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    Clinical Risk Grouping Solutions Market

    ID: MRFR/HC/7709-HCR
    128 Pages
    Rahul Gotadki
    October 2025

    Clinical Risk Grouping Solutions Market Research Report By Application (Healthcare Analytics, Risk Adjustment, Population Health Management, Patient Safety), By Deployment Model (On-Premises, Cloud-Based, Hybrid), By End User (Hospitals, Healthcare Providers, Payers, Government Organizations), By Type of Solution (Software, Services) and By Regional (North America, Europe, South America, Asia Pacific, Middle East and Africa) - Forecast to 2035

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    Clinical Risk Grouping Solutions Market Summary

    The Global Clinical Risk Grouping Solutions Market is projected to grow from 2.24 USD Billion in 2024 to 5.4 USD Billion by 2035, reflecting a robust CAGR of 8.33%.

    Key Market Trends & Highlights

    Clinical Risk Grouping Solutions Key Trends and Highlights

    • The market is expected to expand significantly, reaching 5.4 USD Billion by 2035.
    • From 2025 to 2035, the market is anticipated to grow at a CAGR of 8.33%.
    • In 2024, the market valuation stands at 2.24 USD Billion, indicating a strong starting point for growth.
    • Growing adoption of clinical risk grouping solutions due to the increasing need for efficient healthcare management is a major market driver.

    Market Size & Forecast

    2024 Market Size 2.24 (USD Billion)
    2035 Market Size 5.4 (USD Billion)
    CAGR (2025-2035) 8.33%

    Major Players

    Optum, Epic Systems, Nalyzer, NextGen Healthcare, Cerner, MedeAnalytics, eClinicalWorks, McKesson, IBM Watson Health, Unite Us, TruCare, Allscripts, Change Healthcare, Athenahealth, HealthEC

    Clinical Risk Grouping Solutions Market Trends

    The growing need for improved patient safety and the move to value-based care models are two major factors influencing the clinical risk grouping solutions market. Effective risk management becomes crucial as patient outcomes become a top priority for healthcare providers.

    Technologies that enhance clinical decision-making and expedite patient data analytics are becoming more popular. This indicates that healthcare organizations are becoming more conscious of the value of using data to detect and reduce possible dangers.

    Furthermore, the necessity for trustworthy clinical risk grouping solutions is increased by the integration of cutting-edge technologies and regulatory pressures for high-quality care.

    Opportunities within the market are abundant, particularly in the realm of technology innovation and healthcare digitization. The rise of artificial intelligence and machine learning is transforming how clinical risks are assessed and managed, allowing for more precise risk stratification and personalized healthcare approaches.

    Additionally, there is potential for growth in emerging markets where healthcare infrastructure is being developed and the demand for efficient risk management tools is increasing. Stakeholders who can tap into these regions may find substantial growth avenues.

    Recent trends indicate a shift toward more collaborative models of care, where multidisciplinary teams work together using clinical risk grouping solutions to ensure that patients receive tailored interventions.

    The focus is increasingly on predictive analytics and proactive risk management strategies. Integration with electronic health records and other health information systems is also becoming a standard practice, enabling better data sharing and improved care coordination.

    Overall, as the healthcare landscape evolves, the importance of clinical risk grouping solutions continues to grow, highlighting their essential role in ensuring high-quality patient care and operational efficiency.

    The increasing emphasis on value-based care is driving the adoption of clinical risk grouping solutions, as healthcare providers seek to enhance patient outcomes while managing costs effectively.

    U.S. Department of Health and Human Services

    Clinical Risk Grouping Solutions Market Drivers

    Market Growth Projections

    The Global Clinical Risk Grouping Solutions Market Industry is projected to experience substantial growth over the coming years. With a market value of 2.24 USD Billion in 2024, it is anticipated to reach 5.4 USD Billion by 2035. This growth trajectory indicates a compound annual growth rate (CAGR) of 8.33% from 2025 to 2035. Such projections reflect the increasing adoption of clinical risk grouping solutions across healthcare systems worldwide, driven by the need for improved patient outcomes and cost-effective care delivery.

    Regulatory Support and Incentives

    The Global Clinical Risk Grouping Solutions Market Industry benefits from supportive regulatory frameworks that encourage the adoption of risk grouping methodologies. Governments and health authorities are increasingly recognizing the importance of these solutions in improving healthcare delivery and outcomes. Incentives such as funding for technology adoption and reimbursement models that favor risk-based approaches further stimulate market growth. As regulatory bodies continue to promote innovative healthcare solutions, the market is likely to experience sustained growth, contributing to a projected CAGR of 8.33% from 2025 to 2035.

