Clinical and Care Management Operations Services – Provider Compendium 2024

The growing cost of healthcare services and a gap in the quality of care provided in traditional fee-for-service models have propelled the traction of value-based care models in the market. With this in mind, the Centers for Medicare and Medicaid Services (CMS) has planned for increased value-based care adoption by transferring all Medicare fee-for-service beneficiaries into a care relationship with accountability for quality and a reduction in the total cost of care by 2030.

While alternate care delivery models, such as home-based care and virtual care, were initially brought on due to the onset of the pandemic, they are being utilized by enterprises to improve continuity of care, reduce costs, and drive value for their member/patient base. However, with a growing push toward value-based care and improving overall population health, both payer and provider perspectives require further investments for integrated care management and effective utilization management. Providers can fulfill enterprises’ clinical and care management operations requirements by delivering clinical services from cost-effective locations and deploying advanced technology solutions built on a foundation of clinical, claims, and Social Determinants of Health (SDoH) data for personalized care programs and engagement.

In this report, we assess 15 healthcare providers featured on the clinical and care management operations PEAK Matrix^®. The study will enable healthcare enterprises to identify suitable providers to transform their business processes and differentiate themselves.

Scope

• Industry: healthcare business process
• Geography: global
• The assessment is based on Everest Group’s annual RFI process for the calendar year 2023, interactions with leading healthcare payer operations providers, client reference checks, and an ongoing analysis of the healthcare business process services market

Contents

In this report, we examine:

• 15 healthcare providers featured on the clinical and care management operations PEAK Matrix^®
• Providers’ capabilities and market shares
• Providers’ key strengths and limitations

Membership(s)

Healthcare Payer and Provider Business Process

Sourcing and Vendor Management