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

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

The objective of this research service is to present a comprehensive analysis of the US Health Insurance Information Technology (IT) market with respect to market potential and key market dynamics at play over the coming 5 years.

The regional scope of the analysis is focused on the United States.

The study period covered by this service for the US Health Insurance IT market is from 2014 to 2020, with the base year as 2014 and the 6-year forecast period from 2015 to 2020.

The study describes and defines the market for various types of IT solutions used by health insurance organizations; 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 health insurance IT market and key market segments for the 6-year period (2015-2020).

About this report

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.


  • Methodology
  • Executive Summary
    • Key Findings-Study Highlights
    • Key Findings
    • Scope and Segmentation
    • Key Questions This Study Will Answer
    • Market Engineering Measurements
    • CEO's Perspective
    • Executive Summary-3 Big Predictions
  • Market Background
    • Snapshot of the Health Insurance Industry in 2014
      • Table Top 5 Companies by Revenue
      • Table Top 5 Companies by Member Enrollment*
    • 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 Common Types of Health Insurance Plans
    • 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
  • Trends in Health Insurance Expenditures
    • Health Insurance Coverage-Snapshot of US Population
      • Table Health Insurance IT: Health Insurance Coverage by Type of Health Insurance, US, 2013 and 2014
    • Government Definitions for Health Insurance and Payment Categories of National Health Insurance Expenditures
    • Trends in National Health Expenditures
      • Table Health Insurance IT: NHE Forecast, US, 2014-2020
    • Historical and Projected Average Annual Growth Rates for Per Capita Health Spend
    • National Health Expenditures by Type of Service
      • Table Health Insurance IT: National Health Expenditures and Growth Forecast by Select Service Type, US, 2014 and 2020
    • Percentage Distribution of National Health Expenditures for Public and Private Health Insurance
    • National Health Expenditures for Public and Private Health Insurance
      • Table Health Insurance IT: Projected National Health Expenditures for Public and Private Health Insurance, US, 2014 and 2020
    • Projected Average Annual Growth for Select NHE Categories Compared to National Gross Domestic Product (GDP)
      • Table Health Insurance IT: Projected Average Annual Growth for GDP and Select NHE Categories, US, 2014 and 2020
    • Projected Average Annual Growth in Health Insurance Spend by Select Categories
      • Table Health Insurance IT: Projected Average Annual Growth in Select Health Insurance Spend Categories, US, 2014 and 2020
  • 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
      • Table Total Health Insurance IT Market: Market Engineering Measurements, US, 2014
    • Forecast Assumptions and Definitions
    • Forecast Methodology
    • Total Health Insurance IT-Revenue Forecast
      • Table Total Health Insurance IT: Revenue Forecast, US, 2014-2020
    • Total Market Revenue Forecast Discussion
    • Total Health Insurance IT-Percent Revenue Forecast by Segment
      • Table Total Health Insurance IT: Percent Revenue Forecast by Segment, US, 2014-2020
    • Revenue Forecast by Market Segment
      • Table Total Health Insurance IT: Revenue Forecast by Segment, US, 2014-2020
  • Revenue Forecast and Trends-Market Segments
    • Market Engineering Measurements-IT Infrastructure/Hardware Segment
      • Table Health Insurance IT, IT/Infrastructure/Hardware Segment: Market Engineering Measurements, US, 2014
    • Revenue Forecast-IT Infrastructure/Hardware Segment
      • Table Health Insurance IT, IT Infrastructure/Hardware Segment: Revenue Forecast, US, 2014-2020
    • Discussion of Forecast Assumptions-IT Infrastructure/Hardware Segment
    • Market Engineering Measurements-Core Administrative Systems Segment
      • Table Health Insurance IT, Core Administrative Systems Segment: Market Engineering Measurements, US, 2014
    • Revenue Forecast-Core Administrative Systems Segment
      • Table Health Insurance IT, Core Administrative Systems Segment: Revenue Forecast, US, 2014-2020
    • Discussion of Forecast Assumptions-Core Administrative Systems Segment
    • Market Engineering Measurements-BI/Analytics Segment
      • Table Health Insurance IT, BI/Analytics Segment: Market Engineering Measurements, US, 2014
    • Revenue Forecast-Health Insurance IT, BI/Analytics Segment
      • Table Health Insurance IT, BI/Analytics Segment: Revenue Forecast, US, 2014-2020
    • Discussion of Forecast Assumptions-BI/Analytics Segment
    • Market Engineering Measurements-Consumer Engagement Segment
      • Table Health Insurance IT, Consumer Engagement Segment: Market Engineering Measurements, US, 2014
    • Revenue Forecast-Health Insurance IT, Consumer Engagement Segment
      • Table Health Insurance IT, Consumer Engagement Segment: Revenue Forecast, US, 2014-2020
    • Discussion of Forecast Assumptions-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
  • 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
      • Table Health Insurance IT: Historical Statistics for Health and Medical Insurance Carriers , US, 1997, 2002, 2007, and 2012
    • Top Health Insurance Companies by Net Premium Written
      • Table Health Insurance IT: Top 20 Health Insurance Companies by Net Premiums Written, US, 2014
    • Top Health Insurance Companies by Total Enrollment
      • Table Health Insurance IT: Top 20 Health Insurance Companies by Total Enrollment, US, 2014
    • Market Engineering Methodology
    • Sources

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