Health Insurance Information Technology: US Overview and Outlook, 2014-2020

Health Insurance Information Technology: US Overview and Outlook, 2014-2020

Changing IT Priorities for Next Generation Health Plans

RELEASE DATE
06-Nov-2015
REGION
North America
Research Code: NF1E-01-00-00-00
SKU: HC02594-NA-MR_16716

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Description

Healthcare payers are grappling with a number of significant challenges that are upending their traditional business models and operational processes. To tackle these many challenges, health insurance organizations are actively looking at information technology as a lever of operational efficiency and transformational change, with spending priorities focusing on new tools for analytics, consumer engagement, and population health/care management. This study sizes and forecast the health insurance IT market at a broad market level, looking at revenue for the total market and four main IT market segments as defined by Frost & Sullivan -infrastructure/hardware; core administrative systems; business intelligence(BI)/analytics; and consumer engagement. The study covers factors driving the need to deploy IT in response to dynamic industry shifts; discusses key challenges impacting the health insurance industry and the IT market that serves the industry; provides an overall outlook for future business and IT trends for health insurance companies; and forecasts revenue growth for the total payer IT market and key market segments for the 6-year period from 2015 to 2020.

RESEARCH: INFOGRAPHIC

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Table of Contents

Key Findings – Study Highlights

Scope and Segmentation

Health Insurance IT: Market Engineering Measurements*, US, 2014

CEO’s Perspective

3 Big Predictions

Snapshot of the Health Insurance Industry in 2014

Health Insurance Industry Fundamentals

IT Solutions Used by Health Insurance Organizations

Market Scope and Definition for Health Insurance IT

Market Distribution Structure for IT Solutions Used by Health Insurance Organizations

Introduction to Insurance

What is Health Insurance?

Key Functions and Core Processes of Health Insurance Organizations

How Health Insurance Fits in With Funding for Healthcare Services

Public Versus Private Health Insurance

Definitions of Types of Managed Care Organizations

Key Market Categories for Health Insurance Plans

Macro Conditions Impacting Health Insurance Organizations

Summary of Enveloping Elements Impacting Health Insurers

Winning Strategies to Drive Business Value

The Affordable Care Act and the Health Insurance Industry

The Patient Protection and Affordable Care Act

Timeline of Key Events for the Affordable Care Act

How is ACA Funded?

Estimated Distribution of ACA Funding Sources Over Time

Key Health Insurance Market Reforms Due to ACA

The Impact of ACA Medical Loss Ratio

Premium Distribution Based on ACA-MLR Rule

Ten Essential Health Benefits of ACA

ACA Online Insurance Exchanges

The Key ACA Insurance Plans

Health Insurance Coverage—Snapshot of US Population

Government Definitions for Health Insurance and Payment Categories of National Health Insurance Expenditures

Trends in National Health Expenditures

Historical and Projected Average Annual Growth Rates for Per Capita Health Spend

National Health Expenditures by Type of Service

Percentage Distribution of National Health Expenditures for Public and Private Health Insurance

National Health Expenditures for Public and Private Health Insurance

Projected Average Annual Growth for Select NHE Categories Compared to National Gross Domestic Product (GDP)

Projected Average Annual Growth in Health Insurance Spend by Select Categories

Market Segmentation—Health Insurance IT

Core IT Architecture

Market Penetration for Software Applications

Select IT Vendors Serving the Health Insurance Industry

IT Infrastructure/Hardware

Core Administrative Systems

BI/Analytics

Consumer Engagement

Health Insurers View IT Investments as Key to Transformation, Growth, and Innovation

