Healthcare Payments

Healthcare payers are feeling the pressure to achieve greater cost containment and reduce fraud, waste and abuse that costs the U.S. at least $120 billion annually. Shifting from traditional cost-containment methods of the past to technologies like artificial intelligence (AI) has reshaped the industry’s future. At the same time, providers are evolving and making changes to their billing processes based on new models. In order to mitigate potential payment errors, health plans are moving from a retrospective process of identification and recovery to a more cost-effective prospective approach. New laws surrounding surprise billing are also adding complexity to the payment integrity market. According to a recent survey, 74% of respondents were unsure if they can meet Advanced Explanation of Benefits (AEOB) requirements, further fueling market turmoil with patients bearing more payment responsibility. This report takes a closer look into the market as well as companies in the ecosystem, M&A and private placement activity.