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収益サイクル管理 (RCM) の米国市場:市場分析・予測

Assessment of the US Revenue Cycle Management Market, Forecast to 2022

発行 Frost & Sullivan 商品コード 590283
出版日 ページ情報 英文 123 Pages
納期: 即日から翌営業日
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収益サイクル管理 (RCM) の米国市場:市場分析・予測 Assessment of the US Revenue Cycle Management Market, Forecast to 2022
出版日: 2017年10月31日 ページ情報: 英文 123 Pages
概要

当レポートでは、米国の病院・診療所向け収益サイクル管理 (RCM) ソリューションの市場を調査し、市場の定義と概要、市場の背景、主要動向と導入の推進因子・抑制因子の分析、エンドユーザー・提供内容別の収益予測、競合環境、主要ベンダーのプロファイル、成長機会の分析、将来の展望などをまとめています。

第1章 エグゼクティブサマリー

第2章 市場概要

  • 市場の定義
  • 市場背景

第3章 イントロダクション

  • 米国のRCM市場のエコシステム:主な製品の導入先
  • エンドユーザー・製品の分類
  • 産業推進因子
  • エンドユーザー固有の推進因子
  • 医師のワークフロー
  • RCMのトレンドの重要性
  • 医療請求・コード化に関連する人材の課題
  • 主要事業課題
  • RCMプラットフォームの交換・付加価値追加の推進因子
  • デジタル化の状況とプロバイダーのRCM費用への影響

第4章 病院向けRCM市場の分析

  • 重要RCMコンポーネントの導入
  • 次世代RCMコンポーネントの導入
  • 買替え率 vs 純粋なアップグレード

第5章 診療所向けRCM市場の分析

  • 主なペインポイント
  • 診療所管理ソリューションのメリット
  • 診療管理システムから最適な結果を得るための考察
  • 診療管理システムの進化
  • 買替え率 vs 初回購入 (アドオンを含む)
  • 病院のKPI

第6章 バリューベースのRCMエコシステム

第7章 アウトソースRCMサービス

  • イントロダクション・市場影響因子
  • 市場の展望:多様なビジネスモデル
  • 主な考察
  • ベストプラクティスの分析

第8章 市場予測・市場動向:総市場

  • マーケットエンジニアリング測定
  • 予測手法・前提因子
  • 収益予測
  • 収益シェア予測:エンドユーザー別
  • 収益予測:エンドユーザー別
  • 収益予測に関するディスカッション

第9章 市場予測・市場動向:病院向けRCM市場

  • マーケットエンジニアリング測定
  • 収益予測
  • 収益予測に関するディスカッション
  • 収益予測:提供内容別

第10章 市場予測・市場動向:診療所向けRCM市場

  • マーケットエンジニアリング測定
  • 収益予測
  • 収益予測に関するディスカッション
  • 収益予測:提供内容別
  • 収益予測に関するディスカッション:ソフトウェア
  • 収益予測に関するディスカッション:サービス

第11章 普及分析

  • 病院
  • 診療所

第12章 ベンダー環境の分析

  • 競合への影響因子
  • ベンダーの市場シェア
  • ベンダー動向
  • バリューベースRCMソリューションによるリスク縮小戦略
  • 米国における市場のギャップ

第13章 競合構造

  • 競合環境
  • ヘルスケアRCMのM&A
  • 主なM&A

第14章 ベンダーの分類・プロファイル

  • ソフトウェアアプリケーションプロバイダー
  • サービスプロバイダー

第15章 成長機会の分析

  • 主な成長機会
  • 成功・成長のための戦略的必須要件

第16章 将来の展望

  • 総論:三大予測
  • 総論:ディスカッション
  • 免責事項

第17章 付録

目次
Product Code: K1C3-48

How Value-Based Care is Transforming the Ecosystem

Revenue cycle management (RCM) refers to myriad administrative and clinical functions around the capture, management, and collection of patient service revenue. The RCM process starts with admission (patient access) and continues through to accounts receivable (payment and collections). A variety of RCM solutions (e.g., IT applications and services) are deployed to help healthcare providers perform different functions.

The objective of this research service is to present a comprehensive analysis of the US RCM market with respect to trends, revenue growth potential, and the dynamics at play for RCM information technology (IT) and services deployed by hospitals and physician practices through 2022.

