Canada Healthcare Claims Management Market Analysis Sample Report

Canada Healthcare
Claims Management
Market
A sample report on
www.insights10.com
Includes Market Size, Market Segmented by Types
and Key Competitors (Data forecasts from 2022 – 2030F)

This report presents a strategic analysis of the Canada Healthcare
Claims Management Market and a forecast for its development in the
medium and long term. It provides a comprehensive overview of the
market value, dynamics, segmentation, main players, growth and demand
drivers, challenges & future outlook, etc. This is one of the most
comprehensive reports about the Canada Healthcare Claims
Management Market, and offers unmatched value, accuracy, and expert
insights

3
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential
Report Scope
Report Attribute Details
Number of Pages 70-80
Base Year for Estimation 2022
Forecast Period 2023-2030
Report Coverage
Market Overview, Revenue Forecast, Market Segmentation, Growth Factors and Trends,
Competitive Landscape, Key Company Profiles, Government Policies, Regulatory Landscape,
Reimbursement Scenario
Quantitative Units Revenue in USD Million/Billion (Mn/Bn)
Research Approach Secondary Research (60%), Primary Research (40%)
Click on the icon to know the detailed methodology

4
Table of Content
CONTENT PG. NO.
1. Healthcare Claims Management Overview 08-24
1.1. Healthcare Claims Process In Canada
1.2. Canada Overview
1.3. Economic Overview: Canada
1.4. Healthcare Claims Management Market in Canada
1.5. Healthcare Services Market in Canada
1.6. Healthcare Scenario in Canada
1.7. Health Insurance Coverage: Canada
1.8. Budget of the Government for Public Insurance
1.9. Mergers and Acquisitions
2. Market Size and Forecasting 25-33
2.1 Market size and forecasts (Excel and Methodology)

5
Table of Content
CONTENT PG. NO.
2.2. Market Segmentation
2.2.1. By Service Type
2.2.2. By Deployment Mode
2.2.3. By End User
2.2.1. By Component
2.2.2. By Organization Size
2.2.3. By Mode of Delivery
3. Market Dynamics 34-38
3.1. Market Growth Drivers
3.1.1. Canada Healthcare Claims Management Market Driver 1

6
Table of Content
CONTENT PG. NO.
3.2. Market Restraints
3.2.1. Canada Healthcare Claims Management Market Restraint 1
4. Competitive Landscape 39-49
4.1. Major Market Share
4.2. Key Company Profile
4.2.1. Accenture
4.2.2. IBM Corporation
4.2.3. McKesson Corporation
4.2.4. Infosys Limited
4.2.5. Cognizant

7
Table of Content
CONTENT PG. NO.
4.2.6. TELUS Health
4.2.7. Optum, Inc.
4.2.8. CGI Group Inc.
4.2.9. Change Healthcare
4.2.10. Allscripts Healthcare
5. Reimbursement Scenario 50-55
5.1. Reimbursement Regulation
5.2. Reimbursement Process for Diagnosis
5.3. Reimbursement Process for Treatment
6. Methodology & Scope 56-61

Canada Healthcare Claims Management Market Analysis
1. Healthcare Claims Management Overview

9
1.1 Healthcare Claims Process In Canada
1. Patient Registration: Similar to other healthcare systems, patients need to register with their healthcare provider and provide their personal
information, including their provincial health insurance number, which grants them access to publicly funded healthcare services
2. Service Documentation: Healthcare providers document the services provided to the patient, including diagnoses, procedures, treatments,
medications, and other relevant information. This documentation is essential for accurate billing and claim submission
3. Claim Creation: Based on the service documentation, a claim is created using specific billing codes and other relevant information. In Canada, the
billing codes used for procedures and services are typically based on the Canadian version of the International Statistical Classification of Diseases
and Related Health Problems (ICD-10-CA) and the Canadian Classification of Health Interventions (CCI)
4. Claim Submission: The claim is submitted to the respective provincial or territorial health authority or an intermediary organization responsible for
processing claims on behalf of the government. Each province or territory may have its own electronic or paper-based claim submission processes
5. Adjudication: The provincial or territorial health authority reviews the claim to determine if the services provided are covered under the publicly
funded healthcare system. This process involves assessing the submitted documentation and comparing it against the province or territory's
guidelines and policies
6. Payment or Denial: After the claim is adjudicated, the health authority will either approve the claim and provide payment to the healthcare provider or
deny the claim if it does not meet the necessary requirements. Denials can occur for various reasons, such as incomplete documentation or services
not meeting the eligibility criteria
7. Patient Billing: If there are any patient fees or costs not covered by the publicly funded healthcare system, such as copayments or deductibles, the
healthcare provider may bill the patient directly for those amounts
8. Claim Follow-Up: In cases of denials or payment discrepancies, healthcare providers may need to follow up with the health authority to resolve any
issues and ensure proper reimbursement
Here are the main parts of the healthcare claim process in Canada:

