Healthcare EDI Market Outlook 2030: Industry Insights & Opportunity Evaluation, 2019-2030
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
Product Overview
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.
Market Overview
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).
Component
• Services
• Solutions
Transaction Type
• Claims Management
o Claims Submission
o Claim Status
o Eligibility Verification
o Payment Remittance
o Referral Certification & Authorization
o Claim Payments
o Others
• Healthcare Supply Chain
Delivery Mode
• Web & Cloud-based EDI
• EDI VAN
• Point-to-Point EDI
• Mobile EDI
End-User
• Healthcare Providers
• Healthcare Payers
• Medical Device & Pharmaceutical Industries
• Pharmacies
Contents
1. Executive Summary
2. Global Healthcare EDI Market
2.1. Product Overview
2.2. Market Definition
2.3. Segmentation
2.4. Assumptions and Acronyms
3. Research Methodology
3.1. Research Objectives
3.2. Primary Research
3.3. Secondary Research
3.4. Forecast Model
3.5. Market Size Estimation
4. Average Pricing Analysis
5. Macro-Economic Indicators
6. Market Dynamics
6.1. Growth Drivers
6.2. Restraints
6.3. Opportunity
6.4. Trends
7. Correlation & Regression Analysis
7.1. Correlation Matrix
7.2. Regression Matrix
8. Recent Development, Policies & Regulatory Landscape
9. Risk Analysis
9.1. Demand Risk Analysis
9.2. Supply Risk Analysis
10. Global Healthcare EDI Market Analysis
10.1. Porters Five Forces
10.1.1. Threat of New Entrants
10.1.2. Bargaining Power of Suppliers
10.1.3. Threat of Substitutes
10.1.4. Rivalry
10.2. PEST Analysis
10.2.1. Political
10.2.2. Economic
10.2.3. Social
10.2.4. Technological
11. Global Healthcare EDI Market
11.1. Market Size & forecast, 2020A-2030F
11.1.1. By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
11.1.2. By Volume (Million Units) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12. Global Healthcare EDI Market: Market Segmentation
12.1. By Regions
12.1.1. North America:(U.S. and Canada), By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.1.2. Latin America: (Brazil, Mexico, Argentina, Rest of Latin America), By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.1.3. Europe: (Germany, UK, France, Italy, Spain, BENELUX, NORDIC, Hungary, Poland, Turkey, Russia, Rest of Europe), By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.1.4. Asia-Pacific: (China, India, Japan, South Korea, Indonesia, Malaysia, Australia, New Zealand, Rest of Asia Pacific), By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.1.5. Middle East and Africa: (Israel, GCC, North Africa, South Africa, Rest of Middle East and Africa), By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.2. By Component: Market Share (2020-2030F)
12.2.1. Services, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.2.2. Software, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.3. By Transaction Type: Market Share (2020-2030F)
12.3.1. Claims Management, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.3.2. Healthcare Supply Chain, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.4. By Delivery Mode: Market Share (2020-2030F)
12.4.1. Web & Cloud-based EDI, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.4.2. EDI VAN, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.4.3. Point-to-Point EDI, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.4.4. Mobile EDI, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.5. By End-User: Market Share (2020-2030F)
12.1.1. Healthcare Providers, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.1.2. Healthcare Payers, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.1.3. Medical Device & Pharmaceutical Industries, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.1.4. Pharmacies, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
13 Company Profile
13.1. McKesson Corporation (US)
13.1.1. Company Overview
13.1.2. Company Total Revenue (Financials)
13.1.3. Market Potential
13.1.4. Global Presence
13.1.5. Key Performance Indicators
13.1.6. SWOT Analysis
13.1.7. Product Launch
13.2. Optum (US)
13.3. Allscripts Healthcare Solutions Inc. (US)
13.4. athenahealth (US)
13.5. Nextgen Healthcare (US)
13.6. Cognizant Technology Corporation (US)
13.7. SSI Group, LLC (US)
13.8. Cerner Corporation (US)
13.9. Comarch SA (Poland)
13.10. Axway Software SA (France)
13.11. Optum Inc. (US)
13.12. Dell Technologies Inc. (US)
13.13. Nextgen Healthcare (US)
13.14. Synnex Corporation (US)
13.15. Comarch (Poland)
13.16. Axway Solutions (US)
13.17. Other Prominent Players
14 Consultant Recommendation
**The above given segmentations and companies could be subjected to further modification based on in-depth feasibility studies conducted for the final deliverable.
