Global Healthcare Reimbursement Market

The community oncology services market consists of sales of community oncology services by entities (organizations, sole traders and partnerships) of health practitioners who practice community oncology as a private physician-owned business not part of a hospital or academic or medical teaching institution. The community oncology practice may be only a single oncologist, with one office and a support staff of physician extenders, nurses, pharmacists, or pharmacy technicians and other staff. Only goods and services traded between entities or sold to end consumers are included. The global community oncology services market is expected to decline from $77.4 billion in 2019 to $70.98 billion in 2020 at a compound annual growth rate (CAGR) of -8.29%. The decline is mainly due to the acquisitions of private healthcare institutions and changes in patients preference to choose other healthcare providers due to ease of insurance claim processes. The market is further expected to decline to $70.38 billion in 2023 at a CAGR of -0.29%. The lower-cost care in community oncology centers is anticipated to boost the demand for the community oncology service market. The cancer care services are considered to be cost-effective in community oncology centers as compared to hospitals. According to the Community Oncology Alliance’s report published in October 2018, the cost of cancer care per patient per month for various tumors in community-based clinics (CCs) was approximately $12,000 whereas the cost of cancer care in hospital-based oncology clinics (HCs) was about $20,000. Furthermore, the cost per patient per month for treatment of chemotherapy in a community setting was nearly $5,000 compared to around $8,500 in hospital-based clinics. Hence, the low cost of community oncology settings or community oncology centers is expected to drive the demand for the community oncology services market over the forecast years. Coronavirus outbreak is likely to act as a major restraint for the growth of the community oncology services market during the forecast period. The World Health Organization (WHO) declared the COVID-19 outbreak as pandemic on March 11, 2020. Coronavirus has created a significant risk of mortality for cancer patients worldwide. COVID-19 is predicted to have a long-term impact on oncology practices. According to a survey conducted by the Medical Group Management Association in April 2020, the healthcare practices recorded a decline of 55% in the revenue and a 60% decline in the patient volume since the beginning of the COVID-19 pandemic. Moreover, according to a survey of 51 USA oncologists conducted by MJH Life Sciences during May 2020, 73% of the oncologist limited their surgeries to urgent cases, 53% modified dosing regimens to reduce in-patient visits, and 71% had canceled routine office visits of the patients. Therefore, the coronavirus outbreak has caused a rapid decline in overall oncology in-person services, subsequently impacting the community oncology services market. Major companies are undergoing various acquisition and research collaboration in the community oncology services market to expand their services and offerings, which is gaining significant popularity over the recent years. According to a report published by Community Oncology Alliance in April 2020, the rate of community oncology practices acquired by hospitals increased by 9.7% during 2018 and 2020. For instance, in August 2020, The Community Cancer Center, a US-based clinic engaged in providing community-based cancer care, was acquired by Carle Health. Carle Health is a US-based hospital and healthcare company with more than 9,500 employees in its five hospitals and associated healthcare business. In addition to this, in May 2019, Amgen Inc., a US-based biopharmaceutical company, announced the new research collaborations with community oncology networks. Amgen Inc., also launched Amgen Community Oncology Research Collaborators (ACORC), a new initiative to improve access to innovative oncology clinical research for community centers. In May 2019, Amgen announced its decision to collaborate with community oncology service providers such as US Oncology Research and TRIO-US to enhance access by community centers to innovative oncology clinical research. This collaboration is expected to allow Amgen to significantly expand its clinical research footprint to more than 200 patient care sites across the U.S. and help community centers reach more than 900,000 new patients each year with investigational medicines.