Top Areas of IT Investments for Health Plans

IT Priorities for Next Generation Health Plans: Where Vendors Need to Focus

The Big Picture: Macro Forces Impacting the Health Insurance Industry

Key IT and Business Challenges Facing Health Insurance

Market Drivers

Market Restraints

Impact Mapping of Drivers and Restraints for the US Health Insurance IT Market

Market Engineering Measurements

Forecast Methodology

Total Health Insurance IT—Revenue Forecast

Total Market Revenue Forecast Discussion

Total Health Insurance IT—Percent Revenue Forecast by Segment

Revenue Forecast by Market Segment

Market Engineering Measurements—IT Infrastructure/Hardware Segment

Revenue Forecast—IT Infrastructure/Hardware Segment

Market Engineering Measurements—Core Administrative Systems Segment

Revenue Forecast—Core Administrative Systems Segment

Market Engineering Measurements—BI/Analytics Segment

Revenue Forecast—Health Insurance IT, BI/Analytics Segment

Market Engineering Measurements—Consumer Engagement Segment

Revenue Forecast—Health Insurance IT, Consumer Engagement Segment

Competitive Market Forces Impacting Payer IT Vendors

Competitive Market Structure

Recent Notable Deals

Select Vendors and Products

3 Big Predictions

Legal Disclaimer

Definition of Select Terms Related to Health Insurance

Summary of Select Provisions of the ACA Impacting the Health Insurance Industry

US Health and Medical Insurance Carriers— Historical Statistics

Top Health Insurance Companies by Net Premium Written

Top Health Insurance Companies by Total Enrolment

Market Engineering Methodology

Sources

Learn More – Next Steps

List of Figures
  • 1. Snapshot of the Health Insurance Industry in 2014
  • 2. Health Insurance IT: Health Insurance Coverage by Type of Health Insurance, US, 2013 and 2014
  • 3. Health Insurance IT: National Health Expenditures and Growth Forecast by Select Service Type, US, 2014 and 2020
  • 4. Health Insurance IT: Projected National Health Expenditures for Public and Private Health Insurance, US, 2014 and 2020
  • 5. Total Health Insurance IT Market: Key Drivers, US, 2015–2020
  • 6. Total Health Insurance IT Market: Key Restraints, US, 2015–2020
  • 7. Total Health Insurance IT Market: Market Engineering Measurements, US, 2014
  • 8. Total Health Insurance IT: Revenue Forecast by Segment, US, 2014–2020
  • 9. Health Insurance IT, IT/Infrastructure/Hardware Segment: Market Engineering Measurements, US, 2014
  • 10. Health Insurance IT, Core Administrative Systems Segment: Market Engineering Measurements, US, 2014
  • 11. Health Insurance IT, BI/Analytics Segment: Market Engineering Measurements, US, 2014
  • 12. Health Insurance IT, Consumer Engagement Segment: Market Engineering Measurements, US, 2014
  • 13. Health Insurance IT: Competitive Market Structure, US, 2014
  • 14. Health Insurance IT: Notable Industry Deals, US, 2015
  • 15. Health Insurance IT: Select Vendors and Products, US, 2015
  • 16. 3 Big Predictions
  • 17. Health Insurance IT: Definitions for Select Health Insurance Terms, US, 2015
  • 18. Health Insurance IT: Select Provisions of the Patient Protection and Affordable Care Act (P.L. 111-148) Impacting the Health Insurance Industry, US, 2015
  • 19. Health Insurance IT: Historical Statistics for Health and Medical Insurance Carriers , US, 1997, 2002, 2007, and 2012
  • 20. Health Insurance IT: Top 20 Health Insurance Companies by Net Premiums Written, US, 2014
  • 21. Health Insurance IT: Top 20 Health Insurance Companies by Net Premiums Written, US, 2014
  • 22. Health Insurance IT: Top 20 Health Insurance Companies by Total Enrolment, US, 2014
List of Charts
  • 1. Health Insurance IT: Percentage Revenue Allocation by Market Segment, US, 2014
