Healthcare Claims Management Market

Healthcare Claims Management Market by Component (Software, and Services), Delivery Mode (On-Premise, and Cloud Based), Type (Integrated, and Standalone), End User (Healthcare Payers, Providers) - Global Forecast to 2023

Report Code: HIT 6389 Jun, 2018, by marketsandmarkets.com

[139 Pages Report] The global healthcare claims management market was valued at USD 10.16 billion in 2017 and is projected to reach USD 13.93 billion by 2023, at a CAGR of 5.3% during the forecast period. Base year considered for the report is 2017 and the forecast period is 2018–2023.

Objectives of the Study:

  • To define, describe, segment, and forecast the healthcare claims management market by component, delivery mode, type, end user, and region
  • To provide detailed information about factors (drivers, restraints, opportunities, and challenges) influencing healthcare claims management market growth
  • To analyze micromarkets with respect to individual growth trends, prospects, and contributions to the overall market
  • To analyze market opportunities for stakeholders and provide details of the competitive landscape for key players
  • To forecast the size of the healthcare claims management market segments with respect to North America, Europe, Asia, and the Rest of the World (RoW)
  • To strategically analyze the market structure and profile the key players of the global healthcare claims management and comprehensively analyze their core competencies
  • To track and analyze competitive developments such as agreements, collaborations, and partnerships; product deployments, product launches, and enhancements; acquisitions; and expansions in the healthcare claims management market

Research Methodology

Top-down and bottom-up approaches were used to validate the size of the global healthcare claims management market and estimate the size of other dependent submarkets. Various secondary sources such as associations like the World Health Organization, Centers for Disease Control and Prevention, American Society for Metabolic and Bariatric Surgery, International Federation for the Surgery of Obesity And Metabolic Disorders, European Association for the Study of Obesity, Australian Institute of Health and Welfare, directories, industry journals, databases, and annual reports of the companies have been used to identify and collect information useful for the study of this market. Primary sources such as experts from both supply and demand sides have been interviewed to obtain and validate information as well as to assess dynamics of healthcare claims management market. The breakdown of profiles of primaries is shown in the figure below:

Healthcare Claims Management Market

To know about the assumptions considered for the study, download the pdf brochure

The major players in the healthcare claims management market include Cerner Corporation (US), McKesson Corporation (US), athenahealth (US), eClinicalWorks (US), Optum, Inc, (US), Conifer Health Solutions (US), and nThrive (US).

Target Audience:

  • Healthcare insurance companies/payers
  • Healthcare IT service providers
  • Healthcare institutions/providers (hospitals, medical groups, physician practices, diagnostic centers, pharmacies, ambulatory centers, and outpatient clinics)
  • Venture capitalists
  • Healthcare BPO Vendors
  • Healthcare KPO Vendors
  • Government bodies
  • Corporate entities
  • Accountable care organizations

Scope of the Report:

The research report categorizes the healthcare claims management market into the following segments and subsegments:

Healthcare Claims Management Market, by Component

  • Software
  • Services

Healthcare Claims Management Market, by Type

  • Integrated Solutions
  • Standalone Solutions

Healthcare Claims Management Market, by Delivery Mode

  • On-premise
  • Cloud-based

Healthcare Claims Management Market, by End User

  • Healthcare Payers
  • Healthcare Providers
  • Other End Users

Healthcare Claims Management Market, by Region

  • North America
    • US
    • Canada
  • Europe
    • UK
    • Germany
    • France
    • Italy
    • Rest of Europe (RoE)
  • Asia
  • RoW

Available Customizations

With the given market data, MarketsandMarkets offers customizations as per the company’s specific needs. The following customization options are available for the report:

By Component

  • Further breakdown of the software and services segment of the healthcare claims management market

Geographic Analysis

  • Further breakdown of the Asian countries China, Japan, India, and Rest of Asia

Company Information

  • Detailed analysis and profiling of additional market players (Up to 5)

The global healthcare claims management market is projected to reach USD 13.93 billion by 2023 from USD 10.77 billion in 2018, at a CAGR of 5.3% during the forecast period. The key factors driving the growth of this market are increasing patient volumes, expanding health insurance market, growing importance of denials management, and declining reimbursement rates.