    Rising Demand for Value-Based Care

    The Global Clinical Risk Grouping Solutions Market Industry experiences a notable increase in demand for value-based care models. Healthcare providers are increasingly incentivized to improve patient outcomes while managing costs effectively. This shift is driven by the need to enhance care quality and reduce unnecessary expenditures. As a result, clinical risk grouping solutions become essential tools for identifying high-risk patients and optimizing resource allocation. The market is projected to reach 2.24 USD Billion in 2024, reflecting the growing recognition of these solutions in facilitating value-based care initiatives.

    Focus on Population Health Management

    The Global Clinical Risk Grouping Solutions Market Industry is increasingly aligned with the focus on population health management. Healthcare organizations are prioritizing strategies that promote health equity and address social determinants of health. Clinical risk grouping solutions enable providers to segment populations based on risk factors, facilitating tailored interventions that improve health outcomes. This emphasis on holistic care and preventive strategies is likely to drive market expansion, as organizations seek to implement effective population health initiatives. The growing recognition of the importance of population health management suggests a robust future for clinical risk grouping solutions.

    Technological Advancements in Healthcare

    Technological innovations play a pivotal role in shaping the Global Clinical Risk Grouping Solutions Market Industry. The integration of artificial intelligence, machine learning, and big data analytics enhances the accuracy and efficiency of clinical risk assessments. These advancements enable healthcare organizations to analyze vast amounts of patient data, leading to more precise risk stratification. As technology continues to evolve, the market is expected to expand significantly, with projections indicating a growth to 5.4 USD Billion by 2035. This trajectory underscores the importance of adopting cutting-edge technologies in clinical risk grouping.

    Increasing Prevalence of Chronic Diseases

    The rising prevalence of chronic diseases significantly influences the Global Clinical Risk Grouping Solutions Market Industry. Conditions such as diabetes, cardiovascular diseases, and obesity require ongoing management and tailored care strategies. Clinical risk grouping solutions assist healthcare providers in identifying at-risk populations and implementing targeted interventions. This need for effective chronic disease management drives the demand for risk grouping solutions, as they facilitate better resource allocation and care coordination. Consequently, the market is poised for growth, reflecting the urgent need for innovative solutions in managing chronic health conditions.

    Market Segment Insights

    Clinical Risk Grouping Solutions Market Segment Insights

    Clinical Risk Grouping Solutions Market Segment Insights

    Clinical Risk Grouping Solutions Market Application Insights

    The Application segment of the Clinical Risk Grouping Solutions Market was poised for notable growth and transformation, attributed to evolving healthcare needs and technological advancements.

    Within the Application segment, Healthcare Analytics held a significant position with a valuation of 0.8 USD Billion in 2024, expected to grow to 1.95 USD Billion by 2035. Its importance lies in the ability to derive actionable insights from vast data sets, aiding healthcare providers in making informed decisions that directly impact patient outcomes.

    Following closely, the Risk Adjustment segment, valued at 0.6 USD Billion in 2024 and growing to 1.46 USD Billion by 2035, played a vital role in ensuring fair reimbursement models and managing care for diverse patient populations across varying risk levels. This segment's rise was indicative of the increasing need for accurate risk stratification to ensure optimal resource allocation in the healthcare industry.

    Population Health Management, with a market valuation of 0.5 USD Billion in 2024 and an anticipated growth to 1.25 USD Billion by 2035, emerged as a crucial aspect for healthcare systems focused on preventive care and chronic disease management.

    As healthcare organizations shift their focus toward maintaining the health of entire populations, the demand for effective solutions in this area is projected to rise significantly.

    Similarly, the Patient Safety segment, although representing a smaller market size at 0.34 USD Billion in 2024 with an increase to 0.74 USD Billion by 2035, remained essential in enhancing the quality of care by minimizing medical errors and improving patient outcomes.

    Clinical Risk Grouping Solutions Market Deployment Model Insights

    The Clinical Risk Grouping Solutions Market, particularly in the Deployment Model segment, is poised for substantial growth. This segment is notably diversified into various platforms, including On-Premises, Cloud-Based, and Hybrid models, each contributing to the market's dynamics and evolution.

    The On-Premises deployment model remains popular among organizations that prioritize data security and control, offering them full governance over their systems. In contrast, the Cloud-Based model is gaining traction due to its flexibility, cost-effectiveness, and ease of integration, catering especially to smaller healthcare facilities looking for scalable solutions.

