July 19, 2024
Healthcare Payer Network Management Market

Growing Adoption of Value Based Care Models to Boost Growth of Healthcare Payer Network Management Market

The global 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% over the forecast period 2023 to 2030, as highlighted in a new report published by Coherent Market Insights.

Market Overview:

The Healthcare Payer Network Management market comprises software and services that help healthcare payers to efficiently manage and administer their provider networks. This includes provider credentialing, claims management, network access, tiering, and other operational aspects. Payer network management solutions help to reduce administrative costs while improving quality of care through effective selection and monitoring of network providers. They support payers in implementing value-based care models by enabling activities like gainsharing, risk adjustment, and payment reform. Overall, these solutions are essential infrastructure for payers to successfully administer healthcare plans and drive better health outcomes at lower costs.

Market key trends:

The Healthcare Payer Network Management Market is witnessing increasing adoption of value based care models by payers to improve healthcare quality and affordability. Under value-based models, payers are incentivizing providers to deliver higher quality care at lower costs through activities like bundled payments, shared savings programs, and pay-for-performance initiatives. This is driving greater need for payer network management solutions that can support value-based reimbursement methodologies through analytical capabilities, risk adjustment, and integration with other clinical and financial systems. Additionally, growing focus on controlling healthcare spending through initiatives like narrow networks is boosting demand for tools to better optimize provider networks. Adoption of more sophisticated payer network management platforms will continue rising to help organizations navigate the ongoing industry shift towards value in healthcare.
Here are the Porter’s Analysis and Key Takeaways for the “Healthcare Payer Network Management Market” requested:

Porter’s Analysis

Threat of new entrants: New entrants face high initial costs to enter this established market. However, companies providing adjacent services like care management and analytics can leverage existing capabilities to enter this market.

Bargaining power of buyers: Large payers have greater bargaining power due to their size and budget. They can demand better pricing and customized solutions. However, the need for network management solutions keeps their bargaining power in check.

Bargaining power of suppliers: Major companies dominate the supply side. However, the availability of several solution providers ensures payers have alternatives to choose from, limiting suppliers’ bargaining power.

Threat of new substitutes: No significant threat as network management solutions play a key role in optimizing healthcare costs and are integral to payers’ operations.

Competitive rivalry: The market is highly competitive with major players competing based on capabilities, geographical reach and pricing.

Key Takeaways

The 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 healthcare costs and the need for payers to efficiently manage networks to optimize costs.

The North American region dominates the global market, with the US being the largest market. This is attributed todeveloped healthcare infrastructure and early adoption of digital health solutions. The Asia Pacific region is expected to grow at the highest CAGR during the forecast period due to increasing healthcare expenditure and focus on expanding health insurance coverage in populous countries like India and China.

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 partnerships, acquisitions and new product development to further strengthen their portfolio and geographic presence.

*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it

About Author - Ravina Pandya

Ravina Pandya, Content Writer, has a strong foothold in the market research industry. She specializes in writing well-researched articles from different industries, including food and beverages, information and technology, healthcare, chemical and materials, etc. With an MBA in E-commerce, she has an expertise in SEO-optimized content that resonates with industry professionals.  LinkedIn Profile

About Author - Ravina Pandya

Ravina Pandya,  Content Writer, has a strong foothold in the market research industry. She specializes in writing well-researched articles from different industries, including food and beverages, information and technology, healthcare, chemical and materials, etc. With an MBA in E-commerce, she has an expertise in SEO-optimized content that resonates with industry professionals.  LinkedIn Profile

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