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市場調査レポート

医療部門向け不正アナリティクスの世界市場 ~2025年:記述的アナリティクス・予測的アナリティクス・処方的アナリティクス

Healthcare Fraud Analytics Market by Solution Type (Descriptive, Predictive, Prescriptive), Application (Insurance Claim (Postpayment, Prepayment), Payment Integrity), Delivery (On-premise, Cloud), End User - Global Forecast to 2025

発行 MarketsandMarkets 商品コード 923889
出版日 ページ情報 英文 145 Pages
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価格
本日の銀行送金レート: 1USD=108.54円で換算しております。
医療部門向け不正アナリティクスの世界市場 ~2025年:記述的アナリティクス・予測的アナリティクス・処方的アナリティクス Healthcare Fraud Analytics Market by Solution Type (Descriptive, Predictive, Prescriptive), Application (Insurance Claim (Postpayment, Prepayment), Payment Integrity), Delivery (On-premise, Cloud), End User - Global Forecast to 2025
出版日: 2020年01月29日 ページ情報: 英文 145 Pages
概要

医療部門向け不正アナリティクスの市場は予測期間中29.8%のCAGRで推移し、2020年の12億米ドルから、2025年には46億米ドルの規模に成長すると予測されています。ソーシャルネットワークアナリティクスの出現、AIやブロックチェーンなどの技術の採用、アジア太平洋地域などの新興諸国における利用拡大などの要因が成長の機会を提供しています。しかし一方で、これらのソリューションの展開にかかる時間の長さや頻繁な更新の必要性などがさらなる成長の課題となっています。デリバリーモデル別では、予測期間中、オンデマンド部門がオンプレミス部門を超える成長を記録すると予測されています。オンデマンドのセルフサービスアナリティクス、ハードウェアへの先行投資の不要性、容量の柔軟性、従量課金制などの要因が、オンデマンドの不正検出ソリューションの需要を促進しています。 また用途別では、保険金支払い前に不正を回避し、迅速な措置を講じることができるという利点から、保険金支払い前のレビューモデルが今後数年間で大きな注目を集めることが期待されています。 さらに地域別では、アジア太平洋地域が予測期間中最大の成長を記録すると予想されています。健康保険・医療保険に対する需要の拡大や、不正取り締りに向けた政府・ハイテク大手との提携・協力の増加などの要因が同市場の成長を推進する見通しです。

当レポートでは、医療部門向け不正アナリティクスの市場を調査し、市場の定義と概要、市場成長への各種影響因子および市場機会の分析、ソリューションタイプ・デリバリーモデル・用途・エンドユーザー・地域/主要国別の動向と市場規模の推移と予測、競合環境、主要企業のプロファイルなどをまとめています。

923889_4.4 HEALTHCARE FRAUD ANALYTICS MARKET_ REGIONAL MIX_FIGURE 12

第1章 イントロダクション

第2章 調査手法

第3章 エグゼクティブサマリー

第4章 重要考察

第5章 市場概要

  • イントロダクション
  • 市場力学
  • 促進要因
  • 抑制要因
  • 機会
  • 課題

第6章 産業分析

  • 産業動向

第7章 医療部門向け不正アナリティクス市場:ソリューションタイプ別

  • イントロダクション
  • 記述的アナリティクス
  • 予測的アナリティクス
  • 処方的アナリティクス

第8章 医療部門向け不正アナリティクス市場:デリバリーモデル別

  • イントロダクション
  • オンプレミス
  • オンデマンド

第9章 医療部門向け不正アナリティクス市場:用途別

  • イントロダクション
  • 保険請求レビュー
    • 支払い後
    • 支払い前
  • 薬局による請求の誤用
  • ペイメントインテグリティ
  • その他

