[136 Pages Report] The back-end revenue cycle management market is projected to reach USD 10.4 billion by 2023 from USD 8.1 billion in 2018, at a CAGR of 5.0%. Factors such as the growing importance of denials management, increasing patient volume, process improvements in healthcare organizations, and declining reimbursement rates are driving the growth of the market. However, the high cost of deployment, integration of back-end revenue cycle management solutions, data breaches and loss of confidentiality, and lack of skilled IT professionals in healthcare are expected to limit market growth to a certain extent in the coming years.
To reduce costs and maximize profits, insurance companies are increasingly denying claims as well as coverage to patients being treated for chronic or persistent illnesses. This is putting an extra burden on healthcare providers to manage operating costs, and in turn is supporting the adoption of back-end revenue cycle management solutions (with a growing number of healthcare providers focusing on properly analyzing denied claims and appealing them).
Many healthcare providers across the globe still use manual and paper-oriented approaches to manage denials. This results in errors, delayed follow-ups, and miscommunication between healthcare providers and insurance companies. The use of back-end revenue cycle management solutions over manual and paper-oriented approaches can not only help healthcare providers overcome these issues but also help them save significant costs. As a result, the demand for back-end revenue cycle management solutions is expected to increase among end users during the forecast period.
Back-end revenue cycle management solutions are fairly high-priced, and the maintenance and software update costs of these tools may be greater than the actual price of the software. Support and maintenance services, which include software upgrades, represent a recurring expenditure amounting to around 30% of the total cost of ownership. Moreover, a lack of internal IT expertise in the healthcare industry necessitates training for end users to maximize the efficiency of back-end revenue cycle management solutions, thereby adding to the cost of ownership.
Hospitals often prefer investing in core technologies directly linked to the quality of care for patients than on investing in technologies for allied departments. Thus, the high cost of deployment and maintenance and the low inclination on spending on non-core technologies is restricting the adoption of back-end revenue cycle management solutions, especially among smaller healthcare organizations. This trend is more evident in emerging markets across Asia and Latin America.
In Asia and Australasia, the rollout of public healthcare programs, combined with the growing consumer wealth, is expected to boost healthcare spending at an average of 8.1% from 2014 to 2018 (Source: The Economist Intelligence Unit). Government initiatives for the implementation of HCIT solutions and rising government spending on healthcare systems are the major factors favoring the adoption of back-end revenue cycle management solutions in several emerging countries across the Asia Pacific region.
Mentioned below is an indicative list of pointers that showcase the potential of the Asia Pacific back-end revenue cycle management solutions market:
Rapid growth in healthcare spending is expected in the Middle East and Africa, with an annual average increase of 8.7% from 2014 to 2018 (Source: The Economist Intelligence Unit, May 2014). Also, healthcare spending in Latin America is projected to increase at an average of 4.6% per annum from 2014 to 2018 (Source: World Health Organization). With the growth in healthcare spending, the healthcare infrastructure (including the HCIT infrastructure) in several countries across the Middle East, Africa, and Latin America is expected to improve in the coming years. This, in turn, is expected to provide significant growth opportunities to players operating in the back-end revenue cycle management market in the coming years.
The information-intensive nature of data in the healthcare industry has highlighted a need for integration at all levels to ensure that data is collated and compiled into a single exhaustive and accurate patient record. This also applies to back-end revenue cycle management solutions due to the need to maintain end-to-end recordsfrom registration and appointment scheduling to final payment. However, integrating a new back-end revenue cycle management solution with a healthcare organizations legacy information management systems is a difficult task for market players. This is because of the differences in data communication standards, owing to which a number of information systems are unable to exchange data. Issues related to effective integration are thus a major challenge limiting the successful utilization of back-end revenue cycle management solutions.
On the basis of product & service, the market is segmented into software and services. The services segment is estimated to witness the highest CAGR during 20182023. The high growth of this segment is primarily due to the recurring nature of services such as training and development, installation, software upgrades, consulting, and maintenance.
