Market Trends of US Healthcare BPO Industry
Claims Management is Expected to Grow with High CAGR in the Forecast Period
Claims processing outsourcing (CPO) is a relatively new business concept for insurance firms. This has emerged as the preferred option for organizations aiming to minimize operating expenses while improving service quality. The relationship between policyholders, healthcare providers, and insurance companies is essential for understanding the medical billing and coding process details.
Medical claims management is the process that deals with the billing, filling, updating, and processing of medical claims related to the patient's diagnosis, treatments, and medications. Many hospitals and medical facilities outsource these tasks to medical claims management firms, as maintaining patient records, interacting with health insurance agencies, and medical service invoices are time-consuming processes.
The increased burden of chronic diseases, the aging population, and rising healthcare claims activity are driving segment expansion. For instance, according to Cancer Facts and Figures 2023, published in January 2023 by the American Cancer Society, an estimated 1.9 million new cancer cases will be diagnosed in the United States in 2023, among which prostate cancer is estimated to be 288,300, followed by 238,340 cases of lung cancer, and 300,590 cases of female breast cancer. Therefore, with a rising burden of chronic diseases such as cancer, healthcare providers claim the request to insurance companies to offset the treatment cost incurred in cancer, which drives the demand for claim management services, thereby boosting segment growth.
Furthermore, strategic activities by market players, such as partnerships, are expected to boost the market over the forecast period. For instance, in January 2021, Tractable announced a collaboration with Hartford to use artificial intelligence to speed up claims processing.
Thus, all the factors above, such as the growing burden of chronic diseases and strategic activities by the market players, are expected to boost the segment's growth.
Revenue Cycle Management Segment is Expected to Hold a Significant Share Over the Forecast Period
Revenue cycle management (RCM) is a tool healthcare institutions use to monitor all financial interactions with patients, from their first appointment until the settlement of any outstanding debt. All clinical and administrative tasks involved in managing and collecting patient service revenues collectively are called the RCM. Therefore, the growing need for RCM services in healthcare is anticipated to promote segment expansion.
The RCM provides various advantages to the supplier, from billing and collections to administrative responsibilities. It is a cutting-edge system that manages administrative tasks via sophisticated billing, payment processing, and electronic health record systems—according to a June 2022 article published by the Medical Group Management Association (MGMA), medical practices that outsource their RCM experience increased performance in collections, staff efficiency, and more. Thus, owing to the benefits associated with the RCM and growing adoption, RCM is expected to boost the segment growth over the forecast period.
The market players are focusing on new partnerships and agreements to bolster their market positions, which is ultimately responsible for segment growth. For instance, in July 2022, Waystar, a revenue cycle management (RCM) vendor, planned to buy Patientco in the latest transaction involving an RCM vendor and a patient payment company.
Further, the RCM vendor hopes the combination will improve the patient's financial experience by providing user-friendly options for medical costs. In December 2022, Luminis Health, situated in Annapolis, Maryland, selected VisiQuate, an AI-powered analytics firm, to handle its revenue cycle management operations. Similarly, in November 2022, Cornerstone Specialty Hospitals partnered with CareCloud to take on its revenue cycle management services in West Monroe, Louisiana.
Thus, all the factors above, such as the enormous benefits of RCM outsourcing and strategic collaboration between healthcare companies and market vendors, are expected to boost the segment's growth.
