Medical Case Management Market Share, Size and Growth Analysis By 2029

The medical case management sector is anticipated to grow significantly, with projections indicating it will reach approximately US$ 5,228.35 million by 2028, up from US$ 4,109.20 million in 2021. This growth represents a compound annual growth rate (CAGR) of 3.5% from 2021 to 2028. The report outlines the prevailing trends and key factors contributing to the expansion of the medical case management market. The increase in market size is primarily driven by the rising incidence of chronic diseases and the growing integration of advanced technologies in healthcare management. However, challenges such as ineffective collaborations and concerns regarding security and privacy are hindering market growth.

In recent years, there has been a marked rise in the prevalence of chronic pain, chronic diseases, and both long- and short-term disabilities. These health issues have led to a heightened demand for medical case management services, which encompass case management by care managers, billing management, support, rehabilitation, and other related services. Chronic pain is associated with various physical and mental health conditions, significantly impacting healthcare expenses and productivity losses among patients, which in turn affects economic performance. Research suggests that the prevalence of chronic pain can range from 11% to 40%. This pain often restricts mobility and daily activities, leads to opioid dependence, and increases levels of anxiety and depression, ultimately resulting in a diminished quality of life. According to the Centers for Disease Control and Prevention (CDC), chronic pain prevalence was reported at 20.4% in 2019, with high-impact chronic pain affecting 7.4% of the population. Women, non-Hispanic white adults, and older adults are particularly affected, with prevalence rates of 21.7%, 23.6%, and 30.8% respectively. Such conditions necessitate long-term care and rehabilitation, making medical case management services essential for implementing effective treatment protocols. Consequently, the increasing incidence of chronic pain is driving the demand for these services and fostering market growth.

Moreover, chronic diseases such as heart disease, diabetes, stroke, and obesity represent a significant portion of healthcare expenditures. The US National Diabetes Statistics Report estimates that 11.3% of the US population, or approximately 37.3 million individuals, are living with diabetes, with over 8.5 million (or 23% of adults) potentially undiagnosed. Complications from uncontrolled diabetes can lead to severe health issues, including lower-limb amputations and kidney failure. The report also indicates that more than 2 million new diabetes cases are diagnosed annually in the US. This trend is mirrored in other regions, including Europe, Asia Pacific, and the Middle East & Africa. The International Diabetes Federation's IDF Diabetes Atlas reported that in 2021, approximately 1 in 11 adults in Southeast Asia, or around 90 million people, are affected by diabetes.

According to findings from the American College of Cardiology Foundation, cardiovascular diseases (CVDs) were the leading cause of mortality in the US as of 2018, with stroke (16.8%), high blood pressure (9.4%), and heart failure (9.0%) being the most prevalent types. Projections indicate that by 2035, over 130 million adults in the US (approximately 45.1%) will be affected by CVD, with total costs expected to reach US$ 1.1 trillion. The increasing elderly population and the associated chronic conditions further underscore the necessity for medical case management services to provide adequate support, treatment, and rehabilitation.

The rise in chronic pain, long-term and short-term disabilities, and catastrophic cases necessitates effective patient and care management strategies. Chronic pain is linked to various physical and mental health issues, contributing to elevated healthcare costs and lost productivity. Studies estimate that chronic pain affects between 11% and 40% of the population, leading to mobility restrictions, daily activity limitations, opioid dependence, and increased anxiety and depression. The CDC reported that in 2019, chronic pain affected 20.4% of the population, with high-impact chronic pain affecting 7.4%. The highest prevalence rates were found among women (21.7%), non-Hispanic white adults (23.6%), and individuals aged 65 and older (30.8%). High-impact chronic pain was most prevalent among women (8.5%) and older adults (11.8%). This type of pain is a common reason for adults seeking medical care, further driving the demand for medical case management services.