By software, the market is broadly segmented into integrated and standalone software. In 2018, the integrated software segment is expected to account for the largest share of the market. The large share of this segment can be attributed to the ability of integrated solutions to help users to streamline and coordinate multiple financial functions through a single platform.
By end user, the market is segmented into healthcare payers and healthcare providers. In 2018, the healthcare payers segment is expected to account for the largest share of the market. Insurance providers need to comply with various federal and regional laws and regulations. Many of these regulations have privacy and security concerns relating to patient information and strict auditing and reporting requirements. With the help of back-end revenue cycle management solutions, insurance providers adhere to regulatory requirements and reduce unnecessary penalties and punishments. The growing stringency of regulations for payers is thus driving the adoption of back-end revenue cycle management by healthcare payers.
Geographically, the North American market is expected to account for the largest share of the market in 2018. The large share of North America in the market can be attributed to factors such as growing HCIT investments in the region, the presence of regulatory mandates supporting market growth in the US, and increasing digitalization and favorable funding initiatives by the Canadian government.
athenahealth (US), Cerner Corporation (US), Allscripts Healthcare Solutions, Inc. (US), eClinicalWorks (US), Optum, Inc. (US), McKesson Corporation (US), Conifer Health Solutions (US), GeBBs Healthcare Solutions (US), The SSI Group (US), GE Healthcare (US), nThrive (US), DST Systems (US), Cognizant Technology Solutions (US), and Quest Diagnostics (US) are the key players in the market.
McKesson is one of the major players in the market. To sustain its leading position in the market, the company focuses on deploying products in various hospitals and institutes. In line with this, during 20162017, the company deployed its products at various healthcare organizations in the US, some of which include Oregon Advanced Imaging (US), Emergency Recovery (US), and the Orthopedic Institute of Wisconsin (OIW) (US).
Optum provides a variety of back-end revenue cycle management solutions and facilitates the complete lifecycle of claims processing, eliminating multiple systems and inefficient processes. The company focuses on partnerships and product deployments to enhance its presence in the market. The OptumInsight segment helps healthcare payers and providers to improve performance; achieve efficiency; reduce costs; advance quality; and meet the compliance mandates of hospital systems, physicians, health plans, governments, life science companies, and other organizations.
Report Metric |
Details |
Market Size Available for Years |
20162023 |
Base Year Considered |
2017 |
Forecast Period |
20182023 |
Forecast Units |
Value (USD) |
Segments Covered |
Product & Service, Delivery Mode, End User, and Region |
Geographies Covered |
North America (US & Canada), Europe, Asia, RoW |
Companies Covered |
Athenahealth (US), Cerner Corporation (US), McKesson Corporation (US). Major 10 players covered. |
This research report categorizes the market based on product & service, delivery mode, end user, and region.
To speak to our analyst for a discussion on the above findings, click Speak to Analyst
Table of Contents
1 Introduction (Page No. - 15)
1.1 Objectives of the Study
1.2 Market Definition
1.3 Market Scope
1.3.1 Markets Covered
1.3.2 Years Considered for the Study
1.4 Currency
1.5 Limitations
1.6 Stakeholders
2 Research Methodology (Page No. - 18)
2.1 Research Data
2.1.1 Secondary Data
2.1.1.1 Secondary Sources
2.1.2 Primary Data
2.1.2.1 Key Data From Primary Sources
2.1.2.2 Breakdown of Primaries
2.1.2.3 Key Industry Insights
2.2 Market Size Estimation
2.3 Market Breakdown and Data Triangulation
2.4 Assumptions for the Study
3 Executive Summary (Page No. - 28)
4 Premium Insights (Page No. - 31)
