of critical patient data that may be used to improve a company’s healthcare outcomes. It reduces personnel expenses and increased organizational productivity, all of which help the healthcare analytics market to grow during the forecast period.
U.S. Healthcare Predictive Payer Market SkyQuest Analysis
SkyQuest’s ABIRAW (Advanced Business Intelligence, Research & Analysis Wing) is our Business Information Services team that Collects, Collates, Co-relates, and Analyses the Data collected utilizing Primary Exploratory Research backed by the robust Secondary Desk research.
According to our US Healthcare Payer Analytics market, use of big data analytics has also propelled the growth of the market, the data generated with the high volume of patients through electronic records and various other sources like connected technologies and devices. All of this data is raw and unstructured, requiring analysis to derive meaningful observations. The industry is increasingly using business intelligence (BI) tools to make sense of this data. The digital form of data is being continually generated by pharma companies, healthcare providers, payers, patients, etc., use of BI tools not only recommends the best action to take in the treatment process but also helps mitigate the risk of disease. Due to technological advancements, decision-making for payers and healthcare providers has become easier with the help of analytical tools. Early adopters have shown the intent to move beyond traditional use cases of analytics to pioneer advanced applications such as imaging analytics, genomics analytics, social vulnerability index classification, automated claims preadjudication, and real-time supply chain management reporting. Consequently, more than 150 companies are offering both modular and plug-in based analytics solutions in the US marketplace.
| Report Metric | Details |
|---|---|
| Market size value in 2019 | USD 2.62 billion |
| Market size value in 2031 | USD 19.4 billion |
| Growth Rate | 22.1% |
| Base year | 2023 |
| Forecast period | 2024-2031 |
| Forecast Unit (Value) | USD Billion |
| Segments covered |
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| Regions covered | North America (US, Canada), Europe (Germany, France, United Kingdom, Italy, Spain, Rest of Europe), Asia Pacific (China, India, Japan, Rest of Asia-Pacific), Latin America (Brazil, Rest of Latin America), Middle East & Africa (South Africa, GCC Countries, Rest of MEA) |
| Companies covered |
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| Customization scope | Free report customization with purchase. Customization includes:-
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Table Of Content
Executive Summary
Market overview
- Exhibit: Executive Summary – Chart on Market Overview
- Exhibit: Executive Summary – Data Table on Market Overview
- Exhibit: Executive Summary – Chart on U.S. Healthcare Predictive Payer Market Characteristics
- Exhibit: Executive Summary – Chart on Market by Geography
- Exhibit: Executive Summary – Chart on Market Segmentation
- Exhibit: Executive Summary – Chart on Incremental Growth
- Exhibit: Executive Summary – Data Table on Incremental Growth
- Exhibit: Executive Summary – Chart on Vendor Market Positioning
Parent Market Analysis
Market overview
Market size
- Market Dynamics
- Exhibit: Impact analysis of DROC, 2021
- Drivers
- Opportunities
- Restraints
- Challenges
- Exhibit: Impact analysis of DROC, 2021
- SWOT Analysis
KEY MARKET INSIGHTS
- Technology Analysis
- (Exhibit: Data Table: Name of technology and details)
- Pricing Analysis
- (Exhibit: Data Table: Name of technology and pricing details)
- Supply Chain Analysis
- (Exhibit: Detailed Supply Chain Presentation)
- Value Chain Analysis
- (Exhibit: Detailed Value Chain Presentation)
- Ecosystem Of the Market
- Exhibit: Parent Market Ecosystem Market Analysis
- Exhibit: Market Characteristics of Parent Market
- IP Analysis
- (Exhibit: Data Table: Name of product/technology, patents filed, inventor/company name, acquiring firm)
- Trade Analysis
- (Exhibit: Data Table: Import and Export data details)
- Startup Analysis
- (Exhibit: Data Table: Emerging startups details)
- Raw Material Analysis
- (Exhibit: Data Table: Mapping of key raw materials)
- Innovation Matrix
- (Exhibit: Positioning Matrix: Mapping of new and existing technologies)
- Pipeline product Analysis
- (Exhibit: Data Table: Name of companies and pipeline products, regional mapping)
- Macroeconomic Indicators
COVID IMPACT
- Introduction
- Impact On Economy—scenario Assessment
- Exhibit: Data on GDP - Year-over-year growth 2016-2022 (%)
- Revised Market Size
- Exhibit: Data Table on U.S. Healthcare Predictive Payer Market size and forecast 2021-2027 ($ million)
- Impact Of COVID On Key Segments
- Exhibit: Data Table on Segment Market size and forecast 2021-2027 ($ million)
- COVID Strategies By Company
- Exhibit: Analysis on key strategies adopted by companies
MARKET DYNAMICS & OUTLOOK
- Market Dynamics
- Exhibit: Impact analysis of DROC, 2021
- Drivers
- Opportunities
- Restraints
- Challenges
- Exhibit: Impact analysis of DROC, 2021
- Regulatory Landscape
- Exhibit: Data Table on regulation from different region
- SWOT Analysis
- Porters Analysis
- Competitive rivalry
- Exhibit: Competitive rivalry Impact of key factors, 2021
- Threat of substitute products
- Exhibit: Threat of Substitute Products Impact of key factors, 2021
- Bargaining power of buyers
- Exhibit: buyers bargaining power Impact of key factors, 2021