Additionally, the report will

  • analyze market forces impacting adoption of RCM IT and service solutions among hospitals and physician practices
  • evaluate existing and emerging regulatory objectives centered on providers' financial risk management initiatives
  • highlight best practices in the areas of design and deployment of an integrated financial workflow that supports value-based care
  • assess the outlook of outsourced or shared service-based RCM operating models
  • identify 5 major growth opportunity areas related to RCM
  • estimate the revenue potential of the total US RCM market (software applications and services), and include breakdowns by hospitals and physician practices, from 2016 to 2022
  • shortlist vendors that propose best-in-class solutions for hospitals and tphysician practices

This study is segmented into major functional segments of RCM,

  • Patient access
  • Registration and charge capture
  • Billing and collection

In terms of end-user adoption, this study classifies the buyer market in two broad provider categories:

  • Hospitals
  • Physician practices

The market projection ($ value) is stratified based on the following overarching RCM product segments:

  • IT (software applications)
  • Services

Market Background

The shift in population demographics coupled with the rise of risk or value-based reimbursement models is driving the need for better prediction and management of revenue cycles, especially for high and at-risk patient populations. The prevalence of legacy RCM IT systems, which do not optimally support the goal of building a broader but coordinated and enterprise-wide financial ecosystem, is restricting providers from achieving the desired results around healthcare cost and collection. Most US-based providers still grapple with low operating margins, resulting from poor accounts receivable (A/R) performance and high average denial volumes. Many health systems attribute this inefficiency to their suboptimal knowledge and implementation of value-based RCM pathways that require significant investments in RCM IT. The need for efficient claims processing, which in turn results in optimized collection of risk-based revenue, supports adoption of value-based financial management solutions. Most providers that embrace alternative payment models acknowledge the need to deploy progressive scheduling, billing, and analytics technology modules capable of digitizing the entire RCM ecosystem. This view results from the growing adoption of payer contracts with specific provisions for efficient claims management, in addition to the need for integrating new capabilities that will meet the increasing financial responsibility of patients with coinsurance and large deductibles. Overall, the top unmet market needs driving adoption of next-generation RCM solutions among health systems in US are:

  • Comprehensive regulatory compliance and financial risk mitigation
  • The ability to collaborate with payers to customize revenue cycle workflows
  • Elimination of preventable operational expenses, attributed to claims processing
  • Automated identification of hidden patterns and root causes of claim denial
  • Optimized collection of payments, rebates, and incentives for patient services
  • Real-time reporting of financial and operational performance at an enterprise level

As a result, new growth opportunities involving external RCM solutions have gained precedence among many hospitals and physician practices. Most of them are willing to invest in advanced RCM capabilities that can streamline financial performance cost effectively by paving the way for seamless payer-provider communications pertaining to financial risk management.

These end users are likely to prioritize procurement of RCM solutions from external IT vendors based on implementation evidence and cost/benefit benchmarks. Hence, going forward, they are expected to rely on RCM vendors with proven expertise in optimizing financial performance through comprehensive patient access, error-free claims preparation, automated billing workflows, and robust RCM analytics. Vendors with solutions that can complement providers' incumbent value-based payment arrangements and RCM IT ecosystems are expected to thrive in this market.

Table of Contents

1. EXECUTIVE SUMMARY

  • Key Findings-Study Highlights
  • Key Findings-Study Highlights (continued)
  • Scope and Segmentation
  • Market Engineering Measurements
  • Market Engineering Measurements (continued)
  • CEO's Perspective
  • Key Companies to Watch
  • Executive Summary-3 Big Predictions

2. MARKET OVERVIEW

  • Market Definition
  • Market Background
  • Market Background (continued)
  • Introduction to MACRA-Significant Changes to Provider Reimbursement Processes
  • Comparison of the 3 Payment Pathways Under MACRA
  • MACRA's Final Rule-Implementation Timeline and Payment Adjustment Metrics
  • MACRA Final Rule for Reporting Year 2018-5 Key Takeaways
  • MACRA Final Rule for Reporting Year 2018-5 Key Takeaways (continued)

3. INTRODUCTION TO RCM

  • US RCM Ecosystem-Key Product Applications
  • End-User and Product Segmentation of RCM
  • End-User and Product Segmentation of RCM (continued)
  • End-User and Product Segmentation of RCM (continued)
  • Key Market Elements Driving the US RCM Industry
  • End User-Specific Market Drivers
  • Physician Workflow
  • Why is it Important to Understand Trends in RCM?
  • Staffing Challenges Related to Medical Billing and Coding
  • Key Business Challenges
  • Drivers of Replacing RCM Platforms or Adding Value-added Capabilities
  • State of Digitization and Its Impact on Providers' RCM Expense

