US Population Health Management Market—Analysis and Competitive Landscape Assessment

US Population Health Management Market—Analysis and Competitive Landscape Assessment

Research Overview

This Frost & Sullivan research service presents a comprehensive analysis of the market potential and dynamics of the population health management (PHM) market in the United States (US). The study provides a strategic PHM road map 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 the patient population while taking responsibility of a value-driven reimbursement relationship.
It includes market drivers, challenges, forecasts, and trends. This research examines the following market segments:

Advisory: Clinical & Financial Consulting
Data Analysis: Data Aggregation & Management, Risk Stratification & Modeling
Care Management: Care Coordination, Patient Engagement
Performance Management: Clinical Performance Management, Financial Performance Management

Accountable Care Organizations (ACO)
Payers & Payer-Providers
Hospitals outside of ACO contracts
Physician practices outside of ACO contracts

Market Overview

Population health hanagement is the leading growth opportunity in a post-EHR healthcare era.

The rising cost burden of chronic disease management coupled with evolving value-based payment programs supports the requirement of individualized digital interventions that aim to transform care delivery and improve chronic conditions at a population level.

The adoption of PHM solutions that demonstrate meaningful use of IT applications is expected to accelerate in 2016 through 2020. Patient care is moving into a broader but coordinated environment where routine, manual tasks are automated by PHM solutions that unify siloed systems, stratify comorbidities, empower patients through engagement, and benchmark outcomes at network, practice, and patient level.

Health systems, on the road to accountable care, are striving to identify appropriate care workflows, control readmissions, and promote self-care so that incoming patients heal quickl, transitioning patients avoid readmitting, and healthy populations stay healthy.

Payer, payer-provider, and ACO communities are the top promoters of PHM in the United States. Best-in-class solutions are sought to help track, monitor, analyze, and manage provider/member performance. These groups are expected to invest in technologies that support value-based contracts, set provider-specific quality goals, initiate member engagement, and minimize financial risk through episodic care management.

Additionally, the need to coordinate care departments, meet payer targets, and engage patients during, pre-, and post-care is expected to strongly accelerate investment in the non-ACO hospital segment. Non-ACO physician practices are challenged by growing competition, imposing regulations, and limited investment capabilities. However, as CMS drives new MU objectives that consider physician preferences, the adoption of PHM solutions across this segment is expected to be substantial during 2018–2020.

The US PHM supply market is at a nascent stage and a select few companies have managed to better patient outcomes and minimize financial risk for their clients. Many providers and payers are in dire need of a suite of healthcare technology solutions and services that improve care delivery efficiency and enable transitions toward various value- or risk-based healthcare ecosystems. The market is likely to observe fierce competitive rivalry as small modular PHM firms compete against large, platform providers. Winners will successfully weigh in market needs and offer secure, interoperable, and highly customized PHM solutions that achieve the coveted triple aim around cost, quality, and access.

