US Population Health Management Market—Analysis and Competitive Landscape Assessment

The Largest Opportunity in Health IT in a Post-EHR Era

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Research Overview

This Frost & Sullivan research service presents a comprehensive analysis of the market potential and dynamics of the population health management (PHM) market in the United States (US). The study provides a strategic PHM road map to progressive health entities that aspire to practice proactive care monitoring at a community level and synthesize clinical, administrative, and financial information to improve the well-being of the patient population while taking responsibility of a value-driven reimbursement relationship.
It includes market drivers, challenges, forecasts, and trends. This research examines the following market segments:

Services
•     Advisory: Clinical & Financial Consulting
•     Data Analysis: Data Aggregation & Management, Risk Stratification & Modeling
•     Care Management: Care Coordination, Patient Engagement
•     Performance Management: Clinical Performance Management, Financial Performance Management

Customers
•     Accountable Care Organizations (ACO)
•     Payers & Payer-Providers
•     Hospitals outside of ACO contracts
•     Physician practices outside of ACO contracts


Market Overview

Population health hanagement is the leading growth opportunity in a post-EHR healthcare era.

The rising cost burden of chronic disease management coupled with evolving value-based payment programs supports the requirement of individualized digital interventions that aim to transform care delivery and improve chronic conditions at a population level.

The adoption of PHM solutions that demonstrate meaningful use of IT applications is expected to accelerate in 2016 through 2020. Patient care is moving into a broader but coordinated environment where routine, manual tasks are automated by PHM solutions that unify siloed systems, stratify comorbidities, empower patients through engagement, and benchmark outcomes at network, practice, and patient level.

Health systems, on the road to accountable care, are striving to identify appropriate care workflows, control readmissions, and promote self-care so that incoming patients heal quickl, transitioning patients avoid readmitting, and healthy populations stay healthy.

Payer, payer-provider, and ACO communities are the top promoters of PHM in the United States. Best-in-class solutions are sought to help track, monitor, analyze, and manage provider/member performance. These groups are expected to invest in technologies that support value-based contracts, set provider-specific quality goals, initiate member engagement, and minimize financial risk through episodic care management.

Additionally, the need to coordinate care departments, meet payer targets, and engage patients during, pre-, and post-care is expected to strongly accelerate investment in the non-ACO hospital segment. Non-ACO physician practices are challenged by growing competition, imposing regulations, and limited investment capabilities. However, as CMS drives new MU objectives that consider physician preferences, the adoption of PHM solutions across this segment is expected to be substantial during 2018–2020.

The US PHM supply market is at a nascent stage and a select few companies have managed to better patient outcomes and minimize financial risk for their clients. Many providers and payers are in dire need of a suite of healthcare technology solutions and services that improve care delivery efficiency and enable transitions toward various value- or risk-based healthcare ecosystems. The market is likely to observe fierce competitive rivalry as small modular PHM firms compete against large, platform providers. Winners will successfully weigh in market needs and offer secure, interoperable, and highly customized PHM solutions that achieve the coveted triple aim around cost, quality, and access.

