MedClaims International Blog

The Increasing Need for Claims Management Solutions

Posted by Tessa Tinley on Jul 31, 2018 1:06:00 PM

Hand drawing image of businessman. Business challengeAccording to research by MarketsandMarkets, the global healthcare claims management market is expected to reach nearly $14 billion by 2023. At the start of 2018, this market was estimated to have a value around $10 billion, meaning that data indicates there will be about a 5% compound growth rate over the next 5 years. Experts believe that this significant market growth is being driven by a few fundamental factors: growing patient volumes, expanding health insurance market, greater need for professional denials management, and declining reimbursement rates.

Integrated and Cloud-Based Solutions

One of the strongest areas for growth in the claims management sector is in integrated solutions. Healthcare providers believe that integrated products are a key component to increasing organizational efficiency. Of course, integrated should not be confused with internal, as outsourced solutions can often be integrated with company's existing systems. Providers also value cloud-based solutions because they have reduced operational costs and lower upfront capital expenses. In addition, they provide greater flexibility and scale-ability than on-premises solutions.

Claims Management End Users

Market research indicates that payers are likely to be the largest group of end users looking for claims management solutions in 2018 and beyond. That's because payers will face some of the most intense regulatory burdens, many of which could result in extensive financial punishments and penalties. Solutions that improve compliance can reduce their exposure to these costs. The second biggest group expected to outsource is healthcare providers, followed by various other industry stakeholders. Providers continue to outsource with the goal of reducing denials and decreasing operations expenses.

Geographic Trends

The structure of healthcare systems in North America, mostly in the United States, force a significant portion of the claims management market into this region. This is largely due to regulatory mandates that negatively affect the efficiency of in-house claims management. Despite this fact, analysts expect the highest growth year-over-year to occur in Asia, where the development of new healthcare infrastructure is likely to be explosive. Payers and providers in these markets will find a lot of value in outsourcing claims management as part of their overall growth strategies.

Factors Limiting Growth

Even though the claims management market seems to be very healthy, there are certain factors limiting growth according to industry analysts. Many companies worry that outsourcing could increase the risk of data breaches and loss of patient confidentiality. Some in the industry also believe that there is a lack of IT professionals in healthcare who are qualified to handle high-tech claims management solutions. While many of these fears are unfounded, they still impact growth potential.

A greater number of providers and payers, despite factors limiting growth, are expected to outsource their claims management processes in the coming years. Not only does outsourcing make it easier for companies to handle a growing number of patients and an expanding market, but experts in the field are better positioned to help clients comply with changing regulations and declining reimbursement rates. For most healthcare companies, internal claims management is simply not adequate for the modern challenges of the industry.



Topics: healthcare revenue cycle