Population Health Management (PHM) Market Size, Share & Trends Analysis Report By Product (Software, Service), By End Use (Payers, Providers, Employer Groups), By Region, And Segment Forecasts, 2019 - 2025

Industry Insights

The global Population Health Management market size was valued at USD 27.1 billion in 2018 and is expected to register a CAGR of 20.7% over the forecast period. The medical industry is rapidly transforming from a paper-based system into a digitized system, which is accelerating the demand for healthcare IT services. In addition, increasing demand for solutions supporting value-based care delivery by stakeholders has resulted in a shift from Fee-for-Service (FFS) to a Value-based Payment (VBP) models.

PHM solutions aim at data-driven healthcare at a population level and enable segmentation of patient population, based on common medical conditions and attributes. It enables data aggregation, risk stratification, care coordination, and patient communication. As complexity in care delivery and payment models and clinical needs is increasing, the requirement for a PHM program that combines multiple functionalities is rising, which can process clinical, financial, and operational data to improve efficiency and patient care.

In 2010, the U.S. government introduced the Patient Protection and Affordable Care Act that facilitates high quality of care and reduces costs. This act also encouraged the formation of Accountable Care Organizations (ACOs), including the Medicare Shared Savings Program (MSSP). Adoption of healthcare IT solutions is a result of the growing preference for value-based reimbursement structure and accountable care. ACOs are groups of doctors, hospitals, and other providers who contract with a payer to deliver high quality health care.

Disease management programs analyze demographic characteristics and healthcare utilization, along with the identification of target high-risk population. This facilitates understanding of technological benefits. The rise in demand for effective disease management strategies is expected to boost growth of the PHM market in the forthcoming years. In addition, China, and India are growing due to change in the FDI norms, which permits the implementation of new healthcare solutions that will facilitate management of patient records and provide a more central and accessible healthcare delivery.

Product Insights

The services segment currently holds majority of the market share as hospitals and other care providers now prefer an in-house system instead of involving third parties to assess their patient data. In addition, the increasing need for integrated healthcare systems is responsible for the high demand for PHM software. Third party service providers are increasingly experiencing growth in demand for PHM solutions.

The healthcare scenario is changing rapidly with a shift from fee-for-service to value-based care delivery. PHM software offers a robust care management system with risk stratification structure. PHM software solutions provide a well-managed network that provides actionable analytics for providers and has the ability to manage multiple lines of business seamlessly on one platform.

End-use Insights

Healthcare providers held majority of the Population Health Management (PHM) market share in 2018. PHM improves clinical outcomes by aiding in better disease management. This will result in reduced duration of inpatient stay and overall observation hours of physicians. As a result, a provider can focus more on patient-centric care and can reduce overall costs.

Payers in healthcare are third-party entities, such as insurance carriers. These entities finance or reimburse the cost of health services. Predictive analytics competency gives payers advantage over other providers in interpreting population behavior and unstructured clinical content. This competitive advantage is instrumental in increasing the demand for PHM software for payers and is expected to propel growth of the segment at a significant CAGR during the forecast period. 

Regional Insights

North America emerged as the largest market in 2018. Total healthcare spending in U.S. is expected to reach up to USD 4.8 trillion in 2021 from USD 2.6 trillion in 2010-accounting for nearly 20% of the Gross Domestic Product (GDP) by 2021. Thus, the alarming increase in costs is, in turn, escalating the demand for an effective population health management. The government is focusing on increased incentives and investment to improve national health by accurately tracking health of the population and its subgroups.

More than 130 million people in U.S. suffer from at least one chronic condition. These conditions are responsible for around 70% of deaths in U.S. each year, killing 1.7 million Americans. Managing comorbidities is challenging due to the large target population in the region. Furthermore, the switch from volume- to value-based reimbursement is increasing the need for PHM in North America.

In U.S., providers, payers, providers-payers, and accountable care organizations are the promoters of PHM systems. Many providers and payers require upgrading and automating their healthcare management systems, which can improve healthcare delivery and help departments collaborate with each other.

Asia Pacific PHM market is anticipated to experience the fastest growth over the forecast period due to improving healthcare infrastructure and rising expenditure. Furthermore, the incidence of chronic diseases is expected to double from 2001 to 2025 in the Asia Pacific region. Managing the data generated from this increase will require advanced data analytics, which is expected to boost growth of the Asia Pacific PHM market.

Population Health Management (PHM) Market Share Insights

Some of the key players are Allscripts, McKesson Corporation, Cerner Corporation, etc. Acquisitions and partnerships with other market players are some of the most undertaken strategies by the companies in this market to strengthen regional presence. For instance, Allscripts announced acquisition of CarePort in 2016, to strengthen its position across post-acute care settings. Some of the companies are focusing on research initiatives to widen the services portfolio.

In October 2016, Conifer Health Solutions entered into a partnership with Verity Health System, California. As per this multiyear agreement, Conifer Health was expected to deliver Accounts Receivable Management, Enrollment and Eligibility, Health Information Management, and Clinical Documentation Improvement and services for six hospitals belonging to Verity Health based in Southern and Northern California.

In August 2018, Allscripts announced that it received accreditation from Healthcare Network Accreditation Program for Payerpath and ePAP accreditation for ePrescribe from the Electronic Healthcare Network Accreditation Commission. In May 2018, the Department of Veterans Affair announced an agreement with Cerner Government Services-a subsidiary of Cerner-to use its solutions that will offer veteran care providers access to their medical history through EHRs.

In April 2017, McKesson Corporation announced the completion of the acquisition of CoverMyMeds LLC-a developer of Electronic Prior Authorization (ePA) solutions. Moreover, the company automates prior authorization process for more than 500 EHR systems, 700,000 providers, 49,000 pharmacies, most health plans as well as Pharmacy Benefit Managers (PBMs).

Report Scope

Segments Covered in the Report

This report forecasts revenue growth at global, regional, and country levels and provides an analysis of the latest industry trends in each of the sub-segments from 2014 to 2025. For the purpose of this study, Grand View Research has segmented the global Population Health Management (PHM) market report based on product, end use, and region:

• Product Outlook (Revenue, USD Million, 2014 - 2025)

  • Software

  • Services

• End-use Outlook (Revenue, USD Million, 2014 - 2025)

  • Payers

  • Providers

  • Employer Groups

• Regional Outlook (Revenue, USD Million, 2014 - 2025)

  • North America

    • U.S.

    • Canada

  • Europe

    • U.K.

    • Germany

    • France

    • Italy

    • Spain

  • Asia Pacific

    • Japan

    • China

    • India

  • Latin America

    • Brazil

    • Mexico

  • Middle East & Africa

    • South Africa

    • Saudi Arabia

    • United Arab Emirates