The medical case management market is projected to reach US$ 5,228.35 million in 2028 from US$ 4,109.20 million in 2021; it is estimated to grow at a CAGR of 3.5% during 2021-2028. The report highlights trends prevailing in the market and factors driving the medical case management market growth. The medical case management market growth is attributed to the rising prevalence of chronic diseases and increasing adoption of advanced technologies in medical care management. However, ineffective collaborations, and security and privacy concerns hamper the medical case management market growth.

A noticeable increase in the number of cases of chronic pain, chronic diseases, and long- and short-term disabilities has been observed in recent years. Consequently, these ailments have created a significant demand for medical case management services, including case management through care managers, bill management, support, rehabilitation, and other related services. Chronic pain is linked to numerous physical and mental conditions, and it contributes heavily to healthcare costs and productivity loss among patients, which has indirect effects on economies. Studies indicate the estimated prevalence of chronic pain ranges from 11% to 40%. The pain causes restrictions in mobility and daily activities, dependence on opioids, a rise in anxiety and depression, perceived poor health, and lowered quality of life. As per the findings of the Centers for Disease Control and Prevention (CDC), the prevalence of chronic pain stood at 20.4% in 2019, while the prevalence of high-impact chronic pain was 7.4%. Women, non-Hispanic white adults, and the geriatric population held the largest shares of chronic pain prevalence at 21.7%, 23.6%, and 30.8%, respectively. Generally, such conditions require long-term care, treatment, and rehabilitation, for which medical case management services are preferred to ensure an appropriate as well as rigorous protocol and treatment plan. Therefore, the growing cases of chronic pain are propelling the demand for medical case management services and aiding the growth of the medical case management market.

Further, chronic diseases, such as heart disease, diabetes, stroke, and obesity, account for the largest share of a country's healthcare costs. The US National Diabetes Statistics Report estimates that 11.3% of the US population, i.e., 37.3 million people, has diabetes, and more than 8.5 million (23% of adults) people can be undiagnosed. In diabetic complications arising from unchecked diabetes can include lower-limb amputation and kidney failure. The US National Diabetes Statistics Report also estimates that more than 2 million people are diagnosed with diabetes in the US every year. A similar scenario of a high prevalence of diabetes is observed in other regions, such as Europe, Asia Pacific, and the Middle East & Africa. As per the International Diabetes Federation's report IDF Diabetes Atlas, in 2021, 1 in 11 adults, i.e., ~90 million people, have diabetes in Southeast Asia.

As per the 2018 findings of the American College of Cardiology Foundation, cardiovascular diseases (CVDs) were the leading cause of death in the US, with stroke (16.8%), high blood pressure (9.4%), heart failure (9.0%) being the leading type of CVDs. Further, more than 130 million adults in the US (45.1%) are projected to have CVD by 2035, and the total costs of CVDs are expected to reach US$ 1.1 trillion. Also, the rising geriatric population and related chronic disorders are creating a need for medical case management services for support, treatment, and rehabilitation.

There is an increase in the number of cases of chronic pain, long-term and short-term disability, and catastrophic cases. To treat these cases and increase the recovery rate of the patients, it has become essential to maintain adequate patient and care management. Chronic pain is linked with numerous physical and mental conditions, and it contributes to high healthcare costs and lost productivity. Several studies estimate that the prevalence of chronic pain ranges from 11% to 40%. Chronic pain results in restricted mobility and hamper daily activities; trigger dependence on opioids, and anxiety and depression; poor perceived health or reduced life quality. According to the Centers for Disease Control and Prevention (CDC), in 2019, the prevalence of chronic pain was 20.4%, and the prevalence of high-impact chronic pain was 7.4%. Chronic pain cases are highest among women (21.7%), non-Hispanic white adults (23.6%) and people aged 65 and above (30.8%). High impact chronic pain was highest among women (8.5%) and those aged 65 and above (11.8%). This type of pain is one of the most common conditions for which adults seek medical care. Therefore, the growing cases of chronic pain propels the demand for medical case management services.

