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市場調查報告書

收益循環管理 (RCM)的美國市場:市場分析、預測

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

出版商 Frost & Sullivan 商品編碼 590283
出版日期 內容資訊 英文 123 Pages
商品交期: 最快1-2個工作天內
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收益循環管理 (RCM)的美國市場:市場分析、預測 Assessment of the US Revenue Cycle Management Market, Forecast to 2022
出版日期: 2017年10月31日 內容資訊: 英文 123 Pages
簡介

本報告提供美國的醫院、診療所收益循環管理 (RCM) 解決方案的市場調查,市場定義和概要,市場背景,主要趨勢與引進的推動因素、抑制因素分析,各終端用戶、提供內容的收益預測,競爭環境,主要供應商的簡介,成長機會分析,未來展望等彙整資料。

第1章 摘要整理

第2章 市場概要

  • 市場定義
  • 市場背景

第3章 簡介

  • 美國的RCM市場生態系統:主要的產品的引進處
  • 終端用戶、產品的分類
  • 產業推動因素
  • 終端用戶固有的推動因素
  • 醫生的工作流程
  • RCM的趨勢的重要性
  • 醫療申請、編碼化相關的人力資源的課題
  • 主要事業課題
  • RCM平台的替換、附加價值追加的推動因素
  • 數位化狀況和供應商的RCM費用的影響

第4章 醫院用RCM市場分析

  • 重要RCM零組件的引進
  • 下一代RCM零組件的引進
  • 買替換率 vs 純粹的升級

第5章 診療所RCM市場分析

  • 主要痛點
  • 診療所管理解決方案的優點
  • 為了從診療管理系統取得最適合的結果的考察
  • 診療管理系統的演進
  • 更換率 vs 初期購買 (包含附加元件)
  • 醫院的KPI

第6章 價值為基礎的RCM生態系統

第7章 外包RCM服務

  • 簡介、市場影響因素
  • 市場展望:多樣的經營模式
  • 主要的考察
  • 最佳業務實踐分析

第8章 市場預測、市場趨勢:整體市場

  • 市場工程評估
  • 預測手法、前提條件
  • 收益預測
  • 收益佔有率預測:各終端用戶
  • 收益預測:各終端用戶
  • 收益預測相關討論

第9章 市場預測、市場趨勢:醫院用RCM市場

  • 市場工程評估
  • 收益預測
  • 收益預測相關討論
  • 收益預測:各提供內容

第10章 市場預測、市場趨勢:診療所用RCM市場

  • 市場工程評估
  • 收益預測
  • 收益預測相關討論
  • 收益預測:各提供內容
  • 收益預測相關討論:軟體
  • 收益預測相關討論:服務

第11章 普及分析

  • 醫院
  • 診療所

第12章 供應商環境分析

  • 競爭的影響因素
  • 廠商市場佔有率
  • 供應商趨勢
  • 價值為基礎的RCM解決方案的風險縮小策略
  • 美國的市場差距

第13章 競爭結構

  • 競爭環境
  • 醫療保健RCM的M&A
  • 主要的M&A

第14章 供應商的分類、簡介

  • 軟體應用程式供應商
  • 服務供應商

第15章 成長機會分析

  • 主要的成長機會
  • 成功、成長的策略性必要條件

第16章 未來展望

  • 總論:三大預測
  • 總論:討論
  • 免責聲明

第17章 附錄

目錄
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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