バックエンド収益サイクル管理市場：製品・サービス別、提供形態別、地域別、2024年～2031年

バックエンド収益サイクル管理市場の評価、2024年～2031年

バックエンド収益サイクル管理（RCM）市場は、今後数年間で着実な成長が見込まれます。この成長の背景には、ヘルスケア請求の複雑化などいくつかの要因が考えられます。新しいコーディングシステムが採用され、バリューベースの支払いが一般的になり、ヘルスケアプランが統合されるにつれて、ヘルスケア請求プロセスはより複雑になります。この複雑さにより、作業を自動化し、ワークフローを合理化できるRCMソリューションの利用が必要となっています。2023年の市場規模は107億1,000万米ドルで、2031年には160億8,000万米ドルに拡大すると予測され、2024年から2031年までのCAGRは5.21%です。

市場成長のもう一つの促進要因は、ヘルスケアプロバイダーの間で効率的な収益サイクル管理のニーズが高まっていることです。診療報酬の低下、医療費の増加、患者満足度の向上というプレッシャーは、すべてこのニーズに寄与しています。RCMソリューションは、医療提供者のキャッシュフローを改善し、請求拒否を減らし、支払い回収を迅速化するのに役立ちます。

バックエンド収益サイクル管理市場定義/概要

バックエンド収益サイクル管理（RCM）は、ヘルスケア業界における重要なプロセスです。RCMは、保険会社などの支払者からの適切な収益回収を確実にするため、患者来院後に発生する重要な業務に焦点を当てています。この複雑なプロセスは、指定されたシステムによって監督され、いくつかのステップを伴います。最初のステップは請求処理です。患者が治療を受けた後、提供されたサービスに関する詳細な情報を請求書にまとめます。この請求書は、担当の保険会社に電子的または紙で提出されます。バックエンドのRCMは、請求が関連するすべてのコーディングとフォーマットの規制に準拠していることを確認します。

市場の成長を後押しする主な要因は？

ヘルスケアにかかる費用が増加の一途をたどっているため、医療機関は収益サイクル業務の強化を余儀なくされています。バックエンドRCMソリューションは、請求漏れの特定と回収、請求精度の向上、請求管理の合理化を支援します。効果的なバックエンド処理による収益の最適化が、市場成長の大きな促進要因となっています。

ヘルスケアの診療報酬の状況は絶えず変化しており、複雑な規則や複数の支払いスキームが存在します。バックエンドRCMソリューションは、ヘルスケアプロバイダがこうした変化に対応し、正確なコーディングと文書化を行って請求書を提出し、否認をうまく管理できるよう支援します。このような複雑なヘルスケア償還に対応する能力は、バックエンドRCMテクノロジーを使用するプロバイダーに大きなメリットをもたらします。

さらに、ヘルスケア部門は、フィー・フォー・サービス・アプローチからバリュー・ベース・ケアへと移行しつつあります。バックエンドRCMテクノロジーは、患者データと相互作用し、品質指標を管理することができるため、プロバイダーは価値を実証し、価値ベースのケアモデルにおける報酬を最大化することができます。このように変化するヘルスケア支払いシステムと統合することで、バックエンドRCMソリューションはヘルスケアプロバイダーにとって重要なツールとなります。

バックエンドRCM市場が直面する主な課題とは？

バックエンドRCMシステムは、電子カルテ（EHR）や診療管理ソフトウェアなど、他のヘルスケアITシステムと相互作用する必要があります。しかし、これらのさまざまなシステム間で完璧なデータフローを実現するのは難しく、時間もかかります。一貫性のないデータ形式や相互運用標準の欠如は、収益サイクルにおけるエラー、遅延、非効率を引き起こし、市場開拓を制限しています。

さらに、RCMには複雑なコーディングや請求ルールを理解する熟練したスタッフが必要です。ヘルスケアビジネスでは、有資格の医療コーダーやビラーが不足しています。さらに、新しい従業員にバックエンドRCMシステムや規制を教育するにはコストと時間がかかるため、市場拡大の妨げとなっています。

