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2 HEALTHCARE EDI MARKET [By Component (EDI Software, EDI Services), By Transaction (Claim Status, Eligibility Verification) By Mode of Delivery (Webbased EDI, Mobile EDI, EDI Van) By End user (Healthcare Payers, Providers)] MarketsandMarkets

3 MarketsandMarkets is a global market research and consulting company based in the U.S. We publish strategically analyzed market research reports and serve as a business intelligence partner to Fortune 500 companies across the world. MarketsandMarkets also provides multi-client reports, company profiles, databases, and custom research services. MarketsandMarkets covers fourteen industry verticals, including aerospace and defence, advanced materials, automotives and transportation, banking and financial services, biotechnology, chemicals, consumer goods, energy and power, food and beverages, industrial automation, medical devices, pharmaceuticals, semiconductor and electronics, and telecommunications and IT. Copyright 2014 MarketsandMarkets All Rights Reserved. This document contains highly confidential information and is the sole property of MarketsandMarkets. No part of it may be circulated, copied, quoted, or otherwise reproduced without the approval of MarketsandMarkets. MarketsandMarkets Sample Page 2

4 1 EXECUTIVE SUMMARY Electronic data interchange (EDI) is the automated transfer of data as per specific format between healthcare providers and payers for better claims management, and also between healthcare organizations and medical equipment or accessories suppliers for better management of supply chain. EDI has been increasingly embraced by the healthcare industry and is experiencing a growth due to various advantages such as reduction in the administration costs, reduced errors and time for transfer of claims, and initiatives by various governments. In the U.S., the overall uptake of EDI in the healthcare industry is driven by greater adoption after implementation of the Obamacare Act in 2010, which mandated the use of EDI solutions for variety of transactions including claims processing, enrollment and disenrollment, premium payments, and eligibility verification. The North American market accounted for the maximum share of the global healthcare EDI market, while the European market also occupied a significant share of the global healthcare EDI market. The Asian market exhibits the maximum growth opportunity in the forecast period due to upgradation of healthcare infrastructure and government initiatives for the support of healthcare IT implementation in these regions. The global healthcare EDI market was valued at $ million in 2013 and is poised to grow at a CAGR of % in the forecast period, to reach $ million by For the purpose of this study, the healthcare EDI Market is divided into two components, namely software and services. The market is further divided by type of transaction into claim status, eligibility verification, payment remittance, referral certification authorization, enrollment/disenrollment transactions, and premium payments. The healthcare EDI market is also divided by mode of delivery into web-based EDI/EDI cloud, point-to-point EDI, mobile EDI, EDI VAN, and EDI via AS2. The end users of the healthcare EDI market include healthcare payers, healthcare providers, and medical equipment and accessories suppliers/pharmacies. MarketsandMarkets Sample Page 3

5 FIGURE 1 GLOBAL HEALTHCARE EDI MARKET, BY TYPE OF TRANSACTION, 2013 VS ($MILLION) Claim Status Payment Remittance Eligibility Verification Premium Payments Referral Certification Authorization Enrollment/Disenrollment Transactions Source: Annual Reports, SEC Filings, Integrated Healthcare Association (IHA), Health Level Seven International (HL7), Healthcare Information and Management System Society (HIMSS), American Health Information Management Association (AHIMA), other Healthcare IT Integration Associations, Expert Interviews, and MarketsandMarkets Analysis The claim status transactions dominated the healthcare EDI market, by type of transaction, with a % market share in The healthcare EDI market for claim status transactions was valued at $ million in 2013 and is poised to grow at a CAGR of % to reach $ million by With an increase in the number of policies, there is a considerable rise in an individual coverage and thereby the billing volume, which in turn is driving the demand for EDI solutions to streamline claims management in the healthcare industry. Decreased duplication of claims status, lesser time spent on manual work, and improved productivity are some major drivers for the adoption of EDI for claim status processing which further helps reduce the overall healthcare cost. MarketsandMarkets Sample Page 4

6 FIGURE 2 GLOBAL HEALTHCARE EDI MARKET, BY MODE OF DELIVERY, 2013 VS ($MILLION) Web-based EDI / EDI Cloud EDI via AS2 (EDI INT) Point-to-Point EDI EDI VAN Mobile EDI Source: Annual Reports, SEC Filings, Integrated Healthcare Association (IHA), Health Level Seven International (HL7), Healthcare Information and Management System Society (HIMSS), American Health Information Management Association (AHIMA), other Healthcare IT Integration Associations, Expert Interviews, and MarketsandMarkets Analysis The web-based EDI is the most preferred mode of delivery which contributed around % of the healthcare EDI market in This market was valued at $ million in 2013 and is poised to grow at a CAGR of % in the forecast period to reach $ million by This is mainly attributed to its benefits in the form of ease of use and affordability, which makes it a preferred choice for low-volume users. MarketsandMarkets Sample Page 5