第10章 医療部門向け不正アナリティクス市場:エンドユーザー別

  • イントロダクション
  • 公共機関・政府機関
  • 民間保険会社
  • サードパーティサービスプロバイダー
  • 雇用者

第11章 医療部門向け不正アナリティクス市場:地域・主要国別

  • イントロダクション
  • 北米
  • 欧州
  • アジア太平洋
  • 中南米
  • 中東・アフリカ

第12章 競合環境

  • イントロダクション
  • 競合状況・動向
  • 競合リーダーシップマッピング

第13章 企業プロファイル

  • IBM
  • OPTUM
  • COTIVITI HOLDINGS, INC.
  • FAIR ISAAC CORPORATION
  • SAS INSTITUTE
  • CHANGE HEALTHCARE
  • EXL SERVICE HOLDINGS, INC.
  • WIPRO
  • CONDUENT, INC.
  • HCL TECHNOLOGIES
  • CGI GROUP
  • DXC TECHNOLOGY COMPANY
  • NORTHROP GRUMMAN CORPORATION
  • LEXISNEXIS (A PART OF RELX GROUP)
  • PONDERA SOLUTIONS
  • その他

第14章 付録

図表

LIST OF TABLES

  • TABLE 1 LIST OF STAKEHOLDERS INTERVIEWED FOR THE STUDY
  • TABLE 2 COMPANIES OFFERING INNOVATIVE FRAUD ANALYTICS SOLUTIONS
  • TABLE 3 HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2018-2025 (USD MILLION)
  • TABLE 4 DESCRIPTIVE ANALYTICS SOLUTIONS FOR HEALTHCARE FRAUD DETECTION
  • TABLE 5 DESCRIPTIVE ANALYTICS MARKET, BY REGION, 2018-2025 (USD MILLION)
  • TABLE 6 DESCRIPTIVE ANALYTICS MARKET, BY COUNTRY, 2018-2025 (USD MILLION)
  • TABLE 7 PREDICTIVE ANALYTICS SOLUTIONS FOR HEALTHCARE FRAUD DETECTION
  • TABLE 8 PREDICTIVE ANALYTICS MARKET, BY REGION, 2018-2025 (USD MILLION)
  • TABLE 9 PREDICTIVE ANALYTICS MARKET, BY COUNTRY, 2018-2025 (USD MILLION)
  • TABLE 10 PRESCRIPTIVE ANALYTICS SOLUTIONS FOR HEALTHCARE FRAUD DETECTION
  • TABLE 11 PRESCRIPTIVE ANALYTICS MARKET, BY REGION, 2018-2025 (USD MILLION)
  • TABLE 12 PRESCRIPTIVE ANALYTICS MARKET, BY COUNTRY, 2018-2025 (USD MILLION)
  • TABLE 13 HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2018-2025 (USD MILLION)
  • TABLE 14 KEY VENDORS OFFERING ON-PREMISE SOLUTIONS IN THE MARKET
  • TABLE 15 HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-PREMISE DELIVERY MODELS, BY REGION, 2018-2025 (USD MILLION)
  • TABLE 16 HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-PREMISE DELIVERY MODELS, BY COUNTRY, 2018-2025 (USD MILLION)
  • TABLE 17 KEY VENDORS PROVIDING ON-DEMAND SOLUTIONS
  • TABLE 18 HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-DEMAND DELIVERY MODELS, BY REGION, 2018-2025 (USD MILLION)
  • TABLE 19 HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-DEMAND DELIVERY MODELS, BY COUNTRY, 2018-2025 (USD MILLION)
  • TABLE 20 HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2018-2025 (USD MILLION)
  • TABLE 21 DEPLOYMENT OF PREPAYMENT VS. POSTPAYMENT ANALYTICS SYSTEMS
  • TABLE 22 HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018-2025 (USD MILLION)
  • TABLE 23 HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY REGION, 2018-2025 (USD MILLION)
  • TABLE 24 HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY COUNTRY, 2018-2025 (USD MILLION)
  • TABLE 25 HEALTHCARE FRAUD ANALYTICS MARKET FOR POSTPAYMENT CLAIMS REVIEW, BY REGION, 2018-2025 (USD MILLION)
  • TABLE 26 HEALTHCARE FRAUD ANALYTICS MARKET FOR POSTPAYMENT CLAIMS REVIEW, BY COUNTRY, 2018-2025 (USD MILLION)
  • TABLE 27 HEALTHCARE FRAUD ANALYTICS MARKET FOR PREPAYMENT CLAIMS REVIEW, BY REGION, 2018-2025 (USD MILLION)
  • TABLE 28 HEALTHCARE FRAUD ANALYTICS MARKET FOR PREPAYMENT CLAIMS REVIEW, BY COUNTRY, 2018-2025 (USD MILLION)
  • TABLE 29 HEALTHCARE FRAUD ANALYTICS MARKET FOR PHARMACY BILLING MISUSE APPLICATIONS, BY REGION, 2018-2025 (USD MILLION)
  • TABLE 30 HEALTHCARE FRAUD ANALYTICS MARKET FOR PHARMACY BILLING MISUSE APPLICATIONS, BY COUNTRY, 2018-2025 (USD MILLION)
  • TABLE 31 HEALTHCARE FRAUD ANALYTICS MARKET FOR PAYMENT INTEGRITY APPLICATIONS, BY REGION, 2018-2025 (USD MILLION)
