Global Healthcare Claims Management Market – Industry Trends and Forecast to 2030

Global Healthcare Claims Management Market, By Type (Integrated Solutions, Standalone Solutions) Component (Services, Software), Delivery Mode (On-Premise Delivery Mode, Cloud-Based Delivery Mode), End User (Healthcare Payers, Healthcare Providers, Others) – Industry Trends and Forecast to 2030.

 Healthcare Claims Management Market Analysis and Size

Population aging is a major reason for this in many countries, an increasing proportion of the population is over the age of 65, and the prevalence of chronic diseases rises as people age. Furthermore, the economics of health insurance has shifted. The average per capita cost of healthcare in many countries increased at a compound annual growth rate of more than 4%. Insurance plans were initially designed to cover the cost of care for patients with severe, acute illnesses or traumatic injuries, but they now more frequently cover the predictable risks (and costs) associated with chronic illness. Furthermore, advances in healthcare quality (for instance, innovative treatments like gene therapy) frequently result in better outcomes but often raise healthcare costs.

Data Bridge Market Research analyses that the healthcare claims management market, which was USD 12.29 billion in 2022, is expected to reach USD 18.15 billion by 2030, at a CAGR of 5.0% during the forecast period 2023 to 2030. In addition to the insights on market scenarios such as market value, growth rate, segmentation, geographical coverage, and major players, the market reports curated by the Data Bridge Market Research also include depth expert analysis, patient epidemiology, pipeline analysis, pricing analysis, and regulatory framework.

Healthcare Claims Management Market Scope and Segmentation  

Market Definition

Healthcare claims management is a process that includes tasks like organizing, billing, filling, updating, and processing medical claims related to patients' diagnoses, treatment, and medication. In other words, it is software that manages medical claims and reimbursement processes that is increasingly allowing healthcare providers to maximize their revenues through proper claim management. It is a two-way street between patients, healthcare providers, billing companies, and insurance providers.

Global Healthcare Claims Management Market Dynamics

Drivers

• Growing concerns about data privacy

Despite the market's expected growth, there are growing concerns about data privacy. As technology advances, modern technologies such as cloud, mobile, and next-generation databases are increasingly used to manage, store, and retrieve such claims data. These factors have combined to make healthcare data security a persistent concern for the entire healthcare industry. Rules and regulations governing healthcare data are constantly evolving to ensure patients have the data protection they require and deserve. These are certain factors that boost the growth of the market.

• Digitization of software

Healthcare providers and medical offices adopted digitization at a rapid rate. A lot of information about the patients who receive services each day is being gathered. An adequate system is required for health services to organize, manage, and carry out plans efficiently. The ‘Administrative Errors: Technical Series on Safer Primary Care 2016’ report published by the World Health Organization (WHO) estimated that about 5–50% of medical errors in primary care are administrative errors, further prompting the need for digitization. As a result, there is a growing need for medical billing software.

Opportunities

• Rising duplicate insurance claims

The use of software facilitates communication across various domains and subdomains of hospitals. The programme uses cutting-edge approaches to ensure seamless interoperability between insurance companies and hospitals while managing patient data and information about their treatment. The identical claims and a lack of transparency, the insurance firms reportedly reject about one out of every five claims. Thus, the use of advanced methodologies and interoperability between these domains of hospitals will aid in reducing the number of fraudulent claims, further boosting the market growth.

Restraints/Challenges

• Threat of cyber crimes

Concerns over the privacy of the patient's medical history and other personal information have grown as a result of the rise in cybercrime over the past few years. The Indiana Attorney General reported in 2015 that a cyberattack on the Indiana-based company Medical Informatics Engineering compromised the data of more than four million patients from 230 institutions (MIE). Malware, phishing, Man in the Middle attacks, Trojans, and other rising cyber threats are among those limiting market expansion to some extent.

This healthcare claims management market report provides details of new recent developments, trade regulations, import-export analysis, production analysis, value chain optimization, market share, impact of domestic and localized market players, analyses opportunities in terms of emerging revenue pockets, changes in market regulations, strategic market growth analysis, market size, category market growths, application niches and dominance, product approvals, product launches, geographic expansions, technological innovations in the market. To gain more info on the healthcare claims management market contact Data Bridge Market Research for an Analyst Brief, our team will help you take an informed market decision to achieve market growth.