7 FIGURE 3 GLOBAL HEALTHCARE EDI MARKET REVENUE TREND, ($MILLION) 2, ,500.0 Market Size ($Million) 1, CAGR ( ) % % % % North America Europe Asia RoW Source: Annual Reports, SEC Filings, Integrated Healthcare Association (IHA), Health Level Seven International (HL7), Healthcare Information and Management System Society (HIMSS), American Health Information Management Association (AHIMA), other Healthcare IT Integration Associations, Expert Interviews, and MarketsandMarkets Analysis North America will continue to dominate the healthcare EDI market, followed by Europe, Asia, and the RoW till The U.S. has been a frontrunner in the development of IT infrastructure for the healthcare industry and is a well-established market for healthcare IT solutions. However, there lies a further growth opportunity for the healthcare EDI market in the U.S. considering the presence of large hospitals in the country demanding innovative IT solutions to streamline the processes and availability of government funding for healthcare providers toward the development of health services. As the Asian market is relatively new to healthcare EDI, the market share of this region is not expected to change significantly in the next five years. However, the increasing number of government initiatives toward the implementation of IT in the healthcare industry will propel the demand for healthcare IT solutions, which in turn will drive the healthcare EDI market at a CAGR of % between 2013 and Some major players in the global healthcare EDI market include Emdeon Inc. (U.S.), Allscripts (U.S.), Mckesson (U.S.), Optum Health (U.S.), GE Healthcare (U.K.), Siemens Healthcare (Germany), SSI Group (U.S.), ZirMed (U.S.), Passport Health Communications (U.S.), and Capario (U.S.). MarketsandMarkets Sample Page 6

8 2 MARKET DYNAMICS 2.1 MARKET SHARE ANALYSIS McKesson Corporation (U.S.), Emdeon Inc. (U.S.), OptumHealth (U.S.), SSI Group Inc. (U.S.), Allscripts Healthcare Solutions Inc. (U.S.), and Siemens Healthcare (Germany) collectively contributed a share of % to % of the global healthcare EDI market in McKesson Corporation dominated the global healthcare electronic data interchange (EDI) market. The company s large share can primarily be attributed to its strong presence in the healthcare information technology (IT) market as well as its wide range of product offerings for healthcare EDI. The company provides software, automation, and consulting services to hospitals, physician offices, imaging centers, home healthcare agencies, and payers. With its strong presence in the healthcare IT market for more than 100 years, the company has built a strong relationship with its customers and is further expected to retain its leadership position by launching new products and by enhancing its existing products in the coming years. Partnerships and collaborations have also helped the company in maintaining a robust product portfolio, making it the company of choice for healthcare EDI users across the globe. MarketsandMarkets Sample Page 7

9 FIGURE 4 GLOBAL HEALTHCARE EDI MARKET SHARE, BY KEY PLAYERS, 2013 Company Name Rank Market Share McKesson Emdeon OptumHealth SSI Group -% Allscripts Siemens Others -% Source: Annual Reports, SEC Filings, Integrated Healthcare Association (IHA), Health Level Seven International (HL7), Healthcare Information and Management System Society (HIMSS), American Health Information Management Association (AHIMA), other Healthcare IT Integration Associations, Expert Interviews, and MarketsandMarkets Analysis MarketsandMarkets Sample Page 8

10 3 HEALTHCARE EDI MARKET, BY PRODUCT 3.1 INTRODUCTION The healthcare EDI market is broadly divided into two components, namely software and services. The market is further divided by type of transaction which includes claim status, eligibility verification, payment remittance, referral certification authorization, enrollment/disenrollment transactions, and premium payments. The healthcare EDI market is also divided by mode of delivery into web-based EDI/EDI cloud, Point-to-point EDI, mobile EDI, EDI VAN, and EDI via AS2. FIGURE 5 HEALTHCARE EDI MARKET, BY PRODUCT GLOBAL HEALTHCARE EDI MARKET, BY PRODUCT Component Type of Transaction Mode of Delivery EDI Software Eligibility Verification Web-based EDI EDI Services Payment Remittance EDI via AS2 (EDIINT) Referral Certification Authorization Enrollment/Disenrollment Transactions Point-to-Point EDI EDI VAN Premium Payments Mobile EDI Source: Annual Reports, SEC Filings, American Society of Healthcare Engineers (ASHE), Healthcare Information & Management Systems Society (HIMSS), International Economic Development Council (IEDC), Electronic Healthcare Network Accreditation Commission (EHNAC), Global Healthcare IT (HCIT) Commercial Council, American Health Information Management Association (AHIMA), Expert Interviews, and MarketsandMarkets Analysis MarketsandMarkets Sample Page 9

