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Value-Based Care Market: Current Analysis and Forecast (2021-2027)

Region:Global

Author(s):

Product Code:UMHE21235

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Published on

May 2021

Total pages

237

Table of Content

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About the Report

About the Report

IN MEDICARE INDUSTRY THE VALUE-BASED CARE MODELS ARE SEEKING INTEREST OF MANY INVESTORS IN RECENT TIMES. THESE MODELS CONNECTS THE PROVIDERS, INSURERS, PAYERS, AND PATIENTS TOGETHER AND BENEFITS EVERYONE IN A SIGNIFICANT MANNER ALONG WITH LOWERING THE HEALTHCARE COSTS WHICH IS WHY THE MARKET FOR VBC IS EXPECTED TO THRIVE IN THE FORECAST PERIOD. FOR INSTANCE, DELOITTE, CENTER FOR HEALTH SOLUTIONS IN 2019, REPORTED SOME SIGNIFICANT INVESTMENTS WHICH HAS DONE BY THE PAYERS AND OTHER STAKEHOLDERS FOR THE IMPLEMENTATION OF VALUE-BASED CARE INITIATIVES. THESE INVESTMENT INCLUDE:

BLUE CROSS BLUE SHIELD HEALTH SPEND MORE THAN USD 65 MILLION ANNUALLY OR ABOUT 20% OF THEIR SPENDING ON MEDICAL CLAIMS, ON VBC.

THE DEPARTMENT OF HEALTH & HUMAN SERVICES, HAS SPEND 30% OF PAYMENTS ON TRADITIONAL MEDICARE BENEFITS TO VALUE-BASED PAYMENT MODELS AT THE END OF 2016 AND HAD REACHED UP TO 50% IN 2018.

AETNA DEVOTED 15% OF ITS 2013 SPENDING ON VALUE-BASED CARE EFFORTS AND REACHED AT THE AMOUNT TO 45% IN 2017.

VALUE-BASED CARE IS A HEALTH CARE DELIVERY PLAN UNDER WHICH PROVIDERS LIKE HOSPITALS, LABS, DOCTORS, NURSES AND OTHERS ARE PAID BASED ON THE HEALTH RESULTS OF THEIR PATIENTS AND THE QUALITY OF SERVICES PROVIDED. PROVIDERS SHARES SOME FINANCIAL RISK WITH HEALTH INSURANCE COMPANIES UNDER SOME VALUE-BASED CONTRACTS WHERE IN ADDITION TO NEGOTIATED PAYMENTS, THEY EARN INCENTIVES FOR PROVIDING HIGH-QUALITY AND EFFICIENT CARE. VBC VARIES FROM THE TRADITIONAL FEE-FOR-SERVICE PLAN WHERE PROVIDERS ARE PAID DISTINCTLY FOR EACH MEDICAL SERVICES. ALTHOUGH, QUALITY CARE IS PROVIDED UNDER BOTH MODELS, THE MAIN DIFFERENCE IS HOW PROVIDERS ARE PAID, CONNECTED WITH PATIENT AND CARE IS MANAGED, THAT ONLY OFFERS IN A VBC SURROUNDINGS BY PROVIDING HEALTHCARE ENHANCEMENTS AND COST SAVINGS.

