PUBLISHER: The Business Research Company | PRODUCT CODE: 1810850
PUBLISHER: The Business Research Company | PRODUCT CODE: 1810850
A clinical risk grouping (CRG) solution is a healthcare analytics system designed to categorize patients into clinically meaningful and mutually exclusive risk groups based on factors such as medical history, diagnoses, procedures, and other health-related data. This classification supports healthcare providers, payers, and policymakers in predicting healthcare utilization, managing population health, and optimizing resource allocation.
The core components of a clinical risk grouping solution include software and services. The software functions as a digital tool that classifies patients according to health risk to facilitate care management, lower costs, and support data-driven decision-making. The solution offers a range of products such as dashboard analytics, scorecards, data visualization tools, and risk reporting systems, and can be deployed via private, public, or hybrid cloud environments. Key applications encompass population health management, chronic disease management, clinical decision support, fraud detection and prevention, among other healthcare-related functions. It is used by various end-users including hospitals and clinics, ambulatory surgical centers, long-term care facilities, and others.
Note that the outlook for this market is being affected by rapid changes in trade relations and tariffs globally. The report will be updated prior to delivery to reflect the latest status, including revised forecasts and quantified impact analysis. The report's Recommendations and Conclusions sections will be updated to give strategies for entities dealing with the fast-moving international environment.
The sudden escalation of U.S. tariffs and the consequent trade frictions in spring 2025 are severely impacting the healthcare sector, particularly in the supply of critical medical devices, diagnostic equipment, and pharmaceuticals. Hospitals and healthcare providers are facing higher costs for imported surgical instruments, imaging equipment, and consumables such as syringes and catheters, many of which have limited domestic alternatives. These increased costs are straining healthcare budgets, leading some providers to delay equipment upgrades or pass on expenses to patients. Additionally, tariffs on raw materials and components are disrupting the production of essential drugs and devices, causing supply chain bottlenecks. In response, the industry is diversifying sourcing strategies, boosting local manufacturing where possible, and advocating for tariff exemptions on life-saving medical products.
The clinical risk grouping solution market research report is one of a series of new reports from The Business Research Company that provides clinical risk grouping solution market statistics, including the clinical risk grouping solution industry global market size, regional shares, competitors with the clinical risk grouping solution market share, detailed clinical risk grouping solution market segments, market trends, and opportunities, and any further data you may need to thrive in the clinical risk grouping solution industry. These clinical risk grouping solution market research report delivers a complete perspective of everything you need, with an in-depth analysis of the current and future scenarios of the industry.
The clinical risk grouping solution market size has grown rapidly in recent years. It will grow from $0.61 billion in 2024 to $0.69 billion in 2025 at a compound annual growth rate (CAGR) of 12.6%. The growth during the historic period can be attributed to regulatory initiatives promoting value-based care, the rise in healthcare data digitization, increasing healthcare costs, widespread adoption of electronic health records (EHR), and the expansion of risk adjustment programs.
The clinical risk grouping solution market size is expected to see rapid growth in the next few years. It will grow to $1.10 billion in 2029 at a compound annual growth rate (CAGR) of 12.4%. The growth in the forecast period can be attributed to the shift toward personalized care management, the expansion of government healthcare programs, increasing demand for predictive analytics, a stronger focus on population health management, and a growing aging population. Key trends expected during this period include the integration of artificial intelligence and machine learning, the development of real-time risk stratification tools, enhanced interoperability with electronic health record systems, incorporation of social determinants of health (SDOH) data, and the cloud-based deployment of risk solutions.
The increasing use of electronic health records (EHRs) is anticipated to drive the growth of the clinical risk grouping solution market in the coming years. Electronic health records are digital representations of patients' paper charts that offer real-time, patient-focused records accessible to authorized personnel. The rising adoption of EHRs is largely due to the need for more efficient data management, as healthcare providers aim to streamline how patient information is stored, improve access, and enhance coordination among departments to support better clinical decisions and health outcomes. The use of EHRs contributes to clinical risk grouping solutions by supplying comprehensive, real-time data that enables accurate patient risk classification and supports effective population health management. For example, in June 2022, the Department of Health and Social Care, a government agency in the UK, reported that all NHS trusts are expected to implement electronic health records by March 2025, up from 90% that had adopted them by December 2023. Consequently, the growing adoption of electronic health records is accelerating the expansion of the clinical risk grouping solution market.
