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  • Viewpoint
    May 28, 2025

    US healthcare organizations face operational challenges, including rising chronic disease prevalence, workforce shortages, and growing administrative complexity. In this environment, legacy operating models are proving insufficient, prompting healthcare enterprises to reconsider their long-held hesitancy toward clinical…
  • Viewpoint
    March 06, 2025

    The evolving landscape of Revenue Cycle Management (RCM) highlights how AI, automation, and outsourcing are transforming financial and operational efficiencies for healthcare providers. Despite persistent challenges such as billing complexities and staffing shortages, healthcare leaders are…
  • 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…
  • 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…
  • Webinar Deck
    March 11, 2025

    Enterprise spending priorities in traditional areas have largely matured, and they have a playbook on how to optimize it. However, a wave of new pressures – including evolving regulations, geopolitical shifts, supply chain disruptions, tariffs, and…
  • 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…
  • 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…
  • Viewpoint
    June 27, 2025

    US health insurance carriers face escalating pressures, from soaring costs and workforce shortages to rising member expectations and complex compliance demands. In this environment, traditional administrative processes and outdated systems are proving inadequate. To address these…
  • PEAK Matrix®
    Sep. 17, 2024

    In 2023, US healthcare providers faced formidable challenges. Although patient volumes have started to recover, increased labor expense and talent shortage caused administrative burdens and workflow issues to become more pronounced. Despite slight improvements in hospital…
  • 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…
  • Webinar Deck
    June 10, 2025

    Life sciences enterprises are under increasing pressure to accelerate innovation, optimize costs, and embrace emerging technologies like AI. These priorities are reshaping how and where organizations source capabilities, prompting a fresh look at the roles of…
  • 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,…
  • Provider Compendium
    June 30, 2025

    The payment integrity market is shifting from post-payment recovery to a proactive focus on pre-payment accuracy, aiming to reduce costs and improve efficiencies. AI is enhancing fraud detection, real-time claims validation, and predictive risk modeling. Simultaneously,…
  • 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
    Oct. 08, 2024

    The payment integrity sector is transforming as the healthcare industry seeks to enhance payment process accuracy and efficiency. With rising financial pressures, the demand for effective payment integrity solutions has intensified, prompting stakeholders to explore innovative…
  • Viewpoint
    May 31, 2024

    Healthcare organizations use Revenue Cycle Management (RCM) to manage the administrative and clinical functions related to processing claims, receiving payments, and generating revenue. The cycle begins with a patient scheduling an appointment and continues until the…

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