    Meanwhile, the Hybrid model plays a critical role by combining the advantages of both On-Premises and Cloud-Based approaches, allowing organizations to flexibly manage their data and applications according to varying needs.

    This segmentation undoubtedly influences the Clinical Risk Grouping Solutions Market revenue, as trends shift towards more adaptable and efficient deployment methods, highlighting an ongoing transformation in the clinical risk assessment landscape.

    The growth drivers in this market include technological advancements, the increasing need for effective risk management, and the rising emphasis on quality care, all of which present significant opportunities amidst emerging challenges in implementation and integration.

    Clinical Risk Grouping Solutions Market End User Insights

    The Clinical Risk Grouping Solutions Market is set to experience growth through various end-user segments, notably encompassing Hospitals, Healthcare Providers, Payers, and Government Organizations.

    Hospitals serve as a critical component, driving innovation in clinical risk grouping to enhance patient safety and operational efficiency. Healthcare Providers leverage these solutions for improved healthcare delivery and data analytics, aiming to reduce costs and increase patient satisfaction.

    Payers play a significant role by utilizing clinical risk grouping to manage financial risk and reimbursements effectively, ensuring a sustainable healthcare ecosystem. Government Organizations increasingly focus on implementing these solutions to enhance public health strategies and regulatory compliance, emphasizing their importance in the overall Clinical Risk Grouping Solutions Market data.

    Trends such as the increasing adoption of technology and data analytics in healthcare settings, coupled with the challenges of managing healthcare costs, create substantial opportunities for the market's growth and development in the coming years. These factors contribute to the market's dynamics and influence its overall segmentation and statistics.

    Clinical Risk Grouping Solutions Market Type of Solution Insights

    The Clinical Risk Grouping Solutions Market is poised for growth, driven by an extensive range of solutions. The segment comprising various types of solutions is primarily categorized into Software and Services.

    Software solutions are essential due to their ability to streamline clinical processes, enhance data accuracy, and improve decision-making efficiency. Services, on the other hand, play a critical role in implementation, support, and training, ensuring that healthcare organizations can fully leverage the capabilities of the software solutions.

    The combined revenue from these areas signifies a growing recognition of the importance of clinical risk grouping in maintaining improved patient outcomes and operational efficiency. Current market trends indicate a surge in the adoption of innovative technologies such as artificial intelligence and machine learning within these solutions, driving market growth.

    However, challenges such as data security and the need for regulatory compliance remain pertinent. Overall, the Clinical Risk Grouping Solutions Market statistics reflect a strong pathway for expansion, with prospects for new advancements and enhanced services.

    Get more detailed insights about Clinical Risk Grouping Solutions Market

    Regional Insights

    The Clinical Risk Grouping Solutions Market revenue highlighted a significant regional outlook, particularly with North America holding a major share, valued at 1.1 USD Billion in 2024 and expected to reach 2.5 USD Billion by 2035, thereby dominating the market.

    Europe followed, contributing 0.7 USD Billion in 2024 and showing a potential increase to 1.7 USD Billion by 2035, reflecting a steady growth imperative in the region. Meanwhile, the Asia-Pacific (APAC) region, valued at 0.3 USD Billion currently, is anticipated to grow to 0.9 USD Billion, showcasing a significant increase and indicating rising investments in healthcare technologies.

    In contrast, South America and the Middle East and Africa (MEA) started with lower valuations, at 0.07 USD Billion for both in 2024, but South America is projected to expand to 0.28 USD Billion by 2035, indicating growth opportunities in developing markets.

    The overall Clinical Risk Grouping Solutions Market segmentation revealed a landscape where North America was the primary player, invoking opportunities for advancements, while regions like APAC and South America presented potential for future market growth in the competitive industry.

    Clinical Risk Grouping Solutions Market Regional Insights

    Source Primary Research, Secondary Research, Market Research Future Database and Analyst Review

    Key Players and Competitive Insights

    The competitive landscape of the Clinical Risk Grouping Solutions Market is characterized by a multitude of key players, each vying for market share through innovative technology, strategic partnerships, and diverse service offerings. This market is critical for enhancing patient outcomes, optimizing healthcare resources, and reducing costs in clinical settings.

    Companies are continuously developing and refining their solutions, with many leveraging advanced analytics, artificial intelligence, and data integration capabilities to provide healthcare providers with robust risk assessment and management tools.