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1.1 Healthcare Claims Administration In Canada (continued)
BPO
Business
Process
Outsourcing
ADM
Application
Development and
Maintenance
ITI
IT Infrastructure
The manual process of receiving,
recording, handling and processing of
claims (e.g., back and front office
outsourcing, knowledge process
outsourcing)
Building and maintaining applications
and design IT processes (e.g.,
production support, security and
controls, application development and
support
Building the physical capabilities to run
applications and house data (e.g., Data
Centers, Servers, Networks, etc.)
Outsourcing options for health claims administrations Type Of Stakeholders In the
Healthcare Claim Management
Market
➢ Healthcare Providers
➢ Insurance Payers
➢ Third-Party Administrators (TPAs)
➢ Government Healthcare Agencies
➢ Medical Billing Companies
➢ Employers
➢ Healthcare Clearinghouses

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1.2 Global Top 10 Digital Health Trends in 2023 and Start Ups
Digital Health
Healthcare
Analytics
Cloud Healthcare
Electronic Health
Records
Medical
Wearables
Remote Patient
Monitoring
Digital
Therapeutics
Patient
Engagement
Home Healthcare
Digital
Biomarkers
Mobile Health
Illustrative

12
1.2 Overview of Healthcare Claims Management Market in the World
(continued)
North America
~ Market Size of
$93.5 Bn
Europe
~Revenue to reach
$XX Bn by 2027
Asia
-Fastest CAGR
Africa
~Market Size of
$XX Bn
Canada
Market
~$XX Bn
Illustrative

13
1.3 Canada Overview
38 Mn
Is the population of
Canada
40.2
Is the median age
in Canada
$2.090 trillion
GDP
$52,722
per capita
▪ Please be aware that this sample report is
intended to provide you with a brief
overview of the kind of information and
analysis that will be presented in the final
report
▪ In this section you will get an
understanding of the demographics of the
country/region, which includes the
population, GDP, healthcare expenditure
and other details related to the topic
▪ In order to obtain access to all of the
information that you are seeking, you will
need to purchase the final report
▪ Final report will be comprehensive and
detailed, and it will include data, analysis,
trends, and other relevant information
related to the topic or subject matter of
interest
Illustrative

14
1.3 Economic Overview: Canada
XX
XX
2020 2021 2022 2023F 2024F 2025F 2026F 2027F 2028F 2029F 2023F
Population of Canada, (2020-2030)
XX
XX
2020 2021 2022 2023F2024F2025F2026F2027F2028F2029F2023F
GDP of Canada, (2020-2030)
Population Split (2023)
55-64
0-14
15-24
25-54
65+
Male
49%
Female
51%
By Age Group
By Gender
▪ In this section you will get an understanding of the demographics
of the country/region, which includes the population, GDP,
healthcare expenditure and other details related to the topic
▪ In order to obtain access to all of the information that you are
seeking, you will need to purchase the final report
▪ Final report will be comprehensive and detailed, and it will
include data, analysis, trends, and other relevant information
related to the topic or subject matter of interest
Illustrative

15
1.4 Digital Health Overview in Canada
Digital Health Services Survey: At a glance
▪ Please be aware that this sample report
is intended to provide you with a brief
analysis that will be presented in the
final report
understanding of the topic, which
includes the prevalence of the disease,
the application of medical devices, new
technology, and other details related to
the topic in Canada
information that you are seeking, you
will need to purchase the final report
detailed, and it will include data,
analysis, trends, and other relevant
information related to the topic or
subject matter of interest
72%
receive medical
advice from a health
care provider by
telephone
42%
access websites, mobile
applications, or interactive online
tools and services designed to
help support monitor their health
58%
have made an
appointment
electronically
89%
of patients find it
easy to receive care
via telephone
69%
find it easy to receive care through
secure messaging
60%
find it easy to receive
care through video
91%
of Canadians are
satisfied with the
quality of virtual care
69%
find it easy to receive care through
secure messaging
70%
of physicians believe
that virtual care
improves patient
access and enables
both quality and
efficient care
Illustrative

16
1.5 Healthcare Services in Canada
620 639 658 677 698 719 740 763 785
2022 2023F 2024F 2025F 2026F 2027F 2028F 2029F 2030F
Canada Healthcare Services Market Forecast, 2022-2030 (in $Bn)
▪ Please be aware that this sample report is intended to provide you with a brief overview of the kind of information and analysis that will be
presented in the final report
▪ In this section you will get an understanding of the overall Healthcare Services market in Canada, which includes the market size, current
trends and other details related to the topic
▪ In order to obtain access to all of the information that you are seeking, you will need to purchase the final report
▪ Final report will be comprehensive and detailed, and it will include data, analysis, trends, and other relevant information related to the topic or
Illustrative