  • TABLE 32 HEALTHCARE FRAUD ANALYTICS MARKET FOR PAYMENT INTEGRITY APPLICATIONS, BY COUNTRY, 2018-2025 (USD MILLION)
  • TABLE 33 HEALTHCARE FRAUD ANALYTICS MARKET FOR OTHER APPLICATIONS, BY REGION, 2018-2025 (USD MILLION)
  • TABLE 34 HEALTHCARE FRAUD ANALYTICS MARKET FOR OTHER APPLICATIONS, BY COUNTRY, 2018-2025 (USD MILLION)
  • TABLE 35 HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2018-2025 (USD MILLION)
  • TABLE 36 HEALTHCARE FRAUD ANALYTICS MARKET FOR PUBLIC & GOVERNMENT AGENCIES, BY REGION, 2018-2025 (USD MILLION)
  • TABLE 37 HEALTHCARE FRAUD ANALYTICS MARKET FOR PUBLIC & GOVERNMENT AGENCIES, BY COUNTRY, 2018-2025 (USD MILLION)
  • TABLE 38 HEALTHCARE FRAUD ANALYTICS MARKET FOR PRIVATE INSURANCE PAYERS, BY REGION, 2018-2025 (USD MILLION)
  • TABLE 39 HEALTHCARE FRAUD ANALYTICS MARKET FOR PRIVATE INSURANCE PAYERS, BY COUNTRY, 2018-2025 (USD MILLION)
  • TABLE 40 HEALTHCARE FRAUD ANALYTICS MARKET FOR THIRD-PARTY SERVICE PROVIDERS, BY REGION, 2018-2025 (USD MILLION)
  • TABLE 41 HEALTHCARE FRAUD ANALYTICS MARKET FOR THIRD-PARTY SERVICE PROVIDERS, BY COUNTRY, 2018-2025 (USD MILLION)
  • TABLE 42 HEALTHCARE FRAUD ANALYTICS MARKET FOR EMPLOYERS, BY REGION, 2018-2025 (USD MILLION)
  • TABLE 43 HEALTHCARE FRAUD ANALYTICS MARKET FOR EMPLOYERS, BY COUNTRY, 2018-2025 (USD MILLION)
  • TABLE 44 HEALTHCARE FRAUD ANALYTICS MARKET, BY REGION, 2018-2025 (USD MILLION)
  • TABLE 45 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY COUNTRY, 2018-2025 (USD MILLION)
  • TABLE 46 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2018-2025 (USD MILLION)
  • TABLE 47 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2018-2025 (USD MILLION)
  • TABLE 48 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2018-2025 (USD MILLION)
  • TABLE 49 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018-2025 (USD MILLION)
  • TABLE 50 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2018-2025 (USD MILLION)
  • TABLE 51 US: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2018-2025 (USD MILLION)
  • TABLE 52 US: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2018-2025 (USD MILLION)
  • TABLE 53 US: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2018-2025 (USD MILLION)
  • TABLE 54 US: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018-2025 (USD MILLION)
  • TABLE 55 US: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2018-2025 (USD MILLION)
  • TABLE 56 CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2018-2025 (USD MILLION)
  • TABLE 57 CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2018-2025 (USD MILLION)
  • TABLE 58 CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2018-2025 (USD MILLION)
  • TABLE 59 CANADA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018-2025 (USD MILLION)
  • TABLE 60 CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2018-2025 (USD MILLION)
  • TABLE 61 LIST OF SOME OF THE EHFCN MEMBER ORGANIZATION ACROSS EUROPE
  • TABLE 62 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY COUNTRY, 2018-2025 (USD MILLION)
  • TABLE 63 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2018-2025 (USD MILLION)
  • TABLE 64 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2018-2025 (USD MILLION)
  • TABLE 65 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2018-2025 (USD MILLION)
  • TABLE 66 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018-2025 (USD MILLION)
