Driver: Implementation of initiatives to shift the burden of risk from healthcare payers to providers

Globally, various initiatives are being implemented to shift the burden of risk borne by healthcare payers to providers. This shift promotes the adoption of healthcare information technology (HCIT) solutions (such as care management solutions) to increase the efficiency of healthcare delivered and reduce unnecessary costs. For instance, in 2015, Medicare applied the Value-based Payment Modifier program to payments under the Medicare Physician Fee Schedule (PFS) for physicians in groups of 100 or more eligible practitioners.

The Value-based Payment Modifier program offers differential payment to a physician or group of physicians based on the quality of care furnished instead of the cost of care. Value-based care is also promoted through alternative payment models such as bundled payments, physician incentives, and consumer incentives, among others. These models of payment are designed to encourage healthcare providers to accept the accountability of care delivered, thus leading to the shift of risk from payers to providers.

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Restraint: High cost of deployment

Healthcare IT systems are high-priced software solutions. Moreover, the maintenance and software update costs of these systems may be more than the price of the software. Support and maintenance services (which include software upgrades as per changing user requirements) form a recurring expenditure, which amounts to almost 30% of the total cost of ownership. Lack of internal IT expertise in the healthcare industry necessitates training for end users in order to maximize the efficiency of various healthcare IT solutions, thereby adding to the cost of ownership of the systems. Hospitals often prefer investing in core technologies directly linked to the quality of care for patients than investing in technologies for allied departments of healthcare organizations. Thus, the high cost of deployment and maintenance restricts smaller healthcare organizations from investing in healthcare IT solutions, especially in the emerging markets across the APAC and Latin American regions.

Global Key Players:

The global care management market is projected to reach USD 19.28 billion by 2023 from an estimated USD 9.15 billion in 2018, at a CAGR of 16.1%. The care management market is rapidly emerging with many regional as well as international players. In 2017, the care management solutions market was dominated by a few large players, namely, EXL Service Holdings, Inc. (US), Casenet, LLC (US), Medecision Inc. (US), ZeOmega Inc. (US), Cognizant Technology Solutions (US), Cerner Corporation (US), Allscripts Healthcare Solutions, Inc. (US), and TCS Healthcare Technologies (US).

Product deployments and launches, acquisitions, partnerships, agreements, and collaborations were strategies adopted by key players between 2015 and 2018 to enhance their share in the care management market. Important players that adopted these strategies include EXL Service Holdings, Inc. (US), Casenet, LLC (US), Medecision Inc. (US), ZeOmega Inc. (US), Cognizant Technology Solutions (US), Cerner Corporation (US), Allscripts Healthcare Solutions, Inc. (US), and TCS Healthcare Technologies (US).

EXL Service Holdings, Inc. is one of the major players in the global care management solutions market. EXL also offers qualitative software tools by adopting advanced technologies. The company focuses on product deployments and partnerships to expand its business operations. In line with this strategy, from 2015-2018, EXL deployed its CareRadius suite of solutions in key organizations in the healthcare domain, such as Health Alliance Plan (HAP) (US), EmblemHealth Inc. (US), and Anthem, Inc. (US) to enhance its capabilities and competency in the care management market. In 2016, the company also partnered with organizations, such as Novu LLC, to develop solutions to enhance consumer satisfaction and reduce costs for payers and providers. Such developments helped the company to maintain and enhance its position in the market.

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Zeomega is another key player in the global care management solutions market. The company provides the integrated Jiva medical management platform to enable payers and care-delivery organizations to improve health outcomes and performance. Zeomega focuses on partnerships and product deployments to enhance its market presence. For instance, in February 2016, ZeOmega partnered with Vivify Health, Inc. (US) to integrate ZeOmega’s Jiva platform with Vivify mobility applications. The partnership was aimed at managing chronic care across multiple populations, such as the frail and elderly, and populations with complex co-morbidities. The partnership helped ZeOmega to extend the reach of its Jiva platform across a wide variety of care settings, including patient homes.

Some of the other players competing in this market are Koninklijke Philips N.V. (Netherlands), IBM Corporation (US), Health Catalyst Inc. (US), Harmony Information Systems, Inc. (US), Salesforce.com, Inc. (US), i2i Systems, Inc. (US), Pegasystems Inc. (US), and Epic Corporation Inc. (US).

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