4.1 Market Overview
4.2 Geographic Analysis: North American Market, By End User
4.3 US Market, 2018
4.4 Geographical Snapshot of the Market
5 Market Overview (Page No. - 35)
5.1 Introduction
5.2 Market Dynamics
5.2.1 Market Drivers
5.2.1.1 Growing Importance of Denials Management
5.2.1.2 Increasing Patient Volume
5.2.1.3 Process Improvements in Healthcare Organizations
5.2.1.4 Declining Reimbursement Rates
5.2.2 Market Restraints
5.2.2.1 High Cost of Deployment
5.2.3 Market Opportunities
5.2.3.1 Emerging Countries
5.2.3.2 Cloud-Based Solutions
5.2.3.3 Artificial Intelligence in Health Insurance
5.2.3.4 Rising Adoption of Electronic Health Records
5.2.4 Market Challenges
5.2.4.1 Integration of Back-end Revenue Cycle Management Solutions
5.2.4.2 Data Breaches and Loss of Confidentiality
5.2.4.3 Lack of Skilled It Professionals in Healthcare
6 Market, By Product & Service (Page No. - 41)
6.1 Introduction
6.2 Services
6.2.1 Recurring Nature of Services to Drive Market Growth
6.3 Software
6.3.1 Integrated Software
6.3.1.1 Integrated Solutions Help Users to Streamline and Coordinate Multiple Financial Functions Through A Single Platform
6.3.2 Standalone Software
6.3.2.1 Claims Processing Software
6.3.2.1.1 Claims Processing Software to Account for the Largest Share of the Standalone Software Market in 2018
6.3.2.2 Denial Management Software
6.3.2.2.1 Denial Management Software Segment to Witness the Highest Growth Rate During the Forecast Period
6.3.2.3 Coding & Auditing Software
6.3.2.3.1 Mandate to Convert From Icd-9 Classifications to the New Icd-10 Version has Resulted in the Increased Demand for Coding & Auditing Software
6.3.2.4 Billing/Billing Review Software
6.3.2.4.1 Rising Number of Billing Errors to Drive the Adoption of Billing/Billing Review Software
6.3.2.5 Payment Integrity Software
6.3.2.5.1 Payment Integrity Software Provides Advanced Analytics for Assessing Payment Compliance at A Granular Level
7 Market, By Delivery Mode (Page No. - 53)
7.1 Introduction
7.2 On-Premise Delivery Mode
7.2.1 Benefits Offered By On-Premise Delivery Models and Limited Penetration of Cloud-Based Technologies to Drive Market Growth
7.3 Cloud-Based Delivery Mode
7.3.1 Open-Access Nature of Cloud-Based Models Poses Security Challenges
8 Market, By End User (Page No. - 58)
8.1 Introduction
8.2 Healthcare Payers
8.2.1 Need to Ensure Regulatory Compliance is Aiding the Growth of the Payers Market
8.3 Healthcare Providers
8.3.1 Inpatient Facilities
8.3.1.1 Growing Need to Improve the Profitability of Healthcare Operations to Drive the Adoption of Back-End Rcm Solutions in Inpatient Facilities
8.3.2 Outpatient Facilities & Physician Clinics
8.3.2.1 Need to Improve Operational Workflows and Minimize Medical Errors to Drive Market Growth
9 Market, By Region (Page No. - 65)
9.1 Introduction
9.2 North America
9.2.1 US
9.2.1.1 Government Regulations to Support Market Growth in the US
9.2.2 Canada
9.2.2.1 Increasing Digitization and Favorable Funding Initiatives By the Canadian Government are Boosting Market Growth in Canada
9.3 Europe
9.4 Asia
9.5 Rest of the World
10 Competitive Landscape (Page No. - 93)
10.1 Overview
10.2 Competitive Scenario
10.2.1 Product Launches and Enhancements
10.2.2 Agreements, Partnerships, and Collaborations
10.2.3 Acquisitions
10.2.4 Expansions
11 Company Profile (Page No. - 97)
(Business Overview, Products Offered, Recent Developments, SWOT Analysis, MnM View)*
11.1 Athenahealth
11.2 Cerner
11.3 Allscripts Healthcare Solutions
11.4 Eclinicalworks
11.5 Optum, Inc. (A Subsidiary of Unitedhealth Group Inc.)
11.6 Mckesson (Now A Part of Change Healthcare, Inc.)
11.7 Conifer Health Solutions
11.8 Gebbs Healthcare Solutions
11.9 The SSI Group
11.10 GE Healthcare
11.11 Nthrive
11.12 DST Systems
11.13 Cognizant Technology Solutions
11.14 Quest Diagnostics
11.15 Context 4 Healthcare
11.16 Ram Technologies
11.17 Health Solutions Plus (HSP)
11.18 Plexis Healthcare Systems
*Details on Business Overview, Products Offered, Recent Developments, SWOT Analysis, MnM View Might Not Be Captured in Case of Unlisted Companies.