The report describes and studies the global healthcare claims management market by component, type, delivery mode, end user, and region. It provides detailed information regarding the major factors influencing the growth of this market.

On the basis of type, the global healthcare claims management market is segmented into integrated solutions and standalone solutions. The integrated solutions segment is expected to register the highest CAGR during the forecast period. The high growth in this segment can be attributed to increasing demand for integrated solutions, which play an integral role in improving process efficiency and reducing costs.

Based on delivery mode, the healthcare claims management market is segmented into on-premise and cloud-based. The cloud-based segment is expected to grow at the highest CAGR during the forecast period. The high growth of this segment can be attributed to the comparatively lower capital expenses and operational costs incurred along with better scalability, flexibility, and affordability.

The geographic segments in this report include North America, Europe, Asia, and the Rest of the World. Of these, the North American market is expected to account for the largest share of the market in 2018. The large share of North America can be attributed to the high and growing HCIT investments in the region and the presence of regulatory mandates favoring the implementation of healthcare claims management solutions. Also, several major global players are based in the US, owing to which the US has become a center for innovation in the healthcare claims management solutions market.

Asia is expected to grow at the highest CAGR during the forecast period of 2018–2023. Factors such investments to modernize the healthcare infrastructure and growing adoption of healthcare IT solutions in China, measures to boost the quality of healthcare delivery in Japan, and rapid growth of the healthcare industry in India are contributing to the high growth in Asia during the forecast period.

Healthcare Claims Management Market

However, integration of claims management solutions, data breaches and loss of confidentiality, lack of skilled IT professionals in healthcare, and high cost of deployment of claims management solutions are some of the factors restraining the growth of this market. On the other hand, the emerging markets such as China and India to offer significant growth opportunities for this market in the near future. Cerner Corporation (US), McKesson Corporation (US), athenahealth (US), eClinicalWorks (US), Optum, Inc, (US), Conifer Health Solutions (US), and nThrive (US) are the key players in the healthcare claims management market. Other players involved in this market are DST Systems (US), Cognizant Technology Solutions (US), Allscripts Healthcare Solutions, Inc. (US), Context 4 Healthcare (US), Health Solutions Plus (US), GE Healthcare (US), RAM Technologies (US), Quest Diagnostics (US), The SSI Group (US), PLEXIS Healthcare Systems (US), and GeBBS Healthcare Solutions (US).

To speak to our analyst for a discussion on the above findings, click Speak to Analyst

Table of Contents

1 Introduction (Page No. - 13)
    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. - 16)
    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. - 26)

4 Premium Insights (Page No. - 29)
    4.1 Healthcare Claims Management Solutions: Market Overview
    4.2 Healthcare Claims Management Market, By End User (2018)
    4.3 Healthcare Claims Management Solutions Market Share, By Type (2018 vs 2023)
    4.4 Geographical Snapshot of the Healthcare Claims Management Market

5 Market Overview (Page No. - 33)
    5.1 Introduction
    5.2 Market Dynamics
           5.2.1 Market Drivers
                    5.2.1.1 Increasing Patient Volumes
                    5.2.1.2 Expanding Health Insurance Market
                    5.2.1.3 Process Improvements in Healthcare Organizations
                    5.2.1.4 Growing Importance of Denials Management
                    5.2.1.5 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 Claim Management Solutions
                    5.2.4.2 Data Breaches and Loss of Confidentiality
                    5.2.4.3 Lack of Skilled It Professionals in Healthcare

6 Healthcare Claims Management Market, By Component (Page No. - 39)
    6.1 Introduction
    6.2 Services
    6.3 Software

