Healthcare Claims Management Solutions Global Market Report 2024

Healthcare claims management solutions aim to achieve comprehensive automation of claims processing, ensuring rapid access to client information while maintaining the confidentiality of private medical data.

The primary categories of healthcare claims management solutions include software and services. Software encompasses a set of data, instructions, or programs utilized in computers to execute specific tasks. Deployment methods include web-based, cloud-based, and on-premise solutions. These solutions cater to various end-users, including healthcare payers, healthcare providers, and other entities.

The healthcare claims management solutions market research report is one of a series of new reports that provides healthcare claims management solutions market statistics, including healthcare claims management solutions industry global market size, regional shares, competitors with a healthcare claims management solutions market share, detailed healthcare claims management solutions market segments, market trends and opportunities, and any further data you may need to thrive in the healthcare claims management solutions industry. This healthcare claims management solutions market research report delivers a complete perspective of everything you need, with an in-depth analysis of the current and future scenario of the industry.

The healthcare claims management solutions market size has grown strongly in recent years. It will grow from $15.32 billion in 2023 to $16.34 billion in 2024 at a compound annual growth rate (CAGR) of 6.7%. The growth observed in the historical period can be attributed to several key factors, including a rise in healthcare costs, a focus on regulatory compliance, the transition to paperless claims processing, enhancements in accuracy, and increased collaboration between providers and payers. These elements collectively played a significant role in driving growth during this historical timeframe.

The healthcare claims management solutions market size is expected to see strong growth in the next few years. It will grow to $21.24 billion in 2028 at a compound annual growth rate (CAGR) of 6.8%. The anticipated growth in the forecast period can be attributed to various key factors, including the expansion of telehealth services, the shift towards value-based care models, efforts in achieving interoperability, heightened focus on cybersecurity, and increased preparedness for pandemics. Major trends expected in the forecast period encompass the utilization of blockchain for claims processing, the application of AI-powered claims analytics, the adoption of predictive analytics for fraud detection, the facilitation of mobile claims submission, and the implementation of automated claims adjudication. These factors and trends collectively contribute to the projected growth in the upcoming period.

The rapid increase in the ageing population is anticipated to drive the growth of the healthcare claims management solutions market. The ageing population, referring to individuals aged 65 and over, requires streamlined processes for healthcare claims to expedite the payment lifecycle. Healthcare claims management solutions offer easier access to claim management, meeting the demands of an ageing population. As reported by the World Health Organization in October 2022, globally, 1 in 6 individuals is projected to be 60 or older by 2030, reaching an expected 2.1 billion elderly people by 2050. This demographic shift is identified as a significant driver propelling the healthcare claims management market.

The increasing incidence of chronic diseases is expected to contribute to the growth of the healthcare claims management solutions market. Chronic diseases, which persist over an extended period, necessitate ongoing medical management. Healthcare claims management solutions play a crucial role in supporting the efficient and accurate processing of claims, ensuring timely reimbursement for healthcare providers offering chronic disease management services. Projections from the National Center for Biotechnology Information (NCBI) in January 2023 indicate that by the year 2050, the number of individuals aged 50 years and older with at least one chronic illness is expected to surge by 99.5%, from 71.522 million in 2020 to 142.66 million. This growing incidence of chronic diseases is identified as a key factor propelling the healthcare claims management solutions market.

Advancements in technology for innovative treatments in healthcare represent a key trend gaining popularity in the healthcare claims management solutions market. Major companies operating in this sector are actively introducing new technologies to provide innovative treatments, contributing to the sustainability of their positions in the market. For example, in January 2022, Treatment.com International Inc., a US-based healthcare software solutions provider, including healthcare claims management, launched the Treatment Digital Health App. This doctor-built digital health app utilizes AI software technology to provide users with wide access to highly accurate insights about their health, offering diagnoses and customized treatments. This integration of technology and healthcare solutions reflects the industry's commitment to innovation in providing enhanced patient care through healthcare claims management solutions.

Leading companies in the healthcare claims management solutions market are actively focusing on product innovation, exemplified by the introduction of AI-enabled solutions such as the Claims Data Activator Suite, to sustain their positions in the market. The Claims Data Activator Suite aims to establish data interoperability, intelligent analytics, and smart reporting by leveraging technologies such as Document AI, the Healthcare Natural Language API, and the Healthcare API. This innovation enables the transformation of unstructured data into structured data, offering enhanced capabilities for healthcare claims management. In April 2023, Google LLC, a major US-based technology company, launched a new Google Cloud AI-enabled claims data activator. This solution is designed to assist health plans and providers in reducing administrative costs and responsibilities by converting unstructured data into structured data. The Claims Data Activator empowers specialists to make quicker, better-informed decisions, ultimately improving patient care.

In February 2022, Hellman & Friedman, a prominent US-based private equity firm, and Bain Capital, a leading US-based private investment firm, made a significant move by acquiring Athenahealth for a deal amount of $17 billion. This strategic acquisition positions Hellman & Friedman and Bain Capital with the largest and most innovative provider of cloud-based electronic medical records and physician practice solutions across the healthcare industry. Athenahealth, a US-based healthcare technology provider, operates in the healthcare claims management solutions market. This acquisition reflects the industry's strategic focus on partnerships and acquisitions to strengthen capabilities and offerings, emphasizing the importance of innovative solutions in healthcare claims management.

Major companies operating in the healthcare claims management solutions market include Allscripts Healthcare Solutions Inc., Athenahealth, McKesson Corporation, Quest Diagnostics, Oracle Corporation, Alpha II LLC, Dell Inc., Availity Co., Cerner Corporation, Change Healthcare, Conifer Health Solutions LLC, eClinicalWorks, EmblemHealth Co., Emdeon Inc., Epic Systems Corporation, GE Healthcare, Inovalon Co., InstaMed Co., Kareo Co., NaviNet Inc., NTT Data Services, Optum Inc., Provation Medical, NetApp Co., SSI Group LLC, The SSI Group, Cognizant Technology Ltd., TruBridge Co., Waystar Co., ZirMed Inc.

North America was the largest region in the healthcare claim management solution market in 2023. Asia-Pacific is expected to be the fastest-growing region in the forecast period. The regions covered in the healthcare claim management solution market share report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East, and Africa.

The countries covered in the healthcare claim management solution market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK and USA.

The healthcare claims management solutions market consists of sales of healthcare software and related services. Values in this market are ‘factory gate’ values, that is the value of goods sold by the manufacturers or creators of the goods, whether to other entities (including downstream manufacturers, wholesalers, distributors and retailers) or directly to end customers. The value of goods in this market includes related services sold by the creators of the goods.

The market value is defined as the revenues that enterprises gain from the sale of goods and/or services within the specified market and geography through sales, grants, or donations in terms of the currency (in USD unless otherwise specified).

The revenues for a specified geography are consumption values that are revenues generated by organizations in the specified geography within the market, irrespective of where they are produced. It does not include revenues from resales along the supply chain, either further along the supply chain or as part of other products.


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