12 Appendix (Page No. - 129)
12.1 Discussion Guide
12.2 Knowledge Store: Marketsandmarkets Subscription Portal
12.3 Available Customizations
12.4 Related Reports
12.5 Author Details
List of Tables (79 Tables)
Table 1 Market, By Product & Service, 20162023 (USD Million)
Table 2 Back-end Revenue Cycle Management Services Market, By Region, 20162023 (USD Million)
Table 3 North America: Back-end Revenue Cycle Management Services Market, By Country, 20162023 (USD Million)
Table 4 Back-end Revenue Cycle Management Software Market, By Region, 20162023 (USD Million)
Table 5 North America: Back-end Revenue Cycle Management Software Market, By Country, 20162023 (USD Million)
Table 6 Back-end Revenue Cycle Management Software Market, By Type, 20162023 (USD Million)
Table 7 Back-end Revenue Cycle Management Integrated Software Market, By Region, 20162023 (USD Million)
Table 8 North America: Back-end Revenue Cycle Management Integrated Software Market, By Country, 20162023 (USD Million)
Table 9 Back-end Revenue Cycle Management Standalone Software Market, By Region, 20162023 (USD Million)
Table 10 North America: Back-end Revenue Cycle Management Standalone Software Market, By Country, 20162023 (USD Million)
Table 11 Back-end Revenue Cycle Management Standalone Software Market, By Type, 20162023 (USD Million)
Table 12 Claims Processing Software Market, By Region, 20162023 (USD Million)
Table 13 North America: Claims Processing Software Market, By Country, 20162023 (USD Million)
Table 14 Denial Management Software Market, By Region, 20162023 (USD Million)
Table 15 North America: Denial Management Software Market, By Country, 20162023 (USD Million)
Table 16 Coding & Auditing Software Market, By Region, 20162023 (USD Million)
Table 17 North America: Coding & Auditing Software Market, By Country, 20162023 (USD Million)
Table 18 Billing/Billing Review Software Market, By Region, 20162023 (USD Million)
Table 19 North America: Billing/Billing Review Software Market, By Country, 20162023 (USD Million)
Table 20 Payment Integrity Software Market, By Region, 20162023 (USD Million)
Table 21 North America: Payment Integrity Software Market, By Country, 20162023 (USD Million)
Table 22 Market, By Delivery Mode, 20162023 (USD Million)
Table 23 On-Premise Market, By Region, 20162023 (USD Million)
Table 24 North America: On-Premise Market, By Country, 20162023 (USD Million)
Table 25 Cloud-Based Market, By Region, 20162023 (USD Million)
Table 26 North America: Cloud-Based Market, By Country, 20162023 (USD Million)
Table 27 Market, By End User, 20162023 (USD Million)
Table 28 Market for Healthcare Payers, By Region, 20162023 (USD Million)
Table 29 North America: e Management Market for Healthcare Payers, By Country, 20162023 (USD Million)
Table 30 Market for Healthcare Providers, By Region, 20162023 (USD Million)
Table 31 North America: Market for Healthcare Providers, By Country, 20162023 (USD Million)
Table 32 Market for Healthcare Providers, By Type, 20162023 (USD Million)
Table 33 Market for Inpatient Facilities, By Region, 20162023 (USD Million)
Table 34 North America: Market for Inpatient Facilities, By Country, 20162023 (USD Million)
Table 35 Market for Outpatient Facilities & Physician Clinics, By Region, 20162023 (USD Million)
Table 36 North America: Market for Outpatient Facilities & Physician Clinics, By Country, 20162023 (USD Million) 64
Table 37 Market, By Region, 20162023 (USD Million)
Table 38 North America: Market, By Country, 20162023 (USD Million)
Table 39 North America: Market, By Product & Service, 20162023 (USD Million)
Table 40 North America: Back-end Revenue Cycle Management Software Market, By Type, 20162023 (USD Million)
Table 41 North America: Back-end Revenue Cycle Management Standalone Software Market, By Type, 20162023 (USD Million)
