HFS Horizons: Healthcare Payer Service Providers, 2024

The HFS Horizons: Healthcare Payer Service Providers, 2024 report is for health plan, government payer, and self-insured employer leaders, sourcing executives, and service provider strategists evaluating which providers can improve the quadruple aim of care through technology, domain expertise, and outcome-based delivery.

Overview

HFS Horizons: Healthcare Payer Service Providers, 2024 is an HFS Research assessment of 45 service providers supporting health plans, government payers, and self-insured employers, evaluating each across four dimensions: value proposition, capabilities, go-to-market, and outcomes delivered. It examines how these providers help payers improve the quadruple aim of care, meaning the cost of care, experience of care, health outcomes, and health equity.

Key findings

1. Horizon 3 Market Leaders include Accenture, Carelon, Cognizant, Evernorth, Eviden, Evolent, EY, HCLTech, Infosys, Innova Solutions, Inovalon, NTT DATA, Optum, TCS, Tech Mahindra, UST, and Wipro. Horizon 2 Enterprise Innovators include Brillio, Capgemini, CitiusTech, Deloitte, Emids, EXL, Firstsource, Genpact, HTC Global Services, Infinite, KPMG, Omega Healthcare, Persistent, Publicis Sapient, PwC, Sagility, Smart Data Solutions, SoftServe, Sonata Software, Sutherland, Virtusa, WNS, and Zensar. Horizon 1 Disruptors include Apexon, Conduent, Hexaware, LTIMindtree, and Mphasis.
2. HFS evaluated 45 service providers across the four Horizon dimensions, drawing on inputs from more than 300 US and global payers and over 50 supplier partners.
3. Reference checks covered 85 active healthcare enterprise clients and 78 active partners of the study participants.
4. 72% of all US lives are underwritten by the government or self-insured employers rather than health insurers, while average US health insurance margins sit near 2%.
5. About 6 in 10 health plans have acquired non-similar businesses in the past 3 years, yet 95% of service providers that serve both payers and providers still go to market separately.

HFS finds that declining margins, a shrinking fully insured business, and mounting cost pressure are pushing health plans to outsource rapidly, fueling service provider growth. HFS assesses that self-insured employers, which underwrite roughly 30% of US lives and grow faster than any other coverage type, are the market’s largest untapped opportunity.

Research methodology

The report draws on HFS Pulse demand-side data featuring roughly 600 service provider ratings from about 32 health plan enterprises, vendor briefings, and reference checks with 85 clients and 78 partners in 2024.

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