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U.S. Healthcare BPO Market - Payer (Claims Processing, HR Services, and Finance and Accounts), Provider (Medical Billing and Coding), and Pharmaceutical (Clinical Trials, Contract Manufacturing, and Non-Clinical Services) - Trends and Global Forecasts to 2018

The U.S. healthcare outsourcing market has great potential for growth owing to the measures taken by the government to curb the ever-increasing healthcare costs. The other factors that have led to the growth of the market are: developments and innovation in information technology and regulatory changes. Approximately 75% of U.S. healthcare companies outsource their work to external locations. This is due to the shortage of qualified staff in key positions, such as nurses and coders, and due to the new set of rules and regulations that they need to comply with. Some services that are commonly outsourced are insurance claims processing, adjudication and receivables management, billing and coding services, radiology reporting, transcription services, and clinical outsourcing, among others.

Implementation of various reforms such as the American Recovery and Reinvestment Act of 2009 and the Health Information Technology for Economic and Clinical Health Act (HITECH) as well as the conversion from the ICD-9 coding system to the ICD-10 coding system (to be implemented by October 2014) has created an upward growth trend. Furthermore, constant improvements in the quality of work from destination countries have reinforced the confidence of various healthcare payers, providers, and pharmaceutical companies in outsourcing. This is considered as the key driver of the healthcare process outsourcing market. On the other hand, data security and confidentiality concerns are the restraints for the growth of the market.

The key players in this market are Accenture (Ireland), GeBBS Healthcare (U.S.), Quintiles (U.S.), Covance (U.S.), PPD (U.S.), Parexel International (U.S.), Lonza (Switzerland), Catalent (U.S.), Boehringer Ingelheim (Germany), and DSM Pharma (U.S.).

In this report, the U.S. healthcare BPO market is categorized into three segments, namely, payer outsourcing, provider outsourcing, and pharmaceutical outsourcing. Each segment is further sub-segmented on the basis of services provided. Payer services consist of claims processing, HR services, member services/customer care, and finance and accounts. Provider services include medical billing, medical coding, medical transcription, and finance and accounts. Pharmaceutical services comprise clinical research organizations (CROs), contract manufacturing organizations (CMOs), and non-clinical services. An exhaustive value analysis for all these markets is provided for 2011, 2012, and 2013, with forecast till 2018.

Scope of the report
This research report categorizes the U.S. healthcare BPO market into the following segments and sub-segments. Each market segment is further categorized on the basis of the services provided.

The U.S. Healthcare BPO Market, by Segment:

Payer
Provider
Pharmaceutical

The U.S Healthcare Payer Outsourcing Market, by Services:

Claims Processing
HR Services
Member Services/Customer Care
Finance and Accounts

The U.S Healthcare Provider Outsourcing Market, by Services:

Medical Billing
Medical Coding
Medical Transcription
Finance and Accounts

The U.S Healthcare Pharmaceutical Outsourcing Market, by Services:

CRO Market
Drug Discovery
Pre-clinical
Phase I
Phase II
Phase III
Phase IV
Clinical Data Management and Biostatistics
Medical Writing
Regulatory Services Outsourcing
Other Services

CMO Market

API Manufacturing
Formulation & Packaging

Non-clinical Services Market

Supply Chain Management and Logistics
Sales and Marketing Management
Other Non-clinical Functions

Table Of Contents

U.S. Healthcare BPO Market - Payer (Claims Processing, HR Services, and Finance and Accounts), Provider (Medical Billing and Coding), and Pharmaceutical (Clinical Trials, Contract Manufacturing, and Non-Clinical Services) - Trends and Global Forecasts to
1 INTRODUCTION 16
1.1 KEY TAKE-AWAYS 16
1.2 REPORT DESCRIPTION 16
1.3 MARKETS COVERED 18
1.4 STAKEHOLDERS 20
1.5 RESEARCH METHODOLOGY 20
1.5.1 MARKET SIZE 20
1.5.2 KEY DATA POINTS FROM SECONDARY SOURCES 21
1.5.3 KEY DATA POINTS FROM PRIMARY SOURCES 21
1.5.4 ASSUMPTIONS 21
2 EXECUTIVE SUMMARY 22
3 MARKET OVERVIEW 25
3.1 INTRODUCTION 26
3.2 MARKET DYNAMICS 27
3.2.1 DRIVERS 28
3.2.1.1 Introduction of the Patient Protection and Affordable Care Act (PPACA) 28
3.2.1.2 Need to reduce rising healthcare costs 29
3.2.1.3 Shortage of skilled personnel 30
3.2.2 RESTRAINTS 30
3.2.2.1 Unforeseen costs 30
3.2.2.2 Confidentiality and security of data is a major concern 31
3.2.2.3 Loss of managerial control 31
3.2.3 OPPORTUNITIES 31
3.2.3.1 Consolidation of the healthcare system 31
3.2.3.2 ICD-10 conversion 32