  • TABLE 67 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2018-2025 (USD MILLION)
  • TABLE 68 GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2018-2025 (USD MILLION)
  • TABLE 69 GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2018-2025 (USD MILLION)
  • TABLE 70 GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2018-2025 (USD MILLION)
  • TABLE 71 GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018-2025 (USD MILLION)
  • TABLE 72 GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2018-2025 (USD MILLION)
  • TABLE 73 UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2018-2025 (USD MILLION)
  • TABLE 74 UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2018-2025 (USD MILLION)
  • TABLE 75 UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2018-2025 (USD MILLION)
  • TABLE 76 UK: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018-2025 (USD MILLION)
  • TABLE 77 UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2018-2025 (USD MILLION)
  • TABLE 78 FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2018-2025 (USD MILLION)
  • TABLE 79 FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2018-2025 (USD MILLION)
  • TABLE 80 FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2018-2025 (USD MILLION)
  • TABLE 81 FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018-2025 (USD MILLION)
  • TABLE 82 FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2018-2025 (USD MILLION)
  • TABLE 83 ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2018-2025 (USD MILLION)
  • TABLE 84 ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2018-2025 (USD MILLION)
  • TABLE 85 ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2018-2025 (USD MILLION)
  • TABLE 86 ROE: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018-2025 (USD MILLION)
  • TABLE 87 ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2018-2025 (USD MILLION)
  • TABLE 88 ASIA PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2018-2025 (USD MILLION)
  • TABLE 89 ASIA PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2018-2025 (USD MILLION)
  • TABLE 90 ASIA PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2018-2025 (USD MILLION)
  • TABLE 91 ASIA PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018-2025 (USD MILLION)
  • TABLE 92 ASIA PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2018-2025 (USD MILLION)
  • TABLE 93 LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2018-2025 (USD MILLION)
  • TABLE 94 LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2018-2025 (USD MILLION)
  • TABLE 95 LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2018-2025 (USD MILLION)
  • TABLE 96 LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018-2025 (USD MILLION)
  • TABLE 97 LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2018-2025 (USD MILLION)
  • TABLE 98 MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2018-2025 (USD MILLION)
  • TABLE 99 MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2018-2025 (USD MILLION)
  • TABLE 100 MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2018-2025 (USD MILLION)
  • TABLE 101 MEA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018-2025 (USD MILLION)
  • TABLE 102 MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2018-2025 (USD MILLION)
  • TABLE 103 MERGERS, ACQUISITIONS, AND JOINT VENTURES: JANUARY 2017-DECEMBER 2019
  • TABLE 104 COLLABORATIONS, PARTNERSHIPS, AND AGREEMENTS: JANUARY 2017-DECEMBER 2019
  • TABLE 105 EXPANSIONS: JANUARY 2017-DECEMBER 2019