Table 42 North America: Market, By Delivery Mode, 20162023 (USD Million)
Table 43 North America: Market, By End User, 20162023 (USD Million)
Table 44 North America: Market for Healthcare Providers, By Type, 20162023 (USD Million)
Table 45 US: Market, By Product & Service, 20162023 (USD Million)
Table 46 Us: Back-end Revenue Cycle Management Software Market, By Type, 20162023 (USD Million)
Table 47 US: Back-end Revenue Cycle Management Standalone Software Market, By Type, 20162023 (USD Million)
Table 48 US: Market, By Delivery Mode, 20162023 (USD Million)
Table 49 US: Market, By End User, 20162023 (USD Million)
Table 50 US: Market for Healthcare Providers, By Type, 20162023 (USD Million)
Table 51 Canada: Market, By Product & Service, 20162023 (USD Million)
Table 52 Canada: Back-end Revenue Cycle Management Software Market, By Type, 20162023 (USD Million)
Table 53 Canada: Back-end Revenue Cycle Management Standalone Software Market, By Type, 20162023 (USD Million)
Table 54 Canada: Market, By Delivery Mode, 20162023 (USD Million)
Table 55 Canada: Market, By End User, 20162023 (USD Million)
Table 56 Canada: Market for Healthcare Providers, By Type, 20162023 (USD Million)
Table 57 Europe: Market, By Product & Service, 20162023 (USD Million)
Table 58 Europe: Back-end Revenue Cycle Management Software Market, By Type, 20162023 (USD Million)
Table 59 Europe: Back-end Revenue Cycle Management Standalone Software Market, By Type, 20162023 (USD Million)
Table 60 Europe: Market, By Delivery Mode, 20162023 (USD Million)
Table 61 Europe: Market, By End User, 20162023 (USD Million)
Table 62 Europe: Market for Healthcare Providers, By Type, 20162023 (USD Million)
Table 63 Asia: Market, By Product & Service, 20162023 (USD Million)
Table 64 Asia: Back-end Revenue Cycle Management Software Market, By Type, 20162023 (USD Million)
Table 65 Asia: Back-end Revenue Cycle Management Standalone Software Market, By Type, 20162023 (USD Million)
Table 66 Asia: Market, By Delivery Mode, 20162023 (USD Million)
Table 67 Asia: Market, By End User, 20162023 (USD Million)
Table 68 Asia: Market for Healthcare Providers, By Type, 20162023 (USD Million)
Table 69 RoW: Market, By Component, 20162023 (USD Million)
Table 70 RoW: Back-end Revenue Cycle Management Software Market, By Type, 20162023 (USD Million)
Table 71 RoW: Back-end Revenue Cycle Management Standalone Software Market, By Type, 20162023 (USD Million)
Table 72 RoW: Market, By Delivery Mode, 20162023 (USD Million)
Table 73 RoW: Market, By End User, 20162023 (USD Million)
Table 74 RoW: Market for Healthcare Providers, By Type, 20162023 (USD Million)
Table 75 Growth Strategy Matrix (20142018)
Table 76 Product Launches and Enhancements (20142018)
Table 77 Agreements, Partnerships, and Collaborations (20142018)
Table 78 Acquisitions, 20142018
Table 79 Expansions (20142018)
List of Figures (31 Figures)
Figure 1 Research Methodology:
Figure 2 Research Design
Figure 3 Sampling Frame: Primary Research
Figure 4 Market Size Estimation Methodology: Bottom-Up Approach (1/3)
Figure 5 Market Size Estimation Methodology: Bottom-Up Approach (2/3)
Figure 6 Market Size Estimation Methodology: Bottom-Up Approach (3/3)
Figure 7 Market Size Estimation Methodology: Top-Down Approach
Figure 8 Data Triangulation Methodology
Figure 9 Services to Dominate the Market, By Product & Service, in 2018
Figure 10 On-Premise Solutions to Account for the Larger Market Share in 2018
Figure 11 North America to Hold the Largest Share in the Market During 20182023
Figure 12 Growing Importance of Denials Management to Drive Market Growth During the Forecast Period
Figure 13 Healthcare Payers to Account for the Largest Share of the North American Market in 2018
Figure 14 Inpatient Settings & On-Premise Delivery Mode to Account for the Largest Market Share in 2018
