U.S. Utilization Management Solutions Market Size, Share & Trends Analysis Report By Type (Standalone Solutions, Integrated Solutions), By Mode Of Delivery (Cloud-based, On-premise), By Component (Software, Service), By End Use, And Segment Forecasts, 202

Market Size & Trends

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