17
1.6 Healthcare Scenario in Canada
1. Universal Coverage: Canada has a publicly funded healthcare system known as Medicare, which provides universal coverage for
medically necessary hospital and physician services. This means that all Canadian citizens and permanent residents have access to
essential healthcare services without direct payment at the point of service
2. Provincial/Territorial Responsibility: Healthcare in Canada is primarily administered at the provincial and territorial level, resulting in some
variations in healthcare delivery across different regions. Each province and territory is responsible for managing and delivering healthcare
services within the framework of the Canada Health Act
3. Primary Healthcare: Primary healthcare serves as the first point of contact for Canadians seeking medical care. It includes services
provided by family physicians, nurse practitioners, and other healthcare professionals. Primary care focuses on preventive care, health
promotion, and the management of common illnesses
4. Hospital Care: Hospital care is provided to Canadians through publicly funded hospitals. Hospital services include emergency care,
surgeries, diagnostic tests, and specialized treatments. Access to hospital care is typically based on medical necessity, urgency, and
availability of resources
Canada's healthcare system is often called a publicly funded, universal healthcare system. Here is an overview of the
healthcare scenario in Canada:
Illustrative

18
1.6 Healthcare Scenario in Canada (continued)
5. Prescription Medications: While hospital and physician services are covered under Medicare, prescription medications are not universally
covered. The provision of prescription drug coverage varies by province, with some provinces offering public drug insurance programs to
help subsidize the cost of medications for certain populations, such as seniors or low-income individuals
6. Wait Times: Wait times for certain medical procedures and specialist consultations have been a concern in the Canadian healthcare
system. Efforts have been made to reduce wait times through initiatives such as targeted funding, improved coordination, and innovative
models of care delivery
7. Private Healthcare: While Canada's healthcare system is predominantly publicly funded and publicly delivered, private healthcare also has
a role. Private clinics and facilities exist, providing services that are not covered by the public system, such as cosmetic surgery or elective
procedures. However, access to private healthcare cannot be used to bypass or expedite access to publicly funded care
8. Healthcare Expenditure: Healthcare expenditure in Canada is funded through a combination of federal, provincial, and territorial tax
revenues. The federal government provides financial transfers to the provinces and territories to support healthcare delivery. Canadians also
have the option to purchase private health insurance for additional coverage, such as prescription drugs, dental care, or vision care
Canada's healthcare system is often called a publicly funded, universal healthcare system. Here is an overview of the
healthcare scenario in Canada:
Illustrative

19
1.6 Healthcare Scenario: Patient Journey
Presentation Diagnosis Treatment Follow up
A suspected diagnosis is
usually made, based on
physical examination and
detailed patient and family
history
Prenatal screening/
Neonatal screening
Initial Diagnosis
Complete blood count
(evaluate number &
quality of RBCs, Hb &
WBCs)
Imaging (confirm bone
related changes or
respiratory problems)
Bacterial cultures of
blood, sputum, urine,
stool (detect any
infection)
Genetic testing (detect
the type of SCD)
Confirmatory Diagnosis
Prevention and management of
crisis:
• For VOC and Splenic
Sequestration: HU, Endari,
Adakveo, Oxbryta
• For infections: Antibiotics,
Vaccines
Prevention and management of
complications:
• Stroke: Chronic transfusions, HU
• Long term follow-up is required for
patients with SCD
• Annual assessment: CBC and
reticulocyte count, iron status, liver
and renal function tests, urinalysis,
LDH, vitamin D level and
neurocognitive assessment
• ESOD (End Stage Organ Damage)
evaluation starting from age 7
• Yearly Transcranial Doppler test to
determine risk of stroke
Stakeholders
PCP, paediatrician,
neonatologist,
haematologist and genetic
counsellor
PCP, pediatrician, medical geneticist,
hematologist, gynecologist and pathologist
PCP, pediatrician, medical geneticist,
cardiologist, hematologist,
endocrinologist, psychologist and
psychiatrist
PCP, pediatrician, neonatologist,
endocrinologist, cardiologist,
hematologist, orthopedist, psychologist
and psychiatrist
Depending on the organ complications,
the treatment involves different
specialists at different times
Illustrative

20
1.7 Health Insurance Coverage: Canada
1.0
18.9
18.4
35.7
2.5
3.5
10.2
54.3
66.0
91.7
8.3
Any public plan
TRICARE
Marketplace
Direct-purchase
Employment-based
Any private plan
With health insurance
Uninsured
▪ Canada has a universal healthcare system, which means that all Canadian citizens and permanent residents are eligible for medically
necessary healthcare services. This coverage is provided through the provincial and territorial healthcare plans
▪ While the public healthcare system provides coverage for medically necessary services, certain healthcare services and items are not
covered. This includes prescription drugs outside of the public drug programs, dental care, vision care, and other paramedical services
▪ Many Canadians supplement their coverage through private health insurance plans offered by employers or purchased individually
Coverage Type 2020 2021 Change %
Total 327,521 328,074
Any health plan 299,230 300,887 0.4
Any private plan 217,896 216,366 –0.6
Employment-based 178,737 178,285 –0.2
Direct-purchase 33,869 33,555 –0.1
Marketplace coverage 10,924 11,389 0.1
TRICARE 9,165 8,299 –0.3
Any public plan 112,925 117,095 1.2
58,541 60,226 0.5
58,778 61,940 0.9
2,967 3,151 0.1
Uninsured 28,291 27,187 –0.4
% of People by Type of Health Insurance Coverage
(2021)
Number of People By Health Insurance Coverage
Illustrative