LIST OF FIGURES

  • FIGURE 1 RESEARCH DESIGN
  • FIGURE 2 BREAKDOWN OF PRIMARY INTERVIEWS: BY COMPANY TYPE, DESIGNATION, AND REGION
  • FIGURE 3 DATA TRIANGULATION METHODOLOGY
  • FIGURE 4 HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2020 VS. 2025 (USD MILLION)
  • FIGURE 5 HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2020 VS. 2025 (USD MILLION)
  • FIGURE 6 HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2020 VS. 2025 (USD MILLION)
  • FIGURE 7 HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2020 VS. 2025 (USD MILLION)
  • FIGURE 8 GEOGRAPHICAL SNAPSHOT OF THE HEALTHCARE FRAUD ANALYTICS MARKET
  • FIGURE 9 LARGE NUMBER OF FRAUDULENT ACTIVITIES IN HEALTHCARE TO DRIVE MARKET GROWTH
  • FIGURE 10 DESCRIPTIVE ANALYTICS SEGMENT ACCOUNTED FOR THE LARGEST SHARE OF THE APAC HEALTHCARE FRAUD ANALYTICS MARKET IN 2019
  • FIGURE 11 APAC MARKET TO REGISTER THE HIGHEST GROWTH DURING THE FORECAST PERIOD
  • FIGURE 12 NORTH AMERICA WILL CONTINUE TO DOMINATE THE MARKET IN 2025
  • FIGURE 13 DEVELOPING REGIONS TO REGISTER HIGHER GROWTH DURING THE FORECAST PERIOD
  • FIGURE 14 HEALTHCARE FRAUD ANALYTICS MARKET: DRIVERS, RESTRAINTS, OPPORTUNITIES, AND CHALLENGES
  • FIGURE 15 US NATIONAL HEALTHCARE FRAUD AND OPIOID TAKEDOWN TRENDS
  • FIGURE 16 INCIDENCE OF FRAUDULENT CLAIMS-GLOBAL SCENARIO (2017)
  • FIGURE 17 MAJOR MERGERS AND ACQUISITIONS IN THE HEALTHCARE FRAUD ANALYTICS MARKET
  • FIGURE 18 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET SNAPSHOT
  • FIGURE 19 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET SNAPSHOT
  • FIGURE 20 ASIA PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET SNAPSHOT
  • FIGURE 21 KEY DEVELOPMENTS IN THE HEALTHCARE FRAUD ANALYTICS MARKET BETWEEN JANUARY 2017 AND DECEMBER 2019
  • FIGURE 22 HEALTHCARE FRAUD ANALYTICS MARKET: COMPETITIVE LEADERSHIP MAPPING, 2019
  • FIGURE 23 COMPANY SNAPSHOT: IBM
  • FIGURE 24 COMPANY SNAPSHOT: FAIR ISAAC CORPORATION
  • FIGURE 25 COMPANY SNAPSHOT: EXL SERVICE HOLDINGS, INC.
  • FIGURE 26 COMPANY SNAPSHOT: WIPRO LIMITED
  • FIGURE 27 COMPANY SNAPSHOT: CONDUENT, INC.
  • FIGURE 28 COMPANY SNAPSHOT: HCL TECHNOLOGIES
  • FIGURE 29 COMPANY SNAPSHOT: CGI GROUP 126  
  • FIGURE 30 COMPANY SNAPSHOT: DXC TECHNOLOGY COMPANY
  • FIGURE 31 COMPANY SNAPSHOT: NORTHROP GRUMMAN CORPORATION
  • FIGURE 32 COMPANY SNAPSHOT: RELX GROUP
目次
Product Code: HIT 5868

The healthcare fraud analytics market is projected to reach USD 4.6 billion by 2025 from USD 1.2 billion in 2020 at a CAGR of 29.8%. The emergence of social network analytics, the adoption of technologies such as AI and blockchain, and the growing use of healthcare analytics for fraud detection in emerging nations like the APAC provide growth opportunities in this market. However, the time-consuming deployment of these solutions and the need for frequent updates are some challenges faced by end users of this market.

The on-demand segment is projected to witness the highest growth during the forecast period

On the basis of delivery model, the healthcare fraud analytics market is segmented into on-premise and on-demand models. The on-demand models include the cloud-based and web-based models. The on-demand segment is projected to register the highest CAGR during the forecast period. Factors such as on-demand self-serving analytics, the lack of up-front capital investments for hardware, extreme capacity flexibility, and a pay-as-you-go pricing model are driving the demand for on-demand fraud detection solutions.

The prepayment review model is projected to witness the highest growth during the forecast period

On the basis of application, the healthcare fraud analytics market is segmented into insurance claims review, pharmacy billing misuse, payment integrity, and other applications. The insurance claims review segment is further divided into postpayment and prepayment review, with the latter expected to register the highest growth during the forecast period. This is mainly because the use of prepayment review protocols and analytics can help organizations proactively prevent fraud prior to payment, allowing rapid action to be taken. As a result, prepayment review solutions are expected to garner greater attention in the coming years.

The Asia Pacific to witness the highest growth during the forecast period

The Asia Pacific is expected to witness the highest growth during the forecast period (2020 to 2025), owing to factors such as the growing demand for health insurance and increasing collaborations & partnerships between governments and tech giants for leveraging fraud analytics capabilities.

