US COMPLEX AND CHRONIC CONDITION MANAGEMENT MARKET SIZE AND SHARE ANALYSIS - GROWTH TRENDS AND FORECASTS (2024-2031)

US Complex And Chronic Condition Management Market Size and Trends

US complex and chronic condition management market is estimated to be valued at USD 4.62 Bn in 2024 and is expected to reach USD 11.30 Bn by 2031, exhibiting a compound annual growth rate (CAGR) of 13.6% from 2024 to 2031.

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This sector addresses prevention, diagnosis, treatment, and management of complex chronic conditions through risk stratification, care coordination, and remote patient monitoring solutions. The market is expected to witness significant growth over the forecast period due to rising geriatric population suffering from multiple chronic conditions, increasing need to control healthcare costs, growing adoption of digital health solutions and remote monitoring services for better management of complex chronic patients. Factors such as ongoing pandemic, focus on value-based care and growing focus on patient centric care can offer growth opportunities for market players.

Rise in elderly population

As baby boomers continue to age in the U.S., there will be increase in elderly population aged 65 years old. As individuals get older, these are more likely to suffer from chronic and complex health conditions due to aging such as heart disease, diabetes, cancer, arthritis, and Alzheimer's disease. This boosts need for management of these diseases. By 2030, it is projected that over 70 million Americans will be aged 65 years or older. As life expectancy increases due to advancements in public health and medicine, senior citizens are also living longer with multiple chronic conditions. Proper management of various diseases and coordination of care becomes more crucial. Growing elderly population can boost demand for services geared toward complex condition management. This includes greater need for frequent monitoring, administration of multiple medications, adjustments in treatment plans, and collaboration between various healthcare specialists. For instance, In September 2023 according to the recent report The United Nations Population Fund, along with the International Institute for Population Sciences, titled "India Ageing Report 2023," which noted a notable increase in the country's senior citizen population. Presently making up 10.5% of the population, the elderly are expected to increase to 20.8% (347 million) by 2050 and surpass 36% by the end of the century.

Market Concentration and Competitive Landscape

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Increased Treatment Options and Technologies

Biopharmaceutical industry investment in research and development of new treatment methods for complex chronic illnesses has accelerated dramatically in recent decades. Multiple new drug classes, device innovations, digital health tools, and care delivery models have become available that can help improve outcomes for patients. Whereas management of conditions like cancer, heart disease, or diabetes used to focus mainly on symptom control and episodic acute care, advanced therapeutic approaches now aim to more comprehensively manage patients along the entire disease trajectory. This involves areas like better medication adherence, remote monitoring, lifestyle interventions, and multi-disciplinary care team coordination supported by digital platforms. Newer precision medicine techniques also allow for more individualized treatment strategies based on a person's genetic profile or biomarkers. Access to an increasing array of superior management options can boost utilization of specialized services among populations with complex health issues.

Key Takeaways from Analyst:

US complex and chronic condition management market growth is driven by rising prevalence of chronic diseases such as diabetes, cancer, and cardiovascular conditions due to aging population and sedentary lifestyles. Increased focus on value-based care and aim to reduce healthcare expenditures also boosts adoption of condition management solutions.

High upfront costs of implementing condition management programs can hamper the market growth. Interoperability challenges between various IT systems and healthcare providers can also hamper the market growth. Data privacy and security concerns may also limit full utilization of digital health technologies for condition management.

Growing emphasis on personalized care and patient-centric approach presents an opportunity for providers to offer tailored solutions. Transition towards remote and home-based care post-pandemic can drive the market growth. Advancements in digital technologies such as AI, ML and analytics can enhance early identification of health declines and manage co-morbidities more efficiently.

Provider consolidation and the number of value-based contracts signed can drive the US complex and chronic condition management market growth.

Market Challenges: High costs involved

The high costs involved can hamper the US complex and chronic condition management market growth. Managing chronic and complex conditions require expensive treatments, frequent hospital visits, various diagnostic tests and prolonged therapy sessions. This continuous treatment process becomes very costly for individuals with conditions such as cancer, diabetes, heart diseases, respiratory illnesses, and other. As per recent data, healthcare costs in the US have been consistently increasing over the past few years. For instance, personal healthcare expenditure per capita was US$ 11,582 in 2020, according to the data from the Centers for Medicare and Medicaid Services. This high expenditure becomes a financial burden for many people and discourages them from seeking medical help on a regular basis. This becomes a bigger challenge for the underprivileged population without adequate health insurance coverage.

In 2020, as per the US Census Bureau, around 28 million Americans were uninsured. Managing chronic illnesses requires continuous engagement with healthcare, which becomes very difficult for those without financial support. High deductibles of many insurance plans as well as limited coverage for certain services compels people to delay or avoid care. This gaps in access to affordable treatment can negatively impact the conditions in the long run. Furthermore, health insurers also show restraint in covering expensive chronic illness treatments due to the increased costs. These try to limit payouts and shift more costs to individuals through higher premiums or narrower coverage.

 Market Opportunities: mHealth and telehealth solutions

Telehealth and mHealth solutions hold tremendous potential in managing complex and chronic conditions in the U.S. With the prevalence of smartphones and wearable devices, mobile technologies are increasingly becoming an integral part of healthcare. This allows patients to be remotely monitored and empowered to better manage their conditions from the comfort of their home.

