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.
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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.
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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.
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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.
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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.
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