Exciting new research from the researcher's Transformational Health program touching on some of the most important issues in healthcare now and in the future.
This research service presents a comprehensive analysis of the market potential and dynamics of the population health management (PHM) market in the United States. The study provides a strategic PHM roadmap to progressive health entities that aspire to practice proactive care monitoring at a community level and synthesize clinical, administrative, and financial information to improve the well-being of different populations while taking responsibility of a value-driven reimbursement relationship. It includes the drivers, challenges, forecasts, and trends impacting the market:
Market Overview: PHM 2.0 will be Characterized by the Transition from Population Health to Precision Health Approaches.
Demographic shifts alongside rising demand for evidence-based care and risk-based contracting make PHM an increasingly critical competency for payers and providers. Technologies that provide preventative and proactive health management, especially for vulnerable, high-cost populations, have experienced rapid adoption in the recent past. Key PHM capabilities that are tailored for both private and public reimbursement models include identification, stratification, and management of high-risk populations to improve care quality, streamline costs, and augment outcomes. Overall, the need for improved clinical utility and better financial productivity remains the key driver for continued interest in PHM IT and services in the United States.
Despite its benefits, PHM faces daunting challenges. Legacy PHM strategies centered on high-cost patient populations are being replaced by a more holistic and evidence-based medical approach (PHM 2.0) that considers both high-risk and at-risk patient populations and show better promise of tangible return on investment (ROI). As a result, the scope of PHM-led intervention has been expanded from patients to other populations, namely consumers, physicians, and employees.
The ideal approach is to first identify populations, providers, or payers that are responsible for and understand regional health trends while simultaneously evaluating complex quality metrics to determine relevancy and efficacy of a PHM program. At the same time, PHM implementation should involve deciding which initiative (prevention/prediction/management of disease conditions) will save the most money while producing the greatest clinical impact. Democratization of AI technologies coupled with advanced precision medicine approaches will help achieve that goal.
Overall, this research reveals that effective PHM requires a collaborative, team-based approach supported by a robust health information technology (IT) infrastructure that achieves both regulatory and corporate objectives. CMS has recently replaced the Medicare Shared Saving Program (MSSP) with the ‘Pathway to Success’ program which mandates value-based providers to formulate a six-year digital transformation roadmap and support them with risk-free incentives and regulatory waiver. Such a revolutionary transformation is bound to pave the way for increased spending on PHM solutions. However, the implementation is critical. Successful market participants must offer machine learning-based predictive disease modeling and drive automated risk stratification that proactively identifies populations most receptive for precise intervention. The ability to benchmark patient risk profiles in real-time and develop customized health plans offers a significant competitive edge. Interoperability-for example, the ability to connect disparate data sources in a standardized manner is another critical factor for PHM vendors.
From a business strategy standpoint, it must be acknowledged that enterprise-wide PHM programs involve long-term, phase-based business approaches between payers, providers, and health IT enterprises. All relevant stakeholders across the value chain must remain flexible on strategy, implementation, and management approaches to achieve success.
- Geographic Coverage: The United States
- Study Period: 2017-2022
- Base Year: 2018
- Forecast Period: 2019-2022
- Monetary Unit: US Dollars
Key Issues Addressed
- How sustained momentum of value-based healthcare is transforming the PHM market?
- How chronic condition prevalence is aiding the US PHM market? How healthcare stakeholders aspire to improve clinical and financial outcomes via PHM led to chronic condition management?
- How to define the scope of PHM? What are the key service segments that PHM applications cater to? What are different types of populations that can be provided value-based care via PHM IT and services?
- What are the key market forces that propel growth for the US PHM market?
- What are the key market forces that appear restrictive to the growth of the US PHM market?
- What are the key infrastructure, technical, and service competencies needed to support a successful PHM offering?
- How top vendors conceptualize PHM offerings?
- What are the key business/revenue models of different PHM offerings?
- What are the predominant pricing models of different PHM offerings?
- What are the key purchasing considerations for PHM solutions?
- What is the value of the US PHM market? How is it expected to grow in the next five years?
- What are the competitive characteristics of the US PHM market? Who are the key participants in the market?
1. Executive Summary
- Key Findings - The US PHM Market
- Scope and Segmentation
- Key Questions this Study will Answer
- Market Engineering Measurements
- CEO’s Perspective
- Executive Summary - 3 Big Predictions
2. Market Overview-What Has Changed in Value-Based Healthcare Since 2015
- The Shift to Value based Payment Programs is Real but Is It Good News for the US PHM Market?