4 U.S. HEALTHCARE PAYER OUTSOURCING MARKET, BY SERVICES 33
4.1 INTRODUCTION 34
4.1.1 VENDORS WITH COMPLETE RANGE OF SERVICES ATTRACT INSURANCE PROVIDERS 34
4.1.2 PPACA WILL ADD APPROXIMATELY 30 MILLION AMERICANS TO THE INSURANCE SYSTEM 34
4.1.3 ERRORS DURING CLIENT INTERACTION COULD AFFECT A COMPANY'S REPUTATION 35
4.2 CLAIMS PROCESSING 37
4.3 MEMBER SERVICES/CUSTOMER CARE 39
4.4 HR SERVICES 40
4.5 FINANCE AND ACCOUNTS 41
5 U.S. HEALTHCARE PROVIDER OUTSOURCING MARKET,
BY SERVICES 43
5.1 INTRODUCTION 44
5.1.1 OUTSOURCING SAVES TIME AND COSTS 44
5.1.2 CONCERNS REGARDING QUALITY OF SERVICES 44
5.2 MEDICAL BILLING 47
5.3 MEDICAL CODING 49
5.4 MEDICAL TRANSCRIPTION 50
5.5 FINANCE AND ACCOUNTS 52
6 U.S. PHARMACEUTICAL OUTSOURCING MARKET, BY TYPE 53
6.1 INTRODUCTION 54
6.1.1 OUTSOURCING: A COST-EFFECTIVE APPROACH TO CONCENTRATE ON CORE COMPETENCIES 54
6.1.2 OFF-PATENTING OF DRUGS WILL DRIVE THE OUTSOURCING MARKET 55
6.1.3 EMERGENCE OF BIOLOGICS AS A MAJOR OPPORTUNITY IN THE FUTURE 55
6.1.4 QUALITY CONTROL ISSUES LIMIT OUTSOURCING 56
6.2 U.S. CRO MARKET 59
6.2.1 INTRODUCTION 59
6.2.2 DRUG DISCOVERY 61
6.2.3 PRE-CLINICAL SERVICES 62
6.2.4 CLINICAL DEVELOPMENT PHASE I 64
6.2.5 CLINICAL DEVELOPMENT PHASE II 65
6.2.6 CLINICAL DEVELOPMENT PHASE III 66
6.2.7 CLINICAL DEVELOPMENT PHASE IV 67
6.2.8 CLINICAL DATA MANAGEMENT AND BIOSTATISTICS 68
6.2.9 MEDICAL WRITING 69
6.2.10 REGULATORY SERVICES 70
6.2.11 OTHER SERVICES 72
6.3 U.S. CMO MARKET 73
6.3.1 INTRODUCTION 73
6.3.2 API MANUFACTURING 74
6.3.3 FORMULATION AND PACKAGING 75
6.4 U.S. NON-CLINICAL SERVICES OUTSOURCING MARKET 77
6.4.1 INTRODUCTION 77
6.4.2 SUPPLY CHAIN MANAGEMENT AND LOGISTICS 78
6.4.3 SALES AND MARKETING MANAGEMENT 79
6.4.4 OTHER NON-CLINICAL FUNCTIONS 81
7 GEOGRAPHIC ANALYSIS 82
7.1 U.S. 83
7.1.1 PAYER 84
7.1.2 PROVIDER 86
7.1.3 PHARMACEUTICAL 88
8 COMPETITIVE LANDSCAPE 91
8.1 INTRODUCTION 91
8.2 MERGERS and ACQUISITIONS 95
8.3 AGREEMENTS, PARTNERSHIPS, COLLABORATIONS, AND JOINT VENTURES 100
8.4 NEW PRODUCT LAUNCHES 127
8.5 EXPANSION 133

9 COMPANY PROFILES 145
(Overview, Financials, Services, Strategy and Development)*
9.1 ACCENTURE PLC 145
9.2 ACCRETIVE HEALTH, INC. 150
9.3 ANTHELIO HEALTHCARE SOLUTIONS, INC. 155
9.4 BOEHRINGER INGELHEIM GMBH 159
9.5 CATALENT PHARMA SOLUTIONS, INC. 169
9.6 COGNIZANT TECHNOLOGY SOLUTIONS CORPORATION 180
9.7 COVANCE, INC. 188
9.8 GEBBS HEALTHCARE SOLUTIONS, INC. 195
9.9 GENPACT LIMITED 201
9.10 IBM CORPORATION 208
9.11 ICON PLC 213
9.12 INFOSYS BPO LIMITED 223
9.13 LONZA GROUP LTD. 227
9.14 PAREXEL INTERNATIONAL CORPORATION 238
9.15 QUINTILES TRANSNATIONAL HOLDINGS, INC. 246
9.16 WNS (HOLDINGS) LIMITED 254
*Details on overview, Financials, Services, Strategy and Development might not be captured in case of unlisted companies.