THE MAIN OBJECTIVE DRIVING THE IMPLEMENTATION OF VALUE-BASED HEALTHCARE IS CONCENTRATED ON QUALITY, ORGANIZATIONS HAVE SEEN PROFITS THAT EXTEND TO OPERATIONS AND REDUCED COSTS. FOR INSTANCE, IN FEBRUARY 2019 HEALTH SERVICES PROVIDER CIGNA ANNOUNCED THAT 3.6 MILLION PATIENTS RECEIVING CARE THROUGH A VALUE-BASED MODEL WHICH INTERPRETS, THEY EXCEEDED THEIR GOAL BY 50% OF ITS PAYMENTS. THIS MOVE HELPED TO SAVE CIGNA MORE THAN USD 600 MILLION BETWEEN 2013 AND 2017, AND THE COMPANY HIGHLIGHTED DATA ANALYTICS AND VALUE-BASED CARE AS A CRITICAL ELEMENT OF THEIR SUCCESS.
DUE TO THE IMPACT OF THE COVID-19, THE NATIONAL ASSOCIATION OF ACCOUNTABLE CARE ORGANIZATIONS (NAACOS) SURVEYED THE ACO COMMUNITY TO MEASURE THEIR EXPERIENCE IN HANDLING THE ONGOING PANDEMIC. AS A RESULT, MORE THAN HALF, 56%, OF HEALTHCARE ORGANIZATIONS SAID THAT THEY WERE TAKING FINANCIAL RISK IN A MEDICARE PROGRAM PROVEN TO LOWER THE COST OF CARE AND THEY LIKELY TO DROP OUT THE PROGRAM BECAUSE OF THE FEAR TO PAY MASSIVE LOSSES RESULTING FROM THE COVID-19 PANDEMIC. BUT ALMOST 20% OF MEDICARE BENEFICIARIES AND NEARLY 500,000 CLINICIANS' PRACTICE IN AN ACO IN 2020, MAKING THE SHARED SAVINGS PROGRAM THE LARGEST VALUE-BASED PAYMENT MODEL IN MEDICARE.

BASED ON THE MODELS, THE MARKET IS BIFURCATED INTO ACCOUNTABLE CARE ORGANIZATION (ACO), PATIENT-CENTERED MEDICAL HOME (PCMH), PAY FOR PERFORMANCE (P4P), AND BUNDLED PAYMENTS. THE ACCOUNTABLE CARE ORGANIZATION (ACO) SEGMENT GRABBED THE MAJOR MARKET AS THE QUANTITY OF ACCOUNTABLE CARE ORGANIZATIONS (ACO) IS EXPANDING, BY INSERTING MORE PROTECTION AND SECURITY. FOR INSTANCE, ACCORDING TO THE JOURNAL OF HEALTH AFFAIRS 2018, ALMOST 1,000 ACOS SPREAD ACROSS THE USA IN 2017, WHICH REPRESENTED MORE THAN 1,400 CONTRACTS WITH COMMERCIAL AND GOVERNMENT INSURERS WRAPPING MORE THAN 32 MILLION AMERICANS. THESE MODELS ARE EASY TO USE AND OFFERS HEALTHCARE AT LOW COSTS INCREASES ITS DEMAND IN THE MARKET.

BASED ON DEPLOYMENT, THE MARKET IS FRAGMENTED INTO CLOUD-BASED AND ON-PREMISES. THE CLOUD-BASED SEGMENT ACCOUNTED FOR THE MAJOR REVENUE PORTION IN 2020. AS, THE COMPANIES SUCH AS QUALCOMM LIFE INC., OPZOON TECHNOLOGY CO., LTD., AND FIBOCOM WIRELESS INC. ARE INVOLVED IN THE SALES OF WIRELESS AND CLOUD-BASED TECHNOLOGY PRODUCTS USED IN THE HEALTHCARE INDUSTRY.

BASED ON PLATFORM, THE MARKET IS FRAGMENTED INTO STANDALONE AND INTEGRATED. THE INTEGRATED PLATFORM SEGMENT ACCOUNTED FOR THE MAJOR REVENUE PORTION IN 2020. THE SECTOR IS ANTICIPATED TO OBSERVE SIGNIFICANT GROWTH IN THE UPCOMING YEARS AS BY WORKING IN INTEGRATION THE ORGANIZATIONS MIGHT PRODUCE MORE PROFITS. WHEN PAYERS AND OTHER STAKEHOLDERS MAKE SIGNIFICANT INVESTMENTS, THEY PRODUCE ADDITIONAL PROFITS IN VALUE-BASED MODELS.

