美国医疗保健付款人核心管理处理解决方案市场规模、份额和趋势分析报告：按类型、部署和细分市场预测，2024-2030 年

美国医疗保健付款人核心管理处理解决方案市场成长与趋势：

Grand View Research, Inc.最新报告显示，到2030年，美国医疗保健付款人核心管理处理解决方案市场规模预计将达到28.8亿美元，复合年增长率为7.8%。该市场的成长是由不断增长的业务优化需求所推动的。医疗保健提供者正在部署技术来增强管理工作流程、减少开支并提高业务效率。此外，鑑于严格的医疗保健法规（包括医疗保险准入），对监管合规性的需求不断增加，也是促进市场扩张的因素。

在专注于创新解决方案的科技新兴企业的推动下，投资者和创业投资对医疗保健支付领域的兴趣不断增长。投资激增是由于多种因素造成的，包括数位转型、采用基于价值的护理模式、资料分析的应用以及向以消费者为中心的护理的转变。这些因素支撑了医疗保健产业创新和成长的巨大潜力。例如，2023 年 8 月，为医疗保健付款人云端基础的软体的着名提供者 VBA 与着名成长型股权公司频谱 股权达成了 1.56 亿美元的多数成长型股权交易。 VBA 的目标是利用这项投资来开发技术先进的解决方案，以满足其客户群不断增长的需求。

此外，由于患者期望的变化、向基于价值的护理的转变以及对便利和个人化医疗保健服务的需求不断增长，医疗保健行业正在经历一场转型。这种演变将培育一种竞争格局，新兴企业将部署先进的技术和解决方案，旨在在该国发展医疗保健支付生态系统。 COVID-19 大流行的爆发使得维持业务运作、有效的会员沟通和支援变得至关重要。随着局势从一个新出现的问题演变​​为全球紧急情况，这些因素仍然具有相关性，需要大规模的停工以加强社会距离。为了应对这些挑战，医疗保健提供者与各种相关人员（包括提供者和政府机构）合作。策略包括建立合作伙伴关係、识别高风险成员以及预测供需波动。

此外，市场主要企业正在采取联盟、新产品发布、合资、收购和业务扩张等策略性倡议，以巩固其市场地位并扩大基本客群。例如，2022 年 2 月，HealthEdge 与 CitiusTech 建立策略合作伙伴关係，提供联合市场开发和咨询服务，重点关注 HealthEdge 在护理管理、核心管理和支付完整性的解决方案。该合作伙伴关係旨在帮助健康计划过渡到基于价值的护理，同时优化业务。

美国医疗保健付款人核心管理处理解决方案市场报告亮点

• 按类型划分，市场分为软体和服务。到 2023 年，软体将占据最大的市场占有率，达到 57.56%。对先进整合解决方案的需求不断增长，以简化管理流程、降低营运成本并提高效率，从而推动了成长。
• 云端基础的解决方案具有扩充性，使医疗保健提供者能够有效地调整管理业务以适应不断变化的需求。
• 该市场的着名公司包括 HealthEdge Software, Inc.、Optum、Cognizant、HealthAxis、Plexis Healthcare Systems、Mphasis 和 SS&C Technologies。

目录

第一章调查方法与范围

第 2 章执行摘要

第 3 章：美国医疗保健付款人核心行政处理解决方案 (CAPS) 市场变数、趋势和范围

• 市场体系展望
  • 母市场展望
  • 相关/辅助市场展望
• 药用食品市场价格分析
• 产业分析
  • 使用者观点分析
  • 主要进展
• 技术展望
• 法律规范
• 市场动态
  • 市场驱动因素分析
  • 市场限制因素分析
  • 产业挑战与机会分析
• 适用于美国医疗保健付款人的核心行政处理解决方案 (CAPS) 市场分析工具
  • 波特的分析
  • PESTEL分析
• 美国医疗保险公司核心行政处理解决方案（CAPS）产业重大交易与策略联盟分析
• COVID-19 的影响
• 案例研究

第四章美国医疗保健支付者核心行政处理解决方案（CAPS）市场：类型估计和趋势分析

• 定义和范围
• 2023 年和 2030 年按类型分類的市场占有率分析
• 细分仪表板
• 2018-2030 年美国医疗保健付款人核心行政处理解决方案 (CAPS) 市场（按类型）
• 软体
• 服务

第五章美国医疗保健支付者核心行政处理解决方案（CAPS）市场：发展估算与趋势分析

• 定义和范围
• 2023 年及 2030 年部署市场占有率分析
• 细分仪表板
• 美国医疗保健付款人核心行政处理解决方案 (CAPS) 市场：按部署划分，2018-2030 年
• 本地
• 云端基础

第六章 竞争状况

• 主要市场参与企业的最新趋势和影响分析
• 公司分类
• 公司市场占有率分析
• 企业热力图分析
• 策略规划
  • 扩张
  • 併购
  • 伙伴关係与协作
  • 新类型发布
  • 研究与开发
• 公司简介
  • 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