Chronic diseases, such as heart disease, diabetes, stroke, and obesity, are among the leading causes of death across the world, and these diseases hold the largest share of most country's healthcare costs. According to the CDC, 37.3 million people are affected by diabetes, and it is the major cause of lower-limb amputation and kidney failure in the US. The report also estimates that more than 2 million people are diagnosed with diabetes in the US every year. A similar scenario of a high prevalence of diabetes is observed in other regions, such as Europe, Asia Pacific, and the Middle East & Africa. According to International Diabetes Federation's IDF Diabetes Atlas, published in 2021, Southeast Asia had 1 in 11 adults (90 million) suffer from diabetes. Moreover, according to the American College of Cardiology Foundation, in 2018, coronary heart disease (CHD) (43.8%) is the leading cause of deaths due to cardiovascular diseases (CVDs) in the US, followed by stroke (16.8%), high BP (9.4%), heart failure (HF) (9.0%), and other CVDs (17.9%). By 2035, more than 130 million adults in the US population (45.1%) are projected to have some form of CVD, and total costs of CVD are expected to reach US$ 1.1 trillion in 2035. Thus, the rising geriatric population and related chronic disorders create a need for medical case management services for support, treatment, and rehabilitation.

Further, the rate of obesity is growing rapidly among populations of developed and developing countries across the world. Unhealthy and sedentary lifestyles are among the major factors increasing the number of cases of obesity. According to the Organization for Economic Co-operation (OECD), in 2020, more than 1.9 billion adults were overweight. The overweight population has grown rapidly in Canada, Australia, Chile, the UK, and South Africa. The obese population is expected to be high in the US, Mexico, and England, consisting of ~47%, 39%, and 35%, respectively, by the next two decades. According to the data gathered from the National Safety Council (NSC), 48.3 million injuries were reported in the US in 2019. The treatment of these injuries amounted to an estimated US$ 1.0979 trillion. Also, there were 173,040 preventable injury-related deaths during 2019. The preventable deaths can primarily be attributed to a 5% increase in both poisoning deaths (including opioid overdoses) and fall fatalities. Hence, the rising incidence of catastrophic injuries and increasing prevalence of obesity across the world are driving the demand for medical case management services.

Based on the mode of service, the medical case management market is segmented into web-based case management, telephonic case management, field case management, and bilingual case management. The telephonic case management segment held the largest market share in 2021 and is anticipated to register the highest CAGR among all segments of the medical case management market during the forecast period. Based on the severity of case, the medical case management market is segmented into catastrophic cases, chronic pain, independent medical examinations, long-term disability, and short-term disability. The long-term disability segment held the largest share of the market in 2021 and is expected to hold a significant share of the market during the forecast period. However, the market for the chronic pain segment is expected to witness the highest CAGR from 2021 to 2028. Based on end user, the medical case management market is bifurcated into hospitals and home care settings; the hospitals segment held a larger share in 2021. The same segment is expected to continue to hold a dominant share of the market and experience a higher CAGR growth during the forecast period.

The COVID-19 pandemic created public health and economic crises in many countries in the world. The pandemic adversely affected a large percentage of the population in the first half of 2020. Many regions saw a steep decline in healthcare services, as several elective medical procedures were postponed or canceled, which led to reduction in footfall at hospitals, clinics, and similar healthcare facilities. This led to a decline in the demand for medical case management services. However, service providers of medical case management services soon shifted their operations to digital platforms and continued providing their services in accordance with new regulations and social restrictions. Several services providers also added COVID-19 diagnosis, treatment, support, and rehabilitation to their product portfolio to ensure prompt and adequate services during the pandemic. By the time when the COVID-19 pandemic restrictions and lockdowns were eased, the medical case management market players had primarily digitalized their services for remote work, as a large number of patients continued to opt for remote services. Overall, the medical case management market players saw a steady rise during the pandemic, with the expansion of their product and service offerings.

Various organic and inorganic developments have been adopted by companies in the medical case management market. Organic strategies adopted by the market players include product launches and product approvals, whereas inorganic growth strategies are acquisitions, collaboration, and partnerships, among others. These growth strategies allow the market players to expand their businesses and enhance their geographic presence, contributing to the overall progress of the medical case management market. Additionally, growth strategies such as acquisitions and partnerships helped the medical case management market players in strengthening their clientele and expanding their product portfolios. A few of the significant developments made by key market players are mentioned below:

In October 2021, Genex, Mitchell, and Coventry announced the creation of their new parent brand, Enlyte. The three businesses have been moving toward unification since the merger of Mitchell and Genex in 2018, followed by the acquisition of Coventry in 2020. The Enlyte brand is expected to increase their product and geographic reach in the coming years.

In February 2021, Genex Services initiated its disaster preparedness plan to ensure coverage for the injured workers and customers. Owing to its Unity case management platform, Genex is equipped to handle unexpected situations at a short notice, providing the right case manager at the right time.

A few of the major primary and secondary sources referred to while preparing the medical case management market report are the Centers for Disease Control and Prevention (CDC), UK National Health Services (NHS), and OECD.