7 Healthcare Claims Management Market, By Type (Page No. - 43)
    7.1 Introduction
    7.2 Integrated Solutions
    7.3 Standalone Solutions

8 Healthcare Claims Management Market, By Delivery Mode (Page No. - 46)
    8.1 Introduction
    8.2 On-Premise Delivery Mode
    8.3 Cloud-Based Delivery Mode

9 Healthcare Claims Management Market, By End User (Page No. - 50)
    9.1 Introduction
    9.2 Healthcare Payers
    9.3 Healthcare Providers
    9.4 Other End Users

10 Healthcare Claims Management Market, By Region (Page No. - 55)
     10.1 Introduction
     10.2 North America
             10.2.1 US
             10.2.2 Canada
     10.3 Europe
             10.3.1 UK
             10.3.2 Germany
             10.3.3 France
             10.3.4 Italy
             10.3.5 Rest of Europe
     10.4 Asia
     10.5 Rest of the World

11 Competitive Landscape (Page No. - 87)
     11.1 Overview
     11.2 Competitive Scenario
             11.2.1 Product Launches, Deployments, and Enhancements
             11.2.2 Agreements, Partnerships, Contracts, and Collaborations
             11.2.3 Acquisitions
             11.2.4 Expansions

12 Company Profile (Page No. - 92)
(Introduction, Products & Services, Strategy, & Analyst Insights, Developments, MnM View)*
     12.1 Athenahealth
     12.2 Cerner Corporation
     12.3 Allscripts Healthcare Solutions
     12.4 Eclinicalworks
     12.5 Optum, Inc. (A Subsidiary of Unitedhealth Group Inc.)
     12.6 Mckesson Corporation
     12.7 Conifer Health Solutions
     12.8 Gebbs Healthcare Solutions
     12.9 The SSI Group
     12.10 GE Healthcare
     12.11 Nthrive
     12.12 DST Systems
     12.13 Cognizant Technology Solutions
     12.14 Quest Diagnostics
     12.15 Context 4 Healthcare
     12.16 Ram Technologies
     12.17 Health Solutions Plus (HSP)
     12.18 Plexis Healthcare Systems

*Details on Marketsandmarkets View, Introduction, Product & Services, Strategy, & Analyst Insights, New Developments Might Not Be Captured in Case of Unlisted Companies.

13 Appendix (Page No. - 130)
     13.1 Discussion Guide
     13.2 Knowledge Store: Marketsandmarkets’ Subscription Portal
     13.3 Introducing RT: Real-Time Market Intelligence
     13.4 Available Customizations
     13.5 Related Reports
     13.6 Author Details


List of Tables (65 Tables)

