Healthcare EDI Market worth $7.0 Billion by 2027 – Exclusive Report by Nova one advisor

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The latest report as Healthcare EDI Market acknowledges Size, Application Segment, Type, Regional Outlook, Market Demand, Latest Trends, and Venous Procedure Devices Industry Share and Revenue by Manufacturers, Leading Companies Profiles, Future Growth Potential Forecasts-2027.

The global Healthcare EDI market gathered revenue around USD 3.10 Billion in 2020 and market is set to grow USD 7.0 Billion by the end of 2027 and is estimated to expand at a modest CAGR of 10% during the prediction period 2021 to 2027.

Overview of Healthcare EDI Market Study

Healthcare EDI market study conducted by Nova One Advisor is intended at helping stakeholders get a comprehensive overview of potential challenges and undiscovered opportunities. The report offers exclusive insights to help companies and their customers to make informed decision to sustain growth through the assessment period.

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Growth Factors:

The growth of this market is majorly attributed to the development of regulations for transaction processes, the rising need to curtail healthcare costs, and government support for HCIT implementation. In addition, the need for the efficient management of electronic claims and reimbursement transactions for healthcare providers are expected to drive demand growth in the healthcare EDI market during the forecast period.

Driver: Regulations for transaction processes
The Healthcare Insurance Portability and Accountability Act (HIPAA), passed in 1996, set up a standard for the transmission of insurance data. Prior to this act, there were 400 different medical form standards that not only made it difficult for providers and payers to process claims but also introduced many errors that made it important to implement a standard for claims management. EDI has eased the process of claims management, with the entire process being conducted electronically with software that meets the needs of HIPAA for electronic filing. The Patient Protection and Affordability Care Act, also known as the Obamacare Act, was passed in 2010 in the US The Act aimed at increasing the affordability and quality of health insurance and mandated the 834 EDI transaction for healthcare providers and payers. Its purpose is to electronically transmit enrollment and dis-enrollment information. This step is a major reason driving the adoption of EDI in the healthcare industry in the US.

Restraint: High implementation cost of EDI software
Although the adoption of healthcare EDI by healthcare providers is on the rise, the cost associated with EDI software installation is high. The major reason for this includes third-party solutions and inadequate internal systems and clearinghouses adding high costs per transaction with expensive setup fees. This will significantly affect the total cost of ownership. In developed markets across Europe and North America, the acceptance for EDI solutions has been lower among small- and medium-sized healthcare providers mainly due to the relatively high investments required for the implementation of EDI. Many small- and medium-sized healthcare providers regard tangible costs of implementation of EDI to exceed the tangible benefits, which prevents them from implementing EDI solutions.

Opportunity: Increase in outsourcing of EDI services
EDI outsourcing is the process of having a third party manage a part or the entire process of using EDI to exchange data with trading partners. Growing healthcare costs are increasingly pressurizing in the healthcare industry to provide quality care at lower costs by minimizing wastages at each stage. Healthcare revenue loss in American hospitals due to self-pay billing issues is as high as 20% to 30%. Additionally, according to a Ponemon Institute survey in 2014, of 577 healthcare professionals, the US physicians and hospitals have shown an inability to use the latest mobile devices and internet services to deliver patient care. As a result, US hospitals absorb an estimated USD 8.3 billion annually, while struggling with security and privacy concerns arising from the mainstreaming of social media at a time when federal rules allow for steep fines when it comes to violating patient privacy. For hospitals, this makes the outsourcing of billing and claim services to EDI service providers an attractive proposition.

Challenge: End-user limitations and requirements
Despite its long-term benefits, EDI has witnessed limited success. The reason for this lies in the nature of the hospitals that use healthcare EDI and the healthcare organizations that require it. The demand side/end users are participants who are relatively small, have limited IT resources, and suffer from limited financial strength; this prevents them from adopting EDI. Unlike the retail world, in healthcare, large suppliers mandate the use and adoption of healthcare EDI. While these large vendors have the resources and budgets necessary to deploy and use healthcare EDI, the hospitals and facilities they deal with are often cash-strapped and have limited IT resources, making the adoption of healthcare EDI precarious and time-consuming. This problem of lack of resources, with mandates for solution implementation, means that finding healthcare EDI solutions that are viable can be challenging.

By delivery mode, mobile EDI segment is expected to grow at the highest growth rate during the forecast period
Among the delivery mode, segment, the mobile EDI segment is expected to grow at the highest CAGR during the forecast period. The factors attributing to the high growth of this segment include the technological upgrades in the healthcare industry and growing acceptance of mobile solutions among healthcare providers.

