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市場調查報告書
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1726334

美國利用率管理解決方案市場：市場規模、佔有率、趨勢分析（按類型、交付方式、組件、最終用途和地區）、細分市場預測（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個工作天內

價格

市場規模與趨勢：

預計 2024 年美國利用管理解決方案市場規模將達到 6.1315 億美元，預計 2025 年至 2030 年的複合年成長率為 9.9%。

重新發明使用管理 (UM) 為 PoC 供應商帶來價值、對技術先進的 UM 解決方案的需求不斷增加、各個組織擴大採用使用管理以及戰略夥伴關係和協作交易的增加等因素預計將推動市場的發展。例如，2024 年 1 月，ZeOmega 與 Datycs 合作，實現醫療數據工作流程自動化並將傳真文件數位化。

對 UM 解決方案的投資不斷增加反映了醫療技術的重大進步和向基於價值的護理的轉變，其中效率、患者滿意度和以結果為導向的方法被優先考慮。增加投資為馬大創造了寶貴的機會。例如，2024 年 7 月，為付款人提供 UM 審查解決方案的美國醫學審查研究所 (MRIoA) 從 Parthenon Capital 籌集了資金，作為交易的一部分，現有投資者和 MRIoA 的經營團隊持有了該公司的多數股權。

此外，美國醫療保健支付方和提供者越來越重視 IT 投資，其中 75% 報告指出 2023 年支出將增加。醫療保健組織希望將這些資金用於 IT 服務和基礎設施，例如網路安全、臨床工作流程最佳化、索賠處理、支付、數據平台、互通性、護理協調和收益週期管理 (RCM)。

此外，市場參與企業正在採取各種策略性舉措，如併購、新產品發布和地理擴張，以推動市場成長。例如，2024 年 6 月，Evolent Health, Inc. 宣布已同意收購 Machinify 的某些資產，包括 Machinify Auth 團隊、其 AI主導的利用率管理產品以及相關軟體應用程式。

COVID-19 疫情美國利用管理解決方案產業產生了重大影響，加速了數位工具和自動化的採用，以滿足日益成長的醫療保健需求。醫院和保險公司面臨的挑戰包括選擇性手術的重複就診、專科護理費用的上漲以及門診病人和重症患者覆蓋範圍的激增。作為回應，人們明顯轉向雲端基礎的UM 平台、遠端醫療整合和機器人流程自動化 (RPA)，以簡化核准和護理協作。這些變化背後的動機是為了提高效率，減輕管理人員的負擔，並解決勞動力短缺問題，特別是醫生和護士的短缺問題。這次疫情凸顯了靈活、可擴展的 UM 結果對於維持護理品質和功能永續性的重要性。

目錄

第1章 分析方法與範圍

第2章執行摘要

第3章 市場促進因素、趨勢與範圍

  • 市場聯動展望
  • 市場動態
    • 市場促進因素分析
    • 軟體投資及維護成本高
    • 產業機會分析
    • 產業問題分析
    • 案例研究
  • 商業環境分析
    • 波特五力分析
    • PESTLE分析

第4章美國使用管理解決方案市場：按類型進行估計和趨勢分析

  • 儀表板：依類型
  • 按類型分類的市場佔有率變化分析（2024 年和 2030 年）
  • 市場規模、預測與趨勢分析：按類型（2018-2030 年）
  • 獨立解決方案
    • 獨立解決方案市場（2018-2030）
  • 整合解決方案
    • 整合解決方案市場（2018-2030）

第5章美國使用管理解決方案市場：按組成部分的估計和趨勢分析

  • 儀表板：按組件
  • 各組件市場佔有率變化分析（2024 年及 2030 年）
  • 市場規模、預測與趨勢分析（2018-2030 年）
  • 軟體解決方案
    • 軟體解決方案市場（2018-2030）
  • 服務
    • 服務市場（2018-2030）

第6章：美國使用管理解決方案市場：以交付方式的估算與趨勢分析

  • 儀表板：依交付方式
  • 按交付方式分類的市場佔有率變化分析（2024 年和 2030 年）
  • 市場規模/預測/趨勢分析：按撥備方法（2018-2030 年）
  • 雲端基礎
    • 網路/雲端基礎市場（2018-2030）
  • 本地
    • 本地部署市場（2018-2030）

第7章。美國利用管理解決方案市場：按最終用途的估計和趨勢分析

  • 儀表板：依最終用途
  • 按最終用途分類的市場佔有率變化分析（2024 年和 2030 年）
  • 按最終用途分類的市場規模、預測和趨勢分析（2018-2030 年）
  • 醫療保健提供者
    • 醫療保健提供者市場（2018-2030）
  • 醫療保健付款人
    • 醫療保健支付市場（2018-2030）
  • 其他最終用途
    • 其他最終用途（2018-2030）

第8章 競爭態勢

  • 參與者概覽
  • 公司市場地位分析/佔有率分析（2024年）
  • 公司分類
  • 戰略地圖
  • 公司簡介/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