Most firms in our coverage have shown declining growth rates in the past two quarters due to a variety of factors. Large-scale M&A in the health insurance industry (notably CVS-Aetna and Cigna-Express Scripts) has created pricing pressures and related challenges for some firms, such as Cognizant. In the highly consolidated payer space, several clients are in-sourcing their operations which leads to further pressures on topline growth for firms with large exposure to this sector. At the same time, cost pressures faced by clients have resulted in demand slowdown for the short term.