From prior authorization solutions to underwriting platforms, we break down the categories of tech vendors helping healthcare payers operate more efficiently and improve the member experience.
Because health insurers work with tight margins, any efficiency gains can make a world of difference.
In the US, for instance, the industry-wide profit margin sits just north of 3%, as of Q2’23, according to The National Association of Insurance Commissioners. This figure has been relatively flat since 2021, but it remains well below the levels seen in 2019 (4.5%) and 2020 (5.3%).
To protect the bottom line, health payers are turning to tech vendors that can improve their core operations of covering health risks and paying claims. For instance, some tech providers are leveraging AI to tackle complex issues like health risk scoring and fraud, waste, and abuse detection.
For health insurers, investing in the tech stack offers opportunities to reduce costs, optimize networks, and deliver better outcomes for their members.
In the market map below, we identify 103 tech vendors addressing health insurance operations across 13 different categories.
Note: Our map includes both public companies and private startups. This market map is not exhaustive of the space.
Please click to enlarge.
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