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  • Webinar Deck
    Nov. 16, 2021

    On November 16, Everest Group hosted a webinar titled, "Leaders vs. Laggards: How Payers Can Use Outsourcing to Differentiate." While healthcare payers have deep technology portfolios, they don’t consistently deliver optimal operational efficiency and innovation, causing…
  • Accelerator
    Nov. 21, 2025

    Procurement organizations prioritize reducing costs, managing risks, and creating business value. Category management helps achieve these goals by optimizing category spend, identifying cost-saving opportunities, and improving operational efficiency. This report equips healthcare payer services (BPS and…
  • State of the Market
    Oct. 31, 2025

    Clinical and Care Management (CCM) is becoming a strategic priority for healthcare enterprises, driven by the need to improve outcomes, contain costs, and comply with intensifying regulatory demands. Once seen primarily as a cost-control function, CCM…
  • Tech Vendor Spotlight
    Sep. 30, 2025

    The Payment Integrity (PI) market is structurally resetting. Payers are moving from retrospective audits to preventive, pre-payment validation using AI, predictive analytics, and automation to detect anomalies early, improve coding accuracy, and reduce provider abrasion. This…
  • Provider Compendium
    Nov. 04, 2025

    The shift toward value-based care, proactive population health management, and quality-linked reimbursement models is rapidly transforming the healthcare industry. Care management platforms have become foundational infrastructure, enabling organizations to manage chronic conditions, close care gaps, enhance…
  • PEAK Matrix®
    April 03, 2025

    The payment integrity market is strategically shifting from post-payment recovery to proactive pre-payment accuracy, thereby reducing costs and enhancing efficiency. AI-driven tools are advancing fraud detection, real-time claims validation, and predictive risk modeling, while next-generation technologies,…
  • Thematic Report
    Feb. 12, 2025

    The healthcare payer market is poised for significant shifts in 2025, driven by growing Medicare Advantage enrollments, rising medical loss ratios, and evolving regulatory frameworks. Payers are facing increasing financial and operational pressures, requiring a strategic…
  • PEAK Matrix®
    March 06, 2025

    The Utilization Management (UM) healthcare market faces challenges such as administrative burdens in prior authorization and inconsistent clinical criteria, causing delays and inefficiencies. To overcome these issues, payers are partnering with specialized UM service providers, integrating…
  • PEAK Matrix®
    June 04, 2025

    Healthcare enterprises are increasingly recognizing the strategic value of Data, Analytics, and AI (DAAI) as data-driven decision-making becomes central to achieving business and clinical outcomes. While DAAI initiatives have traditionally focused on cost containment and operational…
  • PEAK Matrix®
    Sep. 26, 2024

    The healthcare payer outsourcing market is rapidly evolving, driven by healthcare payers' need to enhance efficiency, manage costs, meet member expectations, and navigate complex regulations. As the industry shifts toward member-centricity and robust core administrative processes,…
  • PEAK Matrix®
    Nov. 25, 2025

    Healthcare enterprises are increasingly relying on specialist IT service providers to navigate the complexities of digital transformation, regulatory shifts, and cost pressures. Mounting financial strains and evolving compliance requirements are compelling payers and providers to modernize…
  • Provider Compendium
    Dec. 16, 2024

    The healthcare payer outsourcing market is rapidly evolving as payers strive to enhance efficiency, control costs, meet member expectations, and navigate complex regulations. With a growing focus on member-centricity and streamlined core administrative processes, Business Process…
  • PEAK Matrix®
    Aug. 26, 2025

    The Clinical and Care Management (CCM) operations market is rapidly transforming as payers and providers face mounting pressures from rising care complexity, workforce constraints, and financial risk exposure. Fragmented data systems, coupled with growing regulatory demands,…
  • Thematic Report
    Jan. 27, 2025

    Generative AI can potentially revolutionize the healthcare payer industry, driving innovation across critical areas like claims processing, member engagement, and care management. By enhancing operational efficiency and improving outcomes for both payers and members, it is…
  • Viewpoint
    May 06, 2024

    The global payment collection services market is facing various challenges, such as geopolitical and economic uncertainties, marked by increased consumer indebtedness, regulatory measures, and regional conflicts. Recent events such as the Credit Suisse collapse have heightened…
  • State of the Market
    June 30, 2025

    In today’s dynamic healthcare landscape, Patient and Member Engagement (PME) has become a strategic imperative for healthcare enterprises and service and platform providers. Historically overlooked and limited to administrative touchpoints, PME has evolved into a mission-critical…
  • Viewpoint
    April 22, 2025

    As US healthcare providers grapple with a turbulent economic and regulatory landscape, new tariffs and evolving policies are reshaping operational and financial realities across the sector. In response, providers are reassessing spending, delaying technology investments, and…
  • Viewpoint
    May 02, 2024

    The healthcare industry is transforming rapidly, driven by rising costs, stricter regulations, and a growing emphasis on member experience. This pressure highlights the need for healthcare payers to improve efficiency and effectiveness, especially in light of…
  • Provider Compendium
    Dec. 18, 2025

    Healthcare organizations are shifting toward unified data platforms to address growing demands for interoperability, real-time insights, and compliance in a digital-first environment. This report explores how healthcare data management platforms are becoming central to achieving these…
  • State of the Market
    Aug. 12, 2025

    Europe and APAC are at the forefront of healthcare transformation, driven by rising care demands, health equity goals, and digital acceleration. Healthcare enterprises across both regions are adopting scalable, tech-enabled models to deliver integrated, patient-centric care.…

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