Healthcare Provider Network Management Market Set to Grow at ~15% CAGR Through 2030 with AI Integration

The healthcare provider network management (HPNM) market is expected to expand at a CAGR of ~15% during the forecast period. Key growth drivers include increasing healthcare costs, rising demand for efficient healthcare services, expanding insurance coverage and managed care models, a shift towards digital and cloud-based solutions, growing adoption of AI and analytics into HPNM systems, a rise in value-based healthcare models, and increased adoption of healthcare IT solutions.

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Healthcare provider network management (HPNM) oversees and optimizes a network of healthcare providers including hospitals, physicians, specialists, and other medical facilities to deliver high-quality, cost-effective, and compliant healthcare services. This involves contract negotiations, credential verification, performance monitoring, network expansion, issue resolution, and fostering strong relationships with providers. A well-managed HPNM system helps minimize administrative costs, enhance healthcare accessibility, streamline reimbursements, improve patient satisfaction, and support value-based care initiatives.

A rise in value-based healthcare models boosts market growth

With the rise of healthcare consumerism, patient loyalty has become increasingly critical for health plans, as members are more likely to switch providers or networks if their needs are not met. To foster loyalty, payers and providers are increasingly adopting the value-based healthcare model, which focuses on enhancing individual patient care, improving population health management, increasing efficiency, and reducing costs. Effective provider network management is a key component in enabling value-based care, as attracting and retaining top providers while offering them the necessary support helps strengthen patient-provider communication and drive better clinical outcomes. This, in turn, leads to higher quality ratings, improved member retention, and greater overall efficiency. A study by the Medical Group Management Association (MGMA) and Humana found that 67% of providers believe value-based care improves the quality of care delivered to patients. Additionally, 74% of healthcare organizations have added staff, and 71% have adopted new technologies to support the transition to value-based care. The most commonly adopted technologies include data analytics and reporting (82%) and population health management tools (57%). As payers and providers continue to focus on enhancing care coordination, cost efficiency, and patient satisfaction, the demand for advanced HPNM solutions is expected to grow significantly.

Growing adoption of cloud-based and AI-powered solutions drives HPNM market growth

As healthcare organizations and payers seek to streamline operations, enhance efficiency, and ensure compliance, cloud technology provides a scalable, cost-effective, and secure platform for managing provider networks. Cloud-based HPNM solutions enable real-time access to provider data, automate credentialing processes, and facilitate seamless communication between payers and healthcare providers. Meanwhile, artificial intelligence (AI) and machine learning (ML) are transforming network management by automating repetitive tasks, predicting provider performance, and optimizing network utilization. AI-driven analytics help identify gaps in provider coverage, assess care quality, and detect fraudulent activities, leading to better decision-making and cost savings. Additionally, AI-powered chatbots and virtual assistants are improving provider engagement and reducing administrative burdens. With the increasing demand for interoperability, data security, and real-time analytics, the integration of cloud and AI technologies is becoming essential for modern HPNM systems. As a result, healthcare organizations are investing in advanced, technology-driven solutions to enhance provider onboarding, contract management, claims processing, and compliance tracking. This growing reliance on cloud-based and AI-powered tools is expected to accelerate the expansion of the HPNM market, making healthcare networks more efficient, transparent, and patient-centric.

Competitive Landscape Analysis

The global healthcare provider network management market is marked by the presence of established and emerging market players such as Infosys Limited; McKesson Corporation; Mphasis; Optum, Inc.; Atos Syntel Inc.; Cognizant (Trizetto); OSPLabs; Centene Corporation; Virtusa Corp.; Appian; Andros; Salesforce.com, Inc.; Change Healthcare; Avenga; Assured; and Certify among others. Some of the key strategies adopted by market players include new product development, strategic partnerships and collaborations, and investments.

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Market Segmentation 

This report by Medi-Tech Insights provides the size of the global healthcare provider network management market at the regional- and country-level from 2023 to 2030. The report further segments the market based on component, delivery mode, and end user.

• Market Size & Forecast (2023-2030), By Component, USD Million
  • Software
  • Services
• Market Size & Forecast (2023-2030), By Delivery Mode, USD Million
  • On-Premises Delivery Mode
  • Cloud-Based Delivery Mode
• Market Size & Forecast (2023-2030), By End User, USD Million
  • Private Health Insurance
  • Public Health Insurance
  • Healthcare Payers
  • Others
• Market Size & Forecast (2023-2030), By Region, USD Million
  • North America
    • US
    • Canada
  • Europe
    • UK
    • Germany
    • France
    • Italy
    • Spain
    • Rest of Europe
  • Asia Pacific
    • China
    • India
    • Japan
    • Rest of Asia Pacific
  • Latin America
  • Middle East & Africa

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