  • 2. Health Insurance IT: Market Engineering Measurements*, US, 2014
  • 3. Health Insurance IT: Estimated Percentage of Total IT Spend for Products Versus Services, US, 2014
  • 4. Health Insurance IT: Estimated Penetration of Software Applications, US, 2014
  • 5. Total Health Insurance IT Market: Distribution Structure, US, 2015
  • 6. Life/Health and Property/Casualty Health Insurance Premiums, US, 2014*
  • 7. Key Health Plan Stakeholders
  • 8. Health Plan Core Processes
  • 9. The Flow of Funds in U.S. Healthcare
  • 10. Health Insurance IT: Public Versus Private Health Insurance, US, 2014
  • 11. Definitions of Types of Managed Care Organizations
  • 12. Summary of Enveloping Elements Impacting Health Insurers
  • 13. Winning Strategies to Drive Business Value
  • 14. Timeline of Key Events for the Affordable Care Act
  • 15. Tax Changes Related to Health Insurance or Financing Healthcare Reform
  • 16. Health Insurance IT: Estimated Distribution of ACA Funding Sources Over Time, US, 2013-2022
  • 17. Ten Essential Health Benefits of ACA
  • 18. The Key ACA Insurance Plans
  • 19. Health Insurance IT: NHE Payment Categories, US, 2014
  • 20. Health Insurance IT: NHE Forecast, US, 2014–2020
  • 21. Health Insurance IT: Average Annual Growth Rate of Health Spend Per Capita, US, 1970’s-2024
  • 22. Health Insurance IT: Projected Percentage Distribution of National Health Expenditures by Source of Funds, US, 2014 and 2020
  • 23. Health Insurance IT: Projected Average Annual Growth in Select Health Insurance Spend Categories, US, 2014 and 2020
  • 24. Health Insurance IT: Market Segmentation, US, 2015
  • 25. Health Insurance IT: Core IT Architecture, US, 2015
  • 26. Health Insurance IT: Estimated Penetration of Software Applications, 2014
  • 27. Select IT Vendors Serving the Health Insurance Industry
  • 28. Core Administrative Systems - 2014 Revenue Allocation
  • 29. BI/Analytics - 2014 Revenue Allocation
  • 30. Consumer Engagement - 2014 Revenue Allocation
  • 31. Top Five Business Strategy and IT Investment Priorities for US Health Plans, 2015
  • 32. Solutions/Capabilities Where IT Vendors Serving Health Insurers Need to Focus
  • 33. Key IT and Business Challenges Facing Health Insurance
  • 34. Total Health Insurance IT Market: Impact of Drivers and Restraints, US, 2015–2020
  • 35. Total Health Insurance IT: Revenue Forecast, US, 2014–2020
  • 36. Market Summary—Total Health Insurance IT Market
  • 37. Total Health Insurance IT: Percent Revenue Forecast by Segment, US, 2014–2020
  • 38. Health Insurance IT, IT Infrastructure/Hardware Segment: Revenue Forecast, US, 2014–2020
  • 39. Health Insurance IT, IT Infrastructure/Hardware Segment: Revenue Forecast and Percentage Total Revenue, US, 2014 and 2020
  • 40. Health Insurance IT, Core Administrative Systems Segment: Revenue Forecast, US, 2014–2020
  • 41. Health Insurance IT, Core Administrative Systems Segment: Revenue Forecast and Percentage Total Revenue, US, 2014 and 2020
  • 42. Health Insurance IT, BI/Analytics Segment: Revenue Forecast, US, 2014–2020
  • 43. Health Insurance IT, BI/Analytics Segment: Revenue Forecast and Percentage Total Revenue, US, 2014 and 2020
  • 44. Health Insurance IT, Consumer Engagement Segment: Revenue Forecast, US, 2014–2020
  • 45. Health Insurance IT, Consumer Engagement Segment: Revenue Forecast and Percentage Total Revenue, US, 2014 and 2020
  • 46. Competitive Market Forces Impacting Payer IT Vendors
  • 47. Market Engineering Methodology
Related Research
