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US Healthcare Claims Management Growth Opportunities
US Healthcare Claims Management Growth Opportunities
Intelligent Tools to Automate Payer and Provider Functions Will Boost Efficiency and Deliver a Digital Customer Experience
24-Jan-2023
North America
Market Research
$4,950.00
Special Price $4,455.00 save 10 %
Description
The healthcare claims management industry is evolving. Changes include a shifting reimbursement landscape (for virtual care, urgent care, telehealth, and at-home care); a transition to new, value-based care models (e.g., population-based reimbursement and partial and full capitation payment); and disruption from big tech companies, big-box retailers, and big telecom operators entering the primary care and platform play in healthcare domains.
In addition, health consumer empowerment (self-quantified consumers), employer push for greater value in patient care, and regulatory changes are forcing health insurance companies and providers to redesign their claims processes and capabilities by integrating technologies such as robotic process automation (RPA) and artificial intelligence (AI) in claims predictions, prior-authorization, pre/post-adjudication, and payment.
This study offers qualitative and quantitative analysis of select healthcare claims management software, services, and technology interventions for the US market. It also includes in-depth coverage of key vendors’ solutions and services across payer and provider back-office operations including claims intake, preparation, pre/post-adjudication, claims adjustment, and payment. These solutions and services cover RPA, AI, clearinghouse, payment integrity, care management, revenue cycle management, and electronic medical record/electronic health record (EMR/EHR) across the provider and payer claims’ value chain.
Frost & Sullivan expects the healthcare claims management market to hit $23.81 billion by 2026, increasing at a compound annual growth of 11% (2021 to 2026).
The main growth factors include the rising cost and complexity of claims processes, support for value-based reimbursement models, increasing fraud, waste, and abuse (FWA) in the claims pre- and post-adjudication process, overwhelming administrative and operational costs, and consumer demand for a digital experience.
To keep ahead of their competitors, health insurance incumbents must have a robust process to integrate digital technologies into their core operations to become customer-centric, digitally enabled organizations fit to excel in three foundational areas of claims: customer experience, efficiency, and effectiveness.
Author: Rishi Pathak
RESEARCH: INFOGRAPHIC
This infographic presents a brief overview of the research, and highlights the key topics discussed in it.Click image to view it in full size
Table of Contents
Why is it Increasingly Difficult to Grow?
The Strategic Imperative 8™
The Impact of the Top 3 Strategic Imperatives on the US Healthcare Claims Management Industry
Growth Opportunities Fuel the Growth Pipeline Engine™
Scope of Analysis
Voices from the Industry—What Impacts Claims Management Today?
Voices from the Industry—What Impacts Claims Management Today?(continued)
Definitions of Payer & Provider Electronic Administrative Transaction
Definitions of Payer & Provider Electronic Administrative Transaction (continued)
US Healthcare Claims Management—Recent Announcements by Centers for Medicare & Medicaid Services (CMS)
Market Share by Revenue of Top US Health Insurance Companies
US Healthcare Payer Authority
Segmentation
Segmentation (continued)
US Healthcare Claims Management Segmentation by Technology
Growth Environment for the Claims Management Market
Growth Environment for the Claims Management Market (continued)
Payer and Provider Claims Administrative Workflow
Evolving Value Propositions of Key Claims Capabilities
US Healthcare Payer Function Components
US Healthcare Payer Back-office Function Components
US Healthcare Payer Claims Processing, Key Challenges
US Healthcare Payer Top Challenges
Payers’ Approach to Multi-faceted Intelligent Operations
Key Trends Driving Payers’ Next-gen Claims Management Capabilities
Trend 1—Real-time Claims Processing in Health Insurance
Trend 2—Emerging Payment Integrity Paradigm
Trend 3—Payer–Provider Collaboration
Trend 4—Cognitive Digital Automation
Key Competitors in the US Healthcare Claims Management Market
Growth Metrics
Growth Drivers
Growth Restraints
Forecast Assumptions
Revenue Forecast
Revenue Forecast by Product
Revenue Forecast Analysis
Revenue Forecast Analysis (continued)
Pricing Trends and Forecast Analysis
Competitive Environment
Revenue Share
Revenue Share Analysis
Growth Metrics
Revenue Forecast
Forecast Analysis
Growth Metrics
Revenue Forecast
Forecast Analysis
Growth Metrics
Revenue Forecast
Forecast Analysis
Growth Metrics
Revenue Forecast
Forecast Analysis
Growth Opportunity 1—Payer Integration of Digital Claims Functions
Growth Opportunity 1—Payer Integration of Digital Claims Functions (continued)
Growth Opportunity 2—Blockchain Technology for Smart Contracts
Growth Opportunity 2—Blockchain Technology for Smart Contracts (continued)
Growth Opportunity 3—RPA for Intelligent Payer Automation
Growth Opportunity 3—RPA for Intelligent Payer Automation (continued)
Growth Opportunity 4—AI in Prior-Authorization (PA) Automation and Triaging
Growth Opportunity 4—AI in Prior-Authorization (PA) Automation and Triaging (continued)
Your Next Steps
Why Frost, Why Now?
List of Exhibits
List of Exhibits (continued)
Legal Disclaimer
Popular Topics
| Deliverable Type | Market Research |
|---|---|
| Author | Dr. Rishi Pathak |
| Industries | Healthcare |
| No Index | No |
| Is Prebook | No |
| Keyword 1 | Healthcare Claims Management Market |
| Keyword 2 | Healthcare Claims Management Software |
| Keyword 3 | Health Claims Management |
| Podcast | No |
| WIP Number | K7EB-01-00-00-00 |