BASED ON END-USER, THE MARKET IS FRAGMENTED INTO PROVIDERS, PAYERS, AND PATIENTS. THE PROVIDERS SEGMENT IS ANTICIPATED TO OBSERVE LUCRATIVE GROWTH. AS PROVIDERS ARE NOT ONLY CONCENTRATING ON GROWING THEIR INFRASTRUCTURE BUT ALSO TRYING TO IMPROVE IT. SO, THAT PATIENTS CAN GET EASY ACCESS TO HEALTHCARE FACILITIES AND COST REDUCTION.
FOR A BETTER UNDERSTANDING OF THE MARKET ADOPTION OF THE VALUE-BASED CARES, THE MARKET IS ANALYZED BASED ON ITS WORLDWIDE PRESENCE IN THE COUNTRIES SUCH AS NORTH AMERICA (UNITED STATES, CANADA, AND REST OF NORTH AMERICA), EUROPE (GERMANY, FRANCE, ITALY, SPAIN, UNITED KINGDOM AND REST OF EUROPE), ASIA-PACIFIC (CHINA, JAPAN, INDIA, AUSTRALIA AND REST OF APAC), AND REST OF WORLD. NORTH AMERICA CONSTITUTES A MAJOR MARKET FOR THE VALUE-BASED CARE INDUSTRY AND GENERATED REVENUE OF USD XX MILLION IN 2020 OWING TO THE PRESENCE OF KEY COMPANIES AND ADVANCED HEALTHCARE INFRASTRUCTURE WITH HIGHEST SPENDING'S IN HEALTHCARE. HOWEVER, THE ASIA PACIFIC REGION WOULD GROW AT THE HIGHEST CAGR DURING THE FORECAST PERIOD.

SOME OF THE MAJOR PLAYERS OPERATING IN THE MARKET INCLUDE SIEMENS HEALTHINEERS , NEXTSTEP SOLUTIONS, ATHENA HEALTH, NXGN MANAGEMENT, LLC, MCKESSON CORPORATION, OPTUM, OLIVER WYMAN, BAKER TILLY, AETNA, BLUE CROSS BLUE SHIELD ASSOCIATION, ETC. SEVERAL M&AS ALONG WITH PARTNERSHIPS HAVE BEEN UNDERTAKEN BY THESE PLAYERS TO BOOST THEIR PRESENCE IN DIFFERENT REGIONS.

THE GLOBAL VALUE-BASED CARE MARKET WAS VALUED AT USD XX MILLION IN 2020 AND IS PROJECTED TO EXPAND SIGNIFICANTLY WITH A CAGR OF XX% FROM 2021F-2027F. THE GLOBAL VALUE-BASED CARE MARKET IS EXPECTED TO WITNESS A BOOST AS IT PROVIDES BETTER HEALTHCARE OUTCOMES AT LOWER COSTS. THE KEY PLAYERS WORLDWIDE ARE INTRODUCING ADVANCED SHARED SAVINGS PROGRAMS TO CATER MIDDLE-INCOME GROUPS TO BOOST THE GROWTH OF THE VALUE-BASED CARE MARKET.