A breakdown of primary participants involved in making this report is mentioned below:

  • By Company Type: Tier 1-45%, Tier 2-18%, and Tier 3-37%
  • By Designation: C Level-35%, Director Level-50%, Others-15%
  • By Region: North America-60%, Asia Pacific-22%, Europe-13%, Latin America-2%, Middle East and Africa-3%

Some of the major market players in the healthcare fraud analytics market are IBM Corporation (US), Optum (US), SAS Institute (US), Change Healthcare (US), EXL Service Holdings (US), Cotiviti (US), Wipro Limited (India), Conduent (US), HCL (India), Canadian Global Information Technology Group (Canada), DXC Technology Company (US), Northrop Grumman Corporation (US), LexisNexis Group (US), and Pondera Solutions (US).

Research Coverage:

The report analyzes the healthcare fraud analytics market and aims at estimating the market size and future growth potential of this market based on various segmentations, such as solution type, delivery model, application, end user, and region. It also covers the competitive leadership mapping, which analyzes the position of key market players and classifies them based on their capabilities. The report provides a competitive analysis of the key players in this market, along with their profiles, offerings, recent developments, and key market strategies.

Reasons to Buy the Report

The report will enrich established firms as well as new entrants/smaller firms to gauge the pulse of the market to help them garner a greater share of the market. Firms purchasing the report could use one or any combination of the below-mentioned strategies to strengthen their position in the market.

This report provides insights into the following pointers:

  • Market Penetration: Comprehensive information on the portfolios of top players in the global healthcare fraud analytics market. The report analyzes this market by solution type, delivery model, application, end user, and region.
  • Product Enhancement/Innovation: Detailed insights on upcoming technology trends in the global healthcare fraud analytics market
  • Market Development: Comprehensive information on the lucrative emerging markets
  • Market Diversification: Exhaustive information about growing geographies, recent developments, and collaborations in the healthcare fraud analytics market
  • Competitive Assessment: In-depth assessment of growth strategies, offerings, and capabilities of leading players in the global healthcare fraud analytics market

TABLE OF CONTENTS

1 INTRODUCTION

  • 1.1 OBJECTIVES OF THE STUDY
  • 1.2 MARKET DEFINITION
  • 1.3 MARKET SCOPE
    • 1.3.1 MARKETS COVERED
    • 1.3.2 YEARS CONSIDERED FOR THE STUDY
  • 1.4 CURRENCY
  • 1.5 LIMITATIONS
  • 1.6 STAKEHOLDERS

2 RESEARCH METHODOLOGY

  • 2.1 RESEARCH APPROACH
    • 2.1.1 SECONDARY SOURCES
      • 2.1.1.1 Key data from secondary sources
    • 2.1.2 PRIMARY SOURCES
      • 2.1.2.1 Key data from primary sources
  • 2.2 MARKET SIZE ESTIMATION
  • 2.3 MARKET BREAKDOWN AND DATA TRIANGULATION
  • 2.4 ASSUMPTIONS FOR THE STUDY

3 EXECUTIVE SUMMARY

4 PREMIUM INSIGHTS

  • 4.1 HEALTHCARE FRAUD ANALYTICS MARKET OVERVIEW
  • 4.2 ASIA PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE AND APPLICATION (2019)
  • 4.3 HEALTHCARE FRAUD ANALYTICS MARKET: GEOGRAPHIC GROWTH OPPORTUNITIES
  • 4.4 HEALTHCARE FRAUD ANALYTICS MARKET: REGIONAL MIX
  • 4.5 HEALTHCARE FRAUD ANALYTICS MARKET: DEVELOPING VS. DEVELOPED REGIONS

5 MARKET OVERVIEW

  • 5.1 INTRODUCTION
  • 5.2 MARKET DYNAMICS
    • 5.2.1 DRIVERS
      • 5.2.1.1 Large number of fraudulent activities in healthcare
      • 5.2.1.2 Increasing number of patients seeking health insurance
      • 5.2.1.3 Prepayment review model
      • 5.2.1.4 High returns on investment
      • 5.2.1.5 Rise in pharmacy claims-related fraud
    • 5.2.2 RESTRAINTS
      • 5.2.2.1 Limitations in the data capturing process in Medicaid services
    • 5.2.3 OPPORTUNITIES
      • 5.2.3.1 Adoption of healthcare fraud analytics in developing countries
      • 5.2.3.2 Emergence of social media and its impact on the healthcare industry
      • 5.2.3.3 Role of AI in healthcare fraud detection
    • 5.2.4 CHALLENGES
      • 5.2.4.1 Dearth of skilled personnel
      • 5.2.4.2 Time-consuming deployment and the need for frequent upgrades

