Increasing patient volume and subsequent growth in the demand for health insurance, the growing importance of denials management, declining reimbursement rates, increase in the volume of unstructured data in the healthcare industry, and the rising need to curtail escalating healthcare costs are the major factors driving the growth of this market. However, high deployment costs are expected to restrain the growth of this market to a certain extent.

Global patient access solutions market is projected to reach USD 2.4 billion by 2025 from USD 1.6 billion in 2020, at a CAGR of 8.5%.

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Patient access solutions Market Dynamics

Drivers: Need to maintain regulatory compliance

In the US, the Patient Protection and Affordable Care Act (PPACA) has led to the restructuring of private insurance, Medicare, and Medicaid systems. In line with these changes, the “Meaningful Use” rules of the American Recovery and Reinvestment Act (ARRA) and Health Information Technology for Economic and Clinical Health Act (HITECH) have mandated the adoption of electronic medical/health records (EMR/EHR) that will increase data interoperability. This will ease data exchange between different healthcare organizations, including providers and payers. This, in turn, would drive the adoption of patient access solutions such as eligibility verification and medical necessity management.

Restraints: Data breaches and loss of confidentiality

In healthcare, approximately one-third of data breaches result in medical identity theft mainly due to a lack of internal control over patient information, lack of top management support, outdated policies and procedures or non-adherence to existing ones, and inadequate personnel training, all of which contribute to the rise in data breaches and medical identity theft cases in the industry. This makes patient confidentiality a major challenge in the healthcare industry.

In August 2016, the Advocate Health Care Network (US), which operates 12 hospitals and more than 200 other treatment locations in Illinois, US, was fined USD 5.5 million as part of a settlement related to breaches that compromised the electronic data of 4 million patients.

Opportunities: Lucrative growth opportunities in emerging markets

The Asia Pacific region is a highly lucrative market for patient access solutions owing to the implementation of various government initiatives focused on the greater adoption of healthcare IT solutions in China, India, and Australia and the rising government spending on healthcare.

Technological advancements are playing a key role in reforming China’s healthcare system, which is currently facing challenges such as underfunded rural health centers, overburdened city hospitals, and a nationwide shortage of doctors. China is in the midst of reform to provide safe, effective, convenient, and affordable healthcare for both rural and urban residents by 2025. A recent article from China Daily stated that IT investment in the country’s hospital system would reach USD 9.47 billion in 2022, an increase of 53.5% from 2017.

Challenges: Dearth of skilled IT professional

The effective utilization of patient access solutions demands strong IT infrastructure and IT support within the organization as well as at the solution provider’s end. In a healthcare organization, there is a continuous need for technical support for maintaining the server and network, smooth operation of clinical workflow, and optimum interfacing speed of healthcare IT systems. If the maintenance of the server or network is inadequate, it leads to the generation of screen loads, which slows down the denial management procedure.

Some of the prominent players in this market are McKesson Corporation (US), 3M (US), Cerner Corporation (US), Cognizant (US), Conifer Health Solutions (US), and Epic Systems Corporation (US).

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