Products


Companies

SIEMENS HEALTHINEERS

NEXTSTEP SOLUTIONS

ATHENA HEALTH

NXGN MANAGEMENT

LLC

MCKESSON CORPORATION

OPTUM

OLIVER WYMAN

BAKER TILLY

AETNA AND

BLUE CROSS BLUE SHIELD ASSOCIATION

Table of Contents

Table of Contents

1 MARKET INTRODUCTION

1.1 MARKET DEFINITIONS

1.2 OBJECTIVE OF THE STUDY

1.3 LIMITATION

1.4 STAKE HOLDERS

1.5 CURRENCY USED IN REPORT

1.6 SCOPE OF THE GLOBAL VALUE BASED CARE MARKET STUDY

2 RESEARCH METHODOLOGY OR ASSUMPTION

2.1 RESEARCH METHODOLOGY FOR THE GLOBAL VALUE BASED CARE MARKET

2.1.1 MAIN OBJECTIVE OF THE GLOBAL VALUE BASED CARE MARKET

3 MARKET SYNOPSIS

4 EXECUTIVE SUMMARY

5 TOP START-UPS UNDER VALUE BASED CARE SECTOR

6 GLOBAL VALUE BASED CARE AMID COVID-19

7 GLOBAL VALUE BASED CARE MARKET REVENUE (USD BN), 2019-2027F

8 MARKET INSIGHTS BY MODELS

8.1 ACCOUNTABLE CARE ORGANIZATION (ACO)

8.2 PATIENT-CENTERED MEDICAL HOME (PCMH)

8.3 PAY FOR PERFORMANCE (P4P)

8.4 BUNDLED PAYMENTS

9 MARKET INSIGHTS BY DEPLOYMENT

9.1 CLOUD BASED

9.2 ON-PREMISES

10 MARKET INSIGHTS BY PLATFORM

10.1 STANDALONE

10.2 INTEGRATED

11 MARKET INSIGHTS BY END-USER

11.1 PROVIDERS

11.2 PAYERS

11.3 PATIENTS

12 MARKET INSIGHTS BY REGION

12.1 NORTH AMERICA VALUE BASED CARE MARKET

12.1.1 UNITED STATES

12.1.2 CANADA

12.1.3 REST OF NORTH AMERICA

12.2 EUROPE VALUE BASED CARE MARKET

12.2.1 GERMANY

12.2.2 FRANCE

12.2.3 UNITED KINGDOM

12.2.4 ITALY

12.2.5 SPAIN

12.2.6 REST OF EUROPE

12.3 ASIA PACIFIC VALUE BASED CARE MARKET

12.3.1 CHINA

12.3.2 JAPAN

12.3.3 INDIA

12.3.4 AUSTRALIA

12.3.5 REST OF ASIA PACIFIC

12.4 REST OF WORLD VALUE BASED CARE MARKET

13 VALUE BASED CARE MARKET DYNAMICS

13.1 MARKET DRIVERS

13.2 MARKET CHALLENGES

13.3 IMPACT ANALYSIS

14 VALUE BASED CARE MARKET OPPORTUNITIES

15 VALUE BASED CARE MARKET TRENDS

16 LEGAL & REGULATORY FRAMEWORK

17 DEMAND AND SUPPLY SIDE ANALYSIS

17.1 DEMAND SIDE ANALYSIS

17.2 SUPPLY SIDE ANALYSIS

17.2.1 TOP PRODUCT LAUNCHES

17.2.2 TOP BUSINESS PARTNERSHIPS

17.2.3 TOP BUSINESS EXPANSIONS, INVESTMENTS AND DIVESTITURES

17.2.4 TOP MERGER AND ACQUISITIONS

18 VALUE CHAIN ANALYSIS

19 COMPETITIVE SCENARIO

19.1 PORTER'S FIVE FORCES ANALYSIS

19.1.1 BARGAINING POWER OF SUPPLIER

19.1.2 BARGAINING POWER OF BUYER

19.1.3 INDUSTRY RIVALRY

19.1.4 AVAILABILITY OF SUBSTITUTE

19.1.5 THREAT OF NEW ENTRANTS

19.2 COMPETITIVE LANDSCAPE

19.2.1 COMPANY SHARES, BY REVENUE

20 COMPANY PROFILED

20.1 SIEMENS HEALTHINEERS

20.2 NEXTSTEP SOLUTIONS

20.3 ATHENA HEALTH

20.4 NXGN MANAGEMENT, LLC

20.5 MCKESSON CORPORATION

20.6 OPTUM

20.7 OLIVER WYMAN

20.8 BAKER TILLY

20.9 AETNA

20.10 BLUE CROSS BLUE SHIELD ASSOCIATION

21 DISCLAIMER

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