6 INDUSTRY INSIGHTS

  • 6.1 INDUSTRY TRENDS
    • 6.1.1 SHIFTING FOCUS FROM ON-PREMISE MODELS TO CLOUD-BASED ON-DEMAND MODELS
    • 6.1.2 MERGERS AND ACQUISITIONS: THE MOST ADOPTED STRATEGY
    • 6.1.3 TECHNOLOGICAL ADVANCEMENTS
    • 6.1.4 NEW USE CASE: OPIOID EPIDEMIC CRISIS
    • 6.1.5 END-USER TRENDS: ADOPTION OF HEALTHCARE FRAUD ANALYTICS SOLUTIONS BY PHARMACY BENEFIT MANAGERS

7 HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE

  • 7.1 INTRODUCTION
  • 7.2 DESCRIPTIVE ANALYTICS
    • 7.2.1 DESCRIPTIVE ANALYTICS SEGMENT ACCOUNTED FOR THE LARGEST MARKET SHARE
  • 7.3 PREDICTIVE ANALYTICS
    • 7.3.1 PREDICTIVE ANALYTICS HELPS IN SIMULATING FUTURE EVENTS & TRENDS THAT CAN ENABLE PAYERS TO PREDICT PREVENTABLE EVENTS
  • 7.4 PRESCRIPTIVE ANALYTICS
    • 7.4.1 PRESCRIPTIVE MODELS OFFER ADDITIONAL ADVANTAGES RELATING TO THE INVESTIGATION OF SUSPICIOUS BEHAVIOR TO GENERATE COMPREHENSIVE INSIGHTS

8 HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL

  • 8.1 INTRODUCTION
  • 8.2 ON-PREMISE DELIVERY MODELS
    • 8.2.1 ON-PREMISE MODELS ACCOUNT FOR THE LARGEST SHARE OF THE MARKET
  • 8.3 ON-DEMAND DELIVERY MODELS
    • 8.3.1 CLOUD-BASED DELIVERY MODELS OFFER ORGANIZATIONS INCREASED SCALABILITY AND SPEED

9 HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION

  • 9.1 INTRODUCTION
  • 9.2 INSURANCE CLAIMS REVIEW
    • 9.2.1 POSTPAYMENT REVIEW
      • 9.2.1.1 Postpayment review dominated the healthcare fraud analytics insurance claims review market
    • 9.2.2 PREPAYMENT REVIEW
      • 9.2.2.1 The majority of prepayment models use predictive analytics to detect fraud and stop fraudulent claims payments
  • 9.3 PHARMACY BILLING MISUSE
    • 9.3.1 FRAUD, WASTE, AND ABUSE CASES IN PHARMACY AND PRESCRIPTION DRUG AREAS ARE DRIVING THE DEMAND FOR ANALYTICS
  • 9.4 PAYMENT INTEGRITY
    • 9.4.1 CHANGES IN REGULATORY GUIDELINES HAVE AIDED THE ADOPTION OF PAYMENT INTEGRITY SOFTWARE
  • 9.5 OTHER APPLICATIONS

10 HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER

  • 10.1 INTRODUCTION
  • 10.2 PUBLIC & GOVERNMENT AGENCIES
    • 10.2.1 PUBLIC & GOVERNMENT AGENCIES DOMINATE THE HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER
  • 10.3 PRIVATE INSURANCE PAYERS
    • 10.3.1 PRIVATE INSURANCE PAYERS ARE FOCUSED ON DEPLOYING ANALYTICS TO COMBAT INCREASING MONETARY LOSSES
  • 10.4 THIRD-PARTY SERVICE PROVIDERS
    • 10.4.1 ADOPTION OF FRAUD ANALYTICS SOLUTIONS BY PUBLIC INSURERS PUTS PRIVATE BODIES AT RISK, DRIVING ATTENTION TOWARD OUTSOURCING
  • 10.5 EMPLOYERS
    • 10.5.1 EMPLOYERS ARE CONSIDERING FRAUD ANALYTICS SOLUTIONS AS A STEP TOWARD BETTER COST MANAGEMENT

