Patient Access/Front-end RCM Solutions Market

Front-end RCM Solutions: Improving Revenue Cycle Management in Healthcare

Revenue Cycle Management (RCM) is a critical component of the healthcare industry, as it ensures timely and accurate payments for services rendered to patients. With the increasing complexity of the healthcare system and the rising cost of care, it is more important than ever for healthcare organizations to optimize their RCM processes to improve financial outcomes.

One area of RCM that is gaining significant attention is front-end solutions. Front-end RCM solutions refer to the processes and technologies used to manage patient-facing activities, such as registration, eligibility verification, and pre-authorization. These solutions are designed to improve the accuracy and completeness of patient information, reduce errors, and increase the efficiency of the billing process.

Front-end RCM solutions offer several benefits for healthcare organizations. First and foremost, they help reduce claim denials by ensuring that patient information is accurate and complete before services are rendered. This not only improves the accuracy of claims but also reduces the time and resources needed to address denials, which can be a major burden for healthcare organizations.

Another benefit of front-end RCM solutions is that they can help improve patient satisfaction. By streamlining registration and eligibility verification processes, patients can receive care more quickly and with less frustration. This can lead to higher patient retention rates and improved patient outcomes.

Front-end RCM solutions also have a positive impact on the financial health of healthcare organizations. By reducing denials and improving the accuracy of claims, organizations can increase revenue and reduce the administrative costs associated with managing the billing process. Additionally, by improving patient satisfaction and retention rates, organizations can attract and retain more patients, further boosting their bottom line.

In terms of technology, front-end RCM solutions typically involve the use of software platforms and tools that integrate with other RCM systems, such as electronic health record (EHR) systems and billing software. These solutions can be customized to meet the specific needs of healthcare organizations, and can include features such as patient portals, online payment processing, and automated eligibility verification.

There are several companies in the healthcare industry that specialize in front-end RCM solutions. These companies offer a range of products and services, including software platforms, consulting services, and outsourced billing and coding services. Some of the leading companies in this space include Experian Health, Availity, and Change Healthcare.

In conclusion, front-end RCM solutions are becoming increasingly important for healthcare organizations looking to improve their financial outcomes and patient satisfaction rates. By streamlining patient-facing activities, reducing claim denials, and improving the accuracy of claims, these solutions offer significant benefits for healthcare organizations of all sizes. With the right technology and expertise, healthcare organizations can implement front-end RCM solutions that meet their specific needs and improve their bottom line.

Patient access solutions Market Dynamics

Drivers in Patient Access Solutions Market

The Patient Access Solutions market is influenced by a range of drivers and factors, with one of the most significant being the growing importance of denials management. Insurance companies are increasingly denying claims and coverage to patients with chronic or persistent illnesses, in order to reduce costs and maximize profits. This trend places a greater burden on healthcare providers to manage operating costs, which has led to an increased adoption of healthcare IT solutions, such as patient access solutions.

Despite the global adoption of healthcare IT solutions, many healthcare providers still rely on manual and paper-based approaches to manage denials. Such methods can result in errors, delayed follow-ups, and miscommunication between healthcare providers and insurance companies. While some providers use technology to automate aspects of the process, the lack of integration with workflows often prevents them from using technology to its full potential. Automated patient access software, including medical necessity, prior authorization, and denials and appeals management solutions, offer healthcare providers a means of saving significant revenue, while also identifying trends in errors to prevent future denials.

Restraints in Patient Access Solutions Market

The healthcare industry is plagued by a rising number of data breaches, which are primarily caused by hacking or IT-related incidents. Unauthorized access or disclosure is the second most common cause of data breaches, while loss and theft are less prevalent. In the US, the number of healthcare data breaches recorded by the HIPAA Journal in 2023 has increased by 66% compared to 2018. HIPAA-covered companies and business associates paid around USD 14 million for HIPAA violations in 2021 and USD 16 million in 2020, according to a publication by the HIPAA Journal. As a result, developing a secure communication platform has become a significant challenge for IT vendors who cater to the healthcare industry.

Opportunities in Patient Access Solutions Market

There are emerging healthcare IT markets that present promising growth potential. The Asia Pacific region is a highly lucrative market for patient access solutions due to the various government initiatives focused on the adoption of HCIT solutions, rising government spending on healthcare, and technological advancements in the healthcare sector. In Australia, there is significant potential for the adoption and implementation of patient access solutions, such as necessity and claims denial management solutions. The Australian government's state- and country-wide HCIT initiatives are supporting the adoption of these solutions, including the development of a fully integrated statewide electronic health record system by the State of South Australia. The Indian healthcare industry is also exploring the concept of a connected healthcare ecosystem, driven by changing demographics, increased healthcare expenditure, and rising healthcare awareness.

