Westford, USA, Feb. 16, 2023 (GLOBE NEWSWIRE) -- The primary drivers boosting the development of the US healthcare predictive payer market are digital developments in the healthcare sector and the digitization of records. Such technologies are increasingly being adopted, which is boosting the industry. In order to save costs, generate relevant results, and reduce the likelihood of fraudulent insurance claims, digital data is used. Additionally, the U.S. government has been investing more money in healthcare and emphasizing the improvement of digital infrastructure, which is accelerating the development of related technologies. With the aid of analytical tools, decision-making for payers and healthcare providers has grown simpler as a result of technological improvements.
SkyQuest’s latest insight on the US healthcare expenditure shows that hospital spending increased by 4.4% to $1,323.9 billion in 2021, while Medicaid spending increased by 9.2% to $734.0 billion, or 17% of total NHE. The largest shares of total health expenditure were contributed by the federal government (34 percent) and the households (27 percent). The private business share of health spending accounted for 17 percent of total healthcare expenditure.
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A payer is a person, group, or other entity that contributes money for the medical services provided by a healthcare provider. Private insurance firms that offer consumers health plans that cover the costs of medical care and offer payments for related services are most frequently referred to by this term. The use of predictive analytics by healthcare institutions helps them better identify patients who are most likely to require care and take action before it becomes complex and expensive.
Prominent Players in US Healthcare Predictive Payer Market
- CloudMedx
- DataSmart Solutions
- Amitech Solutions
- Altegra Health
- Caserta Concepts
- Greenway Health, LLC
- IMAT Solutions
- Health Catalyst
- Indegene
- IBM
- Optum
- Oracle
- HMS
- Citius Tech
- MedeAnalytics
- Cerner Corporation
Descriptive Analytics Type Segment to Gain the Largest Market Share Owing to Its Increasing Usage in Process Optimization
In 2021, the descriptive analytics market category held a 37.4% market share in the US healthcare predictive payer market. The majority of administrative tasks and process optimization use this form of analytics. This approach examines both historical and current data to uncover relevant information or a trend that could have a big influence on decisions made in the future. By examining the frequency of positive COVID test results in a given population over a certain period of time, it has specifically been used to assess how contagious the virus is.
SkyQuest found that as of February 2023, there were 101,211,478 confirmed instances of COVID-19 in the United States, with 1,100,421 fatalities. Hence, this increasing prevalence of Covid-19 havoc to drive the segment growth during the upcoming years.
Further, the market in Canada is estimated to gain significant market share during the forecast period. The growth of the market can be ascribed to the increasing adoption of digital solutions like telemedicine, the adoption of EHRs, and the plethora of data generated during the pandemic. Moreover, the rising globalization in the region, increasing investment in the healthcare infrastructure, and the presence of key market players in the area to promote cost-effective treatment are predicted to boost market growth.
Financial Application Segment to Dominate the Market Share Owing to Its Increasing Rate of Adoption in Various Sectors
With a revenue share of 35.7% in 2021, the financial application segment dominated the US healthcare predictive payer market and is predicted to hold a prominent position during the forecast period too. The market's expansion has been primarily attributed to the increased adoption of this sector by both public and private organizations. Numerous financial applications can help insurance businesses save millions in bogus claims, claim settlement, and risk analysis. SkyQuest found that healthcare fraud costs the United States close to $80 billion annually and healthcare analytics can be used to optimize insurance policies, recoup losses, and reduce the occurrence of fraud.
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In addition to this, in 2021, the services sector held a 41.8% market share in the US healthcare predictive payer market and is predicted to grow at the fastest rate over the projected time frame. The recent market trend of outsourcing data allows businesses to avoid the expense of educating and training their employees while simultaneously providing them with access to professional industry analysis. All these factors are estimated to support the segment growth during the forecast period.
The US healthcare predictive payer market is a vibrant, quickly changing environment that is characterized by fierce rivalry between numerous providers. The intense competition, market dynamics, and major growth drivers are all examined in the report using sophisticated market research tools. This study provides an excellent resource for established firms and new entrants looking to enter the market with its in-depth market analysis.
Key Developments in the US Healthcare Predictive Payer Market
- HCC Complete, a risk adjustment solution that has been added to the HCC portfolio, was introduced in May 2021 by Apixio, a US-based Al healthcare analytics company. By utilizing the company's market-beating Al engine, HCC Complete supports a full document reviewing experience with Medicare Advantage (MA) and Affordable Care Act (ACA) enterprises. Coders can access these specified characteristics using a user-friendly, secure internet application.
- In light of the expiration of consumer protections that prevented millions from losing benefits during the COVID-19 pandemic, Molina Healthcare executives said that new contracts will reduce the losses of Medicaid members. In addition to acquiring MyChoice Wisconsin, an existing Medicaid plan, Molina also won the contract bid to provide Medicaid services in Iowa last year.
- The biggest Medicaid managed care provider in the country, Centene has agreed to settle claims that it overpriced the state of California's Medicaid program for prescription drugs by paying a $215 million settlement. Between 2017 and 2018, Centene's two California health plans reportedly overstated their reported expenses for prescription drugs and did not pass on benefits to the state's Medicaid program.
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Key Questions Answered in the US Healthcare Predictive Payer Market Research Report
- How big is the US healthcare predictive payer market?
- What is the growth and revenue of the market during the forecast period?
- Which segment accounted for the largest market share?
- What are the major factors driving the growth of the US healthcare predictive payer market?
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