The fertility services market consists of sales of infertility treatment services and related products by entities (organizations, sole traders and partnerships) that provide infertility treatment services which are used in various applications to treat infertile patients. Fertility treatment is a medical procedure intended to increase the chances of conceiving a child. Only goods and services traded between entities or sold to end consumers are included The global fertility services market is expected to decline from $17.67 billion in 2019 to $16.95 billion in 2020 at a compound annual growth rate (CAGR) of -4.08%. The decline is mainly due to the COVID-19 outbreak that has led to deferred care in order to avoid visiting hospitals, which resulted in reduced patient volume. The market is then expected to recover and reach $22.47 billion in 2023 at a CAGR of 9.86%. Growing infertility rates are anticipated to boost the demand for fertility services during the forecast period. Various social and environment-related factors such as lifestyle changes including obesity, stress or depression, and high consumption of alcohol contribute to a surge in infertility rates, thereby generating the high requirement for fertility services. According to the Indian Journal of Community Medicine, as of 2019, around 15 to 20 million or 25% of the couples suffer from infertility annually, thus driving the demand for fertility services. The high cost of fertility services is expected to limit the growth of the fertility services market. The cost of in-vitro fertilization (IVF) primarily depends on infertility workup and varies from person to person. For instance, the average cost of one in-vitro fertilization (IVF) cycle is $12,000. The range of cost involved in one IVF cycle can be between $10,000 and $15,000, which excludes the cost of medication which may be as low as $1,500 or as high as $3,000 per cycle. The IVF cost is continuously rising attributing to modern diagnostic tests and various treatment methods such as hysteroscopy, IUI, and laparoscopy being used to facilitate and aid infertility treatment cost. Therefore, the high cost of fertility treatment is to act as a major challenge for the development of the fertility services market. Companies in the fertility services market have witnessed significant growth in the number of research collaborations as well as research funding approvals. Key companies operating in the market are projected to increase their R&D expenditure to introduce new advanced techniques and drugs used for fertility treatments. For instance, in June 2019, Thermo Fisher Scientific announced a research collaboration with Predictive Laboratories, a wholly-owned subsidiary of Predictive Technology Group, Inc., concentrating on studying the genetic factors causing infertility in women. The collaboration is expected to utilize Thermo Fisher Scientific`s offerings for reproductive health including Ion ReproSeq PGS Assay, Applied Biosystems CarrierScan Assay, Ion AmpliSeq Exome RDY for whole-exome sequencing, and CytoScan Dx Assay. Furthermore, in March 2019, Olympus Corporation, a Japan-based company, announced a collaboration with the Jikei University School of Medicine to develop AI-assisted sperm selection, which aims to reduce the workload in intracytoplasmic sperm injection (ICSI). The research is expected to help embryologists to select good sperm. In July 2019, Monash IVF Group, an Australia-based IVF company, acquired Fertility Solutions, a Queensland-based provider of fertility services for $1.43 million (AUD 2.1 million). The company acquired certain assets, liabilities, and contracts of Fertility Solutions. The acquisition is expected to expand the geographical presence of Monash IVF Group with two clinics of Fertility Solutions located in Bundaberg and Sunshine Coast. Fertility Solutions was established in 2007 and is engaged in providing affordable and high-quality options for fertility services. The company operates as an assisted reproductive service (ARS) clinic with locations in Bundaberg and Buderim.

The payer services market consists of sales of payer services by entities (organizations, sole traders and partnerships) that provide healthcare services that are outsourced by healthcare insurance providers/payers. These outsourcing solutions help the payers to streamline their business processes and deliver better services to their customers. Only goods and services traded between entities or sold to end consumers are included. The global payer services market is expected to grow from $88.97 billion in 2019 to $93.9 billion in 2020 at a compound annual growth rate (CAGR) of 5.5%. The exponential growth is mainly due to the COVID-19 outbreak that has led to an increase in demand for services for medical billing and claims. The market is then expected to adjust and reach $134.65 billion in 2023 from 2021 at a CAGR of 12.77%. The increase in healthcare frauds is expected to drive the payer services market for tightening its security systems. Healthcare fraud includes malpractices such as individuals obtaining subsidized or fully-covered prescription pills that are actually unneeded and then selling them on the black market for a profit billing by practitioners for care that they never rendered, filing duplicate claims for the same service rendered, altering the dates and modifying medical records. The healthcare industry continues to suffer losses attributed to frauds and errors. For instance, according to the National Health Care Anti-Fraud Association, in the USA the loss from healthcare fraud was estimated to be $300 billion in 2018. Therefore, increasing healthcare fraud in the healthcare industry is propelling the demand for rigid security systems, thereby driving the growth of the payer services market. The rising incidences of data breaches and loss of confidentiality have always been a major challenge in the payer service industry. In recent years, the healthcare sector has always been at the forefront in cases of breaching privacy and the resulting loss of confidential data. The healthcare sector accounted for 45% of data breaches in 2019 costing the sector more than $17.76 billion. Moreover, in August 2019, Avenna Healthcare in Georgia detected a phishing attack on 166,077 patients in February and began notification of a potential breach. This was caused due to improper maintenance of information leading to vulnerable cyber-attack. Rising incidences of data breaches and loss of confidentiality are thus hampering the growth of the payer service market. Increased adoption of technologically advanced products is gaining substantial popularity in the payer services market. This has led to improved price transparency, affordable payer services, higher utilization of resources, increasing quality reach, and member satisfaction and loyalty towards the service provider. For instance, in July 2019, Blue Shield California (BSC), with the help of Gemini Health, has built up an online tool to remove out-of-pocket drug spending for individuals. The price transparency tool plots the cost data for accessible suppliers and medical clinics. The innovation recommends lower-cost choices like it coordinates the current drug with lower-cost, dose-equivalent options. In April 2020, Molina, a US-based company engaged in providing managed care in the field of medicare and medicaid programs, announced that it will purchase Magellan Complete Care (MCC), a managed healthcare organization, in a deal worth about $820 million. The acquisition is expected to expand Molina’s geographic footprint in its core businesses of managed medicaid. Magellan Complete Care (MCC) is a US-based company offering care management solutions.

