The global Revenue Cycle Management (RCM) market size was valued at USD 23.6 billion in 2016 and is expected to grow at a CAGR of 12.0% over the forecast period. Optimization of workflow within healthcare facilities and development of synchronized management systems is expected to support growth of the RCM market over the forecast period.
Furthermore, introduction of regulatory reforms and reclassification of various products within the healthcare system is likely to make management of these resources complex. This is anticipated to create higher demand for RCM services. For instance, various healthcare providers are currently trying to find a balance between the value-based care model and the traditional model. Their efforts have made revolutionary changes in trends such as increasing the outsourcing volume and automation of healthcare management.
U.S. RCM market, by product, 2014 - 2025 (USD Million)
Besides the aforementioned factors, other vital impact rendering drivers include rising financial challenges, need for augmenting speed for billing cycles, and overall enlargement of the healthcare industry. Healthcare provision is turning out to be similar to any other business, which needs to foresee hurdles and maintain financial stability for sustenance.
By means of RCM software, particularly the rising focus toward denial management integrated with analytics is expected to provide users with beneficial business models, thereby enhancing work efficiency. Furthermore, ancillary growth of the healthcare IT and analytics industry are expected to support growth of the RCM market. For instance, key players are establishing integrated solutions that will allow physicians and hospitals to manage end-to-end customer care.
A suitable example for this type of software is athenaOne, by athenahealth, Inc. The solution merges together front and back office functions leading to enhanced flexibility and visibility of financial status. In April 2015, Trinity Health announced the installation of athenaOne across their physician office network owing to its higher performance in reducing administrative tasks and boosting organization revenue.
The study analyzes the RCM market on both fronts; software installation and service provision. As of 2016, owing to the upsurge of IT during the last decade, various software have been installed in numerous facilities and witnessed a steady demand, thereby dominating in majority of the regions.
However, services are anticipated to undergo faster growth over the forecast period, due to the rising trend of outsourcing of such services. This may be substantiated by the growing investments by market participants for development of central workstations to handle RCM modalities.
The array of services offered include claim remittance, denial management, patient access management, medical coding, revenue recovery, accounts receivable, and others. These services may be offered in bundled, integrated solutions or may also be offered individually, depending on the need of the client. This flexibility is expected to further boost growth.
In addition, owing to government reforms and rising technological advancement in the field of healthcare IT, the segment is expected to witness launch of various new programs. For instance, there were about 58 such programs launched over the fiscal year 2016 in the U.S. such as the Wellness and Revenue Assistance Program services by iHealth.
The RCM market is classified into integrated and standalone type based on the software and services opted by end-users. Standalone software is commonly opted by individual physician offices whereas mid- to large-size hospitals and diagnostic laboratories opt for integrated solutions.
Over the forecast period, it is anticipated that integrated software may witness fastest growth. This may be attributed to numerous factors such as growing number of hospitals in emerging nations, higher efficiency & cost containment offered by integrated software, streamlining of the administrative efforts, and development of less complex integrated solutions.
The most common integrations observed with RCM are Electronic Health Record (EHR) and practice management solutions. For instance, Cerner Corporation and McKesson Corporation have a vast portfolio offering these integrated solutions that find applications across all types of end-use. Furthermore, they have been expanding their horizon by launching advanced versions since 2012, thereby portraying the rising demand.
Integrated solutions coupled with hospitals opting for service vendors is expected to lead to advantages such as reduction in administration costs, enhanced flexibility & productivity, and improved speed of revenue cycle. Thus, it can be predicted that integrated solutions may progress to be the preferred choice.
Cloud-based solutions are anticipated to witness the fastest growth over the forecast period. Along with practice management, EHR, and other healthcare IT solutions, revenue cycle management software are gaining popularity on the cloud-based delivery model.
Higher accessibility and rising adoption of integrated systems are key drivers for the cloud-based mode. For instance, as of 2016, majority of the new software or upgraded versions are being launched on cloud-based platforms.
Software with on-premise platforms are installed on the user’s workstation or server. Generally, these software have high up-front costs due to large initial investment in the equipment. However, total cost of ownership is low, as there is less or no annual/monthly subscription fee.
Web-based solutions allow operations to be conducted via internet with the web browser and have no additional storage or hardware requirements. Unlike the on-premises software, web-based software is installed off-site and supervised by a third party.
Physician offices dominated the RCM market’s end-use space in 2016 with over 40.0% share.
According to data provided by Medscape, majority of the physicians within the U.S. region offer healthcare services through small practices or individually owned clinics, thereby accounting for a large target group.
Similarly, the hospital fraternity is anticipated to witness lucrative growth over the forecast period. Countries such as Egypt, China, India, Vietnam, Brazil, and the U.S. are amongst the rapidly evolving hospital-based healthcare providers.
Growing demand for reducing diagnostic costs, improving patient care, and declining machine downtime are some of the factors that are accelerating the usage rate of RCM in diagnostic laboratories. High focus on digitalization and centralization of the workflow is the primary driver across all segments.
The other segment of end-use consists of pharmacies, ambulatory centers, and other healthcare facilities. Multiple entities are working on the establishment of facilities in high demand, such as round-the-clock monitoring and care delivery. These are expected to contribute significantly toward revenue generation over the forecast period.
Being a tech-savvy nation, North America leads the RCM market. Their dominance is expected to be maintained over the forecast period. This is attributed to the fact that as of 2016, the U.S. Revenue Cycle Management Market is driven by physician offices, but over the forecast period, the number of hospitals within the region are anticipated to grow.
In addition, alteration in the regulatory guidelines such as introduction of ICD-10 (10th revision of the International Statistical Classification of Diseases and Related Health Problems) leading to higher complexity is expected to promote demand for services segment. Other factors affecting growth include rising investment toward infrastructure building, emerging players with advanced technology, and centralization of end-users.
Global RCM market, by delivery mode, 2016 (%)
Some of the key players of the Revenue Cycle Management Market include Allscripts, Cerner Corporation, McKesson Corporation, The SSI Group, LLC, Epic Systems Corporation, NextGen Healthcare Information Solution LLC, and CareCloud Corporation. Aggressive competition within the vertical is anticipated to be visible over the forecast period. For instance, as of 2016, there are more than 100 companies offering RCM software and services across the U.S.
Products such as Cerner Millennium, athenaCollector, and Greenway RCM are amongst the commonly used solutions. In April 2016, Universal Health Services, Inc. and Cerner Corporation entered into an agreement to implement Cerner Millennium revenue cycle.
However, these globally accepted products are predicted to face competition from local vendors due to attributes such as price and regional regulation relatability. Collectively, the market is expected to be highly consolidated with numerous small- and mid-scale players.
Base year for estimation
Actual estimates/Historical data
2014 - 2016
2017 - 2025
Revenue in USD Million & CAGR from 2017 to 2025
North America, Europe, Asia Pacific, Latin America & MEA
U.S., Canada, UK, Germany, France, Italy, Spain, Japan, China, India, Brazil, Mexico, South Africa, Saudi Arabia
Revenue forecast, company share, competitive landscape, growth factors, and trends
15% free customization scope (equivalent to 5 analyst working days)
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This report forecasts revenue growth and provides an analysis on the latest trends in each of the sub-segments from 2014 to 2025. For the purpose of this study, Grand View Research has segmented the Revenue Cycle Management (RCM) Market on the basis of product, type, delivery-mode, end-use, and region:
Product Outlook (Revenue, USD Million, 2014 - 2025)
Type Outlook (Revenue, USD Million, 2014 - 2025)
Middle East and Africa (MEA)
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