Figure 15 Asia to Witness the Highest Growth Rate During the Forecast Period
Figure 16 Market: Drivers, Restraints, Opportunities, and Challenges
Figure 17 Market, By Region, 2018 Vs. 2023 (USD Million)
Figure 18 North America: Market Snapshot
Figure 19 Europe: Market Snapshot
Figure 20 Asia: Market Snapshot
Figure 21 RoW: Market Snapshot
Figure 22 Key Developments in the Market Between 2014 and 2018
Figure 23 Company Snapshot: Athenahealth (2017)
Figure 24 Company Snapshot: Cerner (2017)
Figure 25 Company Snapshot: Allscripts Healthcare Solutions (2017)
Figure 26 Company Snapshot: Optum, Inc. (2017)
Figure 27 Company Snapshot: Mckesson Corporation (2017)
Figure 28 Company Snapshot: GE Healthcare (2017)
Figure 29 Company Snapshot: DST Systems (2017)
Figure 30 Company Snapshot: Cognizant Technology Solutions (2017)
Figure 31 Company Snapshot: Quest Diagnostics Incorporated (2017)
The study involved four major activities to estimate the current market size for back-end revenue cycle management. Exhaustive secondary research was done to collect information on the market and its different subsegments. The next step was to validate these findings, assumptions, and sizing with industry experts across the value chain through primary research. Both top-down and bottom-up approaches were employed to estimate the complete market size. Thereafter, market breakdown and data triangulation procedures were used to estimate the market size of segments and subsegments.
In the secondary research process, various secondary sources such as Hoovers, D&B, Bloomberg Business, and Factiva have been referred to so as to identify and collect information for this study. These secondary sources included annual reports, press releases & investor presentations of companies, white papers, certified publications, articles by recognized authors, gold-standard & silver-standard websites, regulatory bodies, and databases.
The market comprises several stakeholders such as healthcare insurance companies/payers, healthcare IT service providers, healthcare institutions/providers (hospitals, medical groups, physician practices, diagnostic centers, pharmacies, ambulatory centers, and outpatient clinics). Various primary sources from both the supply and demand sides of the market were interviewed to obtain qualitative and quantitative information. The following is a breakdown of the primary respondents:
To know about the assumptions considered for the study, download the pdf brochure
Both top-down and bottom-up approaches were used to estimate and validate the total size of the market. These methods were also used extensively to estimate the size of various subsegments in the market. The research methodology used to estimate the market size includes the following:
After arriving at the overall market size using the market size estimation processes as explained above the market was split into several segments and subsegments. In order to complete the overall market engineering process and arrive at the exact statistics of each market segment and subsegment, data triangulation and market breakdown procedures were employed, wherever applicable. The data was triangulated by studying various factors and trends from both the demand and supply sides in the back-end revenue cycle management industry.
With the given market data, MarketsandMarkets offers customizations as per the companys specific needs. The following customization options are available for the report:
Growth opportunities and latent adjacency in Back-end Revenue Cycle Management Market
It manages the overall finance of the organization and keeps them going on a daily basis. Several organizations are involved in the process but offering revenue cycle management services is a responsible task and needs to be done with careful and utmost perfection.