11 HEALTHCARE FRAUD ANALYTICS MARKET, BY REGION

  • 11.1 INTRODUCTION
  • 11.2 NORTH AMERICA
    • 11.2.1 US
      • 11.2.1.1 US dominates the global healthcare fraud analytics market
    • 11.2.2 CANADA
      • 11.2.2.1 Growing adoption of data-crunching technologies like predictive analytics to drive market growth
  • 11.3 EUROPE
    • 11.3.1 GERMANY
      • 11.3.1.1 Germany is the fastest-growing market for healthcare fraud analytics solutions in Europe
    • 11.3.2 UK
      • 11.3.2.1 Launch of initiatives such as NHSCFA will support the market for fraud analytics solutions in the UK
    • 11.3.3 FRANCE
      • 11.3.3.1 Increasing adoption of information technology for the detection of healthcare fraud-a key factor driving market growth
    • 11.3.4 REST OF EUROPE
  • 11.4 ASIA PACIFIC
    • 11.4.1 APAC MARKET TO WITNESS THE HIGHEST GROWTH IN THE HEALTHCARE FRAUD ANALYTICS MARKET DURING THE FORECAST PERIOD
  • 11.5 LATIN AMERICA
    • 11.5.1 VOLUME OF CLAIMS PROCESSING IS EXPECTED TO INCREASE IN LATIN AMERICAN COUNTRIES OWING TO THE INCREASING PENETRATION OF HEALTH INSURANCE
  • 11.6 MIDDLE EAST & AFRICA
    • 11.6.1 HEALTHCARE FRAUD IS ONE OF THE LEADING CRIMES IN SOUTH AFRICA

12 COMPETITIVE LANDSCAPE

  • 12.1 INTRODUCTION
  • 12.2 COMPETITIVE SITUATION AND TRENDS
    • 12.2.1 MERGERS, ACQUISITIONS, AND JOINT VENTURES
    • 12.2.2 COLLABORATIONS, PARTNERSHIPS, AND AGREEMENTS
    • 12.2.3 EXPANSIONS
  • 12.3 COMPETITIVE LEADERSHIP MAPPING
    • 12.3.1 VISIONARY LEADERS
    • 12.3.2 INNOVATORS
    • 12.3.3 DYNAMIC DIFFERENTIATORS
    • 12.3.4 EMERGING COMPANIES

13 COMPANY PROFILES

(Business Overview, Products Offered, Recent Developments, MnM View)*

  • 13.1 IBM
  • 13.2 OPTUM (A PART OF UNITEDHEALTH GROUP)
  • 13.3 COTIVITI HOLDINGS, INC.
  • 13.4 FAIR ISAAC CORPORATION
  • 13.5 SAS INSTITUTE
  • 13.6 CHANGE HEALTHCARE
  • 13.7 EXL SERVICE HOLDINGS, INC.
  • 13.8 WIPRO
  • 13.9 CONDUENT, INC.
  • 13.10 HCL TECHNOLOGIES
  • 13.11 CGI GROUP
  • 13.12 DXC TECHNOLOGY COMPANY
  • 13.13 NORTHROP GRUMMAN CORPORATION
  • 13.14 LEXISNEXIS (A PART OF RELX GROUP)
  • 13.15 PONDERA SOLUTIONS
  • 13.16 OTHER PLAYERS OPERATING IN THE HEALTHCARE FRAUD ANALYTICS MARKET
    • 13.16.1 WHITEHATAI
    • 13.16.2 HEALTHCARE FRAUD SHIELD
    • 13.16.3 FRAUDLENS, INC.
    • 13.16.4 HMS
    • 13.16.5 FRAUDSCOPE, INC.

Business Overview, Products Offered, Recent Developments, MnM View might not be captured in case of unlisted companies.

14 APPENDIX

  • 14.1 DISCUSSION GUIDE
  • 14.2 KNOWLEDGE STORE: MARKETSANDMARKETS' SUBSCRIPTION PORTAL
  • 14.3 AVAILABLE CUSTOMIZATIONS
  • 14.4 RELATED REPORTS
  • 14.5 AUTHOR DETAILS