Healthcare payers are grappling with a number of significant challenges that are upending their traditional business models and operational processes. To tackle these many challenges, health insurance organizations are actively looking at information technology as a lever of operational efficiency and transformational change, with spending priorities focusing on new tools for analytics, consumer engagement, and population health/care management. This study sizes and forecast the health insurance IT market at a broad market level, looking at revenue for the total market and four main IT market segments as defined by Frost & Sullivan -infrastructure/hardware; core administrative systems; business intelligence(BI)/analytics; and consumer engagement. The study covers factors driving the need to deploy IT in response to dynamic industry shifts; discusses key challenges impacting the health insurance industry and the IT market that serves the industry; provides an overall outlook for future business and IT trends for health insurance companies; and forecasts revenue growth for the total payer IT market and key market segments for the 6-year period from 2015 to 2020.
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Table of Contents | Executive Summary~ || Key Findings – Study Highlights~ || Scope and Segmentation~ || Health Insurance IT: Market Engineering Measurements*, US, 2014~ || CEO’s Perspective~ || 3 Big Predictions~ | Market Background~ || Snapshot of the Health Insurance Industry in 2014~ || Health Insurance Industry Fundamentals~ || IT Solutions Used by Health Insurance Organizations~ || Market Scope and Definition for Health Insurance IT~ || Market Distribution Structure for IT Solutions Used by Health Insurance Organizations~ | Introduction to the Health Insurance Industry~ || Introduction to Insurance~ || What is Health Insurance?~ || Key Functions and Core Processes of Health Insurance Organizations~ || How Health Insurance Fits in With Funding for Healthcare Services~ || Public Versus Private Health Insurance~ || Definitions of Types of Managed Care Organizations~ || Key Market Categories for Health Insurance Plans~ || Macro Conditions Impacting Health Insurance Organizations~ || Summary of Enveloping Elements Impacting Health Insurers~ || Winning Strategies to Drive Business Value~ || The Affordable Care Act and the Health Insurance Industry~ | The Affordable Care Act and the Health Insurance Industry~ || The Patient Protection and Affordable Care Act~ || Timeline of Key Events for the Affordable Care Act~ || How is ACA Funded?~ || Estimated Distribution of ACA Funding Sources Over Time~ || Key Health Insurance Market Reforms Due to ACA~ || The Impact of ACA Medical Loss Ratio~ || Premium Distribution Based on ACA-MLR Rule~ || Ten Essential Health Benefits of ACA~ || ACA Online Insurance Exchanges~ || The Key ACA Insurance Plans~ | Trends in Health Insurance Expenditures~ || Health Insurance Coverage—Snapshot of US Population~ || Government Definitions for Health Insurance and Payment Categories of National Health Insurance Expenditures~ || Trends in National Health Expenditures~ || Historical and Projected Average Annual Growth Rates for Per Capita Health Spend~ || National Health Expenditures by Type of Service~ || Percentage Distribution of National Health Expenditures for Public and Private Health Insurance~ || National Health Expenditures for Public and Private Health Insurance~ || Projected Average Annual Growth for Select NHE Categories Compared to National Gross Domestic Product (GDP)~ || Projected Average Annual Growth in Health Insurance Spend by Select Categories~ | Health Insurance and Information Technology~ || Market Segmentation—Health Insurance IT~ || Core IT Architecture~ || Market Penetration for Software Applications~ || Select IT Vendors Serving the Health Insurance Industry~ || IT Infrastructure/Hardware~ || Core Administrative Systems~ || BI/Analytics~ || Consumer Engagement~ || Health Insurers View IT Investments