- Value-based Healthcare is Generating Positive Results for Those Embracing a Tiered Payment Strategy
- Receptivity for Health IT Enablers Has Improved Across All Provider Types
- High Cost Burden of Chronic Conditions is Propelling the Growth of PHM Solutions in the United States
- Chronic Condition Related Value-based Care Programs Become More Relevant
3. Introduction to Population Health Management
- PHM-Market Scope and Definition
- Category Segmentation of the US PHM Market
- Revenue Segmentation by Application Areas
- Benchmarking Strategic Attractiveness of PHM Sub-Segments
- Value Benefits of PHM-End-user Expectation
- PHM-Market Maturity Indicator
4. Key Market Forces
- Market Drivers
- Key Market Forces Driving the US PHM Market in 2018
- CMS Has Replaced the MU Program with “Pathway to Success” Program and It is Good News for PHM IT
- The growth of Medicare Shared Saving ACOs is Driving PHM Vendors to Offer Innovative and Scalable Solutions
- Potential Supply-Demand Disparity of Skills Prompt Healthcare Enterprises to Opt for Advanced PHM IT Solutions
- Higher Need for Value-based Contracting Leads to Adoption of IT that Helps to Successfully Implement Risk-based PHM Services
- Consumerism of On-Demand Healthcare Services is Accelerating Revenue for PHM Vendors
- Employer-led PHM Programs are Gaining Popularity Due to Growing Evidence of Positive ROI
- Increased Adoption of Precision Medicine Approaches is Supporting Patients’ Need for Measurable Interventions
- Introduction of Value-based Drug Pricing is Driving the Need for PHM-based Healthcare Strategies
- Prevalence of Mental Illness Among the Aging Population is Paving the Way for IT-enabled Public Health Services
- Growing Evidence of Medication Abuse Needs to be Countered with Real-Time PHM Services
- Benefits of Payer-led Wellness Programs are Prompting Consumers to Embrace Innovative PHM Services
- Higher Need to Address the Physician-Burnout Issue via PHM Programs Has Been Established in the United States
5. Key Market Challenges
- Market Challenges
- Key Market Challenges, Posing Threats to the US PHM Market
6. Infrastructure, Technical Expertise, and Key Competencies Needed to Support a Successful PHM Offering
- Infrastructure and Operating Model Needed to Support a Successful PHM Offering (Technology)
- Technical Expertise and Key Competencies Needed to Support a Successful PHM Offering (Technology)
- Infrastructure Needed to Support a Successful PHM Offering (Services)
- Operating Model Needed to Support a Successful PHM Offering (Services)
- AI-Powered PHM-Framework
7. How Top Vendors Conceptualize PHM Offerings?
- Steps of PHM Program Implementation
- How to Prioritize Strategic Objectives for Each Care Setting in US to Implement a Holistic PHM Program?
- Program Needs that are Met by Basic and Advanced Solution Offerings
8. PHM Revenue and Pricing Models
- PHM Revenue Models for Each Customer Segment
- Pricing Model Assessment for the PHM Market
- Pricing Mix Assessment for PHM IT and Service Deployments
- Cost Structure Assessment-PHM Vendor Perspective
9. Purchasing Considerations for PHM Solutions
- What are the Value Levers that Drive Purchasing Decision in Favor of Any Specific PHM IT and Solution Provider
10. Forecasts and Trends-Total PHM Market
- Market Engineering Measurements
- Forecast Assumptions and Definitions
- Revenue Forecast
- Revenue Forecast Discussion
- Percent Revenue Forecast by Customer Segment
- Revenue Forecast by Segment
- Revenue Forecast by Segment Discussion
11. ACOs Segment Analysis
- Market Engineering Measurements-ACOs Segment
- Revenue Forecast-ACOs Segment
12. Payers & Payer-Providers Segment Analysis
- Market Engineering Measurements-Payers & Payer-Providers Segment
- Revenue Forecast-Payers & Payer-Providers Segment
13. Non-ACO Hospital Segment Analysis
- Market Engineering Measurements-Non-ACO Hospitals Segment
- Revenue Forecast-Non-ACO Hospitals Segment
14. Non-ACO Physician Practice Segment Analysis
- Market Engineering Measurements-Non-ACO Physician Practices Segment
- Revenue Forecast-Non-ACO Physician Practices Segment
15. Demand Analysis
- Penetration Analysis-ACOs
- Penetration Analysis-Payers & Payer-Providers
- Penetration Analysis-Non-ACO Hospitals
- Penetration Analysis-Non-ACO Physician Practices
16. Competitive Environment
- Market Gaps in the United States
- Changes in the Supply Market Landscape-Analyst Perspective
- PHM Vendors Capability Matrix-Definitions
- Mapping of Ecosystem Players
- PHM Vendors Capability Matrix-Snapshot
17. Growth Opportunities
- 5 Growth Opportunities Critical for Future Strategies
- Levers for Growth
- Growth Opportunity 1-Define Patients
- Growth Opportunity 2-Personalize Diagnosis
- Growth Opportunity 3-Automate Care Management
- Growth Opportunity 4-Measure Patient Outcomes
- Strategic Imperatives for PHM
- Legal Disclaimer
- Selected Sources
- Market Engineering Methodology
- List of Exhibits