US Population Health Management Growth Opportunities

Data Management and Care Coordination Challenges Necessitate Cloud-based Technologies and SaaS Business Models to Drive Transformational Growth

This research service will provide an overview of the US population health management (PHM) market. The study period is from 2021 to 2026. The report will provide a detailed analysis of the PHM market and applications, such as data & analysis, care management, and performance management. Discussions include industry challenges, drivers, and restraints as well as a revenue forecast for each application area. The study’s revenue forecast will involve an end-user level breakdown for the US market during the study period. The top end users of PHM IT solutions are accountable care organizations (ACOs), non-ACO hospitals, non-ACO physician practices, payers, and payer-providers. The study delivers detailed analyses of important business models, regulatory outlook, cost structure, and competitive landscape. We will identify and describe the top growth opportunities for the total US PHM market in the context of user relevance and calls to action.

In this market, 3 Strategic Imperatives are at play.

Internal Challenges:

Currently, more than 50% of all PHM information technology (IT) solution users in the United States fail to meet their overarching clinical, financial, and operational objectives. Core reasons include low clinician engagement with the technology, an inability to convert patient-generated data into actionable intelligence, lack of support to engage patients across the care continuum, and an inability to generate analytics-led insights that may improve corporate performance at an enterprise level. In the next 2–3 years, PHM IT solutions will become much more accessible, personalized, and result-driven. Modernized analytics and care coordination solutions will help payers manage provider performance on value-based care (VBC) contracts. Providers will also leverage next-generation (next-gen) PHM solutions to gain a competitive advantage in patient experience, claims management, and workforce management.

Disruptive Technologies:

Agile platforms are disrupting the PHM sector’s status quo. Enterprise-grade companies are deploying Software-as-a-Service (SaaS)-based PHM capabilities that address a wide variety of VBC objectives for providers (accountable care organization [ACO] design and management, payer connectivity, and patient engagement) and payers (utilization management, standardization of care, and network design and management). By 2023, the US PHM market will see increased adoption of SaaS-based PHM capabilities from all types of payers and providers. These modular, plug-in-based capabilities will compliment various electronic medical record (EMR) workflows and pave the way for health-on-cloud consumerism at a population level.

Emerging Business Models:

Most companies do not efficiently manage their PHM program deployments. This results in poor outcomes that include the costly procurement of external databases; delivery of manual Structured Query Language queries to link disparate databases, requiring 3rd-party PHM consultants to identify gaps in care management; and high lead time for reports. Best-in-class PHM companies will offer more targeted capabilities that address most concerns by 2023. These firms will offer a single PHM IT value proposition that incorporates numerous elements of data management, care coordination, patient engagement, and quality reporting via self-service-based and cloud-powered infrastructure, applications, and delivery solutions.