Table 1 Healthcare Claims Management Solutions Market, By Component, 2016–2023 (USD Billion)
Table 2 Healthcare Claims Management Services Market, By Region, 2016–2023 (USD Billion)
Table 3 Healthcare Claims Management Software Market, By Region, 2016–2023 (USD Billion)
Table 4 Healthcare Claims Management Market, By Type, 2016–2023 (USD Billion)
Table 5 Integrated Healthcare Claims Management Solutions Market, By Region, 2016–2023 (USD Billion)
Table 6 Standalone Healthcare Claims Management Market, By Region, 2016–2023 (USD Billion)
Table 7 Healthcare Claims Management Solutions Market, By Delivery Mode, 2016–2023 (USD Billion)
Table 8 On-Premise Healthcare Claims Management Market, By Region, 2016–2023 (USD Billion)
Table 9 Cloud-Based Healthcare Claims Management Solutions Market, By Region, 2016–2023 (USD Billion)
Table 10 Healthcare Claims Management Market, By End User, 2016–2023 (USD Billion)
Table 11 Healthcare Claims Management Solutions Market for Healthcare Payers, By Region, 2016–2023 (USD Billion)
Table 12 Healthcare Claims Management Market for Healthcare Providers, By Region, 2016–2023 (USD Billion)
Table 13 Healthcare Claims Management Solutions Market for Other End Users, By Region, 2016–2023 (USD Million)
Table 14 Healthcare Claims Management Market, By Region, 2016–2023 (USD Billion)
Table 15 North America: Healthcare Claims Management Solutions Market, By Country, 2016–2023 (USD Billion)
Table 16 North America: Healthcare Claims Management Market, By Component, 2016–2023 (USD Billion)
Table 17 North America: Healthcare Claims Management Solutions Market, By Type, 2016–2023 (USD Billion)
Table 18 North America: Healthcare Claims Management Market, By Delivery Mode, 2016–2023 (USD Billion)
Table 19 North America: Healthcare Claims Management Solutions Market, By End User, 2016–2023 (USD Billion)
Table 20 US: Healthcare Claims Management Market, By Component, 2016–2023 (USD Billion)
Table 21 US: Healthcare Claims Management Solutions Market, By Type, 2016–2023 (USD Billion)
Table 22 US: Healthcare Claims Management Market, By Delivery Mode, 2016–2023 (USD Billion)
Table 23 US: Healthcare Claims Management Solutions Market, By End User, 2016–2023 (USD Billion)
Table 24 Canada: Healthcare Claims Management Solutions Market, By Component, 2016–2023 (USD Billion)
Table 25 Canada: Healthcare Claims Management Market, By Type, 2016–2023 (USD Billion)
Table 26 Canada: Healthcare Claims Management Solutions Market, By Delivery Mode, 2016–2023 (USD Billion)
Table 27 Canada: Healthcare Claims Management Market, By End User, 2016–2023 (USD Million)
Table 28 Europe: Healthcare Claims Management Solutions Market, By Country, 2016–2023 (USD Billion)
Table 29 Europe: Healthcare Claims Management Market, By Component, 2016–2023 (USD Billion)
Table 30 Europe: Healthcare Claims Management Solutions Market, By Type, 2016–2023 (USD Billion)
Table 31 Europe: Healthcare Claims Management Market, By Delivery Mode, 2016–2023 (USD Billion)
Table 32 Europe: Healthcare Claims Management Solutions Market, By End User, 2016–2023 (USD Million)
Table 33 Healthcare Claims Management Solutions for Fraud Analytics
Table 34 UK: Healthcare Claims Management  Market, By Component, 2016–2023 (USD Billion)
Table 35 UK: Healthcare Claims Management Solutions Market, By Type, 2016–2023 (USD Billion)
Table 36 UK: Healthcare Claims Management Market, By Delivery Mode, 2016–2023 (USD Billion)
Table 37 UK: Healthcare Claims Management Solutions Market, By End User, 2016–2023 (USD Million)
Table 38 Germany: Healthcare Claims Management Market, By Component, 2016–2023 (USD Billion)
Table 39 Germany: Healthcare Claims Management Solutions Market, By Type, 2016–2023 (USD Billion)
Table 40 Germany: Healthcare Claims Management Market, By Delivery Mode, 2016–2023 (USD Billion)
Table 41 Germany: Healthcare Claims Management Solutions Market, By End User, 2016–2023 (USD Million)
Table 42 France: Healthcare Claims Management Market, By Component, 2016–2023 (USD Million)
Table 43 France: Healthcare Claims Management Solutions Market, By Type, 2016–2023 (USD Million)
Table 44 France: Healthcare Claims Management Market, By Delivery Mode, 2016–2023 (USD Million)
Table 45 France: Healthcare Claims Management Solutions Market, By End User, 2016–2023 (USD Million)
Table 46 Italy: Healthcare Claims Management Market, By Component, 2016–2023 (USD Million)
Table 47 Italy: Healthcare Claims Management Solutions Market, By Type, 2016–2023 (USD Million)
Table 48 Italy: Healthcare Claims Management Market, By Delivery Mode, 2016–2023 (USD Million)
Table 49 Italy: Healthcare Claims Management Solutions Market, By End User, 2016–2023 (USD Million)
Table 50 RoE: Healthcare Claims Management Market, By Component, 2016–2023 (USD Million)
Table 51 RoE: Healthcare Claims Management Solutions Market, By Type, 2016–2023 (USD Million)
Table 52 RoE: Healthcare Claims Management Market, By Delivery Mode, 2016–2023 (USD Million)
Table 53 RoE: Healthcare Claims Management Solutions Market, By End User, 2016–2023 (USD Million)
Table 54 Asia: Healthcare Claims Management Market, By Component, 2016–2023 (USD Billion)
Table 55 Asia: Healthcare Claims Management Solutions Market, By Type, 2016–2023 (USD Billion)
Table 56 Asia: Healthcare Claims Management Market, By Delivery Mode, 2016–2023 (USD Billion)
Table 57 Asia: Healthcare Claims Management Solutions Market, By End User, 2016–2023 (USD Million)
Table 58 RoW: Healthcare Claims Management Market, By Component, 2016–2023 (USD Million)
Table 59 RoW: Healthcare Claims Management Solutions Market, By Type, 2016–2023 (USD Million)
Table 60 RoW: Healthcare Claims Management Market, By Delivery Mode, 2016–2023 (USD Million)
Table 61 RoW: Healthcare Claims Management Solutions Market, By End User, 2016–2023 (USD Million)
Table 62 Product Launches, Deployments, and Enhancements (2014–2018)
Table 63 Agreements, Partnerships, Contracts, and Collaborations (2014–2018)
Table 64 Acquisitions, 2014–2018
Table 65 Expansions (2014–2018)


