U.S. Utilization Management Solutions Market Size, Share & Trends Analysis Report By Type, By Mode Of Delivery, By Component, By End Use, And Segment Forecasts, 2025 - 2030

PUBLISHED: April 24, 2025

PAGES: 120 Pages

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The U.S. utilization management solutions market size was estimated at USD 613.15 million in 2024 and is projected to grow at a CAGR of 9.9% from 2025 to 2030. 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.

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, Grand View Research 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

Product Code: GVR-4-68040-561-1

Chapter 1. Methodology and Scope

1.1. Market Segmentation & Scope
1.2. Segment Definitions
- 1.2.1. Type
- 1.2.2. Component
- 1.2.3. Mode of Delivery
- 1.2.4. End Use
1.3. Estimates and Forecast Timeline
1.4. Research Methodology
1.5. Information Procurement
- 1.5.1. Purchased Database
- 1.5.2. GVR's Internal Database
- 1.5.3. Secondary Sources
- 1.5.4. Primary Research
1.6. Information Analysis
- 1.6.1. Data Analysis Models
1.7. Market Formulation & Data Visualization
1.8. Model Details
- 1.8.1. Commodity Flow Analysis
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
  - 3.3.1.1 Supplier power
  - 3.3.1.2. Buyer power
  - 3.3.1.3. Substitution threat
  - 3.3.1.4. Threat of new entrant
  - 3.3.1.5. Competitive rivalry
- 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
- 4.4.1. Standalone solutions market, 2018 - 2030 (USD Million)
4.5. Integrated Solutions
- 4.5.1. Integrated solutions market, 2018 - 2030 (USD Million)

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
- 5.4.1. Software solutions market, 2018 - 2030 (USD Million)
5.5. Services
- 5.5.1. Services market, 2018 - 2030 (USD Million)

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
- 6.4.1. Web/cloud-based market, 2018 - 2030 (USD Million)
6.5. On-premise
- 6.5.1. On-premise market, 2018 - 2030 (USD Million)

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
- 7.4.1. Healthcare providers market, 2018 - 2030 (USD Million)
7.5. Healthcare Payers
- 7.5.1. Healthcare payers market, 2018 - 2030 (USD Million)
7.6. Other End Use
- 7.6.1. Other end use, 2018 - 2030 (USD Million)

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. Change Healthcare (part of Optum from October 2022)
  - 8.5.1.1. Overview
  - 8.5.1.2. Financial performance
  - 8.5.1.3. Products benchmarking
  - 8.5.1.4. Strategic initiatives
- 8.5.2. Conduent, Inc.
  - 8.5.2.1. Overview
  - 8.5.2.2. Financial performance
  - 8.5.2.3. Products benchmarking
  - 8.5.2.4. Strategic initiatives
- 8.5.3. ZeOmega
  - 8.5.3.1. Overview
  - 8.5.3.2. Financial performance
  - 8.5.3.3. Products benchmarking
  - 8.5.3.4. Strategic initiatives
- 8.5.4. HealthEdge Software, Inc.
  - 8.5.4.1. Overview
  - 8.5.4.2. Financial performance
  - 8.5.4.3. Products benchmarking
  - 8.5.4.4. Strategic initiatives
- 8.5.5. Optum, Inc. (Change Healthcare is a Part of Optum from October 2022)
  - 8.5.5.1. Overview
  - 8.5.5.2. Financial performance
  - 8.5.5.3. Products benchmarking
  - 8.5.5.4. Strategic initiatives
- 8.5.6. Keystone Peer Review Organization, LLC (Kepro acquired eQHealth Solutions, Inc. in 2021)
  - 8.5.6.1. Overview
  - 8.5.6.2. Financial performance
  - 8.5.6.3. Products benchmarking
  - 8.5.6.4. Strategic initiatives
- 8.5.7. ExlService Holdings, Inc.
  - 8.5.7.1. Overview
  - 8.5.7.2. Financial performance
  - 8.5.7.3. Products benchmarking
  - 8.5.7.4 Strategic initiatives
- 8.5.8. AssureCare LLC
  - 8.5.8.1. Overview
  - 8.5.8.2. Financial performance
  - 8.5.8.3. Products benchmarking
  - 8.5.8.4. Strategic initiatives
- 8.5.9. PrimEra Medical Technologies
  - 8.5.9.1. Overview
  - 8.5.9.2. Financial performance
  - 8.5.9.3. Products benchmarking
  - 8.5.9.4. Strategic initiatives
- 8.5.10. Access Healthcare
  - 8.5.10.1. Overview
  - 8.5.10.2. Financial performance
  - 8.5.10.3. Products benchmarking
  - 8.5.10.4. Strategic initiatives

Product Code: GVR-4-68040-561-1

List of Tables

Table 1 List of secondary sources
Table 2 List of abbreviations
Table 3 U.S. Utilization Management Solutions Market, Type, 2018 - 2030 (USD Million)
Table 4 U.S. Utilization Management Solutions Market, by component, 2018 - 2030 (USD Million)
Table 5 U.S. Utilization Management Solutions Market, by mode of delivery, 2018 - 2030 (USD Million)
Table 6 U.S. Utilization Management Solutions Market, by end use, 2018 - 2030 (USD Million)

List of Figures

Fig. 1 U.S. utilization Management Solutions Market Segmentation
Fig. 2 Market research process
Fig. 3 Data triangulation techniques
Fig. 4 Primary research pattern
Fig. 5 Market formulation & validation
Fig. 6 Market research approaches
Fig. 7 Value-chain-based sizing & forecasting
Fig. 8 QFD modelling for market share assessment
Fig. 9 Commodity flow analysis
Fig. 10 Market snapshot
Fig. 11 Market segmentation (USD Million)
Fig. 12 Competitive landscape
Fig. 13 Parent market outlook (In USD Million)
Fig. 14 Related/ancillary market outlook (In USD Million)
Fig. 15 U.S. utilization management solutions market dynamics
Fig. 16 U.S. utilization management solutions market: Porter's five forces analysis
Fig. 17 U.S. utilization management solutions market: PESTLE analysis
Fig. 18 U.S. utilization management solutions market: Type segment dashboard
Fig. 19 U.S. utilization management solutions market: Type market share analysis, 2024 & 2030
Fig. 20 Standalone solutions market, 2018 - 2030 (USD Million)
Fig. 21 Integrated solutions market, 2018 - 2030 (USD Million)
Fig. 22 U.S. utilization management solutions market: Component dashboard
Fig. 23 U.S. utilization management solutions market: Component market share analysis, 2024 & 2030
Fig. 24 Software solutions market, 2018 - 2030 (USD Million)
Fig. 25 Services market, 2018 - 2030 (USD Million)
Fig. 26 U.S. utilization management solutions market: Mode of delivery segment dashboard
Fig. 27 U.S. utilization management solutions market: Mode of delivery segment dashboard
Fig. 28 Web/cloud based market, 2018 - 2030 (USD Million)
Fig. 29 On premise market, 2018 - 2030 (USD Million)
Fig. 30 U.S. utilization management solutions market: End use segment dashboard
Fig. 31 U.S. utilization management solutions market: End use market share analysis, 2024 & 2030
Fig. 32 Healthcare providers market, 2018 - 2030 (USD Million)
Fig. 33 Healthcare payers market, 2018 - 2030 (USD Million)
Fig. 34 Other end use market, 2018 - 2030 (USD Million)
Fig. 35 Company categorization
Fig. 36 Company market position analysis
Fig. 37 Strategic framework