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.
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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.
U.S. Utilization Management Solutions Market Report: Segmentation
This report forecasts revenue growth at country levels and provides an analysis of the latest industry trends in each of the sub-segments from 2018 to 2030. For this study, the analyst has segmented the U.S. utilization management solutions market report based on the product, delivery mode, component, and end use:Type Outlook (Revenue, USD Million, 2018-2030)
- Standalone Solutions
- Integrated Solutions
Components Outlook (Revenue, USD Million, 2018-2030)
- Software Solutions
- Services
Mode of Delivery (Revenue, USD Million, 2018-2030)
- Web/Cloud-Based
- On-Premise
End Use Outlook (Revenue, USD Million, 2018-2030)
- Healthcare Providers
- Healthcare Payers
- Other End Use
Why Should You Buy This Report?
- Comprehensive Market Analysis: Gain detailed insights into the market across major regions and segments.
- Competitive Landscape: Explore the market presence of key players.
- Future Trends: Discover the pivotal trends and drivers shaping the future of the market.
- Actionable Recommendations: Utilize insights to uncover new revenue streams and guide strategic business decisions.
This report addresses:
- Market intelligence to enable effective decision-making
- Market estimates and forecasts from 2018 to 2030
- Growth opportunities and trend analyses
- Segment and regional revenue forecasts for market assessment
- Competition strategy and market share analysis
- Product innovation listings for you to stay ahead of the curve
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Table of Contents
Chapter 1. Methodology and Scope
Chapter 2. Executive Summary
Chapter 3. Market Variables, Trends, & Scope
Chapter 4. U.S. Utilization Management Solutions Market: Type Estimates & Trend Analysis
Chapter 5. U.S. Utilization Management Solutions Market: Component Estimates & Trend Analysis
Chapter 6. U.S. Utilization Management Solutions Market: Mode of Delivery Estimates & Trend Analysis
Chapter 7. U.S. Utilization Management Solutions Systems Market: End Use Estimates & Trend Analysis
Chapter 8. Competitive Landscape
List of Tables
List of Figures
Companies Mentioned
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
Methodology
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Table Information
| Report Attribute | Details |
|---|---|
| No. of Pages | 120 |
| Published | April 2025 |
| Forecast Period | 2024 - 2030 |
| Estimated Market Value ( USD | $ 613.15 Million |
| Forecasted Market Value ( USD | $ 1200 Million |
| Compound Annual Growth Rate | 9.9% |
| Regions Covered | United States |
| No. of Companies Mentioned | 10 |