目次

第1章 世界のバックエンド収益サイクル管理市場のイントロダクション

• 市場概要
• 調査範囲
• 前提条件

第2章 エグゼクティブサマリー

第3章 VERIFIED MARKET RESEARCHの調査手法

• データマイニング
• バリデーション
• 一次資料
• データソース一覧

第4章 世界のバックエンド収益サイクル管理市場の展望

• 概要
• 市場力学
  • 促進要因
  • 抑制要因
  • 機会
• ポーターのファイブフォースモデル
• バリューチェーン分析
• 規制の枠組み

第5章 バックエンド収益サイクル管理の世界市場：製品・サービス別

• 概要
• ソフトウェア
• サービス

第6章 バックエンド収益サイクル管理の世界市場：提供形態別

• 概要
• オンプレミス
• クラウドベース

第7章 バックエンド収益サイクル管理の世界市場：地域別

• 概要
• 北米
  • 米国
  • カナダ
  • メキシコ
• 欧州
  • ドイツ
  • 英国
  • フランス
  • その他欧州
• アジア太平洋
  • 中国
  • 日本
  • インド
  • その他アジア太平洋地域
• 世界のその他の地域
  • ラテンアメリカ
  • 中東・アフリカ

第8章 世界のバックエンド収益サイクル管理市場の競合情勢

• 概要
• 企業市場シェア
• ベンダー情勢
• 主な発展戦略

第9章 企業プロファイル

• Athenahealth
• Cerner
• Allscripts Healthcare Solutions
• Eclinicalworks
• Optum, Inc.
• Mckesson
• Conifer Health Solutions
• Gebbs Healthcare Solutions
• The SSI Group
• R1 RCM Inc.

第10章 主な発展

• 製品の上市／開発
• 合併と買収
• 事業拡大
• パートナーシップと提携

第11章 付録

• 関連調査

Back-End Revenue Cycle Management Market Valuation - 2024-2031

The back-end revenue cycle management (RCM) market is expected to experience steady growth in the coming years. This growth can be attributed to several factors, including the increasing complexity of healthcare billing. As new coding systems are adopted, value-based payments become more common, and health plans consolidate, the healthcare billing process becomes more intricate. This complexity necessitates the use of RCM solutions that can automate tasks and streamline workflows. The market was valued at USD 10.71 Billion in 2023 and is expected to expand toUSD 16.08 Billion in 2031, growing at aCAGR of 5.21% from 2024 to 2031.

Another driver of market growth is the rising need for efficient revenue cycle management among healthcare providers. Declining reimbursement rates, increasing costs of care, and the pressure to improve patient satisfaction all contribute to this need. RCM solutions can be instrumental in improving providers' cash flow, reducing claim denials, and expediting payment collection.

Back-End Revenue Cycle Management Market: Definition/ Overview

Back-end revenue cycle management (RCM) is a crucial process within the healthcare industry. It focuses on the essential tasks that occur after a patient visit to ensure proper revenue collection from payers, like insurance companies. This intricate process is overseen by a designated system and involves several steps. The first step involves claims processing. After a patient receives care, detailed information regarding the services rendered is compiled into a claim. This claim is then submitted electronically or on paper to the responsible insurance company. Back-end RCM ensures the claim adheres to all relevant coding and formatting regulations.

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What are the Primary Factors Bolstering the Growth of the Market?

The ever-increasing expense of healthcare forces providers to enhance their revenue cycle operations. Back-end RCM solutions assist in identifying and recovering missed charges, improving billing accuracy, and streamlining claims management. This emphasis on revenue optimization through effective back-end procedures is a significant driver of market growth.

The healthcare reimbursement landscape is continually changing, with complex rules and several payment schemes. Back-end RCM solutions can assist healthcare providers in keeping up with these changes, ensuring accurate coding and documentation for claims submissions, and successfully managing denials. This capacity to handle the complexities of healthcare reimbursement provides a considerable advantage to providers who use back-end RCM technologies.

Furthermore, the healthcare sector is moving away from a fee-for-service approach and toward value-based care, in which clinicians are compensated on patient outcomes rather than the volume of services delivered. Back-end RCM technologies can interact with patient data and manage quality measures, enabling providers to demonstrate value and maximize compensation in value-based care models. This integration with the changing healthcare payment system establishes back-end RCM solutions as an important tool for healthcare providers.

What are the Key Challenges Faced by the Back-End Revenue Cycle Management Market?

Back-end RCM systems have to interact with other healthcare IT systems, including electronic health records (EHR) and practice management software. However, enabling a flawless data flow across these various systems is difficult and time-intensive. Inconsistent data formats and a lack of interoperability standards cause errors, delays, and inefficiencies in the revenue cycle, limiting market development.

Furthermore, RCM requires skilled staff who comprehend complex coding and billing rules. The healthcare business is experiencing a scarcity of qualified medical coders and billers. Furthermore, educating new workers on back-end RCM systems and regulations is costly and time-consuming, hence impeding market expansion.

Category-Wise Acumens

What are the Potential Drivers that Increase Demand for Back-End RCM Services?

