US - Revenue Cycle Management (RCM) Market by Product and End-user - Forecast and Analysis 2023-2027

US - Revenue Cycle Management (RCM) Market Report 2023-2027:

The US revenue cycle management (RCM) market size is forecast to increase by USD 11,985.2 million and is estimated to grow at a CAGR of 9.94% between 2022 and 2027. The growth of the market depends on several factors, including the growing need to reduce revenue leakages in healthcare systems, the rise in the adoption of electronic health records (EHR) in the US, and the increase in healthcare-related spending in the US. RCM is a financial procedure that healthcare facilities use to track patient care activities, right from registration and appointment scheduling to the final payment of the bill, making use of medical billing software. RCM links administrative data, including the patient name, insurance company, and other personal information, with the treatment a patient receives and his or her healthcare data, thereby integrating the business and clinical sides of healthcare. Furthermore, this market analysis and report includes historic market data from 2017 to 2021.

What will be the Size of the US Revenue Cycle Management (RCM) Market During the Forecast Period?

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Market Overview

Market Driver

The growing need to reduce revenue leakages in healthcare systems is the key driver of this market growth analysis. Healthcare service vendors focus on reducing the growing revenue leakages to remain competitive in the market in focus. Revenue leakage refers to the loss of healthcare service providers owing to inefficiencies in internal processes and payment systems. This issue can be attributed to process leaks. Owing to the additional time and resources needed in manual systems it costs more than using electronic systems. For example, charge capture is a process where healthcare service providers keep track of the services provided

Moreover, in the payer leak process healthcare service providers face revenue leakage through underpayments, insurance denials, and less-than-great contract negotiations. For instance, estimated that an average 400-bed hospital faces a revenue leakage of approximately USD 30 million as a result of not following best practices in four key areas, namely denial write-offs, bad debt, the cost to collect, and contract yield. Similarly, 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, which results in patient-level revenue leakage. Hence, the growing need to reduce revenue leakage in the healthcare system is the major driver that drives the growth of the market in focus during the forecast period.

Market Trends

The growing adoption of a value-based reimbursement model is the key trend in the market. Healthcare service providers are transferring from fee-for-service to value-based care reimbursements. Value-based RCM is a reimbursement payment methodology that focuses more on quality healthcare at a reasonable cost. This model approach makes sure that physicians are rewarded for the quality of treatment. Owing to advantages such as providing better care to individuals, reducing healthcare costs, enhanced customer satisfaction, and customer retention healthcare service providers are adopting this model.

Moreover, the involvement of healthcare service providers across the world in these models is rising due to the adoption of programs and legislation by various governments. The agency also announced that half of these payments would be based on the value-based model during the forecast period. In addition, the New York state government announced the State Innovation Models (SIM) program as an initiative designed to support the state healthcare systems. Such initiatives will have a positive impact on the adoption of value-based RCM, which will boost the growth of the market in the US during the forecast period.

Market Restrain

Interoperability issues associated with RCM solutions is the major challenge for the growth of the market. Interoperability issues associated with the software are impacting the growth of the market in the US.  Although, the rising issues with regard to interoperability in the software have increased the number of denials, leading to reduced revenue generation. In addition, healthcare service providers use multiple IT systems, leading to their reduced compatibility.

Furthermore, large-scale healthcare service providers use healthcare RCM software from many vendors which creates the issue of compatibility. Also, the rising number of acquisitions in the market increases the number of interoperable solutions. Due to the various issues related to interoperability, the use of multiple healthcare RCM software is one of the major challenges faced by the vendors. Hence, interoperability issues can become a major challenge for the growth of the the market in the US during the forecast period.

Market Segmentation By Product

The market share growth by the software segment will be significant during the forecast period. The software segment of the this market in the US is growing due to the various software solutions that are specifically designed to streamline and automate the entire revenue cycle management process. To enhance efficiency, accuracy, and financial performance for healthcare organizations they provide advanced functionalities. One key software solution in this segment is the Electronic Health Record (EHR). EHR often includes RCM functionalities, such as coding, claims management, and billing.

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The software segment showed a gradual increase in the market share of USD 7,930.20 million in 2017 and continued to grow by 2021. There are several vendors operating in the market that offer RCM as software solutions. For example, 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 functionalities. Features like patient registration, charge capture, claims management, payment posting, and reporting are provided by them. Hence, the growing need for this software owing to its several benefits will raise its adoption, which will boost the growth of the software segment in the market in the US during the forecast period.

Market Segmentation By End-User

Based on the end-user, the market has been segmented into hospitals, physicians, and medical labs. The hospitals' segment will account for the largest share of this segment.?The rising adoption of electronic health records (EHRs) in hospitals is one of the prominent reasons for the adoption of healthcare RCM software in hospitals. EHRs manage patient records electronically. Therefore, the combination of both EHR and healthcare RCM software will aid healthcare service providers in managing the entire business process electronically. An EHR is like a digital transcript of the patient's health records. These can be operated by payers as well as healthcare service providers. With the network of hospitals growing worldwide, the demand for EHRs has increased, both in developed and developing regions. 

