Healthcare Provider Network Management Market by Component (Services, Internal, Outsourcing Services, Software), Delivery (On premise and Cloud), End User (Payer, Private, Public Health Insurers), Region (North America, Europe) – Global Forecasts to 2030
Healthcare provider network management helps to finance organizations to manage a provider’s network with superior efficiency for optimum financial results, process claims with more accuracy (which reduces errors and cost), and improve provider satisfaction. A healthcare provider network includes doctors, hospitals, and other healthcare providers such as nurses, therapists, practitioners, and clinicians that are a part of the health insurance plan. Provider network management comprises database management, contracting services, and credentialing pricing maintenance and configuration, among others.
The healthcare provider network management market is projected to reach USD 6.2 billion by 2030 from USD 3.1 billion in 2020, at a CAGR of 15.1%. The growth of this market is driven by the implementation of stringent federal mandates in the US, the growing focus on improving the quality of care through the effective use of payer reporting requirements, the need to curtail escalating healthcare costs, and the in-house shortage of skilled personnel.
COVID-19 Impact on the Healthcare Provider network management Market
Payers will play a critical role throughout the crisis to ensure patients get the care they need at the appropriate cost. While many payer organizations find it difficult to run smoothly, companies that opted for provider network management infrastructure are functioning well. Furthermore, the pandemic has also caused extensive concerns and increasing economic hardships for consumers, businesses, and communities. With the ongoing pressure on the supply and demand side, there is potential for further market disturbance.
Healthcare Provider network management Market Dynamics
Drivers: Implementation of stringent federal mandates in the US
The implementation of healthcare mandates like the Patient Protection and Affordable Care Act (PPACA), which includes Medical Loss Ratio (MLR) and Administrative Loss Ratio (ALR), has compelled payer organizations to effectively manage their provider networks to reduce operating costs while simultaneously improving benefit coverage and increasing customer satisfaction levels. PPACA aimed at providing insurance coverage to every US citizen by 2014.
Restrains: IT infrastructural constraints in developing countries
Cost issues are one of the major barriers to the adoption of HCIT solutions. The cost of a provider network management software is high. Maintenance and software update costs for provider network management systems can be higher than the cost of the software. Support and maintenance services, including software upgrades (as per changing user requirements), represent a recurring expenditure, amounting to almost 30% of the total cost of ownership.
Opportunities: Advanced data analytics
Owing to the dynamic nature of the healthcare industry, payers face various challenges in maintaining provider networks and managing medical loss ratios. As a result, healthcare payers are increasingly focusing on employing highly advanced IT technologies such as data analytics. With a focus on managing medical loss ratios, it is critical for payers to use data analytics to retain current members and implement effective care management programs.
Services segment to hold largest market share in 2020
On the basis of component, the healthcare provider network management market is segmented into software and services. The services segment is expected to hold the largest share of the global healthcare provider network management market in 2020. This segment’s large share can be attributed to the reduced costs of services in healthcare systems and improvements in claims auto adjudication rates, operational efficiencies, and provider relationships.
North America was the largest regional market for healthcare provider network management market in 2019.
The global healthcare provider network management market has been categorized on the basis of four major regional segments—North America, Europe, Asia Pacific, and the Rest of the World. North America was the largest regional segment of the overall market, followed by Europe. The large share of the market can be attributed to the growing health insurance coverage, the rising need to curtail healthcare costs in the US, and a strong government focus on Canada’s healthcare IT solutions.
Key Market Players
Cognizant (US), Optum, Inc. (US), Ayasdi, Inc. (US), Change Healthcare (US), Genpact Limited (US), Infosys BPM Ltd. (India), are some of the leading players of the healthcare provider network management market.
Healthcare Provider Network Management Market By Component
Healthcare Provider Network Management Market By Delivery Mode
• On-premise Delivery Mode
• Cloud-based Delivery Mode
Healthcare Provider Network Management Services Market By End User