Healthcare Provider Network Management Market

Global Healthcare Provider Network Management Marketis valued at USD 4.10 Billion in 2022 and it is expected to reach USD 10.50 Billion by 2029 with a CAGR of 14.38% over the forecast period.

Global Healthcare Provider Network Management Market: Global Size, Trends, Competitive, and Historical & Forecast Analysis, 2022-2028: The market will expand due to the growing adoption of digital solutions and technologies in the healthcare industry, and the increasing demand for value-based care models.

Scope of Global Healthcare Provider Network Management Market Report-

Healthcare Provider Network Management refers to the process of creating and maintaining a network of healthcare providers, including hospitals, clinics, physicians, and other healthcare professionals. The goal of healthcare provider network management is to ensure that patients have access to high-quality healthcare services at a reasonable cost.

The healthcare provider network management industry has been around for several decades. Initially, the focus was on managing provider contracts and credentialing. Over time, the industry has evolved to include a range of services, such as provider directory management, claims processing, and network optimization.

Healthcare provider network management is used by a variety of organizations in the healthcare industry, including health plans, third-party administrators, and self-insured employers. These organizations rely on healthcare provider network management services to help them build and maintain a network of high-quality healthcare providers. The end-users of healthcare provider network management services include healthcare providers, health plans, third-party administrators, and self-insured employers.

COVID-19 Impact on the Healthcare Provider Network Management market:

COVID-19 has had a significant impact on the Healthcare Provider Network Management market, with both positive and negative effects. Here are some of the impacts, increased demand for telemedicine and virtual care services, which has led to an increase in the use of healthcare provider network management services. The pandemic has accelerated the adoption of digital solutions in the healthcare industry, which has benefited the Healthcare Provider Network Management market.

On the negative side, the pandemic has resulted in a decline in elective procedures and non-emergency medical services, which has affected the revenue of healthcare providers and subsequently, the Healthcare Provider Network Management market. The pandemic has also led to a decrease in employer-sponsored health plans, which has impacted the demand for Healthcare Provider Network Management services.

Key Players of Global Healthcare Provider Network Management Market Report-

• UnitedHealth Group
• Cigna Corporation
• Aetna Inc.
• Anthem Inc.
• Humana Inc.
• CVS Health Corporation
• Optum Inc.
• WellCare Health Plans Inc.
• Centene Corporation
• Molina Healthcare Inc.
• Magellan Health Inc.
• Health Net Inc.
• TriWest Healthcare Alliance Corp.
• Beacon Health Options Inc.
• MultiPlan Inc.
• Evolent Health Inc.
• Healthcare Highways Inc.
• Medica
• HealthPartners
• Universal American Corp.
• WPS Health Solutions
• CareSource
• Blue Cross Blue Shield Association
• Bright Health
• NextLevel Health Partners
• Avera Health Plans
• Averde Health
• Elderplan
• FirstCarolinaCare Insurance Company
• Gundersen Health Plan Inc.
• Inland Empire Health Plan
• Iowa Total Care
• Magnolia Health
• MediGold
• Physicians Health Plan of Northern Indiana Inc.
• Premier Health
• Senior Whole Health
• Sharp Health Plan
• Tufts Health Plan
• Virginia Premier Health Plan Inc

Market Segmentation

By Component:

• Services

  • Consulting
  • Implementation
  • Maintenance and Support
• Software

By Delivery Mode:

• On-Premise
• Cloud-Based

By Application:

• Provider Network Management
• Claims Management
• Credentialing
• Others

By End-User:

• Healthcare Providers
• Payers
• Others

Revenue Generation Model:

The revenue generation model for healthcare provider network management companies typically involves a combination of fees for services rendered and a percentage of savings achieved for their clients.

Supply Chain Model:

The supply chain for healthcare provider network management involves a range of stakeholders, including healthcare providers, health plans, third-party administrators, and self-insured employers.

Value Chain Model:

The value chain for healthcare provider network management begins with the identification of healthcare providers and the negotiation of contracts with those providers. This is followed by the management of provider data, claims processing, and network optimization.