Chronic diseases, including heart disease, diabetes, stroke, and obesity, are leading causes of death globally and account for a significant share of healthcare costs. The CDC reports that 37.3 million individuals in the US are affected by diabetes, which is a major contributor to lower-limb amputations and kidney failure. The report also notes that over 2 million new diabetes cases are diagnosed each year in the US. Similar high diabetes prevalence rates are observed in Europe, Asia Pacific, and the Middle East & Africa. The IDF Diabetes Atlas indicated that in 2021, Southeast Asia had approximately 90 million adults living with diabetes. Furthermore, the American College of Cardiology Foundation highlighted that coronary heart disease (CHD) accounted for 43.8% of deaths due to CVDs in the US, followed by stroke (16.8%), high blood pressure (9.4%), and heart failure (9.0%). By 2035, it is projected that over 130 million adults in the US will have some form of CVD, with total costs expected to reach US$ 1.1 trillion. The growing elderly population and related chronic conditions create a pressing need for medical case management services.

Additionally, the prevalence of obesity is rapidly increasing in both developed and developing nations. Sedentary lifestyles and unhealthy eating habits are significant contributors to this trend. The Organization for Economic Co-operation and Development (OECD) reported that in 2020, over 1.9 billion adults were classified as overweight. Countries such as Canada, Australia, Chile, the UK, and South Africa have seen a rapid increase in their overweight populations. Projections suggest that by the next two decades, the obesity rates will be particularly high in the US (approximately 47%), Mexico (39%), and England (35%). Furthermore, the National Safety Council (NSC) reported 48.3 million injuries in the US in 2019, with treatment costs amounting to approximately US$ 1.0979 trillion. There were also 173,040 preventable injury-related deaths that year, largely due to a 5% increase in poisoning deaths (including opioid overdoses) and fall-related fatalities. Thus, the rising incidence of catastrophic injuries and the increasing prevalence of obesity are significant factors driving the demand for medical case management services.

The medical case management market is categorized based on service mode into web-based case management, telephonic case management, field case management, and bilingual case management. The telephonic case management segment dominated the market in 2021 and is expected to exhibit the highest CAGR during the forecast period. Additionally, the market is segmented by case severity into catastrophic cases, chronic pain, independent medical examinations, long-term disability, and short-term disability. The long-term disability segment held the largest market share in 2021 and is projected to maintain a significant share throughout the forecast period, while the chronic pain segment is anticipated to experience the highest CAGR from 2021 to 2028. In terms of end users, the market is divided into hospitals and home care settings, with hospitals holding a larger share in 2021 and expected to continue dominating the market with a higher CAGR during the forecast period.

The COVID-19 pandemic has led to significant public health and economic challenges globally. In the early months of 2020, a large portion of the population was adversely affected, and many healthcare services experienced a sharp decline as elective procedures were postponed or canceled, resulting in reduced patient visits to hospitals and clinics. This decline negatively impacted the demand for medical case management services. However, many service providers quickly adapted by transitioning to digital platforms, allowing them to continue offering services in compliance with new regulations and social distancing measures. Some providers expanded their offerings to include COVID-19 diagnosis, treatment, support, and rehabilitation, ensuring timely and adequate services during the pandemic. As restrictions eased, medical case management providers had largely digitalized their operations, catering to a growing preference for remote services among patients. Overall, the medical case management market saw a steady increase during the pandemic, with players expanding their product and service offerings.

Companies in the medical case management market have adopted various organic and inorganic growth strategies. Organic strategies include product launches and approvals, while inorganic strategies encompass acquisitions, collaborations, and partnerships. These strategies enable market players to broaden their operations and enhance their geographic reach, contributing to the overall development of the medical case management market. Additionally, acquisitions and partnerships have helped strengthen client relationships and expand product portfolios. Notable developments by key market players include:

• In October 2021, Genex, Mitchell, and Coventry announced the formation of their new parent brand, Enlyte, following their merger and acquisition activities aimed at unifying their operations.


• In February 2021, Genex Services implemented its disaster preparedness plan to ensure coverage for injured workers and clients, leveraging its Unity case management platform to respond effectively to unexpected situations.

Key sources referenced in the preparation of the medical case management market report include the Centers for Disease Control and Prevention (CDC), UK National Health Services (NHS), and the OECD.