The study defines care coordination software as “applications that are specifically designed to enable team-based patient care, particularly for at-risk patients with chronic conditions and for patients transitioning between care settings (e.g. hospital to home).” Frost and Sullivan emphasizes that this definition is not pristine, as there is a range of rudimentary to robust solutions that can fit into the care coordination bucket.
Key Factors Affecting Market Drivers and Restraints
Why care coordination market growth now? According to the study, there are three main market drivers contributing to the estimated growth:
- The Affordable Care Act changes financial risk dynamics and drives need for population health.
- Move to value-based, quality-driven reimbursement demands tighter control and integration across the care continuum.
- CMS issues new rules for reimbursement for chronic disease management.
On the flip side, there are three main market restraints. Vendor ingenuity will determine how the market will overcome these obstacles:
- Continued entrenchment of fee-for-service
- Slow adoption of new IT for population health and care coordination due to competing IT priorities.
- Financial constraints among providers limit willingness to invest in care coordination IT.
Opportunity for Healthcare Technology Vendors
The care coordination software market is highly fragmented, with hundreds of vendors and products offering a range of functionalities related to patient care management. While Electronic Medical Records (EMRs) are widely adopted at this point, most systems do not offer interoperability for care coordination. This is where the huge opportunity for healthcare technology vendors lies.
With the care coordination market growing more competitive than ever, vendor success depends on the ability to offer a full suite of comprehensive solutions with demonstrable ROI. Because care coordination is so broad, it is difficult for vendors to offer robust functionality in all areas. Many vendors excel at certain aspects of the care coordination equation, be it patient-provider matching analytics or provider communication, but lack other key functionality.
Leveraging Partnerships to Build Comprehensive Solutions
To combat this, vendors may consider embedding other services within their product suite to offer a more comprehensive care coordination solution for their customers. For example, one vital feature many vendors lack is insurance processing for referrals, as payers do not have uniform capabilities for electronic transmission. In addition, the Affordable Care Act has brought so many changes to the insurance landscape that it requires an expert knowledge base just to keep up. Instead of stretching internal resources, vendors can embed a solution like Clarity Health into their existing user interface to offer insurance processing.
Clarity partners with vendors, running in the background to obtain and electronically deliver insurance authorizations, eligibility, and network checks to customers. This adds huge value for medical providers, as they need accurately obtained insurance authorizations accompanying their patient referrals to ensure they are paid. By embedding a specialized solution for insurance processing, vendors can expand their product without expending internal resources.