Healthcare EDI Market by Component (Solution, Service), Delivery Mode (On-premise & Cloud, Mobile) Transaction Type (Claims Management, Payment Remittance, Payments, Healthcare Supply Chain), End-User – Global Forecast to 2030
Healthcare EDI (electronic data interchange) is a structured way of transmitting the data that provides a secure electronic data interchange between healthcare institutions, care providers, patients, etc. It provides security and efficiency in data processing and healthcare claims processing.
The global Healthcare EDI market is projected to reach USD 6.1 billion by 2030 from USD 3.5 billion in 2020, at a CAGR of 8.1% during the forecast period. The growth of this market is majorly attributed to the development of regulations for transaction processes, the rising need to curtail healthcare costs, and government support for HCIT implementation. In addition, the need for the efficient management of electronic claims and reimbursement transactions for healthcare providers are expected to drive demand growth in the healthcare EDI market during the forecast period.
Covid-19 Impact on the Healthcare EDI Market
The current COVID-19 pandemic has resulted in a massive number of patients visiting healthcare facilities on a daily basis. According to WHO data, there were 62.3 million confirmed COVID-19 cases and 1.4 million deaths globally, as of November 30, 2020. Due to the COVID-19 outbreak, the number of patient data globally has increased. With the COVID-19 pandemic, most countries, including the whole of Europe, the US, India, and Australia, among others, are following complete nationwide lockdowns.
Driver: Regulations for transaction processes
The Healthcare Insurance Portability and Accountability Act (HIPAA), passed in 1996, set up a standard for the transmission of insurance data. Prior to this act, there were 400 different medical form standards that not only made it difficult for providers and payers to process claims but also introduced many errors that made it important to implement a standard for claims management.
Restraint: High implementation cost of EDI software
Although the adoption of healthcare EDI by healthcare providers is on the rise, the cost associated with EDI software installation is high. The major reason for this includes third-party solutions and inadequate internal systems and clearinghouses adding high costs per transaction with expensive setup fees. This will significantly affect the total cost of ownership.
Opportunity: Increase in outsourcing of EDI services
EDI outsourcing is the process of having a third party manage a part or the entire process of using EDI to exchange data with trading partners. Growing healthcare costs are increasingly pressurizing in the healthcare industry to provide quality care at lower costs by minimizing wastages at each stage. Healthcare revenue loss in American hospitals due to self-pay billing issues is as high as 20% to 30%.
Challenge: End-user limitations and requirements
Despite its long-term benefits, EDI has witnessed limited success. The reason for this lies in the nature of the hospitals that use healthcare EDI and the healthcare organizations that require it. The demand side/end users are participants who are relatively small, have limited IT resources, and suffer from limited financial strength; this prevents them from adopting EDI. Unlike the retail world, in healthcare, large suppliers mandate the use and adoption of healthcare EDI.
By component, the services segment is expected to record the highest CAGR during the forecast period
The services segment is expected to witness a faster growth rate in this market due to factors such as, the increasing claims volume, increasing complexity and scale of EDI solutions, as they require extensive training programs. Similarly, a growing trend of outsourcing activities, such as revenue cycle management, claims handling and management, and partner management services, is also expected to propel the growth of the services market.
Asia-Pacific is the fastest growing market for healthcare EDI market during the forecast period
Asia-Pacific is expected to grow at high CAGR during the forecast period. Increasing incidence of chronic diseases and the rising geriatric population, growing demand for advanced healthcare systems due to increasing per capita disposable incomes in the region, and growing awareness of healthcare EDI solutions among healthcare providers and payers are responsible for the high CAGR of the Asia-Pacific healthcare EDI market.
Key Market Players
The major players in the global Healthcare EDI market are McKesson Corporation (US), Optum (US), Allscripts Healthcare Solutions Inc. (US), athenahealth (US), and Nextgen Healthcare (US). Other prominent players in this market include Cognizant Technology Corporation (US), SSI Group, LLC (US), Cerner Corporation (US), Comarch SA (Poland), Axway Software SA (France), Optum Inc. (US), Dell Technologies Inc. (US), Nextgen Healthcare (US), Synnex Corporation (US), Comarch (Poland), Axway Solutions (US), and Plexis Healthcare Systems (US).
• Claims Management
o Claims Submission
o Claim Status
o Eligibility Verification
o Payment Remittance
o Referral Certification & Authorization
o Claim Payments
• Healthcare Supply Chain
• Web & Cloud-based EDI
• EDI VAN
• Point-to-Point EDI
• Mobile EDI
• Healthcare Providers
• Healthcare Payers
• Medical Device & Pharmaceutical Industries