U.S. Population Health Management Market Size, Share & Trends Analysis Report by Product (Software, Services), By End Use (Providers, Payers, Employer Groups), And Segment Forecasts, 2023 - 2030

Report Overview

The U.S. population health management market size was valued at USD 25.0 billion in 2022 and is anticipated to expand at a compound annual growth rate (CAGR) of 19.54% from 2023 to 2030. The market is majorly driven by the growing demand for healthcare IT services and solutions that support value-based healthcare delivery, resulting in a transition from Fee-For-Service (FFS) to a Value-Based Payment (VBP) model.

Increasing healthcare expenditure and the rising need for value-based healthcare and effective disease management across different care settings are expected to drive the market in the U.S. More than 130 million people in the U.S. suffer from at least one chronic condition. Chronic conditions are responsible for around 70% of deaths in the U.S. each year, resulting in 1.7 million deaths. 

Managing comorbidities is challenging due to the large target population in the region. Implementation of PHM can help in the identification of unwell patients and improve disease prevention and management, leading to financial savings. To encourage the adoption of PHM systems, the Centers for Medicare & Medicaid Services (CMS) has introduced the Value-Based Payment Modifier. It provides differential payment to a group of physicians based upon the quality of care provided as opposed to the cost of care during their performance period.

COVID-19 U.S. population health management market impact: 21.43% increase from 2020 to 2021

Population health management solutions based on open Application Programming Interfaces (APIs) are helpful for the management of chronic conditions with high treatment costs, such as cardiac diseases, asthma, and diabetes. PHM solutions also help reduce the cost of care, improve patient outcomes. PHM software also enables better analysis of patient data to make informed decisions.

In the U.S., providers, payers, providers-payers, and accountable care organizations are the promoters of PHM systems. Many providers and payers require upgrading and automating their healthcare management systems, which can improve healthcare delivery and help departments, collaborate with each other. The providers mainly focus on chronic diseases, such as diabetes and cardiovascular disorders that are generally responsible for significant healthcare costs. The rising prevalence of lifestyle disorders has increased the need for effective management of the disease burden on healthcare centers.

Product Insights

The services segment dominated the market in 2022 with a revenue share of more than 51.97% owing to the high demand for post-purchase assistance for PHM solutions. On the other hand, the software segment is expected to register the fastest CAGR of 19.72% over the forecast years. The growth is credited to the well-managed network of software that provides actionable analytics for providers and the ability to manage multiple lines of business seamlessly on one platform.

PHM programs can process clinical, financial, and operational data to improve efficiency and patient care. Healthcare systems use healthcare Customer-Relationship Management (CRM) platforms to organize and analyze large volumes of data and derive consumer insights. These can be used to inform PHM campaigns, leading to personalized patient engagement and improved health outcomes. In May 2020, Allscripts Healthcare, LLC launched CarePort Connect, a new post-discharge tool. The tool is designed to assist hospitals in complying with the interoperability final rules of the Centers for Medicare and Medicaid Services.

The services segment currently holds more than 50% of the market share, as an in-house system is typically preferred over third-party providers for the assessment of patient data by hospitals and other healthcare providers. The Patient-Centered Medical Home (PCMH), a holistic approach to primary care designed to improve care coordination, is among the key building blocks of PHM. PCMHs can track patients’ health conditions systematically & reach out to those who do not visit their doctors regularly to address poor health behavior.

End Use Insights

Based on end use, the market is segmented into providers, payers, and employer groups, out of which, providers held a majority of the market share of over 48.75% in 2022. Healthcare providers need PHM systems that are compatible with Electronic Health Record (EHR) systems to assist in delivering holistic, patient-centric care. Multiple functionalities and advantages offered by PHM solutions are responsible for their increased adoption. The Centers for Medicare & Medicaid Services has announced that the Alternative Payment Model and the Merit-Based Incentive Payment System will help these providers develop technical management capabilities.

Payers in healthcare are third-party entities, such as insurance carriers. The cost of health services is financed or reimbursed by these entities. Predictive analytics competency provides payers an opportunity to leverage over other providers in the interpretation of unstructured clinical content and population behavior. This competitive advantage is efficient to increase the demand for PHM software for payers.

Employer groups require consumer-focused health plans to ensure the well-being of employees. Employee satisfaction is the most important metric as it ensures better services from employees. Employer groups as end users are evolving into a significant market for PHM as it helps employers in information management as well as financial risk management. The employer group end use segment is expected to emerge as the fastest-growing segment with a CAGR of 21.23% during the forecast period. owing to the rising demand for identifying the health and wellness needs of the employee population, which is very essential for a successful business.

Key Companies & Market Share Insights

The market players are increasing their interactions with healthcare systems and organizations leading to multi-level networking within the healthcare industry. The key players are undertaking strategic activities including research initiatives, launching new products, regional expansion, partnerships & collaborations, and mergers & acquisitions to gain a competitive advantage. For Instance, In May 2020, Medecision announced a few important enhancements to its Aerial Platform, to enable customers to support vulnerable patients and members during the COVID-19 crisis. Some of the key players in the U.S. population health management market include:

• Allscripts Healthcare

• Cerner Corp.

• Conifer Health Solutions, LLC

• EClinicalWorks

• Enli Health Intelligence

• McKesson Corp.

• Medecision

• Optum, Inc.

• Advisory Board

• Koninklijke Philips N.V.

• Athenahealth, Inc.

• RedBrick Health

• Welltok

U.S. Population Health Management Market Report Scope

U.S. Population Health Management Market Segmentation

This report forecasts revenue growth at country levels and provides an analysis of the latest industry trends in each of the sub-segments from 2017 to 2030. For this study, Grand View Research has segmented the U.S. population health management market based on product and end use:

• Product Outlook (Revenue, USD Billion, 2017 - 2030)

  • Software

  • Services

• End-use Outlook (Revenue, USD Billion, 2017 - 2030)

  • Providers

  • Payers

  • Employer Groups