Organizations are focused on optimizing and lowering the operational cost of the healthcare claims processing. They are adopting medical claims management solution that seamlessly integrates multiple complex systems, platforms, as well as manual processes to automate medical claim processing workflow throughout the claims life cycle.
Rapid increase in number of patients suffering from chronic diseases and increase in volume of healthcare claims is resulting in demand for healthcare claims management solutions. According to the National Association of Insurance Commissioners (NAIC), in 2018, the accident and health insurance industry’s direct written premiums reached US$1.1 trillion, up by 57.3% from 2009. The largest 10 insurers collectively wrote 51.8% of the total US market. With the increase in healthcare cost each year consumer are inclining towards adoption of health insurance. With the availability of better insurance policies by the government consumers are adopting the viable option available for secure themselves. According to Congressional Research Service an estimated 58million individuals (18.1% of the U.S. population) were enrolled in Medicare in 2019. This is increase demand for claim management solution helps organization to create and deploy automated and agile claims management processes for full-proof claims processing. Major players are focused on enhancing the business through strategic acquisitions this is expected to help the company to enhance the customer base and increase the revenue share. This is expected to augment the growth of healthcare claims management market.
In 2021, Majesco, a global provider of cloud insurance platform software acquired ClaimVantage. The acquisition is expected to help the company to provide next generation insurance technology solutions that enable insurers to accelerate their digital transformation to meet tomorrow’s demands today. This is expected to help the company to increase the product offering and enhance the business.
In 2020, Change Healthcare, a global healthcare technology company acquired “PROMETHEUS Analytics” solution form Altarum. The product acquisition is expected to help company to enhance the business and increase the revenue share in the global market.
In addition, approach towards introduction of innovative solutions in order to increase the product portfolio is expected to support the healthcare claims management market growth. Factors such as high cost associated to product and deployment and data security issues are expected to hamper the growth of global healthcare claims management market. In addition, lack of skilled professionals is expected to challenge the growth of target market. However, increasing adoption of cloud and focus towards implementing AI in healthcare are factors expected to create new opportunities for players operating in the target market. In addition, increasing inductance cases and players focus towards tracking the untapped market in developing countries are expected to support the revenue transaction of the healthcare claims management market. According to Current Population Survey Annual Social and Economic Supplement, in 2019, 8.0 percent of people, or 26.1 million, did not have health insurance at any point during the year
Segment Analysis by Region
The market in North America is expected to account for major revenue share in the global healthcare claims management market due to high patient volume with insurance. In addition, favorable policies by the government and availability of solution from players operating in the country are factors expected to support the regional market growth. Players approach towards improving the operational flow is expected to increase demand for management software.
The market in Asia Pacific is expected to witness faster growth in the target market due to increasing healthcare cost and rising demand for health insurance.
The global healthcare claims management market is highly competitive due to presence of large number of players and innovative product offerings. In addition, business expansion activities through partnerships and agreements are factors expected to further increase the competition.
Healthcare Claims Management Market Segment Analysis, 2019
The global healthcare claims management market is segmented into component, type, delivery mode, and end use. The component segment is divided into software and services. Among component the service segment is expected to account for major revenue share in the global healthcare claims management market. The end use segment is divided into healthcare payers, healthcare providers, and other. The players profiled in the report are Cerner Corporation, McKesson Corporation, athenahealth, eClinicalWorks, Optum, Inc, Conifer Health Solutions, and nThrive.
Market By Component
Market By Type
Market By Delivery Mode
Market By End Use
Rapid increase in number of patients suffering from chronic diseases and increase in volume of healthcare claims is resulting in demand for healthcare claims management solutions.
In type the integrated solutions segment is growing at faster pace.
In the global market the Asia Pacific region is expected to grow faster.
Some of the players considered in the report scope are Cerner Corporation, McKesson Corporation, athenahealth, eClinicalWorks, and Optum, Inc.
The North America is expected to account for major revenue share in the global market.
In delivery mode the on-premise segment is growing at faster pace.
Factors such as high cost associated to product and deployment and data security issues are expected to hamper the growth of global healthcare claims management market.