4. HOSPITAL RCM MARKET ANALYSIS

  • Adoption of Essential RCM Components
  • Adoption of Next-Gen RCM Components
  • Replacement Rate vs. Pure Upgrade

5. PHYSICIAN PRACTICE RCM MARKET ANALYSIS

  • Key Pain Points
  • Benefits of Physician Practice Management Solution
  • Considerations to Ensure Optimal Results from Practice Management Systems
  • Evolution of Practice Management Systems
  • Replacement Rate vs. First-Time Purchase Including Add-ons
  • KPIs for Hospitals

6. VALUE-BASED RCM ECOSYSTEM

  • Value-Based RCM-How the Ecosystem Should be Conceptualized
  • Value-Based RCM-How the Ecosystem Should be Conceptualized (continued)

7. OUTSOURCED RCM SERVICES

  • Introduction to Outsourced RCM Services-Assessment of Market Forces
  • Outlook for Outsourced RCM Services-A Wide Array of Business Models are at Play
  • Key Considerations for RCM Outsourcing
  • Assessment of Best Practices-Outsourced RCM Services

8. FORECASTS AND TRENDS-TOTAL RCM MARKET

  • Market Engineering Measurements
  • Forecast Methodology and Assumptions
  • Revenue Forecast
  • Percent Revenue Forecast by End-User Segment
  • Revenue Forecast by End-User Segment
  • Revenue Forecast Discussion
  • Revenue Forecast Discussion (continued)

9. FORECASTS AND TRENDS-HOSPITAL RCM MARKET

  • Market Engineering Measurements
  • Market Engineering Measurements (continued)
  • Revenue Forecast
  • Revenue Forecast Discussion
  • Revenue Forecast by Offering
  • Revenue Forecast by Offering (continued)
  • Revenue Forecast by Offering Discussion

10. FORECASTS AND TRENDS-PHYSICIAN PRACTICE RCM MARKET

  • Market Engineering Measurements
  • Market Engineering Measurements (continued)
  • Revenue Forecast
  • Revenue Forecast Discussion
  • Revenue Forecast by Offering
  • Revenue Forecast by Offering (continued)
  • Revenue Forecast Discussion-Software Applications
  • Revenue Forecast Discussion-Services

11. PENETRATION ANALYSIS-TOTAL RCM MARKET

  • Penetration Analysis-Hospitals
  • Penetration Analysis-Physician Practices

12. VENDOR LANDSCAPE ASSESSMENT-TOTAL RCM MARKET

  • Competitive Market Forces
  • Vendor Market Share-Total RCM Market
  • Vendor Trends
  • How Vendors Mitigate Financial Risk via Value-based RCM Solutions
  • Market Gaps in the United States

13. COMPETITIVE MARKET STRUCTURE

  • Competitive Environment
  • Competitive Environment (continued)
  • Competitive Environment (continued)
  • Competitive Environment (continued)
  • Competitive Environment (continued)
  • Healthcare RCM M&A-How 2016 Fared Against 2015
  • Notable M&As
  • Notable M&As (continued)

14. VENDOR SEGMENTATION AND PROFILES

  • Vendor Segmentation-Software Application Providers
  • Vendor Segmentation-Software Application Providers (continued)
  • Vendor Segmentation-Software Application Providers (continued)
  • Vendor Segmentation-Software Application Providers (continued)
  • Vendor Segmentation-Service Providers
  • Vendor Segmentation-Service Providers (continued)
  • Vendor Segmentation-Service Providers (continued)
  • Vendor Segmentation-Service Providers (continued)

15. GROWTH OPPORTUNITY ASSESSMENT

  • 5 Major Growth Opportunities
  • Strategic Imperatives for Success and Growth

16. FUTURE PERSPECTIVES

  • The Last Word-3 Big Predictions
  • The Last Word-Discussion
  • Legal Disclaimer

17. APPENDIX

  • Market Engineering Methodology
  • Exhibits
  • Exhibits (continued)
  • Exhibits (continued)
  • Exhibits (continued)
  • Sources
  • Vendor Segmentation Capability Definitions
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