  • Methodology
  • Executive Summary
    • Key Findings-The US PHM Market
    • Scope and Segmentation
    • Market Engineering Measurements
    • Key Questions this Study will Answer
    • CEO's Perspective
    • Executive Summary-3 Big Predictions
  • Market Overview
    • Market Scope and Definition for PHM
    • Market Background
    • Top Healthcare Industry Imperatives-The United States
    • Transition to Accountable Care-4 Essential Steps to Follow
    • Fundamental Characteristics Required to Facilitate PHM
    • Goal of PHM-Shifting Emphasis from Immediate Care to Prevention
    • The Road to Accountable Care-US PHM Market
    • Category Segmentation of the US PHM Market
    • Customer Segmentation of the US PHM Market
    • Definition of Key Customer Market Segments
    • PHM Business Objectives by Key Customer Segments
  • Macro Conditions Prompting Population Health Management
    • Inefficiency in Traditional Healthcare Systems
    • Socioeconomic Indicators
    • Rising Demand for Healthcare
    • Growth of Chronic Diseases
    • Massive Cost Burden of Chronic Disease Management
    • Rising National Health Expenditure
    • Evolving Reimbursement Frameworks Drive Accountable Care
    • Risk-Based Reimbursements Tie Provider Revenue with
  • Introduction to Population Health Management
    • Population Health Management-Definition
    • Population Health Management-Overview
    • Type of PHM Solutions-Market Has a Technology for Every Health System
    • Evolution of PHM
    • PHM-Market Maturity Indicator
    • Evolution of PHM-Technology Roadmap
    • Market Drivers
    • Market Restraints
  • PHM Segment Level Analysis
    • Market Segmentation
    • Advisory-Key Goals
    • Advisory
    • Data Aggregation and Management-Key Goals
    • Data Aggregation and Management-Evolving Service Models
    • Data Aggregation and Management-Key Market Observations
    • Risk Stratification-Key Goals
    • Risk Stratification and Modeling-Framework that Enables PHM
    • Care Coordination-Key Goals
    • Care Coordination
    • Patient Engagement-Key Goals
    • Patient Engagement-A Key Focus Area across All Stakeholders
    • Successful Patient Engagement Requires Behavioral Change for Patients and Their Providers
    • Past and Future Approaches to Patient Engagement
    • Basic-to-Advanced Patient Engagement Guidelines
    • Adoption Outlook of Different Patient Engagement Solutions
    • Performance Management-Key Goals
    • Performance Management
  • Implementation of PHM
    • PHM Value Chain Analysis
    • Payers Triggered PHM to Support Implementation of Value-based Reimbursement Programs
    • Traditional vs. PHM-enabled Care Delivery-Comparative Ecosystem
    • Patient Condition Management through Analytics-Contextual Framework
    • PHM Technology Ecosystem Aid Patient-Centered Care Delivery
    • Population Health Management-Functional Architecture
    • Progressive PHM Approach by Care Settings
    • PHM IT Solutions Interface with Various Clinical and Administrative Solutions to Address Program Objectives
    • Top PHM Investment Areas
    • Incremental Growth Potential for Leading Healthcare Information Technologies that aid PHM
  • Procurement of PHM Services
    • PHM Procurement-Snapshot
    • Supply-Demand Dynamics
    • Engagement Strategy
    • Contract Strategy
    • Sourcing Strategy
    • Cost Structure-Vendors
    • Cost Structure-Providers
    • Procurement Quick Wins
  • Pricing Models for PHM Solutions
    • Pricing Strategy for Specific PHM Applications
    • PHM Pricing Models
    • Software-license-based Pricing Tied to Coverage
    • Risk-based Pricing Tied to Outcomes
  • Forecasts and Trends-Total Population Health Management Market
    • Market Engineering Measurements
      • Table Total Population Health Management Market: Market Engineering Measurements, US, 2015
    • Forecast Assumptions and Definitions
    • Revenue Forecast
      • Table Total Population Health Management Market: Revenue Forecast, US, 2015-2020
    • Revenue Forecast Discussion
    • Percent Revenue Forecast by Customer Segment
      • Table Total Population Health Management Market: Percent Revenue Forecast by Segment, US, 2015-2020
    • Revenue Forecast by Segment
      • Table Total Population Health Management Market: Revenue Forecast by Segment, US, 2015-2020
    • Revenue Forecast by Segment Discussion
    • Pricing Analysis-Projected Unit Price Variance
    • Pricing Analysis by PHM Customer Segment-ACOs
    • Pricing Analysis by PHM Customer Segment-Payers & Payer-Providers
    • Pricing Analysis by PHM Customer Segment-Non-ACO Hospitals
    • Pricing Analysis by PHM Customer Segment-Non-ACO Physician Practices
  • Forecasts and Trends-Market Segments
    • Market Engineering Measurements-ACOs Segment
      • Table ACOs Segment: Market Engineering Measurements, US, 2015
    • Revenue Forecast-ACOs Segment
      • Table ACOs Segment: Revenue Forecast, US, 2015-2020
    • Market Engineering Measurements-Payers & Payer-Providers Segment
      • Table Payers & Payer-Providers Segment: Revenue Forecast, US, 2015-2020
    • Revenue Forecast-Payers & Payer-Providers Segment
      • Table Payers & Payer-Providers Segment: Revenue Forecast, US, 2015-2020
    • Market Engineering Measurements-Non-ACO Hospitals Segment
      • Table Non-ACO Hospital Segment: Market Engineering Measurements, US, 2015
    • Revenue Forecast-Non-ACO Hospitals Segment
      • Table Non-ACO Hospitals Segment: Revenue Forecast, US, 2015-2020
    • Market Engineering Measurements-Non-ACO Physician Practices Segment
      • Table Non-ACO Physician Practice Segment: Market Engineering Measurements, US, 2015
    • Revenue Forecast-Non-ACO Physician Practices Segment
      • Table Non-ACO Physician Practices Segment: Revenue Forecast, US, 2015-2020
  • Demand Analysis
    • Penetration Analysis-ACOs
    • Penetration Analysis-Payers & Payer-Providers
    • Penetration Analysis-Non-ACO Hospitals
    • Penetration Analysis-Non-ACO Physician Practices
  • Competitive Environment
    • Market Gaps in the United States
    • Recommendations for the US Market
    • Changes in the Supply Market Landscape-Analyst Perspective
    • PHM Vendors Capability Matrix-Definitions
    • PHM Vendors Capability Matrix-Snapshot
    • PHM Vendors Capability Matrix-Key Observations
    • Mapping of Leading Ecosystem Players
    • Complex Supply Dynamics of the US PHM Market
    • Select PHM Companies and Products
    • Competitive Market Structure
    • Recent Notable M&As-Investment and Withdrawals
    • Top Companies to Watch
  • Selected Vendor Profiles
    • Optum-Corporate Background
    • Optum-PHM Value Chain
    • Optum-SWOT Analysis
    • Caradigm-Corporate Background
    • Caradigm-PHM Value Chain
    • Caradigm-SWOT Analysis
    • Healthagen-Corporate Background
    • Healthagen-PHM Value Chain
    • Healthagen-SWOT Analysis
    • Evolent Health-Corporate Background
    • Evolent Health-PHM Value Chain
    • Evolent Health-SWOT Analysis
    • IBM Watson Health-Corporate Background
    • IBM Watson Health-Platform solutions for the PHM Value Chain
    • IBM Watson Health-SWOT Analysis
    • Health Catalyst-Corporate Background
    • Health Catalyst-PHM Value Chain
    • Health Catalyst-SWOT Analysis
    • ENLI-Corporate Background
    • ENLI-PHM Value Chain
    • ENLI-SWOT Analysis
    • ZeOmega-Corporate Background
    • ZeOmega-PHM Value Chain
    • ZeOmega-SWOT Analysis
  • Future Perspectives
    • Future Perspectives-3 Big Predictions
    • The Last Word-Discussion
  • Appendix
    • Additional Frost & Sullivan Sources of Information on Healthcare
    • Market Engineering Methodology

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