Furthermore, EHR systems have multiple advantages, such as providing accurate, up-to-date, and complete information about patients; providing new hospitals with quick access to patient records; and enhancing the privacy and security of patient information. The demand for healthcare RCM software has grown significantly in hospitals across the US. The vendors entered into long-term partnerships with hospitals to enhance the patient experience, streamline operations, and maintain positive cash flows during the COVID-19 crisis period. These developments will further accelerate the growth of the hospital's segment of the RCM during the forecast period.

Market Customer Landscape

This market industry report includes the adoption lifecycle of the market, covering from the innovator’s stage to the laggard’s stage. It focuses on adoption rates in different regions based on penetration. Furthermore, the report also includes key purchase criteria and drivers of price sensitivity to help companies evaluate and develop their market growth and forecasting strategies.

US Revenue Cycle Management (RCM) Market Customer Landscape

Who are the Major Market Companies in US?

Companies are implementing various strategies, such as strategic alliances, partnerships, mergers and acquisitions, geographical expansion, and product/service launches, to enhance their presence in the market.

• 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.
  

The research report also includes detailed analyses of the competitive landscape of the market and information about 15 market vendors, including:

• CareCloud Inc.
• Cognizant Technology Solutions Corp.
• Computer Programs and Systems Inc.
• eClinicalWorks LLC
• Epic Systems Corp.
• Experian Plc
• International Business Machines Corp.
• Koch Industries Inc.
• McKesson Corp.
• Medical Information Technology Inc.
• Oncospark Inc.
• Oracle Corp.
• OSP
• Planet DDS
• R1 RCM Inc.
• Sage Group Plc
• The SSI Group LLC
• Veradigm LLC

Qualitative and quantitative analysis of vendors has been conducted to help clients understand the wider business environment as well as the strengths and weaknesses of key market players. Data is qualitatively analyzed to categorize vendors as pure play, category-focused, industry-focused, and diversified; it is quantitatively analyzed to categorize vendors as dominant, leading, strong, tentative, and weak.

Market Analyst Overview

The US Revenue Cycle Management (RCM) Market is experiencing rapid growth fueled by the digitalization of healthcare and the increasing adoption of revenue cycle management solutions. Healthcare organizations are grappling with challenges such as data siloes and unorganized workflows, prompting the need for efficient RCM solutions. With third-party payers and evolving payment models, adherence to guidelines and regulatory reforms is crucial. Technological advancements enable the integration of synchronized management software systems across hospital-owned medical groups and independent practices. Stakeholders are emphasizing the importance of a standardized RCM strategy to streamline operations. The transition to ICD-10 for classifying and reporting data on disease diagnosis and treatment procedures underscores the significance of a robust RCM framework in ensuring financial viability and compliance within the US healthcare landscape.

Segment Overview

This market report forecasts market growth by revenue at global, regional & country levels and provides an analysis of the latest trends and growth opportunities from 2017 to 2027. 

• Product Outlook (USD Million, 2017 - 2027)
  • Software
  • Services

• End-User Outlook (USD Million, 2017 - 2027)
  • Hospitals
  • Physicians
  • Medical labs

 

US Revenue Cycle Management (RCM) Market Scope
Report Coverage	Details
Page number	127
Base year	2022
Historic period	2017-2021
Forecast period	2023-2027
Growth momentum & CAGR	Accelerate at a CAGR of 9.94%
Market growth 2023-2027	USD 11,985.2 million
Market structure	Fragmented
YoY growth 2022-2023(%)	9.45
Competitive landscape	Leading Vendors, Market Positioning of Vendors, Competitive Strategies, and Industry Risks
Key companies profiled	Acclara Solutions LLC, athenahealth Inc., CareCloud Inc., Change Healthcare Inc., Cognizant Technology Solutions Corp., Computer Programs and Systems Inc., eClinicalWorks LLC, Epic Systems Corp., Experian Plc, International Business Machines Corp., Koch Industries Inc., McKesson Corp., Medical Information Technology Inc., Oncospark Inc., Oracle Corp., OSP, Planet DDS, R1 RCM Inc., Sage Group Plc, The SSI Group LLC, and Veradigm LLC
Market dynamics	Parent market analysis, Market growth and trends inducers and obstacles, Fast-growing and slow-growing segment analysis, COVID-19 impact and recovery analysis and future consumer dynamics, Market condition analysis for forecast period.
Customization purview	If our report has not included the data that you are looking for, you can reach out to our analysts and get segments customized.

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What are the Key Data Covered in this Market Research Report?

• CAGR of the market during the forecast period
• Detailed information on factors that will drive the market forecasting of the market between 2023 and 2027
• Precise estimation of the market size and its contribution to the market in focus on the parent market
• Accurate predictions about upcoming trends and changes in consumer behavior
• Growth of the market across the US.
• Thorough analysis of the market’s competitive landscape and detailed information about vendors
• Comprehensive analysis of factors that will challenge the growth of market vendors

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