- Threat of new entrants
- Exhibit: Threat of new entrants Impact of key factors, 2021
- Bargaining power of suppliers
- Exhibit: Threat of suppliers bargaining power Impact of key factors, 2021
- Competitive rivalry
- Skyquest special insights on future disruptions
- Political Impact
- Economic impact
- Social Impact
- Technical Impact
- Environmental Impact
- Legal Impact
Market Size by Region
- Chart on Market share by geography 2021-2027 (%)
- Data Table on Market share by geography 2021-2027(%)
- North America
- Chart on Market share by country 2021-2027 (%)
- Data Table on Market share by country 2021-2027(%)
- USA
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Canada
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Europe
- Chart on Market share by country 2021-2027 (%)
- Data Table on Market share by country 2021-2027(%)
- Germany
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Spain
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- France
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- UK
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Rest of Europe
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Asia Pacific
- Chart on Market share by country 2021-2027 (%)
- Data Table on Market share by country 2021-2027(%)
- China
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- India
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Japan
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- South Korea
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Rest of Asia Pacific
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Latin America
- Chart on Market share by country 2021-2027 (%)
- Data Table on Market share by country 2021-2027(%)
- Brazil
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Rest of South America
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Middle East & Africa (MEA)
- Chart on Market share by country 2021-2027 (%)
- Data Table on Market share by country 2021-2027(%)
- GCC Countries
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- South Africa
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Rest of MEA
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
KEY COMPANY PROFILES
- Competitive Landscape
- Total number of companies covered
- Exhibit: companies covered in the report, 2021
- Top companies market positioning
- Exhibit: company positioning matrix, 2021
- Top companies market Share
- Exhibit: Pie chart analysis on company market share, 2021(%)
- Total number of companies covered
Methodology
For the U.S. Healthcare Predictive Payer Market, our research methodology involved a mixture of primary and secondary data sources. Key steps involved in the research process are listed below:
1. Information Procurement: This stage involved the procurement of Market data or related information via primary and secondary sources. The various secondary sources used included various company websites, annual reports, trade databases, and paid databases such as Hoover's, Bloomberg Business, Factiva, and Avention. Our team did 45 primary interactions Globally which included several stakeholders such as manufacturers, customers, key opinion leaders, etc. Overall, information procurement was one of the most extensive stages in our research process.
2. Information Analysis: This step involved triangulation of data through bottom-up and top-down approaches to estimate and validate the total size and future estimate of the U.S. Healthcare Predictive Payer Market.
3. Report Formulation: The final step entailed the placement of data points in appropriate Market spaces in an attempt to deduce viable conclusions.
4. Validation & Publishing: Validation is the most important step in the process. Validation & re-validation via an intricately designed process helped us finalize data points to be used for final calculations. The final Market estimates and forecasts were then aligned and sent to our panel of industry experts for validation of data. Once the validation was done the report was sent to our Quality Assurance team to ensure adherence to style guides, consistency & design.
Analyst Support
Customization Options
With the given market data, our dedicated team of analysts can offer you the following customization options are available for the U.S. Healthcare Predictive Payer Market:
Product Analysis: Product matrix, which offers a detailed comparison of the product portfolio of companies.
Regional Analysis: Further analysis of the U.S. Healthcare Predictive Payer Market for additional countries.
Competitive Analysis: Detailed analysis and profiling of additional Market players & comparative analysis of competitive products.
Go to Market Strategy: Find the high-growth channels to invest your marketing efforts and increase your customer base.
Innovation Mapping: Identify racial solutions and innovation, connected to deep ecosystems of innovators, start-ups, academics, and strategic partners.
Category Intelligence: Customized intelligence that is relevant to their supply Markets will enable them to make smarter sourcing decisions and improve their category management.
Public Company Transcript Analysis: To improve the investment performance by generating new alpha and making better-informed decisions.
Social Media Listening: To analyze the conversations and trends happening not just around your brand, but around your industry as a whole, and use those insights to make better Marketing decisions.
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