21
1.8 Budget of Canada Government for Public Insurance
Proposed Budget By Category
Outlays 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2022-31
In Billions Of Dollars
Public
Insurence
$769 $709 $766 $841 $840 $947 $1,014 $1,085 $1,227 $1,178 $1,325 $1,412 $10,633
As % Of GDP 3.7% 3.2% 3.3% 3.4% 3.3% 3.6% 3.7% 3.8% 4.1% 3.8% 4.1% 4.2% 3.7%
▪ National Health Expenditures (NHE) grew 2.7% to $4.3 trillion in 2021, or $12,914 per person, and accounted for 18.3% of Gross Domestic Product (GDP)
▪ Public Insurence spending grew 8.4% to $900.8 billion in 2021, or 21% of total NHE
▪ Private health insurance spending grew 5.8% to $1,211.4 billion in 2021, or 28% of total NHE
▪ Out of pocket spending grew 10.4% to $433.2 billion in 2021, or 10% of total NHE
▪ Other Third Party Payers and Programs and Public Health Activity spending declined 20.7% in 2021 to $596.6 billion, or 14% of total NHE
▪ Hospital expenditures grew 4.4% to $1,323.9 billion in 2021, slower than the 6.2% growth in 2020
▪ Physician and clinical services expenditures grew 5.6% to $864.6 billion in 2021, slower growth than the 6.6% in 2020
▪ Prescription drug spending increased 7.8% to $378.0 billion in 2021, faster than the 3.7% growth in 2020
▪ Largest shares of total health spending were sponsored by the federal government (34%) and the households (27%). The private business share of health
spending accounted for 17% of total health care spending, state and local governments accounted for 15%, and other private revenues accounted for 7%
Illustrative

22
1.9 Mergers and Acquisitions
$6.0
$7.7
$10.5
$16.7
$6.8
$11.7
1H 2020 2H 2020 1H 2021 2H 2021 1H 2022 2H 2022
82
112 107 107
89
110
1H 2020 2H 2020 1H 2021 2H 2021 1H 2022 2H 2022
57% of the total deal volume are done by strategic buyers and the rest 43% are done by financial buyers in 2020
RCM M&A Deal Value Trend ($Bn) RCM M&A Deal Volume Trend
Buyer Composition: Strategic Vs Financial (2020)
59%
41% 41%
59% 58%
42%
61%
39%
$0- $25 $25-$50 $50-$100 $100+
Strategic Buyers
Financial Buyers
Buyer Type by Deal Size
($Mn)
Illustrative

23
1.9 Digital Health Market News (continued)
Company Name Year Key Pointers
DeliverHealth
In March 2022,
▪ DeliverHealth, a global provider of technology-enabled solutions for hospitals,
health systems, and group practices, launched its partner program built to unify
point solutions in healthcare and clear the way for essential, resilient
connections among providers, clinicians, and patients
▪ Patform allows for frictionless access and effective workflows to apply purpose-
built, explainable AI with the needed human-in-the-loop flexibility that delivers
speed to value
Blessing Health System
March 2022
▪ Blessing Health System, an integrated rural health system, selected Biofourmis,
a virtual care and digital therapeutics provider, to launch its home hospital
services
▪ Biofourmis is supporting the health system with its turnkey, end-to-end, home
hospital solution for participation in the Rural Home Hospital project.
Global News
Illustrative

24
1.9 Mergers and Acquisitions (continued)
Company Name Type
Amount /
Duration
Year Key Pointers
Merger March 2023
Merger Jan 2023
Latest Deals In Canada

2. Market Size and Forecasting

26
2.1 Market size and forecasts (Excel and Methodology)
XX
XX
2022 2023F 2024F 2025F 2026F 2027F 2028F 2029F 2030F
Canada Healthcare Claims Management Market Forecast, 2022-2030
(in $Bn)
final report
understanding of the overall Canada
Healthcare Claims Management
Market, which includes the market size,
current trends and other details related
to the topic
Click on the icon to know the
methodology and assumption
2023 2024 2025 2026 2027 2028 2029 2030
Major Markets Patient
(Mn)
2.74 2.82 2.90 2.94 2.98 3.02 3.07 3.12
Canada Patient Size (Bn) 0.51 0.61 0.68 0.69 0.70 0.71 0.72 0.73
% of US Patients 18.75% 21.70% 23.56% 23.45% 23.42% 23.39% 23.34% 23.45%
Global Market Size (Bn $) 3,620 3,780 3,950 4,128 4,314 4,508 4,711 4,937
Canada Market Size (Bn
$)
61 74 84 87 91 95 99 106
Illustrative

