GVR Report cover Revenue Cycle Management Market Size, Share & Trends Report

Revenue Cycle Management Market Size, Share & Trends Analysis Report By Product (Software, Service), By Type (Integrated, Standalone), By Delivery Mode, By End-use, By Region, And Segment Forecasts, 2021 - 2028

  • Published Date: Mar, 2021
  • Base Year for Estimate: 2020
  • Report ID: GVR-1-68038-433-8
  • Format: Electronic (PDF)
  • Historical Data: 2016 - 2019
  • Number of Pages: 140

Report Overview

The global revenue cycle management market size was valued at USD 261.8 billion in 2020 and is expected to expand at a compound annual growth rate (CAGR) of 11.5% from 2021 to 2028. Rising need for optimization of organizational workflow coupled with growing innovation in synchronized management software and systems is anticipated to promote market growth. Also, the establishment of teams by federal agencies for regulatory reforms leads to the possibility of reclassification of various healthcare products within the medical industry.

U.S. RCM market size, by product, 2016 – 2028 (USD Billion)

Increasing technological advancements and rising adoption of revenue cycle management (RCM) tools by various healthcare providers and others have led to the development and up-gradation of solutions provided by key players. For instance, in January 2020, R1 RCM announced the launch of R1 Professional, a physician revenue cycle management solution, for serving large hospital-owned medical groups and groups with independent practices. This will help in providing a standardized revenue cycle management strategy of operations and reimbursement models.

The COVID-19 pandemic has caused significant challenges to the healthcare providers, with most of these providers reporting a significant impact on revenue and inpatient volume. This increasing healthcare costs and medical billing complexity have created a rise in outsourcing of revenue cycle management services across the globe. The advanced value-added features provided by the market participants include remote coding services, payer connect, audit and compliance, and reporting and analytics have resulted in maximizing productivity and revenue generation that has influenced the growth of the market.

The major advantages of outsourcing the revenue cycle management are the availability of skilled and trained professionals, cost-effective and efficient services, and compliance to required rules and regulations. These advantages have led to the increased adoption of outsourcing services in recent years. For instance, as per the 2020 article published in Med USA, around two-thirds of the healthcare organizations are utilizing outsourcing services for their revenue cycle management needs. Hence, such increasing adoption is likely to fuel the growth of the market for revenue cycle management during the forecast period.

COVID19 revenue cycle management market impact: 18.0% increase in revenue growth

Pandemic Impact

Post COVID Outlook

The revenue cycle management market increased by 18.0% from 2019 to 2020, as per earlier projections the market was expected to be over USD 220 billion in 2020.

The RCM market is estimated to witness a y-o-y growth of approximately 12% in the next 5 years.

COVID-19 pandemic resulted in inconsistent patient volume, and unpredictable claim volumes. The rise in RCM complexities resulted in an increase in outsourcing.

The shift in focus of the healthcare organizations towards virtual engagements and telehealth is estimated to create further opportunities for the RCM market.

Pressure on RCM staff significantly increased due to increased claim denials, the development of new codes, and changing policies for COVID-19. Moreover, the sudden shift to remote working resulted in reduced efficiencies.

Players in the RCM industry are investing in the automation of RCM using artificial intelligence and robotic process automation to enhance process efficiency.

 

However, lack of proper reimbursement scenario is one of the major challenges faced by patients with respect to insurance and other formalities. The gap between reimbursement by government and private insurers is yet another factor hampering the market growth. For instance, according to a recent article published in Healthcare Financial Management Association (HFMA), the average span of reimbursement of payment by Medicare was around 28 days, while that of a private commercial insurer was twice than that. Such delay and discrepancy in reimbursement are creating hurdles in the adoption of such solutions.

Product Insights

In 2020, the software segment dominated the market for revenue cycle management and held the largest revenue share of 61.1%. An increasing amount of data in recent years owing to the digitalization of processes and streamlining for better patient care have led to the adoption of solutions; hence, healthcare analytical software solutions are used frequently and gaining traction. For instance, according to data published by Health Catalyst, 90% of healthcare organizations use data and analytical software to improve quality and revenue cycle management.

On the other hand, the service segment is projected to be the fastest-growing segment over the forecast period, owing to the growing number of market participants offering outsourcing services to healthcare facilities is expected to boost market growth over the forecast period. In addition, strategic initiatives undertaken by players are also factors likely to boost the growth of the market for revenue cycle management over the forecast period. For instance, in 2020, Cerner announced the sale of its revenue cycle management outsourcing business, Cerner RevWorks, to R1 RCM, Inc. This will help in the integration of technology platforms of both companies and extend R1’s RCM capabilities.

Type Insights

Based on type, the integrated segment dominated the market for revenue cycle management with a revenue share of 69.6% in 2020. This growth can be majorly attributed to various changes, such as the preference for volume-based payments instead of value-based payments. Another reason contributing to the growth of this segment is that integrated solutions provide a coordinated and streamlined format of a variety of financial activities via a single platform, which results in a uniform process of data collection and analysis.

The integrated segment is expected to witness the fastest CAGR over the forecast period. The growth may be attributed to factors such as the need for improving the efficiency of healthcare systems, the growing number of healthcare facilities, and rising healthcare costs. Other factors supporting market growth include benefits such as elimination of human errors and speeding up administrative functions.

Delivery Mode Insights

The web-based segment dominated the market for revenue cycle management and held the largest revenue share of 48.6% in 2020 and is anticipated to grow at a steady rate during the forecast period. Increasing adoption of web-based solutions is likely to fuel the overall market growth in the coming years. Advanced HIMS, Simplex HIMES, e-Hospital Systems, and athenaOne are some of the web-based practice management solutions available in the market.