The service segment is estimated to dominate the market during the forecast period. Healthcare billing and coding standards are complex and continually growing. Healthcare firms can ensure accuracy and compliance by outsourcing these operations to specialized RCM service providers rather than investing in considerable in-house expertise. The complexity of the regulatory landscape drives up demand for RCM services.

The healthcare industry is experiencing a shortage of competent RCM personnel. Outsourcing back-end RCM services enables healthcare firms to tap into a pool of experienced employees without paying the costs involved with hiring, training, and managing in-house professionals. Labor shortages and the opportunity for cost reductions encourage healthcare providers to use RCM services.

Furthermore, RCM service providers provide a wide range of services, allowing healthcare businesses to outsource certain activities or their complete back-end RCM operation. This flexibility and adaptability are especially appealing to smaller practices or those with changing workloads. The ability to tailor services to specific needs reinforces the services segment's dominance.

Country/Region-wise Acumens

What Factors Support the Dominance of North America in the Market?

North America is estimated to dominate the Back-End Revenue Cycle Management Market during the forecast period. The US healthcare system, in particular, is distinguished by a complicated web of laws and coding standards for medical billing. North American healthcare businesses must constantly update and adjust laws such as ICD-10 (International Classification of Diseases, Tenth Revision) coding. This complexity needs powerful back-end RCM solutions to assure proper coding, claims filing, and compliance, resulting in increased demand for advanced RCM services and software across the region.

North America has a well-developed healthcare IT infrastructure, with many providers already utilizing electronic health records (EHR) and other digital technologies. Back-end RCM solutions can effortlessly interface with the existing infrastructure, allowing for more efficient data interchange and task automation. This early adoption of healthcare IT establishes North America as a leader in the use of advanced RCM systems.

Furthermore, North America has some of the world's highest healthcare expenses. This imposes a considerable financial strain on healthcare providers, who are increasingly focused on managing their revenue cycle to maximize reimbursements while reducing denials. Back-end RCM solutions assist in streamlining procedures, decreasing errors, and increasing cash flow, making them an essential tool for healthcare enterprises in North America.

How Do Rising Government Initiatives Promote the Market Growth in the Asia Pacific?

The Asia Pacific region is estimated to exhibit the highest growth during the forecast period. Many governments in the Asia Pacific are actively encouraging healthcare IT adoption through financial initiatives and legislative changes. This emphasis on healthcare infrastructure expansion creates a favorable environment for the introduction of back-end RCM technologies. As healthcare institutions become more digitalized, the requirement for effective RCM solutions to manage billing and claims processing grows.

The deployment of EHR systems in the Asia Pacific is constantly growing. These devices create massive volumes of patient data, which can then be used by back-end RCM software to automate processes, increase coding accuracy, and simplify revenue cycles. The creation and implementation of interoperability standards would enable easy data sharing between various healthcare IT systems, hence increasing the effectiveness of RCM solutions.

Furthermore, healthcare providers in Asia Pacific are becoming aware of the advantages of back-end RCM solutions, such as increased cash flow, fewer denials, and more efficient processes. As competition in the healthcare sector heats up, cost efficiency becomes a top focus. Back-end RCM solutions can assist healthcare businesses in the Asia Pacific in meeting these objectives by lowering administrative expenses and increasing revenue cycle efficiency.

Competitive Landscape

The Back-End Revenue Cycle Management Market is a dynamic environment characterized by the interplay of established vendors, resourceful startups, and innovative technology providers. These participants offer a diverse array of solutions to address the evolving needs of healthcare organizations seeking to optimize their revenue cycle.

Some of the prominent players operating in the Back-End Revenue Cycle Management Market include:

Athenahealth, Cerner, Allscripts Healthcare Solutions, Eclinicalworks, Optum, Inc., Mckesson, Conifer Health Solutions, Gebbs Healthcare Solutions, The SSI Group, Mckesson Corporation, R1 RCM Inc., eClinicalWorks, Allscripts Healthcare Solutions, Inc., Veradigm LLC.

Latest Developments

In January 2024, R1 RCM Inc. acquired Acclara from Providence, a health systems provider, to strengthen its market position and implement advanced technology solutions, aiming to improve patient and customer outcomes.

In July 2023, TELCOR launched version 21.3 of TELCOR RCM, which includes expanded use of web APIs, Report Designer, and an Executive Module to improve laboratory productivity and collections.

In June 2022, R1 RCM Inc. acquired Cloudmed to offer a leading platform for healthcare provider revenue cycle management (RCM) and drive digital transformation through automation and AI.