27
2.2 Snapshot of Healthcare Claims Management Market Segmentation
▪ In this section you will get an understanding of the segmentations which will cover the Canada Healthcare Claims Management
Market
▪ In order to obtain access to all of the information that you are seeking, you will need to purchase the final report
By Service Type
Claims
Processing
Claims Denial
Management
Claims
Analytics and
Reporting
By Deployment
Mode
On-Premises
Cloud-Based
By End User
Hospitals and
Clinics
Insurance
Companies
Others
By Component
Software
Services
By Organization
Size
SMEs
Large
Enterprises
By Mode of
Delivery
Integrated
Solutions
Standalone
Solutions

28
Canada Healthcare Claims Management Market Share, By
Services Type (2022)
Claims
Processing
Claims Denial
Management
Claims Analytics
and Reporting
▪ Claims Processing market in Canada is
a significant component of the overall
Healthcare Claims Management market
▪ It has the maximum market share in
Canada market with approximately
xx%
final report
2.2.1 Market Segmentation: By Service Type
Illustrative

29
Deployment Mode (2022)
On-Premises
Cloud-Based
2.2.2 Market Segmentation: By Deployment Mode
▪ On-Premises market in Canada is a
significant component of the overall
cancer market
▪ It has the maximum market share in
Canada market with approximately
xx%
final report
Illustrative

30
Canada Healthcare Claims Management Market Share, By End
User (2022)
Hospitals and
Clinics
Insurance
Companies
Other
Healthcare
Providers
2.2.3 Market Segmentation: By End User
▪ Hospitals have the maximum market
share in Canada market with
approximately xx%
final report
Illustrative

31
Component (2022)
Software
Services
2.2.3 Market Segmentation: By Component
final report
Illustrative

32
Organization Size (2022)
SMEs
Large
Enterprises
2.2.3 Market Segmentation: By Organization Size
final report
Illustrative

33
Canada Healthcare Claims Management Market Share, By Mode
of Delivery (2022)
Integrated
Solutions
Standalone
Solutions
Integrated Solutions Standalone Solutions
2.2.3 Market Segmentation: By Mode of Delivery
final report
Illustrative

3. Market Dynamics

35
3.1 Market growth drivers
▪ Rising healthcare expenditure in Canada is driving the need for efficient
claims management
▪ As healthcare costs continue to increase, healthcare providers and
payers are seeking ways to streamline claims processing, reduce
administrative costs, and optimize reimbursement to manage overall
healthcare expenditures effectively
▪ Please be aware that this sample report is intended to provide you with a
brief overview of the kind of information and analysis that will be
presented in the final report
▪ In order to obtain access to all of the information that you are seeking,
you will need to purchase the final report
▪ Final report will be comprehensive and detailed, and it will include data,
analysis, trends, and other relevant information related to the topic or
2010 2022 2030
3.1.1 In 2022, total health spending in Canada is projected to reach $331 Bn, equivalent to $8,563 per Canadian,
representing approximately 12.2% of the country's gross domestic product (GDP)
National health expenditure trends
Illustrative

36
3.1 Market growth drivers (continued)
Top countries that are leveraging
technology in their fight against cancer
United States
Japan
Germany
South Korea
China
United Kingdom
France
Canada
Australia
Israel
Switzerland
Singapore
Sweden
Netherlands
Italy
Spain
Belgium
Denmark
Austria
Norway
3.1.2 Growing Emphasis on Data Analytics
▪ There is a growing emphasis on data analytics in healthcare
claims management
▪ Advanced analytics tools enable the identification of trends,
patterns, and anomalies in claims data, allowing healthcare
organizations to detect fraud, improve coding accuracy, and
optimize revenue cycle management
▪ Integration of data analytics in claims management
processes is driving efficiency and cost savings
Illustrative

37
3.1 Market growth drivers (continued)
3.1.3 Technological Advancements
▪ Technological advancements in healthcare IT, such as
automation, artificial intelligence (AI), and machine learning,
are transforming healthcare claims management
▪ Automation can streamline claims processing, reduce
manual errors, and accelerate reimbursement cycles
▪ AI-powered systems can help identify fraudulent claims,
improve coding accuracy, and enhance overall claims
management efficiency
▪ Please be aware that this sample report is intended to
provide you with a brief overview of the kind of information
and analysis that will be presented in the final report
XX
XX
2022 2023F 2024F 2025F 2026F 2027F 2028F 2029F 2030F
Illustrative