List of Figures (29 Figures)

Figure 1 Research Methodology: Healthcare Claims Management Solutions Market
Figure 2 Research Design
Figure 3 Sampling Frame: Primary Research
Figure 4 Market Size Estimation Methodology: Bottom-Up Approach
Figure 5 Market Size Estimation Methodology: Top-Down Approach
Figure 6 Data Triangulation Methodology
Figure 7 Services to Dominate the Healthcare Claims Management Solutions Market, By Component, in 2018
Figure 8 On-Premise Delivery Mode to Account for the Largest Share of the Market, By Delivery Mode, in 2018
Figure 9 Asia to Witness the Highest Market Growth During the Forecast Period
Figure 10 Expanding Health Insurance Market to Drive Market Growth During the Forecast Period
Figure 11 Healthcare Payers to Account for the Largest Share of the Healthcare Claims Management Solutions Market in 2018
Figure 12 Integrated Solutions Will Continue to Dominate the Healthcare Claims Management Solutions Market in 2023
Figure 13 Asian Region to Witness the Highest Growth Rate During the Forecast Period
Figure 14 Healthcare Claims Management Solutions Market: Drivers, Restraints, Opportunities, and Challenges
Figure 15 Healthcare Claims Management Solutions Market, By Region
Figure 16 North America: Healthcare Claims Management Solutions Market Snapshot
Figure 17 Europe: Healthcare Claims Management Solutions Market Snapshot
Figure 18 Asia: Healthcare Claims Management Solutions Market Snapshot
Figure 19 RoW: Healthcare Claims Management Solutions Market Snapshot
Figure 20 Key Developments in the Healthcare Claims Management Solutions Market Between 2014 and 2018
Figure 21 Company Snapshot: Athenahealth (2017)
Figure 22 Company Snapshot: Cerner (2017)
Figure 23 Company Snapshot: Allscripts Healthcare Solutions (2017)
Figure 24 Company Snapshot: Optum, Inc. (2017)
Figure 25 Company Snapshot: Mckesson Corporation (2017)
Figure 26 Company Snapshot: GE Healthcare (2017)
Figure 27 Company Snapshot: DST Systems (2017)
Figure 28 Company Snapshot: Cognizant Technology Solutions (2017)
Figure 29 Company Snapshot: Quest Diagnostics Incorporated (2017)


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Report Code
HIT 6389
Published ON
Jun, 2018
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