as Key to Transformation, Growth, and Innovation~ || Top Areas of IT Investments for Health Plans~ || IT Priorities for Next Generation Health Plans: Where Vendors Need to Focus~ | Total Health Insurance IT Market— Drivers, Restraints, and Trends~ || The Big Picture: Macro Forces Impacting the Health Insurance Industry~ || Key IT and Business Challenges Facing Health Insurance~ || Market Drivers~ || Market Restraints~ || Impact Mapping of Drivers and Restraints for the US Health Insurance IT Market~ | Total Health Insurance IT Market— Revenue Forecast and Trends~ || Market Engineering Measurements~ || Forecast Methodology~ || Total Health Insurance IT—Revenue Forecast~ || Total Market Revenue Forecast Discussion~ || Total Health Insurance IT—Percent Revenue Forecast by Segment~ || Revenue Forecast by Market Segment~ | Revenue Forecast and Trends—Market Segments~ || Market Engineering Measurements—IT Infrastructure/Hardware Segment~ || Revenue Forecast—IT Infrastructure/Hardware Segment~ || Market Engineering Measurements—Core Administrative Systems Segment~ || Revenue Forecast—Core Administrative Systems Segment~ || Market Engineering Measurements—BI/Analytics Segment~ || Revenue Forecast—Health Insurance IT, BI/Analytics Segment~ || Market Engineering Measurements—Consumer Engagement Segment~ || Revenue Forecast—Health Insurance IT, Consumer Engagement Segment~ | Competitive Environment~ || Competitive Market Forces Impacting Payer IT Vendors~ || Competitive Market Structure~ || Recent Notable Deals~ || Select Vendors and Products~ | The Last Word~ || 3 Big Predictions~ || Legal Disclaimer~ | Appendix~ || Definition of Select Terms Related to Health Insurance~ || Summary of Select Provisions of the ACA Impacting the Health Insurance Industry~ || US Health and Medical Insurance Carriers— Historical Statistics~ || Top Health Insurance Companies by Net Premium Written~ || Top Health Insurance Companies by Total Enrolment~ || Market Engineering Methodology~ || Sources~ || Learn More – Next Steps~
List of Charts and Figures 1. Snapshot of the Health Insurance Industry in 2014~ 2. Health Insurance IT: Health Insurance Coverage by Type of Health Insurance, US, 2013 and 2014~ 3. Health Insurance IT: National Health Expenditures and Growth Forecast by Select Service Type, US, 2014 and 2020~ 4. Health Insurance IT: Projected National Health Expenditures for Public and Private Health Insurance, US, 2014 and 2020~ 5. Total Health Insurance IT Market: Key Drivers, US, 2015–2020~ 6. Total Health Insurance IT Market: Key Restraints, US, 2015–2020~ 7. Total Health Insurance IT Market: Market Engineering Measurements, US, 2014~ 8. Total Health Insurance IT: Revenue Forecast by Segment, US, 2014–2020~ 9. Health Insurance IT, IT/Infrastructure/Hardware Segment: Market Engineering Measurements, US, 2014~ 10. Health Insurance IT, Core Administrative Systems Segment: Market Engineering Measurements, US, 2014~ 11. Health Insurance IT, BI/Analytics Segment: Market Engineering Measurements, US, 2014~ 12. Health Insurance IT, Consumer Engagement Segment: Market Engineering Measurements, US, 2014~ 13. Health Insurance IT: Competitive Market Structure, US, 2014~ 14. Health Insurance IT: Notable Industry Deals, US, 2015~ 15. Health Insurance IT: Select Vendors and Products, US, 2015~ 16. 