Methodology/Research Approach
This research study involved the extensive usage of both primary and secondary data sources. The research process involved the study of various factors affecting the industry, including the government policy, market environment, competitive landscape, historical data, present trends in the market, technological innovation, upcoming technologies and the technical progress in related industry, and market risks, opportunities, market barriers and challenges. The following illustrative figure shows the market research methodology applied in this report.Research Programs/Design
| Historical Data (2015-2019) |
|
|
| Influencing Factors |
|
|
| Market Forecast (2021-2026) |
|
|
Market Size Estimation
Top-down and bottom-up approaches are used to validate the global Voluntary Carbon Offset market size market and estimate the market size for Company, regions segments, product segments and Application (end users).
The market estimations in this report are based on the marketed sale price of Voluntary Carbon Offset (excluding any discounts provided by the player, distributor, wholesaler or traders). The percentage splits, market share, and breakdowns of the product segments are derived on the basis of weights assigned to each of the segments on the basis of their utilization rate and average sale price. The regional splits of the overall Voluntary Carbon Offset market and its sub-segments are based on the percentage adoption or utilization of the given product in the respective region or country.
Major Company in the market is identified through secondary research and their market revenues determined through primary and secondary research. Secondary research included the research of the annual and financial reports of the top Company; whereas, primary research included extensive interviews of key opinion leaders and industry experts such as experienced front-line staff, directors, CEOs and marketing executives. The percentage splits, market share, Growth Rate and breakdowns of the product markets are determined through using secondary sources and verified through the primary sources.
All possible factors that influence the markets included in this research study have been accounted for, viewed in extensive detail, verified through primary research, and analyzed to get the final quantitative and qualitative data. The market size for top-level markets and sub-segments is normalized, and the effect of inflation, economic downturns, and regulatory & policy changes or other factors are not accounted for in the market forecast. This data is combined and added with detailed inputs and analysis from Market Intellix and presented in this report
The following figure shows an illustrative representation of the overall market size estimation process used for this study.
Market Breakdown and Data Triangulation
After complete market engineering with calculations for market statistics; market size estimations; market forecasting; market breakdown; and data triangulation, extensive primary research was conducted to gather information and verify and validate the critical numbers arrived at. In the complete market engineering process, both top-down and bottom-up approaches were extensively used, along with several data triangulation methods, to perform market estimation and market forecasting for the overall market segments and sub-segments listed in this report. Extensive qualitative and further quantitative analysis is also done from all the numbers arrived at in the complete market engineering process to list key information throughout the report.
Data Source
Secondary Sources
Secondary sources include such as press releases, annual reports, non-profit organizations, industry associations, governmental agencies and customs data, etc. This research study involves the usage of widespread secondary sources, directories, databases such as Bloomberg Business, Wind Info, Hoovers, Factiva (Dow Jones & Company), and TRADING ECONOMICS, and News Network, statista, Federal Reserve Economic Data, annual reports, BIS Statistics, ICIS; company house documents; CAS(American Chemical Society); investor presentations; and SEC filings of companies. Secondary research was used to identify and collect information useful for the extensive, technical, market-oriented, and Hospitals study of the Voluntary Carbon Offset market. It was also used to obtain important information about the top companies, market classification and segmentation according to industry trends to the bottom-most level, and key developments related to market and technology perspectives.
| Market Size |
|
|
| Market Position of Top Company |
|
|
| Qualitative Analysis |
|
|
Primary Sources
In the primary research process, various sources from both the supply and demand sides were interviewed to obtain qualitative and quantitative information for this report. The primary sources from the supply side include product Company (and their competitors), opinion leaders, industry experts, research institutions, distributors, dealer and traders, as well as the raw materials suppliers and producers, etc.
The primary sources from the demand side include industry experts such as business leaders, marketing and sales directors, technology and innovation directors, supply chain executive, end use (product buyers), and related key executives from various key companies and organizations operating in the global market.
Primary research was conducted to identify segmentation Type, product price range, product Application, key Company, raw materials supply and the downstream demand, industry status and outlook, and key market dynamics such as risks, influence factors, opportunities, market barriers, industry trends, and key player strategies.
Key Executives Interviewed
Key Data Information from Primary Sources
| Primary Sources | Parameters | Key Data |
| Market Segments(by Application, by Type) |
|
|
| Total Market |
|
|