The "U.S. Utilization Management Solutions Market Size, Share & Trends Analysis Report by Type (Standalone Solutions, Integrated Solutions), Mode of Delivery (Cloud-based, on-premise), Component (Software, Service), End Use, with Growth Forecasts, 2025-2030" report has been added to ResearchAndMarkets.com's offering.
The U.S. Utilization Management Solutions Market was valued at USD 613.15 Million in 2024, and is projected to reach USD 1.20 Billion by 2030, rising at a CAGR of 9.90%
Factors such as reinventing utilization management (UM) to bring value to point-of-care providers, increasing demand for technologically advanced UM solutions, growing adoption of utilization management by various organizations, and increased strategic partnerships & collaboration deals are expected to boost the market. For instance, in January 2024, ZeOmega collaborated with Datycs to automate healthcare data workflows and digitize faxed documents.
The rise in investments in UM solutions reflects significant advancements in healthcare technology and a shift toward value-based care, where efficiency, patient satisfaction, and outcome-oriented approaches are prioritized. Increasing investments generate valuable opportunities for UM. For instance, in July 2024, the Medical Review Institute of America (MRIoA), a provider of UM review solutions for payers, secured funding from Parthenon Capital, while existing investors and MRIoA management retained substantial equity ownership in the company as part of the transaction.
Moreover, U.S. healthcare payers and providers are increasingly prioritizing IT investments, with 75% reporting heightened spending in 2023. Providers are directing these funds toward IT services and infrastructure, including cybersecurity, clinical workflow optimization, claims processing, payments, data platforms, interoperability, care coordination, and Revenue Cycle Management (RCM).
In addition, market participants are engaging in various strategic initiatives such as mergers and acquisitions, new product launches, and geographic expansion that foster market growth. For instance, in June 2024, Evolent Health, Inc. announced its agreement to acquire specific assets from Machinify, which include the Machinify Auth team, AI-driven utilization management products, and associated software applications.
The COVID-19 epidemic significantly impacted the U.S. utilization management solutions industry, speeding the acceptance of digital tools and automation to address increased healthcare demand. Hospitals and insurers faced challenges such as remitted optional procedures, rising specialty medicine costs, and a surge in outpatient and critical care applications. In response, there was a notable shift towards cloud-based UM platforms, telehealth integration, and robotic process automation (RPA) to streamline previous authorizations and care collaboration.
These changes were driven by the need to enhance effectiveness, reduce executive burdens, and address workforce shortages, particularly among physicians and nurses. The epidemic underlined the significance of flexible and scalable UM results in maintaining care quality and functional sustainability.
The companies profiled in this U.S. Utilization Management Solutions market report include:
- Optum, Inc. (Change Healthcare is a Part of Optum from October 2022)
- Conduent, Inc.
- ZeOmega
- HealthEdge Software, Inc.
- Keystone Peer Review Organization, LLC (Kepro acquired eQHealth Solutions, Inc. in 2021)
- ExlService Holdings, Inc.
- Access Healthcare
- AssureCare LLC
-
PrimEra Medical Technologies
Key Attributes:
| Report Attribute | Details |
| No. of Pages | 120 |
| Forecast Period | 2024 - 2030 |
| Estimated Market Value (USD) in 2024 | $613.15 Million |
| Forecasted Market Value (USD) by 2030 | $1200 Million |
| Compound Annual Growth Rate | 9.9% |
| Regions Covered | United States |
Key Topics Covered:
Chapter 1. Methodology and Scope
1.1. Market Segmentation & Scope
1.2. Segment Definitions
1.3. Estimates and Forecast Timeline
1.4. Research Methodology
1.5. Information Procurement
1.6. Information Analysis
1.7. Market Formulation & Data Visualization
1.8. Model Details
1.9. List of Secondary Sources
1.10. Objectives
Chapter 2. Executive Summary
2.1. Market Snapshot
2.2. Segment Snapshot
2.3. Competitive Landscape Snapshot
Chapter 3. Market Variables, Trends, & Scope
3.1. Market Lineage Outlook
3.2. Market Dynamics
3.2.1. Market Driver Analysis
3.2.1.1. Rising demand for technologically advanced utilization management solutions
3.2.1.2. Growing adoption of utilization management solutions
3.2.1.3. Increasing number of strategic partnerships and collaborations
3.2.2.4. Market Restraint Analysis
3.2.2. High software investment and maintenance costs
3.2.2.1. Data privacy and security concerns
3.2.3. Industry Opportunity Analysis
3.2.4. Industry Challenge Analysis
3.2.5. Case Studies
3.3. Business Environment Analysis
3.3.1. Porter's Five Forces Analysis
3.3.2. PESTLE Analysis
Chapter 4. U.S. Utilization Management Solutions Market: Type Estimates & Trend Analysis
4.1. Type Segment Dashboard
4.2. Type Market Share Movement Analysis, 2024 & 2030
4.3. Market Size & Forecasts and Trend Analysis, by Type, 2018 to 2030 (USD Million)
4.4. Standalone Solutions
4.5. Integrated Solutions
Chapter 5. U.S. Utilization Management Solutions Market: Component Estimates & Trend Analysis
5.1. Component Segment Dashboard
5.2. Component Market Share Movement Analysis, 2024 & 2030
5.3. Market Size & Forecasts and Trend Analysis, by Component, 2018 to 2030 (USD Million)
5.4. Software Solutions
5.5. Services
Chapter 6. U.S. Utilization Management Solutions Market: Mode of Delivery Estimates & Trend Analysis
6.1. Mode of Delivery Segment Dashboard
6.2. Mode of Delivery Market Share Movement Analysis, 2024 & 2030
6.3. Market Size & Forecasts and Trend Analysis, by Mode of Delivery, 2018 to 2030 (USD Million)
6.4. Web/Cloud-Based
6.5. On-premise
Chapter 7. U.S. Utilization Management Solutions Systems Market: End Use Estimates & Trend Analysis
7.1. End Use Segment Dashboard
7.2. End Use Market Share Movement Analysis, 2024 & 2030
7.3. Market Size & Forecasts and Trend Analysis, by End Use, 2018 to 2030 (USD Million)
7.4. Healthcare Providers
7.5. Healthcare Payers
7.6. Other End Use
Chapter 8. Competitive Landscape
8.1. Participant Overview
8.2. Company Market Position Analysis/ Share Analysis 2024
8.3. Company Categorization
8.4. Strategy Mapping
8.5. Company Profiles/Listing
8.5.1. Overview
8.5.2. Financial performance
8.5.3. Products benchmarking
8.5.4. Strategic initiatives
For more information about this report visit https://www.researchandmarkets.com/r/hjizhx
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