One of the primary challenges associated with patient access solutions is their relatively high deployment costs. These software solutions can be quite expensive, and the cost of maintaining and updating the software can often exceed the initial purchase price. Ongoing support and maintenance services, which include software upgrades, can account for up to 30% of the total cost of ownership. In addition, healthcare organizations may need to invest in training end users if they lack internal IT expertise, further increasing the cost of ownership.

Given these high costs, many hospitals prioritize investing in core technologies such as EHR and e-prescribing that are directly linked to patient care quality, over investing in technologies for other departments within the organization. This means that smaller healthcare organizations, particularly in emerging markets across Asia and Latin America, may be unable to invest in patient access solutions due to their prohibitive cost of deployment and maintenance.

In 2021, the software segment of the patient access solutions market is expected to experience the highest growth rate within the product and service category. This growth can be attributed to the benefits provided by software, such as efficient error management, a wide variety of options, and differentiated functions.

Among the various end-user segments, healthcare providers hold the largest share in the patient access solutions market during the forecast period. The significant market share of this segment is due to the increasing adoption of healthcare IT solutions, rising healthcare spending, and the need to manage escalating healthcare costs, which are the key factors supporting the adoption of patient access solutions among healthcare providers.

During the forecast period, North America is expected to hold the largest share of the patient access solutions market. This growth can be attributed to the region's stringent regulations, increased government support for improving healthcare infrastructure, and the presence of leading market players in the region.

Based on application, the data aggregation segment is expected to be the largest and fastest-growing segment in the patient access solutions market during the forecast period. This segment's growth can be attributed to the benefits provided by the solutions, such as on-demand self-serving analytics, no upfront investment in hardware, extreme capacity flexibility, and the pay-as-you-go pricing model.

The healthcare providers segment is projected to have the highest growth rate in the patient access solutions market in 2021. The rising demand for standardizing patient data, the generation of large amounts of healthcare data, the focus on patient safety, the significant growth in healthcare spending, the increasing rate of medical errors, growing denials, and increasing healthcare costs are expected to drive the demand for patient access solutions services in the future.

Denial management is an essential component of revenue cycle management. Hospitals can investigate every unpaid claim, identify trends, and appeal rejected claims. The importance of denial management is increasing, driving the need for patient access solutions. The number of denial claims is increasing, with the average claim denial rate exceeding 12% and increasing by more than 20% over the past five years, according to an article published in the Journal of AHIMA in April 2022. Healthcare providers are turning to healthcare IT solutions, such as patient access solutions, to properly analyze denial claims, driving the patient access solutions market's growth.

Patient portals help improve physician-patient relationships and give patients more control over their treatment. They can check lab results, request prescription refills, update insurance information, manage any unpaid balances, and more. The increasing demand for health insurance and accessibility of patient access solutions for maintaining such data is driving the market's growth. My Healthcare partnered with Amazon and Microsoft in November 2021 to integrate digital clinical solutions across expansive healthcare data, creating a patient longitudinal map. This system maintains a database of patients' insurance information and helps doctors in the fields of cardiology, pediatrics, and other fields ensure better medical outcomes.

The segment of claims denial and appeal management solutions is projected to experience substantial growth in the coming years, due to its ability to leverage both current and historical data to maintain comprehensive patient records. As healthcare organizations increasingly adopt electronic record keeping and other forms of data collection and storage, the volume of data available for analysis is growing exponentially. Numerous companies are now developing software that can analyze this data, thereby driving growth in this segment.

Patient access solutions encompass several types of software, including claims denial and appeal management solutions, payment estimation solutions, and other tools that facilitate patient registration and determine insurance eligibility. The increasing awareness of healthcare denial management has fueled the development of claims denial and appeal management solutions. For example, a study published in the Journal for Healthcare Quality in April 2022 found that a shortage of staff, increased workloads, and backlogs of procedures and claims denials have led to a rise in claim denials. Healthcare technology company Hayes discovered that 40% of claims related to COVID-19 care were denied in the first 10 months of 2021. Such issues are expected to drive the adoption of claims denial and appeal management solutions, thus promoting market growth.

In addition, the demand for these solutions is being propelled by technological advancements and the launch of new electronic health record (EHR) systems. Anomaly, for instance, introduced Anomaly Smart Response in August 2022, which utilizes AI to enable providers and payers to decrease avoidable claim denials, increase payment transparency, and reduce rework, all of which are crucial priorities for healthcare stakeholders. The product delivers real-time responses, predicting actionable denials and payment amounts so that providers can avoid and correct denials before they occur. Smart Response operates directly within providers' native workflows by integrating with payers, practice management software, and claims clearing houses. These types of advancements are expected to further drive growth in the claims denial and appeal management solutions segment in the future.

