Provider network management helps payer organizations to manage their provider’s network for increasing their efficiency, consistency, and accuracy. With provider network management, the payer organizations can negotiate contracts, process their claims with greater accuracy, and manage their network with greater efficiency. This results in time optimization, error reduction, and cost reduction providing the organizations with optimal financial results and increased provider satisfaction. This market is categorized into services and platforms/software.
Growth in the healthcare provider network management market is likely to be centered in the North America region. Growth in North America can be attributed to the increase in health insurance coverage triggered by the Patient Protection and Affordable Act (PPACA) in the U.S., the rising need to curtail escalating healthcare costs in the U.S. and Canada, and the government focus on healthcare IT solutions in Canada.
U.S. have seen increase in the health insurance coverage as a direct result of the Patient Protection and Affordable Care Act (passed in March 2010). With the increase in the number of people covered under insurance and improvements in the quality of healthcare provided, the workload for the payer organizations is likely to increase. The provider network management services and solutions are aimed help the payer organizations with the workload. In line with this, the companies in the U.S. are increase their presence by means of collaborations, agreements, and expansions in the country. For instance, in August 2015, Cognizant (U.S.) entered into an agreement with the New England Healthcare Exchange Network (NEHEN), a consortium of regional payers and providers in northeast U.S. Under this agreement, Cognizant and its subsidiary TriZetto will digitally transform and manage NEHEN’s technology infrastructure to foster seamless collaboration across member organizations, optimize costs, and improve efficiency and patient care. With the increase in the number of people covered under insurance and improvements in the quality of healthcare provided, the workload for the payer organizations will increase, which will boost the market for healthcare provider network management in the U.S.
Canada has seen government initiatives and investment in bringing the advanced technologies in the Canadian healthcare system. This initiative is aimed to make the system more transparent and accountable. IT solutions provide electronic health records that link consumers, payers, and providers across the continuum of care and provide relevant information to these stakeholder groups. The ability to integrate clinical and financial information is considered important for monitoring cost-effectiveness and facilitating service planning. These factors account for the governmental focus on healthcare IT solutions. Moreover, Growing expenditure has stimulated increasing work efficiency to further improve the quality of care across various healthcare delivery units, including payers. To deliver better services while maintaining their budgets, payers are looking for healthcare IT solutions such as provider network management.
Growth in the Canadian market is mainly driven by the rising need to improve the quality of healthcare in the country. This, in addition to the need for healthcare cost containment, is further propelling the adoption of cost-effective provider network management solutions among healthcare payers in Canada.