38
3.2 Market restraints
3.2.1 Complex Regulatory
Environment
▪ Complex regulatory environment
in healthcare, including
compliance with privacy laws,
billing regulations, and
reimbursement policies, poses a
challenge for claims
management
▪ Adhering to various regulations
across different provinces and
territories can create complexity
and increase administrative
burdens, impacting the efficiency
and speed of claims processing
3.2.2 Fragmented Data
Systems
▪ Fragmentation of data systems
and lack of interoperability
between healthcare
organizations and payers can
hinder efficient claims
management
▪ Inconsistent data formats, limited
data sharing, and siloed
information can result in delays,
errors, and challenges in claims
processing and coordination
among stakeholders
3.2.3 Limited Integration with
Electronic Health Records (EHRs)
▪ Integration of claims
management systems with
electronic health records (EHRs)
can enhance the accuracy and
efficiency of claims processing
▪ However, the limited integration
between claims management
systems and EHRs can pose
challenges, leading to manual
data entry, data discrepancies,
and potential errors in claims
submission and processing.
Our analysis will thoroughly investigate the key restraints that may significantly impact business
operations and growth.
Illustrative

4. Competitive Landscape

40
4.1 Major Market Share
XX
Other
▪ Canada Healthcare Claims Management
Market is a highly competitive space, with
many companies developing and marketing
cancer treatments
▪ Some of the top companies in Canada
cancer market based on revenue and
market share include
Revenue of Major Players in Canada Healthcare Claims
Management Market ($ Mn)
Illustrative

41
4.2 Key Company Profile
▪ Here is the list of top 10 companies which
will cover in the final report
▪ Each company will have slides for
o Overview
o Key details
o Offerings
o Name of products
o Recent activities/ Press Coverage
o Distribution and Vendor Partners
o Mergers, Acquisitions and
Collaboration
o Financials
▪ If there are specific companies that you
would like to be included in the report,
please let us know via email
1 Accenture
3 McKesson Corporation
5 Cognizant
7 Optum, Inc.
9 Change Healthcare
2 IBM Corporation
4 Infosys Limited
6 TELUS Health
8 CGI Group Inc.
Allscripts Healthcare
10
Key Note:

42
4.2.1 Accenture
Founded in: 1989
HQ: Dublin, Ireland
Type: Private
Total Revenue: $61.6 Bn
Website: www.accenture.com
▪ Accenture is a global professional services company that provides
a wide range of services, including consulting, technology, and
outsourcing solutions
▪ It offers expertise in healthcare and has experience in supporting
healthcare claims management processes
▪ In the context of healthcare claims management, Accenture
provides consulting services, technology solutions, and process
optimization strategies to help healthcare organizations streamline
their claims operations and improve efficiency
Offerings in Hea
➢ Consulting Services
➢ Technology Solutions
➢ Analytics and Data Insights
➢ Automation and Digital
Transformation
➢ Claims Audit and Compliance
➢ Fraud Detection and Prevention
Recent Activity / Press Coverage
Accenture has announced its intent to acquire Green Domus Desenvolvimento Sustentável LTDA, a leading Brazil-based sustainability consultancy with
experience helping clients design and implement a range of sustainability services with a focus on measurable decarbonization strategies
Celent report titled, “New Business and Underwriting Systems: North America Individual Life Insurance Edition,” recognizes the Accenture Life Insurance &
Annuity Platform (ALIP) as one of the highest-rated solutions among nine new business and underwriting systems in the Advanced Technology category,
awarded every two years
Accenture, Microsoft and Unilever have completed one of the largest and most complex cloud migrations in the consumer goods industry

43
4.2.1 Accenture (continued)
Major Distribution Partners Major Vendor Partners
Partnerships Ecosystem
One of the largest pharmaceutical
distributors in the United States, McKesson
has been a long-standing distribution
partner for Roche
Cardinal Health is a Fortune 500 healthcare
services company that provides
pharmaceutical distribution services to
Roche
It is one of the largest drugstore chains in
the United States and Europe, and its
extensive network of retail locations and
distribution centers make it an important
distribution partner for Roche
A leading healthcare services provider in
Asia, Zuellig Pharma is a distribution
partner for Roche in several Asian countries
One of the largest pharmaceutical
wholesalers in Europe, PHOENIX Group
distributes Roche's products in several
European countries
Roche has been working with SAP, a
leading software company, to develop digital
solutions for its healthcare products
A leading Swiss biotechnology company,
Lonza provides Roche with contract
manufacturing services for the production of
its biologics and pharmaceuticals
Roche has a strategic partnership with
Microsoft to leverage its cloud computing
and AI technologies in the development of
new healthcare products
Thermo Fisher Scientific is a leading
provider of analytical instruments, reagents,
and laboratory services
GE Healthcare provides Roche with
advanced medical imaging and diagnostics
technologies, including CT scanners and
MRI machines
Illustrative