Key players in the clinical risk grouping solution market are investing in advanced solutions, such as artificial intelligence (AI)-powered coding platforms, to boost coding precision and simplify risk assessment procedures. These AI-powered platforms utilize technologies like machine learning and natural language processing to evaluate clinical data and assign medical codes accurately. They help automate the medical coding workflow, reduce manual errors, improve efficiency, and ensure precise risk adjustment, which supports more effective reimbursement and care strategies. For instance, in August 2022, Reveleer Inc., a healthcare technology firm based in the US, introduced Risk Adjustment 2.0-an AI-driven coding solution that combines machine learning, natural language processing, and intelligent automation to enhance coding accuracy, streamline the analysis of clinical information, and improve risk adjustment processes for health plans and providers managing risk. The platform functions as a virtual team member, analyzing complex data and applying custom rule sets to capture hierarchical condition categories (HCCs) accurately.
In October 2023, Optum Health Solutions (UK) Ltd., a healthcare service provider based in the UK, acquired EMIS Group plc for $1.5 billion (£1.2 billion). This acquisition aims to bolster Optum's presence in the UK healthcare sector by incorporating EMIS Group's advanced clinical software and data analytics expertise to enable more efficient and technology-driven healthcare delivery. EMIS Group plc is a UK-based company recognized for its work in clinical risk grouping solutions.
Major players in the clinical risk grouping solution market are Optum Inc., 3M Corporation, Solventum, Conduent Inc., Epic Systems Corporation, Cotiviti Inc., Nuance Communications Inc., Health Catalyst Inc., Edifecs Inc., Innovaccer Inc., Cedar Gate Technologies, Reveleer, ZeOmega, MedeAnalytics Inc., Lightbeam Health Solutions, Apixio, HealthEC LLC, CareEvolution, HBI Solutions, and 4S Information Systems.
North America was the largest region in the clinical risk grouping solution market in 2024. Asia-Pacific is expected to be the fastest-growing region in the forecast period. The regions covered in clinical risk grouping solution report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East and Africa.
The countries covered in the clinical risk grouping solution market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA, Canada, Italy, Spain.
The clinical risk grouping solution market consists of revenues earned by entities by providing services such as risk stratification, predictive analytics, patient classification, clinical decision support, population health management, claims and billing optimization, care coordination, and regulatory compliance and reporting. The market value includes the value of related goods sold by the service provider or included within the service offering. Only goods and services traded between entities or sold to end consumers are included.
The market value is defined as the revenues that enterprises gain from the sale of goods and/or services within the specified market and geography through sales, grants, or donations in terms of the currency (in USD unless otherwise specified).
The revenues for a specified geography are consumption values that are revenues generated by organizations in the specified geography within the market, irrespective of where they are produced. It does not include revenues from resales along the supply chain, either further along the supply chain or as part of other products.
Clinical Risk Grouping Solution Global Market Report 2025 from The Business Research Company provides strategists, marketers and senior management with the critical information they need to assess the market.
This report focuses on clinical risk grouping solution market which is experiencing strong growth. The report gives a guide to the trends which will be shaping the market over the next ten years and beyond.
Where is the largest and fastest growing market for clinical risk grouping solution ? How does the market relate to the overall economy, demography and other similar markets? What forces will shape the market going forward, including technological disruption, regulatory shifts, and changing consumer preferences? The clinical risk grouping solution market global report from the Business Research Company answers all these questions and many more.
The report covers market characteristics, size and growth, segmentation, regional and country breakdowns, competitive landscape, market shares, trends and strategies for this market. It traces the market's historic and forecast market growth by geography.
The forecasts are made after considering the major factors currently impacting the market. These include the technological advancements such as AI and automation, Russia-Ukraine war, trade tariffs (government-imposed import/export duties), elevated inflation and interest rates.