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Healthcare Claims Management Market To Post CAGR of 5.3% to 2023

The global healthcare claims management market is forecast by Markets and Markets to increase at a CAGR of 5.3 percent, reaching $14 billion by 2023.

claims management

Source: Thinkstock

By Fred Donovan

- The global healthcare claims management market is forecast by Markets and Markets to increase at a CAGR of 5.3 percent, reaching $14 billion by 2023.  

Factors fueling this market growth include patient volumes, expanding health insurance market, growing importance of denials management, and declining reimbursement rates.

Some of the leading vendors in the space include Athenahealth, Cerner, Allscripts, Eclinicalworks, Optum, McKesson, Conifer Health Solutions, Gebbs Healthcare Solutions, the SSI Group, GE Healthcare, Nthrive, DST Systems, Cognizant Technology Solutions, Quest Diagnostics, Context 4 Healthcare, Ram Technologies, Health Solutions Plus, and Plexis Healthcare Systems.

Based on type, the healthcare claims management market can be segmented into integrated and standalone solutions, with integrated solutions expected to register the highest growth rate during the forecast period because of the segment’s positive impact on process efficiency and cost reduction.

Based on delivery mode, the market can be broken into on premises and cloud based, with the cloud-based segment expected to post the highest growth rate due to the lower capital expenses and operation costs and better scalability and flexibility than on-premises solutions.

Some of the factor dampening market growth include data breaches and loss of data confidentiality, lack of skilled IT professionals, and high cost of deployment of claims management solutions.

The North American market is expected to account for the largest share this year because of the high healthcare claims management investments in the region and regulatory mandates favoring the implementation of healthcare claims management solutions.

Asia is expected to post the highest growth rate through 2023. Factors such as investments to modernize the healthcare infrastructure and growing adoption of healthcare IT solutions in China, measures to boost the quality of healthcare delivery in Japan, and rapid growth of the healthcare industry in India are contributing to the high growth in Asia.

Earlier this year, Change Healthcare launched the first blockchain solution for healthcare claims management.

Using blockchain technology, healthcare organizations can track the status of claims submission and remittance across the complete claim lifecycle. In addition to improving transparency and efficiency, the incorporation of blockchain technology into Change Healthcare’s Intelligent Healthcare Network enables greater auditability, traceability, and trust.

The Intelligent Healthcare Network processes more than 50 million claims daily and up to 550 transactions per second using blockchain, according to Change Healthcare.

“We are excited to work with customers and partners on applying blockchain technology to improve how payers and providers interact and conduct business, starting with the revenue cycle and payment process,” Change Healthcare President and CEO Neil de Crescenzo said. “We will continue to leverage blockchain and other technologies to develop additional applications that can make healthcare more patient-centric while addressing cost and quality.”

 “We are initially introducing blockchain technology to create a distributed ledger that makes claims processing and secure payment transactions work more efficiently and cost effectively for all healthcare stakeholders,” he continued.

The solution uses Hyperledger Fabric 1.0 framework for its application design and development. Hyperledger Fabric 1.0 is an open source blockchain framework and one of the Hyperledger projects hosted by The Linux Foundation.

Change Healthcare said it will contribute code back to the open source community so other healthcare organizations can improve their blockchain applications.

“With this solution, we've demonstrated that blockchain technology can be effective for high-data volume, high-throughput transaction processing in healthcare,” Change Healthcare CTO Aaron Symanski said. “This expands our opportunities for innovative new products and solutions that leverage blockchain—several of which we have already started to explore.”

“Not only could blockchain technology enable accurate tracking because of its immutability, the ability to make that visible to everyone involved in the encounter opens the door to create a more patient-centric experience and streamline processes, which benefits everyone,” said Symanski.

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