On the other hand, the cloud-based segment is projected to grow rapidly and provide higher flexibility, coupled with cost-efficiency to end-users. Some of the major factors responsible for its largest share include stable internet access, readily available information that can be accessed even from remote locations, higher reliability and faster processing, and one-time update across all domains.

End-use Insights

In 2020, the physician back-office segment dominated the global revenue cycle management market and accounted for the largest revenue share of 37.9%. The rising focus of various healthcare institutions and organizations toward the implementation of these systems and increasing the number of physicians is likely to boost the market growth. For instance, the Association of American Medical Colleges is one such example striving toward increasing the number of physicians in the region. Such instances are beneficial in fuelling the market growth.

Global RCM market share, by end-use, 2020 (%)

The hospitals segment is anticipated to grow at the fastest rate over the forecast period, owing to the rise in scrutiny associated with patient safety by regulatory authorities. Hospitals predominantly use integrated revenue cycle management systems to bring all the hospital staff and patients together on a single platform. Patients, physicians, and payers are updated on the medications billed to an individual. This helps in maintaining a complete database history of purchases, which leads to higher quality and efficiency in healthcare administration.

Regional Insights

North America dominated the Revenue Cycle Management (RCM) market and accounted for the largest revenue share of 52.6% in 2020. Factors responsible for the large market share commanded by this region include the presence of numerous physicians’ offices across the U.S. In addition, amendments in regulatory guidelines such as the addition of ICD-10 in 2015 led to the growing demand for HIT systems including revenue cycle management systems to improve the efficiency of healthcare delivery. Furthermore, the presence of large established hospitals and healthcare infrastructures, favorable regulations, and increased need for reducing healthcare costs present lucrative growth opportunities for the market in North America.

In Asia Pacific, the market is estimated to witness the fastest growth over the forecast period owing to supportive government initiatives to improve the quality of healthcare delivery using HIT systems, rising healthcare expenditure, and growing unmet healthcare needs of the population. Moreover, the ease of doing business in the Asia Pacific is high due to low manufacturing costs and the availability of cheap labor. This is also a high-impact rendering driver for market growth in the region.

Key Companies & Market Share Insights

The key market leaders are undertaking various initiatives for expanding their geographic footprints in the market. Mergers and acquisitions, the launch of new services including streamlined billing, claims submission and claims management, expansion of operations in various countries, and broadening distribution networks for providing variously integrated and standalone revenue cycle management solutions to end-users are few strategies adopted by these companies.

Companies are undergoing mergers and acquisitions in order to increase their technological capabilities or to expand their product portfolios in the revenue cycle management market. For instance, in October 2019, eSolution—a healthcare technology company acquired Medidal—a provider of payer search, transfer DRG, and pharmacy reimbursement solutions to maintain its commitment of offering revenue cycle management products to improve workflow efficiency and save customers’ money and time. Some of the prominent players in the revenue cycle management market include:

  • The SSI Group, Inc.

  • AllScripts Healthcare, LLC

  • Experian Health, R1 RCM Inc.

  • McKesson Corporation

  • athenahealth, Inc.

  • Epic Systems Corporation

  • NXGN Management, LLC

  • CareCloud Corporation

  • Quest Diagnostics, Inc.

  • R1 RCM Inc.

Revenue Cycle Management Market Report Scope

Report Attribute

Details

Market size value in 2021

USD 295.8 billion

Revenue forecast in 2028

USD 633.6 billion

Growth Rate

CAGR of 11.5% from 2021 to 2028

Base year for estimation

2020

Historical data

2016 - 2019

Forecast period

2021 - 2028

Quantitative units

Revenue in USD million and CAGR from 2021 to 2028

Report coverage

Revenue forecast, company ranking, competitive landscape, growth factors, and trends

Segments covered

Product, type, delivery mode, end-use, region

Regional scope

North America; Europe; Asia Pacific; Latin America; MEA

Country scope

U.S.; Canada; U.K.; Germany; France; Italy; Spain; Russia; China; Japan; India; South Korea; Australia; Singapore; Mexico; Brazil; Argentina; South Africa; Saudi Arabia; UAE

Key companies profiled

The SSI Group, Inc.; AllScripts Healthcare, LLC; Experian Health, R1 RCM Inc.; McKesson Corporation; athenahealth, Inc.; Epic Systems Corporation; NXGN Management, LLC; CareCloud Corporation; and Quest Diagnostics, Inc.

Customization scope

Free report customization (equivalent up to 8 analyst’s working days) with purchase. Addition or alteration to country, regional & segment scope.

Pricing and purchase options

Avail customized purchase options to meet your exact research needs. Explore purchase options


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 2016 to 2028. For the purpose of this study, GVR has segmented the global revenue cycle management market report on the basis of type, product, delivery mode, end-use, and region:

  • Product Type Outlook (Revenue, USD Million, 2016 - 2028)

    • Software

    • Services

  • Type Outlook (Revenue, USD Million, 2016 - 2028)

    • Integrated

    • Standalone

  • Delivery Mode Outlook (Revenue, USD Million, 2016 - 2028)

    • On-premise

    • Web-based

    • Cloud based

  • End-use Outlook (Revenue, USD Million, 2016 - 2028)

    • Physician Offices

    • Hospitals

    • Diagnostic Laboratories

    • Others

  • Regional Outlook (Revenue, USD Million, 2016 - 2028)

    • North America

      • U.S.

      • Canada

    • Europe

      • U.K.

      • Germany

      • France

      • Italy

      • Spain

      • Russia

    • Asia Pacific

      • China

      • Japan

      • India

      • Singapore

      • South Korea

      • Australia

    • Latin America

      • Mexico

      • Brazil

      • Argentina

    • MEA

      • South Africa

      • Saudi Arabia

      • UAE

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