44
Company Name Type
Amount /
Duration
Year Key Pointers
Objectivity
Acquisition - May, 2023
▪ Accenture has completed its acquisition of Objectivity, a digital
engineering firm specializing in cloud and platform development
services that help clients accelerate their transformation journey
for rapid innovation
▪ Objectivity’s extensive experience in platform engineering, cloud
native computing and application modernization bolsters
Accenture’s Cloud First capabilities to help clients tap into more
open and adaptable platform models and services in order to
accelerate their digital transformation
Einr AS
Acquisition - May, 2023
▪ Accenture has completed its acquisition of Einr AS, a business
consulting company specialized in high volume logistics solutions
using SAP® technologies to optimize the flow of products from
manufacturers to consumers, headquartered in Oslo, Norway
▪ Acquisition further enhances Accenture’s SAP capabilities,
helping it to accelerate supply chain reinvention for organizations
within the retail and consumer electronics industries
Latest Deals - Mergers and Acquisitions

45
2020 2021 2022 2023F 2024F 2025F 2026F 2027F 2028F 2029F 2030F
Revenues ($Bn), 2020-2030
▪ According to Accenture's 2022 financial
report, the company had a record increase
of 22% in revenue
report
▪ In this section you will the understating of
financial overview of the company, which
includes revenue forecasting, segment
revenue and other key details as per
availability
Breakdown of Net Revenue by Segment, 2022
1 2 3 4
Illustrative

46
4.2.2 Company 2
Founded in:
HQ:
Type:
Revenue:
Website:
Solutions offered by Company
Drugs Indications
Drugs for Cancer Recent Activity / Press Coverage
Illustrative

47
4.2.2 Company 2 (continued)
Major Distribution Partners Major Vendor Partners
Partnerships Ecosystem
Illustrative

48
Company Name Type
Amount /
Duration
Year Key Pointers
Latest Deals - Mergers and Acquisitions
Illustrative

49
xx xx xx
2020 2021 2022 2023F 2024F 2025F 2026F 2027F 2028F 2029F 2030F
Revenues ($Bn), 2020-2030
report
▪ In this section you will the understating of
financial overview of the company, which
includes revenue forecasting, segment
revenue and other key details as per
availability
detailed, and it will include data, analysis,
trends, and other relevant information
related to the topic or subject matter of
interest
Breakdown of Net Revenue by Segment, 2022
1 2 3 4
Illustrative

5. Reimbursement Scenario

51
5.1 Reimbursement Regulation
The reimbursement scenario in the Canada Healthcare Claims Management
Market is complex and can vary depending on the specific treatment, setting of
care, and insurance coverage. Here are some key points to consider:
▪ Public Insurance:
o Medicare is a federal health insurance program for people aged 65 and
older, as well as people with certain disabilities or health conditions
o Medicare covers many cancer treatments, including chemotherapy,
radiation therapy, and some immunotherapies
o However, coverage can be subject to strict guidelines and restrictions,
such as the requirement for prior authorization
o Medicaid is a joint federal-state program that provides health insurance
for people with low incomes
o Medicaid coverage for cancer treatments can vary by state and may be
subject to limits on the amount and type of treatment covered
▪ Private Insurance:
o Private insurance coverage for cancer treatments can also vary widely
depending on the insurer and the specific policy
o Some policies may have high out-of-pocket costs, such as deductibles
and co-pays, while others may have more comprehensive coverage
Public Insurance provides health
insurance coverage for more than 8 in 10
People
17%
21%
Employer-Sponsored
49%
Other Private
3%
Other Public
1%
Uninsured
9%
Health Insurance Coverage, 2022
Illustrative

52
5.1 Reimbursement Regulation (continued)
▪ Affordable Care Act:
o Affordable Care Act (ACA) includes provisions to help improve access to cancer treatments by requiring insurers to cover
certain preventive services, including cancer screenings, without co-pays or deductibles
o It also includes protections for people with pre-existing conditions, such as cancer
▪ Reimbursement for New Treatments:
o Reimbursement for new cancer treatments can be a complex and lengthy process, as insurers and government programs
often require evidence of safety and effectiveness before providing coverage
o This can create challenges for companies developing and marketing new treatments
▪ Value-Based Care:
o There is a growing trend towards value-based care, which aims to improve outcomes and lower costs by focusing on the
value of treatments rather than simply the volume of treatments
o Value-based care models can include payment models that tie reimbursement to outcomes or performance metrics
In order to obtain access to all of the information that you are seeking, you will need to purchase the final report
Final report will be comprehensive and detailed, and it will include data, analysis, trends, and other relevant information related to the
topic or subject matter of interest
Illustrative

