U.S. Revenue Cycle Management Market Size, Share & Trends Analysis Report By End User, By Product Type, By Component, By Delivery Mode, By Physician Specialty, By Sourcing, By Functions, And Segment Forecasts, 2021 - 2028

Report Overview

The U.S. revenue cycle management market size was valued at USD 120.7 billion in 2020 and is expected to grow at a compound annual growth rate (CAGR) of 11.2% from 2021 to 2028. The rising need for optimization of organizational workflow coupled with growing innovation in synchronized management software and systems is anticipated to promote the growth of the revenue cycle management (RCM) market. 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. The healthcare industry can leverage the efficacy & economic value presented by third-party RCM service providers and focus more on a key purpose, which is patient care. The changing aspects of service outsourcing in healthcare RCM are largely driven by finances, business prospects, and value addition.

The major advantages of outsourcing RCM tasks include the availability of skilled & trained professionals, cost-effective & efficient services, and compliance with rules & regulations. Therefore, the increase in outsourcing of services as many healthcare services mandatorily require resources & skillsets for the implementation of RCM solutions is driving the market growth. The Covid-19 pandemic has significantly affected almost all industries across the globe, specifically the healthcare sector. The healthcare providers in the country have reported a significant rise in patient volume, which has also impacted the healthcare costs and medical billing complexities. Due to this, there is a rise in outsourcing of RCM services in the U.S. as providers need to engage in collaborations for outcome-based, service-level agreement-driven RCM services.

Furthermore, the pandemic has also created unstable staffing requirements for front-, middle- and back-office RCM functions owing to the fluctuation in claim volumes. The current staffing models in the hospitals tend to handle normal operations. The manual RCM workflows don’t enable effective remote operations. Due to this, the demand for outsourced RCM services increased rapidly during the pandemic.

Moreover, as the healthcare industry continues to progress, health systems and hospital revenue cycle managers have to adapt to rapid market developments and hurdles by identifying opportunities to enhance patient fulfillment, efficiency, and financial condition of organizations. A one-stop shop dealer version can produce better productivity in RCM. Opportunities for better effectiveness include condensed organizational overhead & vendor supervision time, creation and implementation of best practices, better profit collection rates, improved accounts receivable outstanding days, improved patient satisfaction to decrease downside consequences, and incentives for attaining a higher ranking.

However, the shortage of skilled IT professionals is one of the major challenges faced by the market. Healthcare facilities face challenges in terms of resource allotment & management, rising costs, and management of insurance claims. This increases the need for skilled professionals with technical knowledge to manage Health Information Technology (HIT) systems deployed at these facilities. However, the RCM system is a recent development in healthcare IT, which is why there is a dearth of skilled professionals who can efficiently manage this system.

Component Insights

In 2020, the services component segment accounted for the largest revenue share of more than 66% owing to the predominant trend of outsourcing services. The segment will expand further at the fastest CAGR from 2021 to 2028 due to strategic initiatives are undertaken by companies. For instance, in 2020, Cerner announced the sale of its RCM 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.

The software component segment is projected to register a steady CAGR over the forecast period. The increasing streamlining and digitalization of processes for better patient care have led to the adoption of healthcare analytical software solutions. Software is gaining acceptance due to the recent trends of centralization within the healthcare industry in various geographies and the increasing complexities of patient care and payments.

Product Type Insights

Based on product type, the integrated solutions segment dominated the market with a revenue share of over 70% in 2020. The segment will grow further at the maximum CAGR from 2021 to 2028 owing to increasing technological advancements and the rising adoption of RCM tools by various healthcare providers. Moreover, integrated solutions are end-to-end systems that enhance data sharing & interoperability capabilities, which further improves the efficiency of care delivery across the continuum.

Moreover, factors, such as the growing adoption of Electronic Health Record (EHR) systems by healthcare networks worldwide, the rising need to improve the efficiency of healthcare systems & curtail healthcare costs, and the availability of several integrated RCM solutions in the U.S. market, are expected to fuel the segment growth over the forecast period.

Delivery Mode Insights

The web-based delivery mode segment held the maximum market share of over 57% in 2020 and is anticipated to grow at a steady CAGR during the forecast period. Increasing adoption of web-based solutions is the key factor driving the segment growth. Advanced HIMS, Simplex HIMES, e-Hospital Systems, and athenaOne are some of the web-based practice management solutions available in the U.S. market.

On the other hand, the cloud-based solutions segment is projected to register the fastest growth rate over the forecast period. Cloud computing has revolutionized the healthcare industry with ongoing collaborations among various healthcare institutions and professionals. Medical workers can share data; thus, the ability to provide treatment options is one of the prominent features of cloud-based solutions. These are some of the factors responsible for the fastest growth of this segment.

