Healthcare Provider Network Management Market Size And Forecast

Healthcare Provider Network Management Market size was valued at USD 3,279.06 Million in 2020 and is projected to reach USD 11,215.42 Million by 2028, growing at a CAGR of 16.34% from 2021 to 2028.

The Global Healthcare Provider Network Management Market is driven by the increasing implementation of state and federal rules in the US, rising patient population leading to increasing in health insurance coverage, growing need to improve the accessibility to care, and increased pressure on the payers to reduce administrative cost. The Global Healthcare Provider Network Management Market report provides a holistic evaluation of the market. The report offers a comprehensive analysis of key segments, trends, drivers, restraints, competitive landscape, and factors that are playing a substantial role in the market.

Global Healthcare Provider Network Management Market Definition

Healthcare Provider Network Management provides a central point for access to information about pricing, health insurance plans, government regulations and processes, and other data within the healthcare organization. This helps in improved claim accuracy and automation. A healthcare provider network includes doctors, hospitals, facilities, specialties, and other healthcare providers such as nurses, therapists, doctors, and clinicians who are part of health insurance plans. Provider network management solution automates many of the processes that payers take on a daily basis, saving time and money compared to traditional manual procedures.

The administrative costs of gaps between payers and providers due to inefficient processes and inaccurate data costs the healthcare industry billions annually. The challenges for mutually beneficial payer-provider partnerships are different, however, many of them are rooted in outdated ways of managing provider networks. A provider network management solution addresses several challenges that the payer faces such as recruitment, credentialing contracting, claims, and servicing for providers which lead to lost revenue, increasing administrative burdens, and reimbursement delays. Thus, demand for Healthcare Provider Network Management is expected to increase as it enables payers to reduce unnecessary costs and inefficiencies while improving provider and member satisfaction.

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Global Healthcare Provider Network Management Market Overview

Patient flow to hospitals is increasing, and individuals are becoming more aware of insurance policies, which is one of the major factors boosting the need for Healthcare Provider Network Management. In 2019, over 36 million hospital admissions took place in the United States alone. In 2020, around 91% of the population of the United States was estimated to have health insurance coverage in the country while 8% or 28.0 million, did not have health insurance during the year. The Affordable Care Act, resulted in an estimated 20 million gaining coverage, reducing the share of uninsured adults aged 19 to 64 from 20% in 2010 to 12 percent in 2018. With an increased focus towards accessibility to care, demand for Healthcare Provider Network Management is expected to increase in the years to come, especially in the US.

The IT sector has also played a crucial role in the growth of the market. Healthcare Provider Network Management solution provides payers with robust analytics tools and near real-time transaction data, enabling providers to see the patient status and results through timely reports. Through machine learning and real-time data, providers can identify suspicious reimbursement claims mixed in within the millions of accurate ones. It also helps to monitor patient records to predict hospitalization, readmission, and disease progression, thus enabling providers to manage care-management programs. The provider network management system helps in integrating patient data such as care plans, lab test results, authorizations, and medical claims which helps saving of organizations compared to searching multiple systems.

The system also includes methods for storing and analyzing data because of which providers are able to identify areas of opportunity for expansion. With timely access to accurate network data, payers can better manage costs, improve collaboration with providers, and provide members with the information they need to make informed medical decisions. The Global Healthcare Provider Network Management Market is driven by the increasing implementation of state and federal rules in the US, especially in industries such as Ambulatory Surgery Centers, which has seen a rapid increase in recent years. With the increase in demand for Ambulatory Surgery Centers, these centers are increasingly subjected to various federal regulations, creating demand for Healthcare Provider Network Management Software/Services to maintain regulatory compliance.

Healthcare Provider Network Management solution automates many of the processes that healthcare payers deal with on a regular basis, thus boosting their demand. The US also has a significant number of patients enrolled in Community Health Center, for Long-Term Care/Assisted Living, and Home Health/Hospice, whose major payers are health plan providers and Medicare. Thus, demand for Healthcare Provider Network Management software is also expected to increase with the increase in the number of patients being enrolled in these centers. However, the market for Healthcare Provider Network Management is being hindered by high deployment costs.

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Global Healthcare Provider Network Management Market: Segmentation Analysis

The Global Healthcare Provider Network Management Market is segmented on the basis of Component And Geography.

Healthcare Provider Network Management Market, By Component

• Provider Network Management Software
• Provider Network Management Services

Based on Component, The market is segmented into Provider Network Management Software and Provider Network Management Services. The Provider Network Management Services segment is projected to hold the largest market share since they are frequently employed due to benefits such as lower overall costs, increased operational efficiencies, and regulatory compliance.

Healthcare Provider Network Management Market, By Geography

• North America
• Europe
• Asia Pacific
• Rest of the world

On the basis of Regional Analysis, The Healthcare Provider Network Management Market is segmented into North America, Europe, Asia Pacific, and the Rest of the world. North America accounted for the largest share. An expanding health insurance coverage along with the growing desire to reduce healthcare costs is expected to boost the market in the United States, while in Canada, the growing focus of the government towards healthcare IT solutions is expected to create opportunities for growth. The market in the Asia Pacific, on the other hand, is expected to grow at a fast pace owing to factors such as the evolution of the healthcare ecosystem, increased government initiatives for HCIT adoption in the region, and the growing pressure on the healthcare industry.

Key Players

The “Global Healthcare Provider Network Management Market” study report will provide valuable insight with an emphasis on the global market. The major players in the market are Trizetto Corporation (A Cognizant Company), Ayasdi, Inc., McKesson Corporation, Optum, Inc., Genpact Limited, Infosys BPO, Ltd., Syntel, Inc., Emphasis Limited, Vestica Healthcare, LLC (A Skygen USA Company), Aldera, Inc.

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