Chronic diseases like diabetes, heart disease and respiratory conditions require long-term treatment adherence and lifestyle changes. Mobile apps can help patients track vital signs, medication intake, dietary habits and patterns that may trigger flare-ups. Physiological data collected through Bluetooth-enabled devices and synced with health records provides clinicians deeper insights to perform remote surveillance. This is invaluable for the nearly 50% of Americans living with more than one chronic illness. The current pandemic has further highlighted the need for virtual care options that minimize physical visits while facilitating continuity of care. According to the Digital Health Society, 42% of Americans used some form of wearable device in 2021 for fitness tracking or health monitoring. This user base will grow rapidly as functionalities expand to include EKGs, fall detection, blood oxygen monitoring and more. The evidence clearly shows telehealth and mHealth play a pivotal role in managing the growing burden of chronic diseases in the US population in a cost-effective manner.

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By Disease Type- Demand for effective cancer treatment drives oncology segment growth

In terms of disease type, oncology segment is estimated to contribute the highest market share of 25.3 % in 2024, owing to growing burden of cancer and demand for advanced treatment options. Cancer remains one of the leading causes of mortality in the U.S. The high prevalence of various cancer types such as breast cancer, lung cancer, prostate cancer and colorectal cancer has boosted the need for improved diagnostic, therapeutic and care management services. Healthcare providers are increasingly focusing on personalized treatment approaches and precision medicine to achieve optimal outcomes for cancer patients. This has accelerated research into novel targeted therapies, immunotherapies and combination regimens. Factors such as rising cancer screening rates, expanding medicare coverage for cancer drugs and growing awareness about cancer care management can drive the segment growth.

By Service- Consulting services witness increased uptake due to complex care needs

In terms of service, consulting service segment is estimated to contribute the highest market share of 40.1% in 2024, as managing complex chronic conditions requires an integrated approach involving multiple specialties. Healthcare providers rely heavily on consulting services to navigate the complexities of chronic care delivery, optimize treatment protocols, reduce avoidable hospitalizations and stay compliant with evolving regulations. Consulting helps providers to customize evidence-based guidelines and critical pathways for better patient risk stratification and coordination of multidisciplinary care teams. It also aids in improving health outcomes through consultative advice on disease management programs, quality metrics, data analytics and transition of care models. These advantages have boosted demand for consulting services.

By End User- Healthcare providers lead the market owing to expanding role in population health management

In terms of end user, healthcare providers segment is estimated to contribute the highest market share of 39.2% in 2024, as healthcare organizations, particularly hospitals and clinics, play a central role in providing chronic condition management. With rising prevalence of chronic illnesses, providers are moving from an episodic care model to a long-term approach focusing on prevention, wellness, coordination and social support. This transition requires comprehensive solutions and expertise to monitor patient health across different care settings. As payers shift reimbursements based on quality and value-driven outcomes, providers also see expanding responsibilities in population health management. Their large patient volume and clinical infrastructure make them well positioned to lead the market. Significant investments are being made in integrated healthcare delivery systems, health information technologies, and provider-led coordinated care programs for superior chronic disease management.

Market Report Scope

Key Developments

• In June 2024, Ushur, a cloud-based AI company, launched prebuilt AI-powered digital self-service solutions aimed at health plans and third-party administrators (TPAs). These solutions are designed to automate digital care navigation for two important member journeys: maternal and new baby health, as well as chronic condition management.
• In May 2024, Premier, Inc a corporation focused on improving healthcare, and AstraZeneca established a strategic partnership known as Uncover CKD - Care Collective.This collaboration aims to detect patients with undiagnosed clinical chronic kidney disease (CKD), increase awareness of undiagnosed CKD among healthcare providers, and provide guidance to U.S. health systems seeking to enhance or establish strategies for CKD diagnosis, treatment, and care management.
• In January 2024, Eli Lilly and Company, a pharmaceutical company, introduced LillyDirect, a new digital healthcare platform designed for patients in the U.S., for managing conditions such as obesity, migraine, and diabetes. LillyDirect provides disease management tools, personalized support, and the convenience of home delivery for certain Lilly medications through third-party pharmacy services.

*Definition: US Complex and Chronic Condition Management Market includes companies offering care management and coordination services to patients with complex medical conditions in the U.S. These conditions often involve multiple chronic illnesses, functional limitations and high medical costs. Market players provide services like comprehensive care planning, patient engagement, medication management, and data analytics capabilities to healthcare providers, insurers, employers and government agencies. These aim to improve outcomes and lower costs for patients with complex medical needs.

Market Segmentation

•  Disease Type Insights (Revenue, USD Bn, 2019 - 2031)
  • Cardiovascular Diseases
  • Oncology
  • Neurology
  • Diabetes
  • Musculoskeletal
  • Women’s Health/Fertility/Maternity
  • Chronic Obstructive Pulmonary Disease
  • Chronic Kidney Disease
  • Others
•  Service Insights (Revenue, USD Bn, 2019 - 2031)
  • Consulting Service
  • Implementation Service
  • Education Service
  • Others
•  End User Insights (Revenue, USD Bn, 2019 - 2031)
  • Healthcare Providers
  • Healthcare Payers
  • Pharmaceutical Companies
  • Medical Device Companies
  • Others
• Key Players Insights
  • Medtronic plc.
  • AllScripts
  • Siemens Healthineers
  • Koninklijke Philips N.V.
  • Pegasystems, Inc.
  • Cognizant TriZetto Software Group Inc.
  • IBM Corporation
  • ScienceSoft USA
  • MINES & Associates, Inc.
  • Healthcare at Home
  • Mediware Information Systems
  • Humana
  • Centene Corporation
  • Kaiser Permanente
  • WellCare Health Plans, Inc.