End-user Insights

In 2020, the hospitals segment dominated the U.S. Revenue Cycle Management (RCM) market with a revenue share of 58.5%. Improving revenue cycle implementation is a significant requirement for hospital leaders, and they are executing new technology and collaborating with vendors to steer the ever-changing reimbursement environment, which is likely to boost the segment growth. Furthermore, the revenue cycle advisors are continuously looking for schemes to develop the financial health of their corporations, thus, increasing the demand for RCM software & services in hospitals.

The physician and clinical services segment is expected to record the fastest CAGR over the forecast period owing to the rising focus of various healthcare institutions and organizations on the execution of these systems and increasing the number of physicians. Furthermore, the increasing demand for physician consultation and remote monitoring due to Covid-19 is expected to positively influence the growth of this segment.

Physician Specialty Insights

In 2020, the others' specialty segment dominated the overall market with a revenue share of over 70%. Increasing insurance coverage for a large number of applications is resulting in the demand for RCM solutions in the majority of specialties, which is one of the key factors for the large share of this segment.

The cardiology segment is expected to witness the fastest CAGR over the forecast period. Cardiology and its costly treatment procedures require RCM service as it improves the effectiveness of these procedures and manages medical billing, patient care, and others, particularly when patients are amongst the biggest groups of payers. According to the American College of Cardiology Foundation, in 2013-2016, around 6.2 million Americans suffered from heart failure. With the rise of incidences of cardiology cases, the workload on the payers and the hospital staff increases, driving the segment growth.

Sourcing Insights

Based on sourcing, the in-house segment dominated the market with a revenue share of over 75% in 2020. The largest share is attributable to the benefits offered by in-house sourcing, such as accessibility of in-house medical billers, maintaining control of the entire coding operations, and patient confidentiality over patient records. On the other hand, the outsourcing segment is expected to record the fastest growth rate from 2021 to 2028.

The increasing number of companies providing outsourcing services to healthcare facilities is anticipated to augment the segment growth over the forecast period. Furthermore, the increasing healthcare burden and a large amount of patient data generation can lead to errors in medical billing and other processes. For instance, according to an article published in 2020 in Med USA, around 80% of the medical billings carried out in the country contained at least one error. Thus, outsourcing can help in reducing errors, thereby providing smooth functioning of all the aspects of RCM.

Functions Insights

The claims management segment accounted for the largest revenue share of more than 51% in 2020. The segment is expected to retain its leading position throughout the forecast years. The increasing patient pool, growing geriatric population, and favorable government policies pertaining to medical insurance are among the key factors responsible for the rapidly increasing number of claims & workload of payers.

The aforementioned factors are accountable for the high penetration of claims management software and services in the market. On the other hand, the care management segment is anticipated to register the fastest growth rate over the forecast period owing to the growing demand for mobile health apps that can enhance a patient’s capability to handle circumstances in a considerably easy manner.

Key Companies & Market Share Insights

Prominent companies are undertaking various business strategies, such as widening their product portfolio, and mergers & acquisitions, and geographic expansion, to gain a higher share in the market. For instance, Athenahealth, Inc. partnered with QuickCred to provide QuickCred’s compliance and credentialing system with Athenahealth’s RCM systems in October 2019. In April 2018, Cognizant acquired Bolder Healthcare Solution to integrate its RCM solution with its existing BPS and other IT services. This would enable Cognizant to expand its reach into healthcare institutes. Market players are also focusing on new product launches and network expansion to provide patient-centric services. Some of the key companies in the U.S. Revenue Cycle Management (RCM) market include:

• The SSI Group, Inc.

• McKesson Corp.

• AllScripts Healthcare, LLC

• Athenahealth, Inc.

• Epic Systems Corp.

• NXGN Management, LLC

• Oncospark, Inc.

• eClinicalWorks

U.S. Revenue Cycle Management Market Report Scope

Segments Covered in the Report

This report forecasts revenue growth at the country level 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, Grand View Research has segmented the U.S. revenue cycle management market report on the basis of end user, product type, component, delivery mode, physician specialty, sourcing, and functions:

• End-user Outlook (Revenue, USD Billion, 2016 - 2028)

  • Hospitals

  • Physician & Clinical Services

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

  • Integrated System

  • Standalone System

• Component Outlook (Revenue, USD Billion, 2016 - 2028)

  • Software Solution

  • Services

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

  • On-premise

  • Web-based

  • Cloud-based

• Physician Specialty Outlook (Revenue, USD Billion, 2016 - 2028)

  • Oncology

  • Cardiology

  • Anesthesia

  • Radiology

  • Pathology

  • Pain Management

  • Emergency Services

  • Others

• Sourcing Outlook (Revenue, USD Billion, 2016 - 2028)

  • In-house

  • External RCM Apps/Software

  • Outsourced RCM Services

• Functions Outlook (Revenue, USD Billion, 2016 - 2028)

  • Product Development

  • Member Engagement

  • Network Management

  • Care Management

  • Claim Management

  • Risk and Compliances