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封面
市场调查报告书
商品编码
1726334

美国利用率管理解决方案市场：市场规模、份额、趋势分析（按类型、交付方式、组件、最终用途和地区）、细分市场预测（2025-2030 年）

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
出版日期: | 出版商: Grand View Research | 英文 120 Pages | 商品交期: 2-10个工作天内

价格

市场规模与趋势：

预计 2024 年美国利用管理解决方案市场规模将达到 6.1315 亿美元，预计 2025 年至 2030 年的复合年增长率为 9.9%。

重新发明使用管理 (UM) 为 PoC 供应商带来价值、对技术先进的 UM 解决方案的需求不断增加、各个组织越来越多地采用使用管理以及战略伙伴关係和协作交易的增加等因素预计将推动市场的发展。例如，2024 年 1 月，ZeOmega 与 Datycs 合作，实现医疗数据工作流程自动化并将传真文件数位化。

对 UM 解决方案的投资不断增加反映了医疗技术的重大进步和向基于价值的护理的转变，其中效率、患者满意度和以结果为导向的方法被优先考虑。增加投资为马大创造了宝贵的机会。例如，2024 年 7 月，为付款人提供 UM 审查解决方案的美国医学审查研究所 (MRIoA) 从 Parthenon Capital 筹集了资金，作为交易的一部分，现有投资者和 MRIoA 的经营团队持有了该公司的多数股权。

此外，美国医疗保健支付方和提供者越来越重视 IT 投资，其中 75% 报告指出 2023 年支出将增加。医疗保健组织希望将这些资金用于 IT 服务和基础设施，例如网路安全、临床工作流程优化、索赔处理、支付、数据平台、互通性、护理协调和收益週期管理 (RCM)。

此外，市场参与企业正在采取各种策略性倡议，如併购、新产品发布和地理扩张，以推动市场成长。例如，2024 年 6 月，Evolent Health, Inc. 宣布已同意收购 Machinify 的某些资产，包括 Machinify Auth 团队、其 AI主导的利用率管理产品以及相关软体应用程式。

COVID-19 疫情美国利用管理解决方案产业产生了重大影响，加速了数位工具和自动化的采用，以满足日益增长的医疗保健需求。医院和保险公司面临的挑战包括选择性手术的重复就诊、专科护理费用的上涨以及门诊病人和重症患者覆盖范围的激增。作为回应，人们明显转向云端基础的UM 平台、远端医疗整合和机器人流程自动化 (RPA)，以简化核准和护理协作。这些变化背后的动机是为了提高效率，减轻管理人员的负担，并解决劳动力短缺问题，特别是医生和护士的短缺问题。这次疫情凸显了灵活、可扩展的 UM 结果对于维持护理品质和功能永续性的重要性。

目录

第一章 分析方法与范围

第二章执行摘要

第三章 市场驱动因素、趋势与范围

  • 市场联动展望
  • 市场动态
    • 市场驱动因素分析
    • 软体投资及维护成本高
    • 产业机会分析
    • 产业问题分析
    • 案例研究
  • 商业环境分析
    • 波特五力分析
    • PESTLE分析

第四章美国使用管理解决方案市场：按类型进行估计和趋势分析

  • 仪表板：依类型
  • 按类型分類的市场占有率变化分析（2024 年和 2030 年）
  • 市场规模、预测与趋势分析：按类型（2018-2030 年）
  • 独立解决方案
    • 独立解决方案市场（2018-2030）
  • 整合解决方案
    • 整合解决方案市场（2018-2030）

第五章美国使用管理解决方案市场：按组成部分的估计和趋势分析

  • 仪表板：按组件
  • 各组件市场占有率变化分析（2024 年及 2030 年）
  • 市场规模、预测与趋势分析（2018-2030 年）
  • 软体解决方案
    • 软体解决方案市场（2018-2030）
  • 服务
    • 服务市场（2018-2030）

第六章：美国使用管理解决方案市场：以交付方式的估算与趋势分析

  • 仪表板：依交付方式
  • 按交付方式分類的市场占有率变化分析（2024 年和 2030 年）
  • 市场规模/预测/趋势分析：按拨备方法（2018-2030 年）
  • 云端基础
    • 网路/云端基础市场（2018-2030）
  • 本地
    • 本地部署市场（2018-2030）

第七章。美国利用管理解决方案市场：按最终用途的估计和趋势分析

  • 仪表板：依最终用途
  • 按最终用途分類的市场占有率变化分析（2024 年和 2030 年）
  • 按最终用途分類的市场规模、预测和趋势分析（2018-2030 年）
  • 医疗保健提供者
    • 医疗保健提供者市场（2018-2030）
  • 医疗保健付款人
    • 医疗保健支付市场（2018-2030）
  • 其他最终用途
    • 其他最终用途（2018-2030）

第八章 竞争态势

  • 参与者概览
  • 公司市场地位分析/份额分析（2024年）
  • 公司分类
  • 战略地图
  • 公司简介/上市公司
    • Change Healthcare（part of Optum from October 2022）
    • Conduent, Inc.
    • ZeOmega
    • HealthEdge Software, Inc.
    • Optum, Inc.（Change Healthcare is a Part of Optum from October 2022）
    • Keystone Peer Review Organization, LLC（Kepro acquired eQHealth Solutions, Inc. in 2021）
    • ExlService Holdings, Inc.
    • AssureCare LLC
    • PrimEra Medical Technologies
    • Access Healthcare
Product Code: GVR-4-68040-561-1

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

Table of Contents

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

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