IDC Health Insights Evaluates US Healthcare Payer Fraud, Waste and Abuse

IDC Health InsightsIDC Health Insights new report that describes the distinctive offerings and capabilities from six fraud, waste and abuse (FWA) services providers and the market they compete in. The new study, IDC Marketscape: US Healthcare Payer Fraud, Waste and Abuse Services 2015 Vendor Assessment,” (Document #HI253636) examines in detail the FWA consulting and business process outsourcing (BPO) services.  Vendors evaluated in this report include: Emdeon, IBM, McKesson, Optum, SCIO and Xerox.

Priority for investment in payer fraud, waste and abuse solutions is rising quickly on payer executive agendas because of the accelerated rate of evolution of the payer marketplace in the wake of government-mandated reform. Investment in U.S. healthcare payer FWA solutions (software and services) is rising rapidly in 2014–2015. While already present in over 50% of payers, in the next few years, such solutions will become ubiquitous among payers of all types and sizes in both the commercial and government sectors in some form. In the next three to five years, many payers will continue to enhance their overall FWA defensive capabilities by investing in oftentimes complementary solutions from multiple vendors.

The services component of payer FWA solutions is becoming more and more important, and it is now common for payer FWA software to be delivered to buyers “as a service.” Technology improvements in analytics and software-as-a-service (SaaS) solution delivery have made it more feasible for vendors to provide rapidly scalable, outsourced services at decreasing costs with defensive capabilities that outstrip those available to all but the largest payers.

Because of these developments, payers are therefore seeking guidance on how to invest in the different types of service offerings available and how the major vendors compete with each other. This IDC Health Insights report uses the IDC MarketScape methodology to assess six vendors competing in the U.S. healthcare payer FWA services market. A detailed profile supports the evaluation of the offerings from each of the selected vendors. Each profile outlines a vendor’s offering components, evolution, strengths, and challenges.

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