The revenue cycle management software market consists of sales of revenue cycle management software services by entities (organizations, sole traders and partnerships) that provide revenue cycle management, which is the financial process, utilizing medical billing software, that healthcare facilities use to track patient care episodes from registration and appointment scheduling to the final payment of a balance. Only goods and services traded between entities or sold to end consumers are included. The global revenue cycle management software market is expected to decline from $64.26 billion in 2019 to $63.39 billion in 2020 at a compound annual growth rate (CAGR) of -1.35%. The decline is mainly due to the COVID-19 outbreak that has led to deferred care in order to avoid visiting hospitals, which resulted in reduced patient volume. Elective procedures have been canceled increasing the financial stress of healthcare service providers, thereby affecting the RCM software market. The market is then expected to recover and reach $95.02 billion in 2023 at a CAGR of 14.44%. The rise in the number of hospital and outpatient visits is expected to drive the revenue cycle management software market. Surging healthcare expenditure from an increase in patient visits to the hospital urges the service providers to provide hassle-free services during payment and keep a record of patients’ payments. According to the National Health Expenditure Projections 2018-2027, the USA national healthcare expenditure is expected to reach nearly $6.0 trillion by 2027, growing at an average rate of 5.5% annually, during the period. The increase in the number of patient visits impels the healthcare service providers to adopt revenue cycle management software in healthcare facilities that will provide faster and more accurate claims transmission allowing flexibility in arranging patient care. The lower adoption rate of automated systems due to the shortage of skilled professionals limits the growth of the revenue cycle management software market. An inefficient revenue cycle management system leads to loss of revenues and productivity. The providers are facing issues in leveraging the technology to drive long-term process improvement. For instance, it was estimated that only 14% of healthcare providers use advanced modeling tools to predict patients’ ability to pay. This limits the ability of front-office staff to have financial discussions at the point of service. Many service providers have not upgraded their technology due to lack of technical knowledge, awareness, and resources restraining the revenue cycle management software market. Incorporating artificial intelligence (AI) in revenue cycle management software is shaping the revenue cycle management software market. Major healthcare analytics leaders are actively implementing or planning to execute an AI strategy that will help make decisions faster and reduce operational expenses. For instance, in April 2019, VisiQuate, Inc., a leader in healthcare business analytics, has announced a formal partnership with Etyon Health to integrate the business analytics platform and deep machine-learning algorithms to improve performance continuously through enhanced operational insights and automate the claim decisions based on complex data science. Etyon Health is a developer of AI-driven RCM solutions. In June 2020, R1 RCM, a Chicago-based healthcare revenue management cycle company serving hospitals and physician groups, agreed to acquire Cerner RevWorks for a deal amount of $30 million. The acquisition is expected to extend the comprehensive revenue cycle capabilities of R1 and help driving sustainable financial improvements for healthcare providers and to enhance their patients overall experience. RevWorks is a revenue cycle management-outsourcing division of Cerner.