By component, the services segment is expected to record the highest CAGR during the forecast period
The services segment is expected to witness a faster growth rate in this market due to factors such as, the increasing claims volume, increasing complexity and scale of EDI solutions, as they require extensive training programs. Similarly, a growing trend of outsourcing activities, such as revenue cycle management, claims handling and management, and partner management services, is also expected to propel the growth of the services market.

By transaction type, the claims management segment is expected to account for the largest share of the healthcare EDI market
On the basis of transaction type, the healthcare EDI market is segmented into claims management and healthcare supply chain. The claims management segment is expected to account for the largest share of the healthcare EDI market during the forecast period. The large share of this segment can be attributed to the rising adoption of EDI services by healthcare providers and payers and the need to meet regulatory requirements.

By end user, the healthcare payers segment to record the highest CAGR during the forecast period
Based on end user, the healthcare EDI market is segmented into healthcare providers, healthcare payers, medical device & pharmaceutical industries, and pharmacies. The healthcare payers segment is expected to grow at the highest CAGR during the forecast period due to the increasing number of private insurance players in the market.

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COVID-19 Impact on Healthcare EDI Sales

Businesses today are operating in a dynamic environment. Earlier focus primarily concentrated on keeping pace with changing consumer preferences. COVID-19 outbreak was unprecedented and exposed vulnerabilities of various industries. Pandemic-induces obstacles also were registered in the Healthcare EDI market.

Sales plummeted as COVID-19 gradually tightened its noose worldwide. Supply-chain disruptions caused massive losses, while demand took nose-dive as consumers remained indoors with affected countries implementing either partial or complete lockdown.

Gradual recovery however is on the cards with the roll out of vaccinations. Nonetheless, consecutive waves of the virus compelled businesses to stay prepared for the worst. As government and healthcare organizations successfully implement steps to contain the spread of COVID-19, industries have begun operations, albeit at a slow and more cautious pace.

Against this backdrop, Nova one advisor’s study predicts gradual recovery for the Healthcare EDI market 2021 onwards. This trend will however continue through the course of the report’s assessment period

Key Players:

This report provides detailed company profiles of the key market players. This research report also highlights the competitive landscape of the Healthcare EDI market and ranks noticeable companies as per their occurrence in diverse regions across globe and crucial developments initiated by them in the market space. This research study also tracks and evaluates competitive developments, such as collaborations, partnerships, and agreements, mergers and acquisitions; novel product introductions and developments, promotion strategies and Research and Development (R&D) activities in the marketplace. The competitive profiling of these players includes business and financial overview, gross margin, production, sales, and recent developments which can aid in assessing competition in the market.

Some of the prominent players in the Healthcare EDI market include:

McKesson Corporation (US), Optum (US), Allscripts Healthcare Solutions Inc. (US), athenahealth (US), and Nextgen Healthcare (US). Other prominent players in this market include Cognizant Technology Corporation (US), SSI Group, LLC (US), Cerner Corporation (US), Comarch SA (Poland), Axway Software SA (France), Optum Inc. (US), Dell Technologies Inc. (US), Nextgen Healthcare (US), Synnex Corporation (US), Comarch (Poland), Axway Solutions (US), and Plexis Healthcare Systems (US).  

Unravelling the Critical Segments

This research report offers market revenue, sales volume, production assessment and prognoses by classifying it on the basis of various aspects including product type, application/end-user, and region. Further, this research study investigates market size, production, consumption and its development trends at global, regional, and country level for period 2017 to 2027 and covers subsequent region in its scope:

Component

  • Services
  • Solutions

Transaction Type

  • Claims Management
    • Claims Submission
    • Claim Status
    • Eligibility Verification
    • Payment Remittance
    • Referral Certification & Authorization
    • Claim Payments
    • Others
  • Healthcare Supply Chain

Delivery Mode

  • Web & Cloud-based EDI
  • EDI VAN
  • Point-to-Point EDI
  • Mobile EDI

End-User

  • Healthcare Providers
  • Healthcare Payers
  • Medical Device & Pharmaceutical Industries
  • Pharmacies

Why Buy this Report?

The purpose of Nova one advisor’s Healthcare EDI market study is to provide stakeholders with a detailed picture of potential barriers and untapped opportunities. The report contains exclusive information to assist businesses in making informed decisions about how to maintain growth throughout the assessment period.

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