LIST OF TABLES

TABLE 1 U.S. HEALTHCARE PAYER OUTSOURCING MARKET, BY SERVICES,
2011 - 2018 ($BILLION) 36
TABLE 2 U.S. HEALTHCARE PROVIDER OUTSOURCING MARKET, BY SERVICES, 2011 - 2018 ($BILLION) 46
TABLE 3 U.S. PHARMACEUTICAL OUTSOURCING MARKET, BY TYPE,
2011 - 2018 ($BILLION) 58
TABLE 4 U.S. CRO MARKET, BY SERVICES, 2011 - 2018 ($BILLION) 60
TABLE 5 U.S. CMO MARKET, BY SERVICES, 2011 - 2018 ($BILLION) 74
TABLE 6 U.S.NON-CLINICAL SERVICES OUTSOURCING MARKET, BY SERVICES, 2011 - 2018 ($BILLION) 77
TABLE 7 U.S.HEALTHCARE BPO MARKET, BY SEGMENTS,
2011 - 2018 ($BILLION) 83
TABLE 8 MERGERS and ACQUISITIONS, JANUARY 2011 - JUNE 2013 95
TABLE 9 AGREEMENTS, PARTNERSHIPS, COLLABORATIONS, CONTRACTS and JOINT VENTURES, JANUARY 2011 - JUNE 2013 100
TABLE 10 NEW PRODUCT LAUNCHES, JANUARY 2011- JUNE 2013 127
TABLE 11 EXPANSION, JANUARY 2011 - JUNE 2013 133
TABLE 12 ACCENTURE PLC: TOTAL REVENUE, BY SEGMENT,
2010 - 2012 ($MILLION) 146
TABLE 13 ACCRETIVE HEALTH, INC.: TOTAL REVENUE, BY SEGMENT,
2009 - 2011 ($MILLION) 151
TABLE 14 BOEHRINGER INGELHEIM GMBH: TOTAL REVENUE, BY SEGMENT,
2010 - 2012 ($MILLION) 160
TABLE 15 CATALENT PHARMA SOLUTIONS, INC.: TOTAL REVENUE, BY SEGMENT, 2010 - 2012 ($MILLION) 170
TABLE 16 COGNIZANT TECHNOLOGY SOLUTIONS CORPORATION: TOTAL REVENUE, BY SEGMENT, 2010 - 2012 ($MILLION) 181
TABLE 17 COVANCE, INC.: TOTAL REVENUE, BY SEGMENT,
2010 - 2012 ($MILLION) 189
TABLE 18 GENPACT LIMITED: TOTAL REVENUE, BY SERVICE TYPE,
2010 - 2012 ($MILLION) 202
TABLE 19 GENPACT LIMITED: TOTAL REVENUE, BY INDUSTRY,
2010 - 2012 ($MILLION) 203
TABLE 20 IBM CORPORATION: TOTAL REVENUE, BY SEGMENT,
2010 - 2012 ($MILLION) 209
TABLE 21 ICON PLC: TOTAL REVENUE, BY SEGMENT, 2010 - 2012 ($MILLION) 214
TABLE 22 INFOSYS LIMITED: TOTAL REVENUE, BY SEGMENT,
2011 - 2013 ($MILLION) 224
TABLE 23 LONZA GROUP LTD.: TOTAL REVENUE, BY SEGMENT,
2010 - 2012 ($MILLION) 228
TABLE 24 PAREXEL INTERNATIONAL CORPORATION: TOTAL REVENUE,
BY SEGMENT, 2010 - 2012 ($MILLION) 239
TABLE 25 QUINTILES TRANSNATIONAL HOLDINGS, INC.: TOTAL REVENUE,
BY SEGMENT, 2010 - 2012 ($MILLION) 247
TABLE 26 WNS HOLDINGS LTD: TOTAL REVENUE, BY SEGMENT,
2011 - 2013 ($MILLION) 255

