Driver: Implementation of initiatives to shift the burden of risk from healthcare payers to providers

Globally, various initiatives are being implemented to shift the burden of risk borne by healthcare payers to providers. This shift promotes the adoption of healthcare information technology (HCIT) solutions (such as care management solutions) to increase the efficiency of healthcare delivered and reduce unnecessary costs. For instance, in 2015, Medicare applied the Value-based Payment Modifier program to payments under the Medicare Physician Fee Schedule (PFS) for physicians in groups of 100 or more eligible practitioners.

The Value-based Payment Modifier program offers differential payment to a physician or group of physicians based on the quality of care furnished instead of the cost of care. Value-based care is also promoted through alternative payment models such as bundled payments, physician incentives, and consumer incentives, among others. These models of payment are designed to encourage healthcare providers to accept the accountability of care delivered, thus leading to the shift of risk from payers to providers.

Healthcare organizations across the globe are aiming to provide coordinated, comprehensive care across the continuum to ensure patient satisfaction and improve overall health outcomes. As care management solutions aid stakeholders in the healthcare sector to achieve this objective, their adoption is expected to increase in the coming years.

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Restraint: High cost of deployment

Healthcare IT systems are high-priced software solutions. Moreover, the maintenance and software update costs of these systems may be more than the price of the software. Support and maintenance services (which include software upgrades as per changing user requirements) form a recurring expenditure, which amounts to almost 30% of the total cost of ownership. Lack of internal IT expertise in the healthcare industry necessitates training for end users in order to maximize the efficiency of various healthcare IT solutions, thereby adding to the cost of ownership of the systems.

Hospitals often prefer investing in core technologies directly linked to the quality of care for patients than investing in technologies for allied departments of healthcare organizations. Thus, the high cost of deployment and maintenance restricts smaller healthcare organizations from investing in healthcare IT solutions, especially in the emerging markets across the APAC and Latin American regions.

Expected Revenue Growth:

The global care management solutions market is projected to reach USD 19.28 billion by 2023 from USD 9.15 billion in 2018, at a CAGR of 16.1% during the forecast period.

Major Growth Boosters:

The key factors driving the growth of this market are the implementation of initiatives to shift the burden of risk from healthcare payers to providers, government initiatives and regulations promoting patient-centric care, initiatives to promote healthcare IT, rising geriatric population, and need to reduce healthcare costs are driving the growth of the care management solutions market.

By end user, the payers segment is expected to command the largest share of the market in 2018

On the basis of end user, the market has been segmented into payers, providers, and other end users. The payers segment is expected to command the largest share of the market in 2018. The deployment of care management solutions is increasing among payers as it helps them in the effective management of patient health records, claims processing and reimbursement tasks, coordinating care for their members, and ensuring better health outcomes to mitigate their risk burden. The growing stringency ofregulations for payers is another important factor driving the adoption of care management solutions in this end-user segment.

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Geographical Growth:

North America to dominate the market in 2018

North America is expected to account for the largest share of the care management solutions market in 2018, followed by Europe. The large share of North America can be attributed to the increased adoption of care management solutions by healthcare providers and payers to meet the healthcare goals of better quality care and lower healthcare costs. Also, several major global players are based in the US, owing to which the US has become a center for innovation in the care management solutions market.

Global Key Players:

EXL Service Holdings, Inc. (US), Casenet, LLC (US), Medecision Inc. (US), ZeOmega Inc. (US), Cognizant Technology Solutions (US), Cerner Corporation (US), Allscripts Healthcare Solutions, Inc. (US), and TCS Healthcare Technologies (US) are the key players in the care management solutions market. Other players involved in this market are Koninklijke Philips N.V. (Netherlands), IBM Corporation (US), Health Catalyst Inc. (US), Harmony Information Systems, Inc. (US), Salesforce.com, Inc. (US), i2i Systems, Inc. (US), Pegasystems Inc. (US), and Epic Corporation Inc. (US).

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