Table of Contents

1. Executive Summary
Key Findings—The US PHM Market
Assess Past Performances
Identify Core Care Delivery Goals
Investigate Operational and Technological Feasibility
Define Short- and Long-term PHM goals
PHM Customer Segments
Contribution to Total PHM Market in 2015 ($ Million)
Key PHM Requirements
Scope and Segmentation
Market Engineering Measurements
Total Population Health Management Market, US, 2015
Market Overview
Competitor Overview
Total Addressable Market
CEO’s Perspective
3 Big Predictions
2. Market Overview - US Population Health Management Market
Market Scope and Definition
Market Background
Top Healthcare Industry Imperatives—The United States
Transition to Accountable Care
Fundamental Characteristics Required to Facilitate PHM
Goals of PHM
Segmentations
By Category, US, 2015
Advisory
Data & Analysis
Care Management
Performance Management
Customer Segmentation and Definitions
ACO’s
Payers & Payer-Providers
Non-ACO Hospitals
Non-ACO Physician Practices
Business Objectives by Key Customer Segments
Network Management
Practice Management
Risk Adjusted Revenue Management
3. Macro Conditions Prompting Population Health Management
Inefficiency in Traditional Healthcare Systems
Socioeconomic Indicators
Economic
Demographic
Transformative
Rising Demand for Healthcare
Mortality Rates, US, 2000–2010
Key Causes of Death
Growth of Chronic Diseases, US, 2000–2025
Cost of Chronic Disease Management, US, 2011
Rising National Health Expenditure
Evolving Reimbursement Frameworks Drive Accountable Care
Ongoing transition
Expected transition
Risk-Based Reimbursements
Evolving Payment Programs, US, 2016
4. Introduction to Population Health Management
Definition
Market Overview
Type of PHM Solutions
Evolution of PHM
Market Maturity Indicator
Technology Roadmap
Market Drivers
Market Restraints
5. PHM Segment Level Analysis
Market Segmentation – By Category, US, 2015
Advisory
Data Aggregation and Management
Key Goals
Evolving Service Models
Key Market Observations
Risk Stratification
Key Goals
Framework that Enables PHM
Care Coordination
Patient Engagement
Key Goals
A Key Focus Area across All Stakeholders
Behavioral Change for Patients and Their Providers
Past and Future Approaches
Basic-to-Advanced Patient Engagement Guidelines
Patient Engagement Strategy Outlook, US, 2005–2025+
Performance Management
6. Implementation of PHM
Value Chain Analysis
Payer-Provider Collaboration to Pursue PHM, US, 2015
Traditional vs. PHM-enabled Care Delivery—Comparative Ecosystem
Patient Condition Management through Analytics—Contextual Framework
PHM Technology Ecosystem Aid Patient-Centered Care Delivery
Functional Architecture
Progressive PHM Approach by Care Settings
Technology Architecture, US, 2016
Top Investment Areas, US, 2015
Adoption of Major PHM Enablers among Survey Respondents, US, 2014
7. Procurement of PHM Services
A Snapshot
Supply—Demand Dynamics
Engagement Strategy
Contract Strategy
Sourcing Strategy
Procurement Quick Wins
8. Pricing Models for PHM Solutions
Pricing Strategy for Specific Applications
Opportunity Analysis
Longitudinal Patient Record
Evidence Based Care
Care Coordination
Patient Engagement
Performance Analysis
Pricing Models
Existing
Emerging
Software-license-based Pricing Tied to Coverage
Contract Structure
Governing Committee
Risk-based Pricing Tied to Outcomes
Contract Structure
Governing Committee
9. Forecasts and Trends—Total Population Health Management Market
Revenue Forecast, US, 2015–2020
Market Summary
Percent Revenue Forecast by Customer Segment
Revenue Forecast by Segment
3 Factors That Influence Revenue- Penetration, Scalability and Price
Pricing Analysis—Projected Unit Price Variance , US, 2015–2020
10. Forecasts and Trends—Market Segments
ACOs Segment
Market Measurements, US, 2015
Revenue Forecast, US, 2015–2020
Payers & Payer-Providers Segment
Market Measurements, US, 2015
Revenue Forecast, US, 2015–2020
Non-ACO Hospitals Segment
Market Measurements, US, 2015
Revenue Forecast, US, 2015–2020
Non-ACO Physician Practices Segment
Market Measurements, US, 2015
Revenue Forecast, US, 2015–2020
11. Demand Analysis
Penetration Analysis
ACO’s
Payers & Payer-Providers
Non-ACO Hospitals
Non-ACO Physician Practices
12. Competitive Environment
Market Gaps in the United States
Recommendations for the US Market
Changes in the Supply Market Landscape—Analyst Perspective
Vendors Capability Matrix
Definitions
A Snapshot
Key Observations
Mapping of Leading Ecosystem Players
Complex Supply Dynamics of the US PHM Market
Select PHM Companies and Products
Competitive Market Structure
Recent Notable M&As—Investment and Withdrawals
Top Companies to Watch
IBM Watson Health
Optum
Caradigm
Health catalyst
Evolent health
Others
13. Selected Vendor Profiles
Optum
Corporate Background
PHM Value Chain
SWOT Analysis
Caradigm
Healthagen
Evolent Health
IBM Watson Health
Health Catalyst
ENLI
ZeOmega
14. Future Perspectives
3 Big Predictions
Legal Disclaimer
15. Appendix
Additional Frost & Sullivan Sources of Information on Healthcare
Market Engineering Methodology