Market Drivers:

Growing adoption of digital solutions and technologies in the healthcare industry: this is driven by several factors, including the need to improve patient outcomes, increase efficiency, and reduce costs. Digital solutions such as electronic health records (EHRs), telemedicine, and mobile health applications are helping to streamline healthcare delivery, improve access to care, and enable better collaboration between healthcare providers. According to the American Academy of Family Physicians US healthcare providers, 87% reported using EHRs to manage patient records, and 83% reported that EHRs had improved the quality of patient care. Additionally, advances in technologies such as artificial intelligence (AI), machine learning, and big data analytics are helping to revolutionize healthcare by providing new insights into patient care and facilitating more personalized and effective treatments. For example, a study of an AI-powered algorithm for identifying sepsis in patients found that it reduced mortality rates by 21% and decreased the length of hospital stays by 11%.

Increasing demand for value-based care models: The growing demand for value-based care models is being driven by several factors, including a growing emphasis on patient-centered care, the need to reduce healthcare costs, and the growing recognition that traditional fee-for-service models do not always prioritize patient outcomes. According to the National Business Group on Health found that 84% of large employers are concerned about the impact of fee-for-service payment models on healthcare costs.

Value-based care models aim to provide high-quality care that is coordinated, efficient, and patient-centered, while also incentivizing providers to focus on preventing illness and managing chronic conditions. By prioritizing patient outcomes and reducing unnecessary costs, value-based care models have the potential to improve the overall quality of care, enhance patient satisfaction, and reduce healthcare spending over the long term.

Market Restraints:

High implementation costs of Healthcare Provider Network Management solutions: One of the major restraining factors for the Healthcare Provider Network Management market is the high implementation costs associated with these solutions. Implementing a Healthcare Provider Network Management solution involves significant investment in technology, infrastructure, and personnel. This can be a challenge for many healthcare organizations, especially smaller providers and those operating in resource-constrained environments. In addition, the ongoing maintenance and support costs of Healthcare Provider Network Management solutions can also be significant, further adding to the total cost of ownership. For example, the cost of Healthcare Provider Network Management solutions can range from $10,000 to $5 million or more, depending on the size and complexity of the network, the types of services offered, and the level of customization required.

Geography Analysis:

North America:

North America is the largest market for Healthcare Provider Network Management solutions, accounting for a significant share of the global market. The growth of the market in this region is driven by factors such as the presence of a well-established healthcare infrastructure, the adoption of advanced technologies, and the increasing focus on value-based care models.

The United States is the largest market for Healthcare Provider Network Management solutions in North America, with Canada also being a significant contributor to the market growth. The market is highly fragmented in the region, with several small and large players operating in the market. In 2020, the United States spent approximately $3.8 trillion on healthcare, which represents approximately 18% of the country's GDP.

Europe:

Europe is a significant market for Healthcare Provider Network Management solutions due to the growing demand for digital healthcare technologies in the region. The increasing prevalence of chronic diseases, the aging population, and rising healthcare costs are some of the factors driving the demand for Healthcare Provider Network Management solutions in Europe. For example, the prevalence of chronic diseases is increasing in Europe due to aging populations, lifestyle changes, and environmental factors. The ECDA estimates that 80% of people aged 65 or older in Europe have at least one chronic disease, and 60% have two or more.

Key Benefits of Global Healthcare Provider Network Management Market Report–

• Global Healthcare Provider Network Management Market report covers in-depth historical and forecast analysis.
• Global Healthcare Provider Network Management Market research report provides detailed information about Market Introduction, Market Summary, Global market Revenue (Revenue USD), Market Drivers, Market Restraints, Market Opportunities, Competitive Analysis, and Regional and Country Level.
• Global Healthcare Provider Network Management Market report helps to identify opportunities in the marketplace.
• Global Healthcare Provider Network Management Market report covers extensive analysis of emerging trends and competitive landscape.