53
5.1 Reimbursement Regulation (continued)
Coverage Penetration (% Total Population) Source of Funding
Spend on Healthcare (%of Current Health Expenditure)
Reimbursement Market Trends
 Public healthcare coverage is provided by the government and includes programs like
Medicare and Medicaid
 Medicare is a federal program that provides healthcare coverage to individuals who
are 65 years of age or older, as well as certain younger people with disabilities
 Medicaid is a joint federal-state program that provides healthcare coverage to
individuals with low income and limited resources
▪ Shift towards value-based care has been a significant trend in the US healthcare system, with payers and providers increasingly focused on improving patient
outcomes and reducing costs
▪ This has led to the development of alternative payment models such as accountable care organizations (ACOs) and bundled payment arrangements, which
incentivize providers to deliver high-quality, cost-effective care 38.9%
37.1%
35.6%
32.5%
31.5%
44.0%
46.0%
47.7%
51.0%
51.8%
2017 2018 2019 2020 2021 2022 2023
Government Expenditure
Private Health Insurance
Out of Pocket
Other
NA NA
100% 100% 100% 100% 100%
xx xx xx xx xx
2012 2013 2014 2015 2016
Public Healthcare
Coverage
Private Coverage
6.3% 4.08% 5.1% 3.8% 2.2% 2.4% 3.6% GDP Growth (yoy)
14.7% 11.3% 15.5% 7.5% 4.2% NA NA HC Spend Growth (yoy)
Illustrative

54
5.2 Reimbursement Process for Diagnosis
The reimbursement process in the US healthcare system can be complex and can vary depending on the type of healthcare service,
the healthcare provider, and the insurance coverage. Here are the general steps involved in the reimbursement process:
▪ Service or Treatment Provided: The healthcare provider performs a service or treatment for the patient
▪ Billing: The healthcare provider submits a claim to the insurance company or other payer, requesting reimbursement for the
service provided
▪ Adjudication: The insurance company or other payer reviews the claim to determine whether it meets the criteria for
reimbursement. This can involve verifying the patient's eligibility, reviewing the treatment provided, and checking for any potential
errors or fraud
▪ Payment: If the claim is approved, the insurance company or other payer reimburses the healthcare provider for the service
provided, based on the negotiated payment rates or fee schedule
▪ Patient Responsibility: Depending on the patient's insurance coverage, they may be responsible for paying a portion of the cost
of the service, such as deductibles, co-payments, or co-insurance
In order to obtain access to all of the information that you are seeking, you will need to purchase the final report
Final report will be comprehensive and detailed, and it will include data, analysis, trends, and other relevant information related to the
topic or subject matter of interest
Illustrative

55
5.3 Reimbursement Process for Treatment
The reimbursement process in the US healthcare system can be complex
and can vary depending on the type of healthcare service, the healthcare
provider, and the insurance coverage. Here are the general steps involved
in the reimbursement process:
▪ Service or Treatment Provided: The healthcare provider performs a
service or treatment for the patient
▪ Billing: The healthcare provider submits a claim to the insurance
company or other payer, requesting reimbursement for the service
provided
▪ Adjudication: The insurance company or other payer reviews the claim
to determine whether it meets the criteria for reimbursement. This can
involve verifying the patient's eligibility, reviewing the treatment
provided, and checking for any potential errors or fraud
▪ Payment: If the claim is approved, the insurance company or other
payer reimburses the healthcare provider for the service provided,
based on the negotiated payment rates or fee schedule
FDA
Private Payers Public Payers
Health Technology Assessment
Payment
Coverage
Coding
Coding depends on availability code while coverage and
payment process decisions are made through an HTA.
Market Authorization
1 3
2
Illustrative

6. Methodology & Scope

Research Methodology
▪ Insights 10’s research methodology delves deeper into the market, covering the macro and micro aspects of the industry. We identify the
key growth drivers, opportunities, and restraints that might promote or hinder the future industry growth along with an expansive
overview of the competitive landscape to help our clients make informed strategic decisions
▪ We implement a mix of primary and secondary research for our market estimate and forecast. The secondary research forms the initial
phase of our study where we conduct extensive data mining, referring to verified data sources such as independent studies, government
and regulatory published material, technical journals, trade magazines, and paid data sources
▪ For forecasting, the following parameters are considered:
❑ Market drivers and restraints along with their current and expected impacts
❑ Technological scenario and expected developments
❑ End use industry trends and dynamics
❑ Trends in the consumer behavior
❑ Regulatory scenario and expected developments
❑ Current capacity and expected capacity additions up to 2030
▪ We assign weights to these parameters and quantify their market impacts using the weighted average analysis to derive the expected
market growth rate
▪ We appoint data triangulation strategies to explore different areas of the market. Our qualitative and quantitative assessments are time-
sensitive, reflecting the most recent value and volume of the market across regions
▪ All our estimates and forecasts are verified through exhaustive primary research with the Key Industry Participants (KIPs)
▪ Currency used in the report is the US dollar (USD), with the market size indicated in USD million/billion (Mn/Bn)

Analysis Methodology
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Market Trends
Market Sizing &
Analysis
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Validation
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Insights
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Reporting
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Proprietary
Database
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Data Triangulation & Data Validation
Bottom Up Approach
Summarization of revenue
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Revenue generated by products &
services offered by companies
Validation from
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Final
Market
Size
Top Down Approach
Final Market size break up to
rest of segmentation
Arriving at market size
of each segment
Validation from
Primary Interview
Final
Summary

Key Benefits for Stakeholders from this Report
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