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A medical claim is a detailed invoice that a health care provider sends to the health insurer, exactly showing the services that have been rendered by the providers to the patient. Medical claims management involves multiple administrative and customer service layers that include review, investigation, adjustment, remittance or denial of a claim. Improved focus on quality healthcare services and adoption of cloud technology related services are contributing to the growth of the medical claims management solutions market. Medical claims management solutions generally aim at attaining complete automation of processing of claims, faster access to customer information without negotiating on the security of private medical information. However, insurance claim payers and providers need to be convinced about the need for these solutions and also the benefits of investing in them despite their sizeable cost. Automation helps in reducing costs associated with processing of claims, utilizing a single platform for all data sources, workflows for routing claims for review and approval processes, increasing the uniformity of payments, and timely payment of claims. According to the National Health Insurer Report Card published in 2011 by American Medical Association (AMA), around $17 billion a year (on an average) could be saved by eliminating errors in claims. Automation reduces the paper storage and document retrieval costs while complying with regulatory standards such as Health Insurance Portability and Accountability Act (HIPAA). Health insurance payers invest in their claims management systems to gain interoperability and faster release of new insurance claims, in addition to, improving efficiency of claims processing.
The medical claims management solutions market is segmented on the basis of product, deployment, component and geography. Based on product, the global industry is further divided into standalone claim management system and integrated claim management system.
Based on deployment the market is further divided into cloud based, web based and on-premise based deployments. Since the web-based deployment accounts for a variety of claims systems, it holds the largest share in the global market.
On the basis of component, the medical claims management solutions market is divided into services, hardware, and software. Software is the highest revenue contributor to the medical claims management solutions market, owing to increasing adoption of advanced claims management software by healthcare payers to facilitate easy, accurate, and faster processing of claims.
Growth Drivers and Restraints
The medical claims management solutions market is driven by factors such as advent of new and innovative treatments & technologies, improved focus on quality healthcare services and adoption of cloud-based technology related services. Moreover, increase in the number of patients covered under medical insurance and expensive care required for chronic diseases have supported the growth of the medical claims management solutions industry. Also, the increase in aging population, initiatives taken by government in order to improve insurance coverage among citizens and rise in occurrence of chronic diseases affect the market thus, driving the growth of medical claims management solutions market. According to the World Health Organization (WHO), contribution of chronic diseases is expected to rise to 73% of all deaths and 60% of the global burden of disease by 2020. Moreover, 79% of the deaths attributed to these diseases occur in developing countries. Additionally, as per United Nations Department of Economic and Social Affairs (UN-DESA) report on the global aging population, the population of people aged 60 years or above is growing at a high rate. The number of people aged 60 years or over is projected to grow by 56.0 % globally, i.e. from 901 million in 2015 to 1.4 billion by 2030, and it is projected to more than double its size from 2015, to reach 2.1 billion by 2050.
Factors such as increasing concerns regarding the patient data safety & security limit and cybercrime cases are restraining the growth of medical claims management solutions market.
The increasing investment in the healthcare infrastructure and services in Asia-Pacific offers huge market potential for the players to grow in medical claims management solutions market. Countries such as India and China are the two rapidly growing economies in the Asia-Pacific region, followed by South Korea. The government in these countries are putting in several efforts to provide better healthcare services and improved healthcare infrastructure. Healthcare IT related services bridge the gap between healthcare entities by lowering down the manual errors and also reducing healthcare expenditure. However, the healthcare IT industry in India is at its nascent stage. Thus, heavy inflow of investments by various government agencies to improve healthcare IT infrastructure in emerging markets is expected to create opportunities for healthcare claims management solutions providers.
North America and Europe together hold a significant share of the medical claims management solutions market, due to the increased use of software and hardware for processing claims and presence of top insurance companies in these regions. The North American medical claims management solutions market size accounted for the largest share of the global market in 2016, and is expected to maintain its position during the forecast period (2017-2023). This growth is attributable to the presence of well-established healthcare system in the region, rise in prevalence of chronic diseases, increase in insurance coverage, and technological advancements in the medical claims management solutions market.
However, the Asia-Pacific is expected to witness the fastest growth during the forecast period (2017-2023). The factors driving this growth include increasing geriatric population and improved healthcare infrastructure in the region. In addition, the government initiatives to spread awareness about the benefits of this technology among the general population have also contributed to the medical claims management solutions market in this region. Therefore, the demand for healthcare IT solutions in the region is expected to increase significantly during the forecast period.
The major players in the medical claims management solutions market include IBM Corporation, Cerner Corporation, Oracle Corporation, Avaya Inc., Genpact Limited, Cognizant Technology Solutions Corporation, Accenture PLC, Allscripts Healthcare Solutions, Inc., Athenahealth Inc., Aspect Software Inc., and Infor Inc.