Healthcare Provider Network Management Market Outlook 2030: Industry Insights & Opportunity Evaluation, 2019-2030
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
Product Overview
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.
Market Overview
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
• Services
• Software
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
• Services
• Software
Contents
1. Executive Summary
2. Global Healthcare Provider Network Management 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 Provider Network Management 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 Provider Network Management 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 Provider Network Management 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 Delivery Mode: Market Share (2020-2030F)
12.3.1. On-premise Delivery Mode, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.3.2. Cloud-based Delivery Mode, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
1.1. By End User: Market Share (2020-2030F)
1.1.1. Services, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
1.1.2. Software, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
13 Company Profile
13.1. Cognizant (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. Ayasdi, Inc. (US)
13.3. Change Healthcare (US)
13.4. Optum, Inc. (US)
13.5. Genpact Limited (US)
13.6. Infosys BPM Ltd. (India)
13.7. Atos Syntel, Inc. (France)
13.8. Mphasis, Ltd. (India)
13.9. SKYGEN USA (US)
13.10. Evolent Health, Inc. (US)
13.11. 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
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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.
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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
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