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U.S. Revenue Cycle Management Trends And Competitive Analysis

U.S. Revenue Cycle Management Trends And Competitive Report

U.S. Revenue Cycle Management Trends And Competitive Analysis

Published: Jul, 2024
Report ID: GVR-MT-100194
Format: PDF, Horizon Databook

No. of Pages/Datapoints: 20
Report Coverage: 2024 - 2030

Industry Insights

The U.S. revenue cycle management market size was estimated at USD 155.59 billion in 2023 and is projected to grow at a CAGR of 10.18% from 2024 to 2030. The Revenue Cycle Management (RCM) industry is experiencing significant transformation driven by technological advancements, regulatory shifts, and evolving consumer expectations. This report analyzes key trends, mergers and acquisitions (M&A), strategic investments, and emerging players shaping the future of the RCM industry.

Key Trends Shaping the RCM Industry

Technology and AI Integration

Advanced technology and AI are transforming revenue cycle management (RCM) to be more efficient and accurate. In the U.S., robotic process automation (RPA) helps automate tasks like data entry. More advanced AI systems analyze large amounts of data, identifying trends in patient behavior, payment patterns, and claim statuses.

According to a survey by the Healthcare Financial Management Association, 35% of healthcare organizations that implemented AI in their RCM reported cost savings of 10% or more. Furthermore, KLAS Research in 2019 indicated that using AI-powered analytics to identify patterns in denied claims can reduce claim denials by up to 50%.

Future Trends in AI for Revenue Cycle Management

Use of Natural Language Processing (NLP)
Advanced Analytics for Denial Management
Personalized Revenue Cycle Management
Automation of Prior Authorization
Predictive Analytics for Financial Performance

The integration of these AI technologies promises to enhance RCM's efficiency and effectiveness, driving significant improvements in financial outcomes for healthcare organizations.

Investors focus on acquiring end-to-end RCM solutions that streamline workflows, reduce costs, and improve overall financial performance by covering the patient's financial journey.

U.S. Percentage of Hospitals that Adopted Certified Healthcare IT by Type, 2019

Regulatory Compliance And Data Security

Increasing healthcare regulations and cyber threats necessitate robust compliance measures and data security practices to mitigate financial and data security risks.

M&A Activity

Both strategic and private equity investors actively seek acquisitions of outsourced RCM providers. Healthcare providers partner with RCM providers to maximize reimbursement and gain expertise in navigating the dynamic landscape.

Notable RCM M&A Transactions

Date	Target	Acquiror
August 2022	Mirared	Coronis Health
August 2022	Cura Revenue Cycle Management, LLC	Revecore Technologies
June 2022	Cloudmed	R1 RCM, Inc.
February 2022	Athenahealth	Bain Capital, LP., Hellman & Friedman LLC
January 2022	SilverCreek RCM	PayrHealth, LLC

Major Deals & Strategic Alliances

Aspect	Companies	Major Deals/Strategic Alliances	Duration
Acquisition	R1 RCM, Inc.	R1 RCM, Inc. has acquired Acclara, a technology-focused RCM company, from Providence for USD 675 million. This acquisition is part of a larger agreement in which R1 RCM will work with Providence for the next ten years to provide comprehensive RCM services.	January 2024
Acquisition	Veradigm LLC	Veradigm acquired Koha Health, a full-service revenue cycle management (RCM) provider, to strengthen its RCM services portfolio. This acquisition will add to Veradigm's capabilities and subject matter expertise in the ambulatory healthcare market.	January 2024
Investment	DrChrono	DrChrono Received USD 20 million from Orix Growth Capital to develop DrChrono’s mobile, EHR, & medical billing services and expand its sales, support, & engineering teams.	January 2020
Partnership	Ensemble Health Partners	Microsoft has partnered with Ensemble Health Partners, a top company in revenue cycle management, to enhance the development and use of Ensemble's unique revenue cycle intelligence platform, EIQ. This platform uses Microsoft Azure’s advanced generative AI and machine learning technologies to provide a wide range of revenue cycle management (RCM) solutions.	April 2024

Private Equity Investment in RCM Companies

In addition to strategic mergers and acquisitions, private equity firms are investing in revenue cycle management (RCM) companies as these businesses expand and become more important. Here are some examples of platforms owned by private equity:

Financial Sponsor	RCM Companies	Business Description
Veritas Capital Fund Management, L.L.C.	Coronis Health	Provides outsourced medical billing and revenue cycle management (RCM) solutions to healthcare practices and facilities in the U.S. and around the world. Coronis Health was purchased from 424 Capital in August 2022
Welsh, Carson, Anderson, and Stowe. (WCAS)	EnableComp	Provides claims revenue services, including RCM for workers' compensation and recovery of underpayments for hospitals and healthcare providers. EnableComp was formed when EnableComp and Argos Health merged. Argos Health was purchased by WCAS from NaviMed Capital in September 2021
Aquiline Capital Partners LLC	National Medical Billing Services	Provides revenue cycle outsourcing services for ambulatory surgery centers by combining industry expertise, analytics, helpful guidance, and experienced revenue cycle professionals. National Medical Billing Services received investment from Aquiline Capital Partners in February 2021
Berkshire Partners LLC., Warburg Pincus LLC	Ensemble Health Partners	Provides technology-driven RCM solutions for health systems, including hospitals and affiliated physician groups. The ensemble was acquired from Golden Gate Capital in March 2022

List Of Key Emerging Companies’ /Technology Disruptors/Innovators

Emerging Companies	Technology Disruptors	Innovators
iMedX - The company offers revenue cycle management solutions containing coding services, medical transcription, education and training prospects, and data analytics.	ImagineSoftware, Technology Partners, LLC. - It offers the technology required to make the most of from collections throughout the medical claim. It is also reinventing revenue cycle management to generate a more efficient and patient-focused familiarity.	Abeo - The company offers billing solutions for physicians, clinics, and surgery centers with clients in 40 states across the U.S.
4medica- The company’s iEHR platform is made for easy deployment action at health systems, hospitals, doctor groups, and others.	Apprio, Inc.-The company has produced ApprioHealth, a subsidiary that provides the unique conditions of health systems and hospitals.	Rannsolve Inc.: It is a supplier of invention-enabled social coverage administrations meant to deliver competent revenue cycle management.

The RCM market is evolving rapidly, with significant M&A activities and investments driving consolidation and technological advancements. Healthcare providers increasingly seek comprehensive, technologically advanced RCM solutions to navigate the complex regulatory landscape, enhance financial performance, and improve patient financial experiences.

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