Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Practice Management News

Healthcare Claims Management Market to Reach $13.9B by 2023

Increasing patient volumes and declining reimbursement rates will drive providers and payers to seek healthcare claims management solutions by 2023.

Healthcare claims management

Source: Thinkstock

By Jacqueline LaPointe

- The global healthcare claims management market is slated to reach $13.93 billion by 2023, up from a valuation of $10.16 billion in 2017, MarketsandMarkets recently reported.

The significant projected growth in the healthcare claims management market equates to a 5.3 percent compound annual growth rate (CAGR) during the forecast period.

“The key factors driving the growth of this market are increasing patient volumes, expanding health insurance market, growing importance of denials management, and declining reimbursement rates,” explained the market research organization.

Provider organizations are increasingly seeking integrated healthcare claims management solutions, the report also revealed. Healthcare claims management solutions are either integrated or stand-alone products.

MarketsandMarkets predicts that integrated healthcare claims management solutions will see the greatest CAGR during the forecast period. The high growth in this segment of the market can be “attributed to increasing demand for integrated solutions, which play an integral role in improving process efficiency and reducing costs.”

Additionally, the market research organization projected cloud-based healthcare claims management solutions to dominate the delivery mode in this market.

Provider organizations will be implementing more cloud-based healthcare claims management systems versus on-premise solutions because cloud-based products have comparatively lower capital expenses and smaller operational costs.

Cloud-based healthcare claims management solutions also offer greater scalability and flexibility compared to their on-premise counterparts, the report stated.

By end user, the market research organization predicted payers to account for the largest share in the global healthcare claims management market in 2018.

End users of healthcare claims management solutions include healthcare providers, payers, and other stakeholders. But payers will likely command the largest share of the market in the near future as the organizations respond to “mandates requiring them to meet regulatory requirements and the need to reduce unnecessary penalties and punishments,” the report explained.

In terms of geographic segments, the report also uncovered that the North American market will have the largest share in the healthcare claims management market by 2018.

“The large share of North America can be attributed to the high and growing HCIT [healthcare IT] investments in the region and the presence of regulatory mandates favoring the implementation of healthcare claims management solutions,” the report stated. “Also, several major global players are based in the US, owing to which the US has become a center for innovation in the healthcare claims management solutions market.”

The North American region may have the greatest share of the healthcare claims management market, but MarketsandMarkets pointed out that Asia is likely to grow at the highest CAGR during the forecast period.

While the global healthcare claims management is set to significantly increase, the report noted that several factors are restraining the market’s growth. The factors include the integration of claims management solutions, data breaches and confidentiality risks, lack of skilled IT professionals in healthcare, and the high cost of deployment of claims management solutions.

Despite several factors limiting market growth, MarketsandMarkets still expect Cerner Corporation, McKesson Corporation, athenahealth, eClinicalWorks, Optum, Inc, Conifer Health Solutions, and nThrive to be the top players in the healthcare claims management market.

Other vendors in the healthcare claims management space include DST System, Cognizant Technology Solutions, Allscripts Healthcare Solutions, Inc.), Context 4 Healthcare, Health Solutions Plus, GE Healthcare, RAM Technologies, Quest Diagnostics, The SSI Group, PLEXIS Healthcare Systems, and GeBBS Healthcare Solutions.

Notably, all the players identified in the report are based in the United States.

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