Healthcare provider network management helps to finance organizations to manage a provider’s network with superior efficiency for optimum financial results, process claims with more accuracy (which reduces errors and cost), and improve provider satisfaction. A healthcare provider network includes doctors, hospitals, and other healthcare providers such as nurses, therapists, practitioners, and clinicians that are a part of the health insurance plan. Provider network management comprises database management, contracting services, and credentialing pricing maintenance and configuration, among others. With the help of provider network management, the payer organization is able to expose insights which may have been ignored previously by conventional analytical tools. Healthcare provider network management helps to create consistency in care delivery, leveraging data obtained in daily operations by payer organizations to identify high-risk providers and ensure necessary health insurance coverage for patients. Healthcare provider network management can help payers simplify the management, design, and servicing of provider networks which offers flexibility to apply new network policies and cooperate with providers to successfully distribute new products, payment approaches, and care delivery models. Network management helps payers implement and effectively administer to pay for performance programs to reimburse providers based on the quality of care.
Over the past few decades, the healthcare provider network management market has grown significantly due to increasing focus on improving quality of healthcare through the effective use of requirements and stringent federal mandates implemented in the U.S. However, high cost of deployment is majorly constraining the growth of the healthcare provider network management market. Innovative data analytics in IT provide benefits to payers such as better predictions of situations and risks, superior negotiation capabilities, and reduction in overall cost that provide a good opportunity for this market. Reluctance of users to migrate from legacy systems is a major challenge for this market.
The global healthcare provider network management market is segmented on the basis of components into the following categories: services and platforms/software. Services market is further classified into outsourcing services and internal services. The service segment which is expected to register high growth in the near future, because of high growth and largest share can be attributed to the fact that services helps to improve operational efficiencies, build a stronger provider network, achieve regulatory compliance, and reduce the overall costs. Such benefits gives a competitive advantage to the service sector over platforms/software. The internal services segment is the dominant segment in the provider network management services market due to help ensure profitability, long-term provider relationships, regulatory compliance and better provider network management. These advantages drive the growth of this segment over the outsourcing services segment.
Geographically, the healthcare provider network management market is segmented into North America, Europe, Latin America, Asia Pacific, and Middle East & Africa. North America dominated this market, followed by Europe, Asia Pacific, and the other regions. Key factors driving the growth of the North America market include the increasing need to reduce healthcare costs in the U.S, rise in health insurance coverage under the Patient Protection and Affordable Act (PPACA) in the U.S. and Canada, and government support to healthcare IT solutions in Canada. In order to gain competitive advantage in the industry, key players are actively involved in offering variation to products and services and also continuously undertaking new product launches. Collaborations, partnerships, and agreements are important strategies followed by market players to stay ahead of competition.
Some of the key players operating in healthcare provider network management market include Optum, Inc., Ayasdi, Inc., Aldera, Inc., Genpact Limited, McKesson Corporation, Infosys BPO, Ltd., TriZetto Corporation, Mphasis Limited, Syntel, Inc., and Vestica Healthcare, LLC.
This study by TMR is all-encompassing framework of the dynamics of the market. It mainly comprises critical assessment of consumers' or customers' journeys, current and emerging avenues, and strategic framework to enable CXOs take effective decisions.
Our key underpinning is the 4-Quadrant Framework EIRS that offers detailed visualization of four elements:
- Customer Experience Maps
- Insights and Tools based on data-driven research
- Actionable Results to meet all the business priorities
- Strategic Frameworks to boost the growth journey
The study strives to evaluate the current and future growth prospects, untapped avenues, factors shaping their revenue potential, and demand and consumption patterns in the global market by breaking it into region-wise assessment.
The following regional segments are covered comprehensively:
- North America
- Asia Pacific
- Latin America
- The Middle East and Africa
The EIRS quadrant framework in the report sums up our wide spectrum of data-driven research and advisory for CXOs to help them make better decisions for their businesses and stay as leaders.
Below is a snapshot of these quadrants.
1. Customer Experience Map
The study offers an in-depth assessment of various customers’ journeys pertinent to the market and its segments. It offers various customer impressions about the products and service use. The analysis takes a closer look at their pain points and fears across various customer touchpoints. The consultation and business intelligence solutions will help interested stakeholders, including CXOs, define customer experience maps tailored to their needs. This will help them aim at boosting customer engagement with their brands.
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The various insights in the study are based on elaborate cycles of primary and secondary research the analysts engage with during the course of research. The analysts and expert advisors at TMR adopt industry-wide, quantitative customer insights tools and market projection methodologies to arrive at results, which makes them reliable. The study not just offers estimations and projections, but also an uncluttered evaluation of these figures on the market dynamics. These insights merge data-driven research framework with qualitative consultations for business owners, CXOs, policy makers, and investors. The insights will also help their customers overcome their fears.
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The findings presented in this study by TMR are an indispensable guide for meeting all business priorities, including mission-critical ones. The results when implemented have shown tangible benefits to business stakeholders and industry entities to boost their performance. The results are tailored to fit the individual strategic framework. The study also illustrates some of the recent case studies on solving various problems by companies they faced in their consolidation journey.
4. Strategic Frameworks
The study equips businesses and anyone interested in the market to frame broad strategic frameworks. This has become more important than ever, given the current uncertainty due to COVID-19. The study deliberates on consultations to overcome various such past disruptions and foresees new ones to boost the preparedness. The frameworks help businesses plan their strategic alignments for recovery from such disruptive trends. Further, analysts at TMR helps you break down the complex scenario and bring resiliency in uncertain times.
The report sheds light on various aspects and answers pertinent questions on the market. Some of the important ones are:
1. What can be the best investment choices for venturing into new product and service lines?
2. What value propositions should businesses aim at while making new research and development funding?
3. Which regulations will be most helpful for stakeholders to boost their supply chain network?
4. Which regions might see the demand maturing in certain segments in near future?
5. What are the some of the best cost optimization strategies with vendors that some well-entrenched players have gained success with?
6. Which are the key perspectives that the C-suite are leveraging to move businesses to new growth trajectory?
7. Which government regulations might challenge the status of key regional markets?
8. How will the emerging political and economic scenario affect opportunities in key growth areas?
9. What are some of the value-grab opportunities in various segments?
10. What will be the barrier to entry for new players in the market?
Note: Although care has been taken to maintain the highest levels of accuracy in TMR’s reports, recent market/vendor-specific changes may take time to reflect in the analysis.