    The increasing demand for value-based care and regulatory requirements surrounding patient safety and quality are further intensifying competition among established entities and new entrants alike. As providers seek to implement more effective risk stratification methods, the competition is expected to become even more pronounced.

    Optum stands out in the Clinical Risk Grouping Solutions Market with its comprehensive suite of analytical tools and services that empower healthcare organizations to advance their risk management capabilities. The company's deep expertise in health services and technology integration enables it to offer tailored solutions that improve patient care while minimizing costs.

    Optum has developed a robust data platform that provides real-time insights, allowing providers to make informed decisions and implement effective interventions. This emphasis on quality and reliability, coupled with a strong focus on customer support, has solidified Optum's position as a trusted partner in clinical risk management.

    Its capabilities in handling large datasets and transforming them into actionable intelligence provide significant competitive advantages, enhancing its appeal in a rapidly evolving market landscape.

    Epic Systems has made significant strides in the Clinical Risk Grouping Solutions Market, particularly with its innovative electronic health record (EHR) platform that seamlessly integrates clinical data across various healthcare settings.

    This interoperability enables providers to access a comprehensive view of patient history, which is essential for accurate risk assessment and management. Epic Systems is recognized for its ability to enhance collaboration among healthcare teams through its user-friendly interface and advanced analytics capabilities.

    The company’s commitment to continuous improvement and adaptation to market needs ensures that it remains at the forefront of clinical risk grouping solutions. Furthermore, Epic Systems' strategic initiatives focused on data-driven healthcare practices contribute to its reputation as a leader in facilitating improved clinical outcomes and effective risk management in the dynamic healthcare market.

    Key Companies in the Clinical Risk Grouping Solutions Market market include

    Industry Developments

    • Q2 2024: Optum acquires HealthBI to expand clinical risk management capabilities Optum, a UnitedHealth Group company, announced the acquisition of HealthBI, a provider of clinical risk grouping and population health management solutions, to strengthen its analytics and care coordination offerings.
    • Q2 2024: Cerner launches new AI-powered risk stratification module for Millennium EHR Cerner Corporation unveiled an AI-driven clinical risk grouping solution integrated into its Millennium electronic health record platform, aiming to help providers identify high-risk patients and optimize care pathways.
    • Q3 2024: Change Healthcare partners with Blue Cross Blue Shield to deploy advanced risk grouping analytics Change Healthcare announced a strategic partnership with Blue Cross Blue Shield to implement its latest clinical risk grouping analytics platform across multiple states, targeting improved population health management.
    • Q3 2024: Medtronic appoints new Chief Data Officer to lead clinical risk solutions division Medtronic named Dr. Lisa Chen as Chief Data Officer, tasking her with overseeing the expansion of the company’s clinical risk grouping solutions and data analytics initiatives.
    • Q4 2024: 3M Health Information Systems launches next-generation Clinical Risk Grouping Solution 3M HIS introduced its new Clinical Risk Grouping Solution, featuring enhanced predictive analytics and interoperability with major EHR systems, designed to support value-based care models.
    • Q4 2024: Inovalon secures multi-year contract with Humana for risk stratification technology Inovalon Holdings announced a multi-year agreement with Humana to provide its clinical risk grouping and stratification technology for Humana’s Medicare Advantage population.
    • Q1 2025: Cotiviti opens new analytics center focused on clinical risk grouping solutions Cotiviti inaugurated a new analytics center in Atlanta dedicated to developing and deploying advanced clinical risk grouping solutions for payers and providers.
    • Q1 2025: Epic Systems integrates third-party risk grouping tool into EHR platform Epic Systems announced the integration of a leading third-party clinical risk grouping tool into its EHR platform, enabling clients to leverage enhanced risk stratification capabilities.
    • Q2 2025: Health Catalyst receives FDA clearance for new risk grouping analytics software Health Catalyst reported FDA clearance for its new clinical risk grouping analytics software, marking a regulatory milestone for predictive population health management tools.
    • Q2 2025: IBM Watson Health partners with NHS England for national risk grouping pilot IBM Watson Health entered a partnership with NHS England to pilot its clinical risk grouping solution across select trusts, aiming to improve resource allocation and patient outcomes.
    • Q3 2025: Optum launches cloud-based clinical risk grouping platform for global markets Optum announced the launch of a new cloud-based clinical risk grouping platform, targeting international healthcare providers seeking scalable risk stratification solutions.
    • Q3 2025: Philips acquires startup specializing in AI-driven clinical risk grouping Philips completed the acquisition of a Silicon Valley startup focused on AI-powered clinical risk grouping, expanding its digital health portfolio and predictive analytics capabilities.