11 3.2 HEALTHCARE EDI MARKET, BY COMPONENT Electronic data interchange (EDI) consists of two main components, namely EDI software and EDI services. EDI software consists of different kinds of software provided by the EDI providers which are used by the EDI payers and providers. The software helps in carrying out specific transactions such as claims status and submission, eligibility verification, payment remittance, and enrollment/disenrollment transactions and assists in revenue cycle management for the healthcare organization. On the other hand, EDI services cover a variety of services such as maintenance, consulting, implementation, and customization services for the software provided by the EDI vendors. The services offered help in proper implementation and effective utilization of the EDI solution implemented at the healthcare organization. TABLE 1 GLOBAL HEALTHCARE EDI MARKET, BY COMPONENT, ($MILLION) Type CAGR EDI Software % EDI Services % Total % Source: Annual Reports, SEC Filings, American Society of Healthcare Engineers (ASHE), Healthcare Information & Management Systems Society (HIMSS), International Economic Development Council (IEDC), Electronic Healthcare Network Accreditation Commission (EHNAC), Global Healthcare IT (HCIT) Commercial Council, American Health Information Management Association (AHIMA), Expert Interviews, and MarketsandMarkets Analysis EDI software accounted for % of the global healthcare EDI market in This market was valued at $ million in 2013 and is expected to reach $ million by 2018, growing at a CAGR of % during the forecast period due to increased use of claim status and eligibility verification contributing to the growth of the software market. MarketsandMarkets Sample Page 10

12 3.3 HEALTHCARE EDI MARKET, BY MODE OF DELIVERY Electronic data interchange (EDI) between payers, providers, and other healthcare organizations can be carried out through various means. There are different methods of EDI utilization which could be chosen as per the budget, needs, and technical capabilities of the organizations. It can involve the expansion of an existing EDI infrastructure or the utilization of EDI for the first time. The most commonly used EDI delivery methods include, web-based EDI/EDI cloud, Point-topoint EDI, mobile EDI, EDI VAN, and EDI via AS2, with each one having distinct benefits for the organization implementing it. TABLE 2 GLOBAL HEALTHCARE EDI MARKET, BY MODE OF DELIVERY, ($MILLION) Mode of Delivery CAGR ( ) Web-based EDI/EDI Cloud % EDI via AS2 (EDI INT) % Point-to-Point EDI % EDI VAN % Mobile EDI % Total % Source: Annual Reports, SEC Filings, American Society of Healthcare Engineers (ASHE), Healthcare Information & Management Systems Society (HIMSS), International Economic Development Council (IEDC), Electronic Healthcare Network Accreditation Commission (EHNAC), Global Healthcare IT (HCIT) Commercial Council, American Health Information Management Association (AHIMA), Expert Interviews, and MarketsandMarkets Analysis MarketsandMarkets Sample Page 11

13 4 GEOGRAPHIC ANALYSIS 4.1 INTRODUCTION TABLE 3 HEALTHCARE EDI MARKET, BY GEOGRAPHY, ($MILLION) Region CAGR ( ) North America % Europe % Asia % RoW % Total % Source: Annual Reports, SEC Filings, American Society of Healthcare Engineers (ASHE), Healthcare Information & Management Systems Society (HIMSS), International Economic Development Council (IEDC), Electronic Healthcare Network Accreditation Commission (EHNAC), Global Healthcare IT (HCIT) Commercial Council, American Health Information Management Association (AHIMA), Expert Interviews, and MarketsandMarkets Analysis In 2013, North America commanded the largest share % of the healthcare EDI market. This market was valued at $ million in 2013 and is poised to grow at a CAGR of % in the forecast period to reach $ million by This is mainly attributed to the presence of large hospitals in the country demanding innovative IT solutions to streamline the processes and availability of government funding for healthcare providers toward the development of health services. However, the Asian market is relatively new to the healthcare EDI and is expected to grow at a highest CAGR of % in the forecast period to reach $ million by 2018 from $ million in This is primarily attributed to the increasing number of government initiatives toward the implementation of IT in the healthcare industry which will propel the demand for healthcare IT solutions, which in turn will drive the healthcare EDI market. MarketsandMarkets Sample Page 12

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