Infographic



List of Figures & Charts

1. Market Engineering Measurements - Total Population Health Management Market: Market Engineering Measurements, US, 2015
2. Corporate objectives that trigger population health management
3. Goal of PHM—Shifting Emphasis from Immediate Care to Prevention
4. The Road to Accountable Care—US PHM Market
5. Population Health Management Market: Category Segmentation, US, 2015
6. Total Population Health Management Market: Customer Segmentation, US, 2015
7. Clinical Approach of a Traditional Health System
8. Population Health Management Market: Mortality Rates, US, 2000–2010
9. Population Health Management Market: Growth of Chronic Diseases, US, 2000–2025
10. Population Health Management Market: Cost of Chronic Disease Management, US, 2011
11. Projected Average Annual Growth for GDP and Select NHE Categories, US, 2014–2020
12. Population Health Management Market: Evolving Payment Programs, US, 2016
13. Population Health Management Market: Advanced PHM Solutions, US, 2014–2020
14. Total Population Health Management Market: Key Drivers, US, 2016–2020
15. Total Population Health Management Market: Key Restraints, US, 2016–2020
16. Population Health Management Market: Category Segmentation, US, 2015
17. Population Health Management Market: Patient Engagement Strategy Outlook, US, 2005–2025+
18. Population Health Management Market: Payer-Provider Collaboration to Pursue PHM, US, 2015
19. Population Health Management Market: Typical Patient Composition within a Hospital System, US, 2015
20. Population Health Management Market: PHM by Type of Healthcare Facility, US, 2016–2020
21. Population Health Management Market: Technology Architecture, US, 2016
22. Population Health Management Market: Top Investment Areas, US, 2015
23. Population Health Management Market: Adoption of Major PHM Enablers among Survey Respondents, US, 2014
24. Population Health Management Market: Supply–Demand Dynamics, US, 2015
25. Total Population Health Management Market: Revenue Forecast, US, 2015–2020
26. Population Health Management Market: Market Summary, US, 2015–2020
27. Total Population Health Management Market: Percent Revenue Forecast by Segment, US, 2015–2020
28. Total Population Health Management Market: Revenue Forecast by Segment, US, 2015–2020
29. Total Population Health Management Market: Pricing Analysis, US, 2015–2020
30. ACOs Segment: Market Engineering Measurements, US, 2015
31. ACOs Segment: Revenue Forecast, US, 2015–2020
32. Payers & Payer-Providers Segment: Market Engineering Measurements, US, 2015
33. Payers & Payer-Providers Segment: Revenue Forecast, US, 2015–2020
34. Non-ACO Hospital Segment: Market Engineering Measurements, US, 2015
35. Non-ACO Hospitals Segment: Revenue Forecast, US, 2015–2020
36. Non-ACO Physician Practice Segment: Market Engineering Measurements, US, 2015
37. Non-ACO Physician Practices Segment: Revenue Forecast, US, 2015–2020
38. ACOs Segment: Penetration Analysis, US, 2015
39. Payers & Payer-Providers Segment: Penetration Analysis, US, 2015
40. Non-ACO Hospitals Segment: Penetration Analysis, US, 2015
41. Non-ACO Physician Practices Segment: Penetration Analysis, US, 2015
42. Total Population Health Management Market: Top Vendors, US, 2015
43. Total PHM Market: Select Market Participants by Tiers of Competition, US, 2015
44. Total PHM Market: Competitive Market Structure, US, 2015
45. Total Population Health Management Market: Notable Industry Deals, US, 2014–2015



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