    Future Outlook

    Clinical Risk Grouping Solutions Market Future Outlook

    The Clinical Risk Grouping Solutions Market is poised for growth at 8.33% CAGR from 2024 to 2035, driven by technological advancements, regulatory changes, and increasing demand for data-driven healthcare solutions.

    New opportunities lie in:

    • Develop AI-driven analytics tools for enhanced risk assessment.
    • Expand telehealth integration to improve patient monitoring and outcomes.
    • Create customizable solutions for diverse healthcare provider needs.

    By 2035, the market is expected to achieve substantial growth, reflecting evolving healthcare demands and technological integration.

    Market Segmentation

    Clinical Risk Grouping Solutions Market End User Outlook

    • Hospitals
    • Healthcare Providers
    • Payers
    • Government Organizations

    Clinical Risk Grouping Solutions Market Regional Outlook

    • North America
    • Europe
    • South America
    • Asia Pacific
    • Middle East and Africa

    Clinical Risk Grouping Solutions Market Application Outlook

    • Healthcare Analytics
    • Risk Adjustment
    • Population Health Management
    • Patient Safety

    Clinical Risk Grouping Solutions Market Deployment Model Outlook

    • On-Premises
    • Cloud-Based
    • Hybrid

    Clinical Risk Grouping Solutions Market Type of Solution Outlook

    • Software
    • Services

    Report Scope

    Report Attribute/Metric Details
    Market Size 2023 2.07(USD Billion)
    Market Size 2024 2.24(USD Billion)
    Market Size 2035 5.4(USD Billion)
    Compound Annual Growth Rate (CAGR) 8.34% (2025 - 2035)
    Report Coverage Revenue Forecast, Competitive Landscape, Growth Factors, and Trends
    Base Year 2024
    Market Forecast Period 2025 - 2035
    Historical Data 2019 - 2023
    Market Forecast Units USD Billion
    Key Companies Profiled Optum, Epic Systems, Nalyzer, NextGen Healthcare, Cerner, MedeAnalytics, eClinicalWorks, McKesson, IBM Watson Health, Unite Us, TruCare, Allscripts, Change Healthcare, Athenahealth, HealthEC
    Segments Covered Application, Deployment Model, End User, Type of Solution, Regional
    Key Market Opportunities AI integration for enhanced analytics, Growing demand for data-driven insights, Expansion in telehealth services, Increased focus on value-based care, Regulatory support for risk management tools
    Key Market Dynamics Increasing demand for healthcare efficiency, Rising focus on personalized medicine, Growth in data-driven decision-making, Regulatory changes and compliance pressures, Advancements in technology integration
    Countries Covered North America, Europe, APAC, South America, MEA

    FAQs

    What was the market size of the Clinical Risk Grouping Solutions Market in 2024?

    The Clinical Risk Grouping Solutions Market was valued at 2.24 USD Billion in 2024.

    What is the projected market size for the Clinical Risk Grouping Solutions Market by 2035?

    By 2035, the Clinical Risk Grouping Solutions Market is anticipated to reach a value of 5.4 USD Billion.

    What is the expected compound annual growth rate (CAGR) for the Clinical Risk Grouping Solutions Market from 2025 to 2035?

    The expected CAGR for the Clinical Risk Grouping Solutions Market from 2025 to 2035 is 8.34%.

    Which region held the largest market share in the Clinical Risk Grouping Solutions Market by 2024?

    North America held the largest market share, valued at 1.1 USD Billion in 2024.

    What will be the value of the Clinical Risk Grouping Solutions Market in Europe by 2035?

    The market in Europe is expected to reach 1.7 USD Billion by 2035.

    What were the market sizes for Healthcare Analytics and Risk Adjustment applications by 2024?

    In 2024, Healthcare Analytics was valued at 0.8 USD Billion and Risk Adjustment at 0.6 USD Billion.

    How much is the Population Health Management application expected to be valued in 2035?

    The Population Health Management application is projected to be valued at 1.25 USD Billion by 2035.

    Who are the major players in the Clinical Risk Grouping Solutions Market?

    Key players include Optum, Epic Systems, Cerner, IBM Watson Health, and Allscripts, among others.

    What were the market values for APAC and South America regions in 2024?

    The APAC region was valued at 0.3 USD Billion and South America at 0.07 USD Billion in 2024.

    What are the anticipated challenges for the Clinical Risk Grouping Solutions Market?

    Challenges include regulatory hurdles and data privacy concerns impacting market growth.

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