COVID-19 Impact on the Healthcare Claims Management Market

The pandemic of COVID-19 is expected to have a significant impact on market growth. Since the beginning of the pandemic, there has been tremendous pressure on claim management software developers and providers due to the large number of people becoming infected and then being admitted to hospitals. Claim denials have also increased as a result of the COVID-19 pandemic. COVID-19 had a positive impact on the market. During the COVID-19 pandemic, the general impairment of health for those with SARS-CoV-2 infection lead to increase in claim management solutions, as physiological impact of the pandemic increases the claims related to the healthcare.

Recent developments

• In February 2022, Health Edge and Citius Tech formed a strategic partnership to provide joint go-to-market implementation and consultation services for HealthEdge solutions in Core administration, care management, and payment integrity to health plans pursuing value-based care and streamlined operations.
• In December 2021, HealthEdge Software completed its previously announced acquisition of well frame Inc, a leading digital health management platform.

Global Healthcare Claims Management Market Scope

The healthcare claims management market is segmented on the basis of type, component, delivery mode and end user. The growth amongst these segments will help you analyze meagre growth segments in the industries and provide the users with a valuable market overview and market insights to help them make strategic decisions for identifying core market applications.

Type

• Integrated Solutions
• Standalone Solutions

 Component

• Services
• Software

 Delivery Mode

• On-Premise Delivery Mode
• Cloud-Based Delivery Mode

End User

• Healthcare Payers
• Healthcare Providers
• Others

Healthcare Claims Management Market Regional Analysis/Insights

The healthcare claims management market is analyzed and market size insights and trends are provided by country, type, component, delivery mode and end user as referenced above.

The countries covered in the healthcare claims management market report are U.S., Canada and Mexico in North America, Germany, France, U.K., Netherlands, Switzerland, Belgium, Russia, Italy, Spain, Turkey, Rest of Europe in Europe, China, Japan, India, South Korea, Singapore, Malaysia, Australia, Thailand, Indonesia, Philippines, Rest of Asia-Pacific (APAC) in the Asia-Pacific (APAC), Saudi Arabia, U.A.E, South Africa, Egypt, Israel, Rest of Middle East and Africa (MEA) as a part of Middle East and Africa (MEA), Brazil, Argentina and Rest of South America as part of South America.

North America dominates the healthcare claims management market because of the presence of well-developed healthcare infrastructure and favourable reimbursement policies in the region.

Asia-Pacific is expected to grow at the highest growth rate in the forecast period of 2023 to 2030 owing to the growing healthcare infrastructure.

The country section of the report also provides individual market impacting factors and changes in regulation in the market domestically that impacts the current and future trends of the market. Data points like down-stream and upstream value chain analysis, technical trends and porter's five forces analysis, case studies are some of the pointers used to forecast the market scenario for individual countries. Also, the presence and availability of global brands and their challenges faced due to large or scarce competition from local and domestic brands, impact of domestic tariffs and trade routes are considered while providing forecast analysis of the country data.

Healthcare Infrastructure Growth Installed base and New Technology Penetration

The healthcare claims management market also provides you with detailed market analysis for every country growth in healthcare expenditure for capital equipment, installed base of different kind of products for healthcare claims management market, impact of technology using life line curves and changes in healthcare regulatory scenarios and their impact on the healthcare claims management market. The data is available for historic period 2011-2021.

Competitive Landscape and Healthcare Claims Management Market Share Analysis

The healthcare claims management market competitive landscape provides details by competitor. Details included are company overview, company financials, revenue generated, market potential, investment in research and development, new market initiatives, global presence, production sites and facilities, production capacities, company strengths and weaknesses, product launch, product width and breadth, application dominance. The above data points provided are only related to the companies' focus related to healthcare claims management market.

Some of the major players operating in the healthcare claims management market are:

• Athenahealth (U.S.)
• Plexis Healthcare Systems Inc. (U.S.)
• Cognizant (U.S.)
• Oracle (U.S.)
• Allscripts Healthcare LLC (U.S.)
• nThrive Revenue Systems, LLC (U.S.)
• eClinicalWorks (U.S.)
• Context Healthcare Inc. (U.S.)
• Optum, Inc. (U.S.)
• Mckesson Corporation (U.S.)
• DST Systems (U.S.)
• Ram Technologies Inc. (U.S.)
• General Electric (U.S.)
• Health Solutions Plus (HSP) (U.S.)
• Conifer Health Solutions, LLC (U.S.)
• Quest Diagnostics Incorporated (U.S.)
• Gebbs Healthcare Solutions (India)
• The SSI Group, LLC (U.S.)