Revenue cycle management (RCM) market size in US to grow by USD 11.98 billion from 2022 to 2027, Growing adoption of a value-based reimbursement model to be a major trend, Technavio

NEW YORK, March 6, 2024 /PRNewswire/ — The revenue cycle management (RCM) market in the US is set to grow by USD 11,985.2 million from 2022 to 2027 progressing at a CAGR of 9.94% during the forecast period. The report offers an up-to-date analysis regarding the current global market scenario, the latest trends and drivers, and the overall market environment. The growing need to reduce revenue leakages in healthcare systems drives market growth. There is an increased focus on reducing the growing revenue leakages to remain competitive in the market in focus from the market vendors in the healthcare service industry. Due to the additional time and resources needed in manual systems, revenue leaks cost more than using electronic systems. Furthermore, in the patient leak process, sometimes a healthcare service provider allows a patient to leave the care setting and sends statements to the patient later. This results in patient-level revenue leakage. Hence, owing to factors such as revenue leaks, the RCM market is estimated to grow during the forecast period. 

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The growing adoption of a value-based reimbursement model 

There is a shift from fee-for-service to value-based care reimbursements in the healthcare service industry. Value-based RCM is a reimbursement payment methodology, focusing more on quality healthcare at a reasonable cost. Owing to the adoption of programs and legislation by various governments, the involvement of healthcare service providers across the world in value-based RCM models is rising. Hence, such initiatives are expected to have a positive impact on the adoption of value-based RCM, which will boost the growth of the RCM market in the US during the forecast period.

Interoperability issues associated with RCM solutions challenge the growth of the RCM market in US. 

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Market Segmentation

This US revenue cycle management (RCM) market report extensively covers market segmentation by product (software and services) and end-user (hospitals, physicians, and medical labs). 

The software segment will be significant during the forecast period. The growth of the segment can be attributed to factors such as the various software solutions that are specifically designed to streamline and automate the entire revenue cycle management (RCM) process. Furthermore, there are several vendors operating in the market that offer RCM as software solutions. For instance, Epic Systems Corporation offers an integrated suite of healthcare software solutions, including Epic Resolute, which is the company’s revenue cycle management software and they provide comprehensive RCM functionalities. Hence, owing to such factors, the software segment of the RCM market is estimated to grow during the forecast period.

This report presents a detailed picture of the market by way of study, synthesis, and summation of data from multiple sources through an analysis of key parameters

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Companies Mentioned

Acclara Solutions LLCathenahealth Inc.CareCloud Inc.Change Healthcare Inc.Cognizant Technology Solutions Corp.Computer Programs and Systems Inc.eClinicalWorks LLCEpic Systems Corp.Experian PlcInternational Business Machines Corp.Koch Industries Inc.McKesson Corp.Medical Information Technology Inc.Oncospark Inc.Oracle Corp.OSPPlanet DDSR1 RCM Inc.Sage Group PlcThe SSI Group LLCVeradigm LLC

Vendor Oferings

Acclara Solutions LLC – The company offers revenue cycle management solutions such as Patient Access, Revenue Integrity and Coding, Business Office, and Community Provider Solution.athenahealth Inc. – The company offers revenue cycle management solutions such as athenaIDX for large practices, health systems, billing services, and hospitals.Change Healthcare Inc. – The company offers revenue cycle management solutions and services for healthcare providers including hospitals, health systems, physicians, and non-hospital emergency medical service providers to support cash flow, increase speed to payment, and contain costs at a faster rate.

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Analyst Review

The US Revenue Cycle Management (RCM) market stands at the intersection of healthcare organizations’ financial health and patient care quality. It encompasses a suite of processes vital to the financial viability of healthcare providers, starting from patient registration and extending through claims processing and payment collection. In an era of burgeoning healthcare costs and evolving reimbursement models like value-based care, efficient RCM practices are paramount for sustainability.

In this landscape, artificial intelligence (AI) and machine learning (ML) are emerging as game-changers. Companies like FutureWise Research delve into the AI in Healthcare market, offering innovative solutions for workflow optimization and data security. However, as the digitalization of healthcare accelerates, concerns over data security and confidentiality loom large, especially with the proliferation of EHRs and health information exchanges.

These challenges are exacerbated by the threat of ransomware attacks, underscoring the need for robust data security measures. Amidst this backdrop, R1 RCM Inc. and other players offer RCM software solutions that integrate medical billing and coding with advanced AI algorithms to streamline processes and mitigate risks.

The market’s services segment is witnessing a surge, with providers increasingly outsourcing RCM solutions to specialized firms. These firms leverage machine learning algorithms for claims processing and insurance verification, enhancing efficiency and accuracy while reducing administrative burden.

However, the industry grapples with data siloes and fragmented systems, hindering seamless process digitalization. Companies are thus investing in patient management solutions that break down these barriers, enabling comprehensive patient registration and care coordination.

The transition to ICD-10 further underscores the need for agile RCM solutions capable of adapting to evolving coding standards. Future growth prospects lie in emerging markets, where demand for RCM services is burgeoning, fueled by increasing healthcare expenditure and regulatory reforms.

In essence, the US RCM market is undergoing a transformative shift driven by technological innovation and evolving healthcare dynamics. Companies that navigate this landscape adeptly, harnessing the power of AI and data analytics while prioritizing data security and compliance, are poised to thrive in this dynamic ecosystem. 

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Key Topics Covered:

1 Executive Summary
2 Landscape
3 Sizing
4 Historic Size
5 Five Forces Analysis
6 Segmentations
7 Customer Landscape
8 Geographic Landscape
9 Drivers, Challenges, and Trends
10 Vendor Landscape
11 Vendor Analysis
12 Appendix

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