3 Big Predictions~ 17. Health Insurance IT: Definitions for Select Health Insurance Terms, US, 2015~ 18. Health Insurance IT: Select Provisions of the Patient Protection and Affordable Care Act (P.L. 111-148) Impacting the Health Insurance Industry, US, 2015~ 19. Health Insurance IT: Historical Statistics for Health and Medical Insurance Carriers , US, 1997, 2002, 2007, and 2012~ 20. Health Insurance IT: Top 20 Health Insurance Companies by Net Premiums Written, US, 2014~ 21. Health Insurance IT: Top 20 Health Insurance Companies by Net Premiums Written, US, 2014~ 22. Health Insurance IT: Top 20 Health Insurance Companies by Total Enrolment, US, 2014~| 1. Health Insurance IT: Percentage Revenue Allocation by Market Segment, US, 2014~ 2. Health Insurance IT: Market Engineering Measurements*, US, 2014~ 3. Health Insurance IT: Estimated Percentage of Total IT Spend for Products Versus Services, US, 2014~ 4. Health Insurance IT: Estimated Penetration of Software Applications, US, 2014~ 5. Total Health Insurance IT Market: Distribution Structure, US, 2015~ 6. Life/Health and Property/Casualty Health Insurance Premiums, US, 2014*~ 7. Key Health Plan Stakeholders~ 8. Health Plan Core Processes~ 9. The Flow of Funds in U.S. Healthcare~ 10. Health Insurance IT: Public Versus Private Health Insurance, US, 2014~ 11. Definitions of Types of Managed Care Organizations~ 12. Summary of Enveloping Elements Impacting Health Insurers~ 13. Winning Strategies to Drive Business Value~ 14. Timeline of Key Events for the Affordable Care Act~ 15. Tax Changes Related to Health Insurance or Financing Healthcare Reform~ 16. Health Insurance IT: Estimated Distribution of ACA Funding Sources Over Time, US, 2013-2022~ 17. Ten Essential Health Benefits of ACA~ 18. The Key ACA Insurance Plans~ 19. Health Insurance IT: NHE Payment Categories, US, 2014~ 20. Health Insurance IT: NHE Forecast, US, 2014–2020~ 21. Health Insurance IT: Average Annual Growth Rate of Health Spend Per Capita, US, 1970’s-2024~ 22. Health Insurance IT: Projected Percentage Distribution of National Health Expenditures by Source of Funds, US, 2014 and 2020~ 23. Health Insurance IT: Projected Average Annual Growth in Select Health Insurance Spend Categories, US, 2014 and 2020~ 24. Health Insurance IT: Market Segmentation, US, 2015~ 25. Health Insurance IT: Core IT Architecture, US, 2015~ 26. Health Insurance IT: Estimated Penetration of Software Applications, 2014~ 27. Select IT Vendors Serving the Health Insurance Industry~ 28. Core Administrative Systems - 2014 Revenue Allocation~ 29. BI/Analytics - 2014 Revenue Allocation~ 30. Consumer Engagement - 2014 Revenue Allocation~ 31. Top Five Business Strategy and IT Investment Priorities for US Health Plans, 2015~ 32. Solutions/Capabilities Where IT Vendors Serving Health Insurers Need to Focus~ 33. Key IT and Business Challenges Facing Health Insurance~ 34. Total Health Insurance IT Market: Impact of Drivers and Restraints, US, 2015–2020~ 35. Total Health Insurance IT: Revenue Forecast, US, 2014–2020~ 36. Market Summary—Total Health Insurance IT Market~ 37. Total Health Insurance IT: Percent Revenue Forecast by Segment, US, 2014–2020~ 38. Health Insurance IT, IT Infrastructure/Hardware Segment: Revenue Forecast, US, 2014–2020~ 39. Health Insurance IT, IT Infrastructure/Hardware Segment: Revenue Forecast and Percentage Total Revenue, US, 2014 and 2020~ 40. Health Insurance IT, Core Administrative Systems Segment: Revenue Forecast, US, 2014–2020~ 41. Health Insurance IT, Core Administrative Systems Segment: Revenue Forecast and Percentage Total Revenue, US, 2014 and 2020~ 42. Health Insurance IT, BI/Analytics Segment: Revenue Forecast, US, 2014–2020~ 43. Health Insurance IT, BI/Analytics Segment: Revenue Forecast and Percentage Total Revenue, US, 2014 and 2020~ 44. Health Insurance IT, Consumer Engagement Segment: Revenue Forecast, US, 2014–2020~ 45. Health Insurance IT, Consumer Engagement Segment: Revenue Forecast and Percentage Total Revenue, US, 2014 and 2020~ 46. Competitive Market Forces Impacting Payer IT Vendors~ 47. Market Engineering Methodology~
Author Nancy Fabozzi
Industries Healthcare
WIP Number NF1E-01-00-00-00
Is Prebook No