North America is expected to witness significant growth in the patient access solutions market over the forecast period. This growth can be attributed to various factors, including technological advancements, acquisitions, mergers, and partnerships by key market players. For instance, in May 2021, Optum collaborated with Bassett Healthcare Network to provide software and data analytics technology-enabled services, research and advisory, and revenue cycle management to advance quality care and the patient experience.

Likewise, in July 2021, Philips and Cognizant partnered to develop an end-to-end digital health solution that will help life science companies improve patient care and accelerate clinical trials. The collaboration combines Philips HealthSuite, a cloud-based platform, and Cognizant's digital engineering expertise to deliver and maintain leading-edge digital health solutions at scale, leveraging big data to create actionable insights. Such collaborations are providing better services to patients, leading to increased patient engagement on this portal and driving the growth of the patient access solutions market in the region.

Dominating Companies in Patient Access Solutions Market

• MCKESSON CORPORATION
• OPTUM, INC.
• COGNIZANT
• CERNER CORPORATION
• EXPERIAN PLC
• 3M
• CONIFER HEALTH SOLUTIONS
• CRANEWARE, INC.
• GENENTECH, INC. (ROCHE)
• ALLSCRIPTS HEALTHCARE SOLUTIONS, INC.
• EPIC SYSTEMS CORPORATION
• WAYSTAR
• THE SSI GROUP, LLC
• CIRIUS GROUP, INC.
• ACCUREG SOFTWARE
• PATIENT ACCESS SOLUTIONS, INC.
• KYRUUS
• EXELA TECHNOLOGIES, INC.
• ACCESS ONE, INC.
• VEE TECHNOLOGIES
• CONDUENT, INC.
• FINTHRIVE
• PLEXIS HEALTHCARE SYSTEMS
• HEALTHASYST
• VIRTUSA CORPORATION

Recent Developments in Patient Access Front-end RCM Solutions Market

In March 2022, DAS Health, a provider of health IT and management solutions, announced its acquisition of Kno2, a leading provider of secure interoperability solutions. This acquisition enables DAS Health to enhance its offerings in the areas of patient access, engagement, and care coordination.

In September 2021, Waystar, a healthcare technology company specializing in revenue cycle management, announced its acquisition of Patientco, a leading provider of patient payment technology. The acquisition expands Waystar's patient access solutions portfolio, allowing them to offer end-to-end patient financial engagement services.

In November 2020, Experian Health, a provider of revenue cycle management and patient access solutions, announced a partnership with DigiCert, a leading provider of digital certificates and secure identity solutions. The partnership enables Experian Health to offer enhanced security and protection for patient data, strengthening their patient access solutions.

In February 2019, NextGen Healthcare, a provider of health IT solutions, announced its acquisition of Medfusion, a patient experience and engagement platform provider. The acquisition expands NextGen Healthcare's patient access solutions portfolio, allowing them to offer patient self-scheduling and pre-registration capabilities.

In June 2021, HealthStream, a provider of workforce development and patient experience solutions, announced its acquisition of Change Healthcare's Nurse Residency Program. This acquisition expands HealthStream's offerings in the areas of nurse development and retention, and strengthens their patient access solutions.

In November 2019, Allscripts, a provider of health IT solutions, announced its acquisition of PatientWorks, a provider of patient self-service and registration solutions. The acquisition enhances Allscripts' patient access solutions portfolio, allowing them to offer advanced patient check-in capabilities and improve the patient experience.

In July 2019, Premier Inc., a healthcare improvement company, announced a partnership with Medpricer, a provider of cost management solutions. The partnership enables Premier to offer enhanced supply chain solutions, including improved access to products and services for patients and providers.

In December 2018, Waystar, a healthcare technology company specializing in revenue cycle management, announced its acquisition of Connance, a provider of predictive analytics solutions for healthcare. The acquisition strengthens Waystar's patient access solutions portfolio, allowing them to offer advanced patient scoring and segmentation capabilities.

In conclusion, patient access solutions are transforming healthcare delivery by improving patient access to care, optimizing resources, and enhancing patient engagement. Digital health technologies such as telehealth and patient portals, as well as process optimization and data analytics, are key components of these solutions. By implementing patient access solutions, healthcare organizations can improve patient care and outcomes while reducing costs and optimizing resources.