by The healthcare payer network management Market is estimated to be valued at US$ 5.35 Bn in 2023 and is expected to exhibit a CAGR of 9.0% over the forecast period 2023 to 2030, as highlighted in a new report published by Coherent Market Insights.
Market Overview:
Healthcare payer network management involves managing provider networks and coordinating care for healthcare payers’ member population. It allows payers like insurance companies to reduce healthcare costs by developing networks of doctors, hospitals and other providers who agree to provide services to members at contracted rates. It also helps improve overall population health by improving care coordination and management of high-risk, high-cost patients.
Market Dynamics:
Growth in aging population is one of the major driver of the market. As the geriatric population aged above 65 years is growing rapidly, the demand for healthcare services is expected to rise significantly. This will put pressure on healthcare payers to manage costs efficiently through provider network management. Additionally, growing prevalence of chronic diseases is also driving the need for improved care coordination and management. According to CDC, around 6 in 10 adults in the United States live with at least one chronic disease. Healthcare payers are focusing on network strategies to enhance chronic disease management programs.
Segment Analysis
The healthcare payer network management market can be segmented into software and services. The software segment currently dominates the market owing to the increasing adoption of payer network management platforms that help payers streamline their workflow functions, such as claims management, provider profiling, fraud management, referral management, and others.
PEST Analysis
Political: Regulations such as the Affordable Care Act (ACA) in the U.S. have increased the focus on regulatory compliance and optimizing healthcare networks to control costs.
Economic: Rising healthcare costs have compelled payers to optimize their networks through strategic partnerships with providers to reduce costs and pass on savings to customers.
Social: Growing medical tourism and demand for remote healthcare monitoring are prompting payers to develop wider networks and telehealth capabilities.
Technological: Advancements in AI, blockchain, and cloud computing are enabling payers to better analyze large datasets and enhance network management functions through real-time decision support tools.
Key Takeaways
Global Healthcare Payer Network Management Market Size is expected to witness high growth, exhibiting a CAGR of 9.0% over the forecast period, due to increasing focus on curbing healthcare costs and improving operational efficiencies. The market size for 2023 is estimated at US$ 5.35 Bn.
North America is expected to dominate the market over the forecast period owing to robust infrastructure, early technology adoption, and presence of key players in the region. The Asia Pacific region is anticipated to exhibit the fastest growth rate attributed to rising medical expenditures, growing middle-class population, and improving regulatory scenario in emerging countries.
Key players operating in the healthcare payer network management market are Change Healthcare (Now part of Optum, UnitedHealth Group), Cognizant, McKesson Corporation, Cerner Corporation, OptumInsight (UnitedHealth Group), TriZetto (A Cognizant Company), NTT DATA Corporation, MultiPlan, Athenahealth (Now part of Veritas Capital), Allscripts Healthcare Solutions, Experian Health, eClinicalWorks, Inovalon, Mphasis, Wipro. These players are focusing on developing sophisticated healthcare network management platforms and solutions to gain a competitive edge in the market.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
Money Singh is a seasoned content writer with over four years of experience in the market research sector. Her expertise spans various industries, including food and beverages, biotechnology, chemical and materials, defense and aerospace, consumer goods, etc.
