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for Healthcare & Insurance BPS

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Targeting U.S. Healthcare Provider BPS

Market Analysis

by NelsonHall Analyst

published on Dec 02, 2016

Access to this report is restricted to logged in clients with access. Login to get full access

Report Overview:

NelsonHall's market analysis of U.S. Healthcare Provider BPS consists of 43 pages.

Who is this Report for:

NelsonHall’s “Targeting healthcare provider BPS” report is a comprehensive market assessment report designed for:

•  Sourcing managers investigating sourcing developments within the healthcare provider services market

•   Vendor marketing, sales and business managers developing strategies to target service opportunities within the healthcare provider services market.

Scope of this Report:

The report analyzes the global market for outsourced healthcare provider services and addresses the following questions:

  • What is the current and future market for outsourced healthcare provider services?
  • What is the size and growth of the U.S. revenue cycle management BPS market?
  • Within outsourced healthcare provider services, which service segments are emerging strongly?
  • What are the market segments for outsourced healthcare provider services, and their characteristics? What are the issues, drivers and benefits for each segment? What are vendor capabilities by segment?
  • What are vendor challenges and critical success factors by market segment?
  • How are vendor offerings and delivery capabilities changing to meet emerging market needs?
  • How are vendors positioned within each outsourced healthcare provider services market segment?

Key Findings & Highlights:

The report focuses on revenue cycle management services, along with analytics and RPA implementation.

The market for outsourced revenue cycle management services is changing, driven by a number of trends. These include:

  • Healthcare providers are facing increased costs due to medical coding errors
  • Healthcare providers are facing reduced A/R intake and have to cope with A/R follow-up, a time consuming process
  • Healthcare providers do not have adequately trained personnel who can provide RCM services in a low cost environment
  • Lack of medical coding audit trails and operational process audits leads to time delays and greater costs from human error
  • There is a lack of clarity between payers and providers for certain offerings, as to who is most appropriate to provide services such as telemedicine, remote monitoring, transition of care, and wellness management
  • ACOs which offer new types of bundled services need guidance on engaging with patients on a post-discharge basis, to maximize CMS reimbursements by reducing hospitals readmissions.
  • Patients with one or multiple chronic care conditions including asthma, COPD, diabetes, hypertension, and lipid disorders are projected to increase in the coming decades in the U.S. and other developed economies, as a result of dietary habits and lifestyle choices. Moreover, an increasing proportion of these patients will be elderly, adding risks for further health complications leading to hospitalization. Providers, and consequently vendors, will be required to keep these specific population groups out of hospital, in order to reduce healthcare costs, one of the mandates of the ACA
  • Accelerating healthcare start-ups that operate on (technology leveraging) new care models might disrupt the healthcare market by standardizing procedures on payer/provider clinical data integration, thus making EHR systems less isolated. Genomics is also important for payers and providers as a lot of investments have been observed in this market, in order to understand disease predisposition and risks, while significant investment is made in diabetes population monitoring.
  • This report investigates the impact of these trends in revenue cycle management in the healthcare provider services market, to identify both the precise change in customer requirements and the change in vendor offerings and delivery capabilities that are being put in place to respond to these requirements.

Table of contents:

Table of contents:

  • Introduction
  • Changing Shape of the Healthcare Provider BPS Market
  • Customer Requirements
  • Market Size and Growth
  • Vendor Market Shares
  • Vendor Offerings and Targeting
  • Vendor Delivery in Healthcare Provider BPS
  • Critical Success Factors
  • Appendix I – Vendors Researched

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