Healthcare Claims Management Market to Reach USD 24.93 Billion by 2032, Driven by Technological Innovations and Expanding Healthcare Digitization
Expansion of the healthcare claims management market is due to increased complexity in claims processing, escalating healthcare costs, and rising demand for automation and digital solutions.
Austin, Nov. 11, 2024 (GLOBE NEWSWIRE) — The S&S Insider report indicates that, “The Healthcare Claims Management Market was valued at USD 15.01 Billion in 2023 and is projected to reach USD 24.93 Billion by 2032, growing at a compound annual growth rate (CAGR) of 5.85% from 2024 to 2032.”
Growth and Advancements in the Healthcare Claims Management Market Amid Rising Complexity and Patient Volumes
The healthcare claims management market is growing significantly, driven by increased complexity in medical claims processing and high patient volumes. Demand for automation and digital solutions pushes billing and reimbursement to achieve greater efficiency and accuracy. Generative AI technologies have the potential to bring down loss-adjusting costs by 20-25%, making operations more efficient throughout the industry.
Advanced claims management systems are imperative in this regard, mainly because health expenditure is touching the sky. Automation through cloud-based as well as web-based technologies is in more demand, thus significantly increasing the speed of processing claims with high accuracy levels. Expanded health insurance cover and further reliance on AI and RPA accelerate the need for claims management systems more efficient and support the overall digital transformation of the health industry.
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Major Players:
- McKesson Corporation (McKesson Claims Management Solutions, McKesson Risk Management Solutions)
- The SSI Group, Inc. (SSI Claims Manager, SSI Clearinghouse)
- Quest Diagnostics (Quest Diagnostics Claims Management, Quest Diagnostics Revenue Cycle Management)
- Kareo (Kareo Billing, Kareo Claims Management)
- Optum, Inc. (a subsidiary of UnitedHealth Group) (Optum360 Claims Management, Optum Claims Analytics)
- Conifer Health Solutions (Conifer Revenue Cycle Management, Conifer Claims Management)
- CareCloud (CareCloud Claims Management, CareCloud Revenue Cycle Management)
- eClinicalWorks (eClinicalWorks Claims Management, eClinicalWorks RCM Solution)
- IBM (IBM Watson for Claims, IBM Revenue Cycle Management)
- Cerner Corporation (Cerner Claims Management, Cerner Revenue Cycle)
- Accenture Plc (Accenture Health Claims Solutions, Accenture Revenue Cycle Management)
- Allscripts Healthcare Solutions Inc. (Allscripts Revenue Cycle Management, Allscripts Claims Processing)
- athenahealth (AthenaCollector, AthenaIDX)
- Carecloud Inc. (CareCloud Claims Management, CareCloud Revenue Cycle Management)
- Oracle Corporation (Oracle Healthcare Claims, Oracle Healthcare Revenue Cycle)
- Plexis Healthcare Systems (Plexis Claims Management, Plexis Healthcare Solutions)
- Quest Diagnostics (Quest Diagnostics Revenue Cycle, Quest Diagnostics Claims Management)
- The SSI Group LLC (SSI Clearinghouse, SSI Claims Management)
Healthcare Claims Management Market Report Scope:
| Report Attributes | Details |
| Market Size in 2023 | USD 15.01 Billion |
| Market Size by 2032 | USD 24.93 Billion |
| CAGR | CAGR of 5.85% From 2024 to 2032 |
| Base Year | 2023 |
| Forecast Period | 2024-2032 |
| Historical Data | 2020-2022 |
| Report Scope & Coverage | Market Size, Segments Analysis, Competitive Landscape, Regional Analysis, DROC & SWOT Analysis, Forecast Outlook |
| Key Segments | • By Product (Medical Billing, Claims Processing) • By Component (Software, Services) • By Solution Type (Integrated Solutions, Standalone Solutions) • By Deployment Mode (Cloud-based, On-premise, Web-based) • By End-use (Healthcare Providers, Healthcare Payers) |
| Key Drivers | • Rising Healthcare Costs and Employment-Based Insurance Drive the Need for Efficient Claims Management. • Stricter Government Regulations and the Shift to Value-Based Care Fuel Healthcare Claims Management Growth |
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Rising Healthcare Expenditures Drive Demand for Efficient Claims Management Solutions
The average per capita expenditure in the United States for healthcare was estimated at over USD 12,555 in 2022-a much higher value than other high-income countries. Since more than 54% of Americans obtain work-based health insurance coverage, there is an increasing call for effective claims management solutions with rising costs, and it is becoming very essential to help facilitate faster reimbursement and reduce healthcare providers’ administrative burdens with advanced technologies that can smooth out the processing of claims.