LIST OF FIGURES

FIGURE 1 U.S. HEALTHCARE BPO MARKET SEGMENTATION 18
FIGURE 2 U.S. HEALTHCARE BPO MARKET ($BILLION), 2013, BY INDUSTRY 22
FIGURE 3 MARKET DYNAMICS 27
FIGURE 4 COMPONENTS OF PPACA 28
FIGURE 5 U.S. HEALTHCARE PAYER OUTSOURCING MARKET, BY SERVICES 35
FIGURE 6 U.S. CLAIMS PROCESSING MARKET, 2011 - 2018 ($BILLION) 38
FIGURE 7 U.S. MEMBER SERVICES/CUSTOMER CARE MARKET,
2011 - 2018 ($BILLION) 39
FIGURE 8 U.S. HR SERVICES MARKET, 2011 - 2018 ($BILLION) 40
FIGURE 9 U.S. FINANCE AND ACCOUNTS MARKET, 2011 - 2018 ($BILLION) 41
FIGURE 10 U.S. HEALTHCARE PROVIDER OUTSOURCING MARKET, BY SERVICES 45
FIGURE 11 U.S. MEDICAL BILLING MARKET, 2011 - 2018 ($BILLION) 48
FIGURE 12 U.S. MEDICAL CODING MARKET, 2011 - 2018 ($BILLION) 49
FIGURE 13 U.S. MEDICAL TRANSCRIPTION MARKET, 2011 - 2018 ($BILLION) 51
FIGURE 14 U.S. FINANCE AND ACCOUNTS MARKET, 2011 - 2018 ($BILLION) 52
FIGURE 15 U.S. PHARMACEUTICAL OUTSOURCING MARKET, BY SERVICES 57
FIGURE 16 U.S. DRUG DISCOVERY MARKET, 2011 - 2018 ($BILLION) 62
FIGURE 17 U.S. PRE-CLINICAL SERVICES MARKET, 2011 - 2018 ($BILLION) 63
FIGURE 18 U.S. CLINICAL DEVELOPMENT PHASE I MARKET,
2011 - 2018 ($BILLION) 64
FIGURE 19 U.S. CLINICAL DEVELOPMENT PHASE II MARKET,
2011 - 2018 ($BILLION) 66
FIGURE 20 U.S. CLINICAL DEVELOPMENT PHASE III MARKET,
2011 - 2018 ($BILLION) 67
FIGURE 21 U.S. CLINICAL DEVELOPMENT PHASE IV MARKET,
2011 - 2018 ($BILLION) 68
FIGURE 22 U.S. CLINICAL DATA MANAGEMENT AND BIOSTATISTICS MARKET,
2011 - 2018 ($BILLION) 69
FIGURE 23 U.S. MEDICAL WRITING MARKET, 2011 - 2018 ($BILLION) 70
FIGURE 24 U.S. REGULATORY SERVICES MARKET, 2011 - 2018 ($BILLION) 71
FIGURE 25 U.S. OTHER SERVICES MARKET, 2011 - 2018 ($BILLION) 72
FIGURE 26 U.S. API MANUFACTURING MARKET, 2011 - 2018 ($BILLION) 75
FIGURE 27 U.S. FORMULATION AND PACKAGING MARKET, 2011 - 2018 ($BILLION) 76
FIGURE 28 U.S. SUPPLY CHAIN MANAGEMENT AND LOGISTICS MARKET,
2011 - 2018 ($BILLION) 79
FIGURE 29 U.S. SALES AND MARKETING MANAGEMENT MARKET,
2011 - 2018 ($BILLION) 80
FIGURE 30 U.S. OTHER NON-CLINICAL FUNCTIONS MARKET,
2011 - 2018 ($BILLION) 81
FIGURE 31 U.S. HEALTHCARE PAYER MARKET, BY SERVICES,
2013 - 2018 ($BILLION) 85
FIGURE 32 U.S. HEALTHCARE PROVIDER MARKET, BY SERVICES,
2013 - 2018 ($BILLION) 87
FIGURE 33 U.S. PHARMACEUTICAL OUTSOURCING MARKET, BY TYPES 88
FIGURE 34 KEY GROWTH STRATEGIES OF THE U.S. HEALTHCARE BPO MARKET, 2011 - 2013 91
FIGURE 35 KEY PLAYERS FOCUSING ON AGREEMENTS, PARTNERSHIPS, COLLABORATIONS, CONTRACTS, AND JOINT VENTURES STRATEGY, 2011 - 2013 93
FIGURE 36 KEY PLAYERS FOCUSING ON THE EXPANSION STRATEGY,
2011 - 2013 94

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