TABLE OF CONTENTS

1 INTRODUCTION OF GLOBAL BACK-END REVENUE CYCLE MANAGEMENT MARKET

• 1.1 Overview of the Market
• 1.2 Scope of Report
• 1.3 Assumptions

2 EXECUTIVE SUMMARY

3 RESEARCH METHODOLOGY OF VERIFIED MARKET RESEARCH

• 3.1 Data Mining
• 3.2 Validation
• 3.3 Primary Interviews
• 3.4 List of Data Sources

4 GLOBAL BACK-END REVENUE CYCLE MANAGEMENT MARKET OUTLOOK

• 4.1 Overview
• 4.2 Market Dynamics
  • 4.2.1 Drivers
  • 4.2.2 Restraints
  • 4.2.3 Opportunities
• 4.3 Porters Five Force Model
• 4.4 Value Chain Analysis
• 4.5 Regulatory Framework

5 GLOBAL BACK-END REVENUE CYCLE MANAGEMENT MARKET, BY PRODUCT AND SERVICE

• 5.1 Overview
• 5.2 Software
• 5.3 Services

6 GLOBAL BACK-END REVENUE CYCLE MANAGEMENT MARKET, BY DELIVERY MODE

• 6.1 Overview
• 6.2 On Premise
• 6.3 Cloud-based

7 GLOBAL BACK-END REVENUE CYCLE MANAGEMENT MARKET, BY GEOGRAPHY

• 7.1 Overview
• 7.2 North America
  • 7.2.1 U.S.
  • 7.2.2 Canada
  • 7.2.3 Mexico
• 7.3 Europe
  • 7.3.1 Germany
  • 7.3.2 The U.K.
  • 7.3.3 France
  • 7.3.4 Rest of Europe
• 7.4 Asia Pacific
  • 7.4.1 China
  • 7.4.2 Japan
  • 7.4.3 India
  • 7.4.4 Rest of Asia Pacific
• 7.5 Rest of the World
  • 7.5.1 Latin America
  • 7.5.2 Middle East and Africa

8 GLOBAL BACK-END REVENUE CYCLE MANAGEMENT MARKET COMPETITIVE LANDSCAPE

• 8.1 Overview
• 8.2 Company Market Share
• 8.3 Vendor Landscape
• 8.4 Key Development Strategies

9 COMPANY PROFILES

• 9.1 Athenahealth
  • 9.1.1 Overview
  • 9.1.2 Financial Performance
  • 9.1.3 Product Outlook
  • 9.1.4 Key Developments
• 9.2 Cerner
  • 9.2.1 Overview
  • 9.2.2 Financial Performance
  • 9.2.3 Product Outlook
  • 9.2.4 Key Developments
• 9.3 Allscripts Healthcare Solutions
  • 9.3.1 Overview
  • 9.3.2 Financial Performance
  • 9.3.3 Product Outlook
  • 9.3.4 Key Developments
• 9.4 Eclinicalworks
  • 9.4.1 Overview
  • 9.4.2 Financial Performance
  • 9.4.3 Product Outlook
  • 9.4.4 Key Developments
• 9.5 Optum, Inc.
  • 9.5.1 Overview
  • 9.5.2 Financial Performance
  • 9.5.3 Product Outlook
  • 9.5.4 Key Developments
• 9.6 Mckesson
  • 9.6.1 Overview
  • 9.6.2 Financial Performance
  • 9.6.3 Product Outlook
  • 9.6.4 Key Developments
• 9.7 Conifer Health Solutions
  • 9.7.1 Overview
  • 9.7.2 Financial Performance
  • 9.7.3 Product Outlook
  • 9.7.4 Key Developments
• 9.8 Gebbs Healthcare Solutions
  • 9.8.1 Overview
  • 9.8.2 Financial Performance
  • 9.8.3 Product Outlook
  • 9.8.4 Key Developments
• 9.9 The SSI Group
  • 9.9.1 Overview
  • 9.9.2 Financial Performance
  • 9.9.3 Product Outlook
  • 9.9.4 Key Developments
• 9.10 R1 RCM Inc.
  • 9.10.1 Overview
  • 9.10.2 Financial Performance
  • 9.10.3 Product Outlook
  • 9.10.4 Key Developments

10 KEY DEVELOPMENTS

• 10.1 Product Launches/Developments
• 10.2 Mergers and Acquisitions
• 10.3 Business Expansions
• 10.4 Partnerships and Collaborations

11 Appendix

• 11.1 Related Research