Government Regulations and Rising Denials Propel the Need for Advanced Claims Management
As governments increase their regulatory oversight of healthcare claims, providers and payers are embracing sophisticated solutions to achieve compliance. The transition to value-based care creates even more demand for improved data tracking and quicker claims settlement. Increased claims denials, now at 77% compared to 42% in 2022, and longer reimbursement times (67% in 2024 compared to 51% in 2022) are further emphasizing the need for automation in claims management to optimize payments.
Medical Billing Leads, While Claims Processing Faces Surge in Demand for Automation
Medical billing accounted for the majority of healthcare claims management market share at 58% in 2023, providing vital support to the reimbursement process. However, claims processing is likely to experience the highest growth of 6.65% over the period between 2024 and 2032, with increased demand for sophisticated technologies that combat claim denials, inefficiencies, and fraud. This is an indication of a trend toward automation and smarter solutions in the industry.
Growing Demand for Web-Based and Cloud-Based Solutions in Healthcare Claims Management
The web-based solutions held the major share of the healthcare claims management market in 2023 as they generated a 48% share in the total revenue due to their scalability and ease of integration. However, cloud-based systems are expected to observe maximum growth as the demand for better data security, remote access, and increased storage would appeal it more to healthcare providers.
North America Leads, While Asia Pacific Shows Rapid Growth in Healthcare Claims Management Market
North America held a 40% market share in 2023, led by its strong healthcare infrastructure and its high adoption of technology besides an increased emphasis on digital healthcare solutions. The region also benefits from solid government regulations besides investments in health care innovation.
The Asia Pacific region is the fastest-growing at a CAGR of 7.51% from 2024 to 2032. A rise in the adoption of digital healthcare, an increase in coverage through insurance, and growth in more healthcare networks in emerging markets like India and China drive the need for efficient claims management solutions.
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Key Developments in the Healthcare Claims Management Market
- Oracle Health rolls out 2024 Oracle Health Clinical Data Exchange, a cloud-based offering that automates medical claims, reduces administrative costs, and streamlines processes to process faster payments
- In 2024, Conifer Health Solutions extended its exclusive contract with Dartmouth Health to deliver full revenue cycle management (RCM) services, aiming to enhance healthcare claims processing and patient interaction.
Table of Contents – Major Key Points
1. Introduction
- Market Definition
- Scope (Inclusion and Exclusions)
- Research Assumptions
2. Executive Summary
- Market Overview
- Regional Synopsis
- Competitive Summary
3. Research Methodology
- Top-Down Approach
- Bottom-up Approach
- Data Validation
- Primary Interviews
4. Market Dynamics Impact Analysis
- Market Driving Factors Analysis
- PESTLE Analysis
- Porter’s Five Forces Model
5. Statistical Insights and Trends Reporting
- Adoption Rates, 2023
- User Demographics, By User Type and Roles, 2023
- Cost Analysis, by Software.
- Integration Capabilities
6. Competitive Landscape
- List of Major Companies, By Region
- Market Share Analysis, By Region
- Product Benchmarking
- Strategic Initiatives
- Technological Advancements
- Market Positioning and Branding
7. Healthcare Claims Management Market Segmentation, by Product
8. Healthcare Claims Management Market Segmentation, by Component
9. Healthcare Claims Management Market Segmentation, by Solution Type
10. Healthcare Claims Management Market Segmentation, by End Use
11. Healthcare Claims Management Market Segmentation, by Deployment Mode
12. Regional Analysis
13. Company Profiles
14. Use Cases and Best Practices
15. Conclusion
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