This report identifies key demand-side trends in the healthcare payer business process transformation space to help enterprises fine-tune their operations. It provides an overview of key observations and business challenges that Avasant considers important to highlight in the healthcare payer outsourcing space.
Why read this Market Insights?
The healthcare payer business process industry is under intense pressure from rising costs, complex regulations, and growing consumer expectations for seamless, digital-first experiences. To remain competitive and address margin compression, payers are accelerating digital transformation by deploying AI, automation, and analytics to streamline operations, particularly in claims, prior authorization, and payment integrity. At the same time, there is a decisive industry shift from fee-for-service to value-based care models such as capitation, bundled payments, and pay-for-performance, which incentivize better outcomes, holistic care coordination, and member retention while minimizing costs.
The Healthcare Payer Business Process Transformation 2025 Market Insights™ aids organizations in identifying important market trends and expectations for any healthcare payer services projects that they engage in.
Methodology
The industry insights presented in this report are based on the following: our ongoing interactions with enterprise CXOs and other key executives; targeted discussions with service providers, subject matter experts, and Avasant Fellows; analyst insights from primary and secondary research; and lessons learned from consulting engagements.
Table of contents
About the report (Page 3)
Executive summary (Pages 4–7)
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- Definition and scope
- Key enterprise healthcare payer business process transformation trends shaping the market
- Avasant recognizes 22 top-tier providers offering healthcare payer business process transformation services
Demand-side trends (Pages 8–12)
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- Rising healthcare costs, shrinking budgets, and increasing member expectations are key challenges for healthcare payers
- AI-driven claims processing, prior authorization, and payment integrity to reduce fraud and improve compliance and efficiency
- Shift to value-based care models to improve care outcomes, increase patient engagement, and reduce costs
- Generative AI for better member interactions, personalized services, and enhanced claims and underwriting processing
Key contacts (Page 13)
Read the Research Byte based on this report. Please refer to Avasant’s Healthcare Payer Business Process Transformation 2025 RadarView™ for detailed insights on the service providers and supply-side trends.