The value based care payment market consists of sales of value based care payment services by entities (organizations, sole traders and partnerships) that provide value based care payment in which healthcare providers such as hospitals are paid based on patient`s health outcome, quality, efficiency, cost, and patient experience. Only goods and services traded between entities or sold to end consumers are included. The global value based care payment market is expected to decline from $1.66 billion in 2019 to $1.52 billion in 2020 at a compound annual growth rate (CAGR) of -8.39%. The decline is mainly due to the COVID-19 outbreak that has resulted in losses in attributions, missed outcome metrics, and struggles with reporting requirements. The market is then expected to recover and reach $3.03 billion in 2023 at a CAGR of 25.81%. Rapid development in value-based health care services is expected to contribute to the tremendous growth of the market. Healthcare cost curve and unnecessary health expenditure have been reduced to almost 5.6% on average due to value based healthcare services. According to UnitedHealth Group, a US-based health insurance company, in 2019, value based payments to healthcare providers have recorded a growth of more than 15% supporting incentives to practice supreme quality care while enhancing the effective use of health system resources. Furthermore, UnitedHealth predicted that $75 billion of its payments to medical care providers will be attached to value-based care relationships by the end of 2020. Likewise, the quantity of Accountable Care Organizations (ACO) is expanding, giving more protection inclusion. For example, according to a 2018 analysis in the Journal Health Affairs, there were more than 1,000 ACOs spread across the USA in 2017, which represented more than 1,400 contracts with commercial and government insurers covering more than 32 million Americans. Therefore, rapid expansion in value-based health care services is driving the market by increasing the effective usage of services provided to customers focusing on value-based care model rather than the fee-for-service model. The lack of health care infrastructure is expected to limit the growth of value based care payment market. The main reason for this dearth is the lack of willingness of organizations to take the technological risk. For instance, according to a survey, a large portion of the organizations are yet to embrace artificial intelligence (AI) to accelerate value-based care. About 43% of healthcare organizations are uncertain about actualizing AI and another 21% are not prepared for any AI-related innovation. Moreover, only 13% are prepared for AI and have an execution plan set up attributing to the lack of trained staff with knowledge of data analytics. In addition to this, according to a survey of 2,900 medicinal executives through the span of a year, many healthcare facilities lack the infrastructure to integrate patient data effectively, which implies that value-based care payment cannot be used in these organizations. These factors are expected to impact healthcare infrastructure by limiting the growth of value based care payment market. Partnerships in value based care are gaining popularity among the providers as these partnerships allow partners such as manufacturers, payers, and provider organizations to co-develop programs, solutions, and initiatives collaboratively for the benefit of patients and healthcare systems. Value-based partnerships assist with conveying the highest value incentive to the healthcare system and society by concentrating on improving patient results with regards to the system and societal total costs. For instance, in March 2018, UnitedHealth Group’s health business services arm Optum announced a partnership with HealthBI, a workflow platform for health management and value based care initiatives, aiming at creating an industry-changing operation model for the provider to practice and improve value based care. In August 2019, Signify Health, a US-based technology company that supports in-home care and provides care management services announced its plan to merge with Remedy Partners. The merger helps the two companies to bring together technology, data, and network assets, including 9,000 credentialed providers and a combined nationwide partner network of over 300 provider systems, 2,000 post-acute organizations, and over 200 community locations. Remedy Partners is a US-based software company that collaborates with healthcare organizations to launch bundled payment programs.

The robotic surgery services market consists of the sale of services provided Robotic surgical technology, the highly advanced technological form of non-invasive surgery that utilizes robots and computer systems to conduct surgeries with lesser incision and more precision. The commonly used robotic surgical system consists of a mechanical arm and camera arm attached to surgical instruments with a controlled by a surgeon being seated at a computer console which is usually in the same room as the surgical table, or can be around the world.

Retirement Communities Market Definition

The retirement communities market consists of sales of retirement community care services and related goods by entities that provide accommodation and nursing care services for the elderly who are generally able to care for themselves but might require assistance from home care agencies. The care in retirement communities’ service typically includes room, board, supervision, and assistance in daily living, such as housekeeping services. Activities and socialization opportunities are often provided by retirement communities. The major clientele for retirement communities is the population aged 60 years and above.

Psychiatrists Market Definition

The psychiatrists market consists of sales of psychiatrists services and related goods by entities (organizations, sole traders and partnerships) that provide the diagnosis, treatment and prevention of mental, emotional and behavioral disorders. The psychiatrists industry includes establishments of licensed practitioners having the degree of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathic Medicine) that provide palliative care, treat psychosomatic disorders, mental disorders and others. Psychiatrists operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or health maintenance organization (HMO) medical centers.