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

Changing IT Priorities for Next Generation Health Plans

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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.

Table of Contents

1. Executive Summary
Key Findings – Study Highlights
Scope and Segmentation
Health Insurance IT: Market Engineering Measurements*, US, 2014
CEO’s Perspective
3 Big Predictions
2. 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
3. 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
4. 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
5. 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
6. 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
7. 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
8. 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
9. 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
10. Competitive Environment
Competitive Market Forces Impacting Payer IT Vendors
Competitive Market Structure
Recent Notable Deals
Select Vendors and Products
11. The Last Word
3 Big Predictions
Legal Disclaimer
12. 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

Infographic



List of Figures & Charts

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



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