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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 Infographic
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    Clinical Risk Grouping Solutions Market Summary

    As per MRFR analysis, the Clinical Risk Grouping Solutions Market Size was estimated at 2.24 USD Billion in 2024. The Clinical Risk Grouping Solutions industry is projected to grow from 2.427 USD Billion in 2025 to 5.407 USD Billion by 2035, exhibiting a compound annual growth rate (CAGR) of 8.34 during the forecast period 2025 - 2035.

    Key Market Trends & Highlights

    The Clinical Risk Grouping Solutions Market is poised for substantial growth driven by technological advancements and evolving healthcare paradigms.

    • The integration of advanced technologies is reshaping the Clinical Risk Grouping Solutions Market, particularly in North America.
    • A notable shift towards value-based care is influencing market dynamics, with healthcare analytics emerging as the largest segment.
    • Asia-Pacific is recognized as the fastest-growing region, reflecting a burgeoning demand for innovative healthcare solutions.
    • Rising demand for cost-effective healthcare solutions and increased focus on patient-centric care are key drivers propelling market expansion.

    Market Size & Forecast

    2024 Market Size 2.24 (USD Billion)
    2035 Market Size 5.407 (USD Billion)
    CAGR (2025 - 2035) 8.34%

    Major Players

    Optum (US), Cerner Corporation (US), Epic Systems Corporation (US), McKesson Corporation (US), Allscripts Healthcare Solutions (US), IBM Watson Health (US), TruCare (US), HealthEC (US), eClinicalWorks (US)

    Clinical Risk Grouping Solutions Market Trends

    The Clinical Risk Grouping Solutions Market is currently experiencing a notable evolution, driven by the increasing demand for efficient healthcare management systems. As healthcare providers seek to enhance patient outcomes while managing costs, the adoption of clinical risk grouping solutions appears to be gaining traction. These solutions facilitate the categorization of patients based on their clinical profiles, enabling healthcare organizations to allocate resources more effectively and tailor interventions to individual needs. Furthermore, the integration of advanced analytics and artificial intelligence into these solutions suggests a shift towards more data-driven decision-making processes, which could potentially improve the accuracy of risk assessments and enhance overall care delivery. In addition, regulatory changes and a growing emphasis on value-based care are likely influencing the dynamics of the Clinical Risk Grouping Solutions Market. Stakeholders are increasingly recognizing the importance of aligning reimbursement models with patient outcomes, which may drive further investment in these technologies. As the market continues to evolve, collaboration among technology providers, healthcare organizations, and regulatory bodies seems essential to address the complexities of risk management and ensure the successful implementation of clinical risk grouping solutions.

    Integration of Advanced Technologies

    The Clinical Risk Grouping Solutions Market is witnessing a trend towards the incorporation of advanced technologies such as artificial intelligence and machine learning. These innovations enhance the ability to analyze vast amounts of patient data, leading to more precise risk stratification and improved clinical decision-making.

    Shift Towards Value-Based Care

    There is a growing emphasis on value-based care within the Clinical Risk Grouping Solutions Market. This shift encourages healthcare providers to focus on patient outcomes rather than service volume, prompting the adoption of solutions that facilitate better risk assessment and management.

    Regulatory Influence on Market Dynamics

    Regulatory changes are playing a crucial role in shaping the Clinical Risk Grouping Solutions Market. New policies aimed at improving healthcare quality and efficiency are likely driving the demand for innovative risk grouping solutions, as organizations seek to comply with evolving standards.

    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

    Increased Focus on Patient-Centric Care

    In the Clinical Risk Grouping Solutions Market, there is a growing emphasis on patient-centric care models. Healthcare providers are increasingly recognizing the importance of tailoring treatments to individual patient needs, which necessitates robust risk assessment tools. By utilizing clinical risk grouping solutions, providers can better understand patient demographics and health conditions, leading to more personalized care strategies. This shift towards patient-centricity is supported by data indicating that organizations implementing such solutions report improved patient satisfaction and engagement. Consequently, the demand for clinical risk grouping solutions is likely to rise as healthcare systems prioritize patient outcomes.

    Technological Advancements in Data Analytics

    Technological advancements in data analytics are significantly influencing the Clinical Risk Grouping Solutions Market. The integration of sophisticated analytics tools allows healthcare organizations to process vast amounts of patient data efficiently. These tools enable providers to identify patterns and trends in patient health, which is crucial for effective risk stratification. As organizations increasingly adopt electronic health records and other digital solutions, the reliance on data-driven decision-making is expected to grow. This trend is reflected in market data, which suggests that the adoption of advanced analytics in healthcare could enhance the accuracy of clinical risk assessments, thereby propelling market growth.

    Growing Importance of Population Health Management

    The growing importance of population health management is a key driver in the Clinical Risk Grouping Solutions Market. As healthcare systems shift towards managing the health of entire populations rather than just individual patients, the need for effective risk stratification becomes increasingly critical. Clinical risk grouping solutions provide the necessary tools to analyze population health data, identify at-risk groups, and implement targeted interventions. This trend is supported by data indicating that organizations focusing on population health management experience improved health outcomes and reduced costs. Consequently, the emphasis on population health is likely to drive demand for clinical risk grouping solutions.

    Regulatory Support for Risk Management Initiatives

    Regulatory support for risk management initiatives plays a pivotal role in shaping the Clinical Risk Grouping Solutions Market. Governments and regulatory bodies are increasingly advocating for the implementation of risk assessment frameworks to improve healthcare quality and safety. This support is evident in various policies aimed at incentivizing healthcare providers to adopt clinical risk grouping solutions. As regulations evolve, organizations are likely to invest in these solutions to comply with standards and enhance their operational capabilities. The alignment of regulatory frameworks with market needs suggests a favorable environment for the growth of clinical risk grouping solutions.

    Rising Demand for Cost-Effective Healthcare Solutions

    The Clinical Risk Grouping Solutions Market is experiencing a notable increase in demand for cost-effective healthcare solutions. As healthcare providers strive to optimize their operational efficiency, the need for effective risk management tools becomes paramount. These solutions enable healthcare organizations to categorize patients based on their clinical risk profiles, thereby facilitating targeted interventions. According to recent data, healthcare expenditures are projected to rise, prompting organizations to seek innovative ways to manage costs while maintaining quality care. This trend underscores the importance of clinical risk grouping solutions in enhancing resource allocation and improving patient outcomes, ultimately driving market growth.

    Market Segment Insights

    By Application: Healthcare Analytics (Largest) vs. Population Health Management (Fastest-Growing)

    In the Clinical Risk Grouping Solutions Market, Healthcare Analytics holds the largest market share among the various application segments, driven by the increasing need for data-driven decision-making in healthcare. Healthcare providers are leveraging analytics to improve patient outcomes and streamline operations, leading to a dominance in market presence. In contrast, Population Health Management is witnessing significant growth, as healthcare organizations focus on managing the health outcomes of a defined group of individuals. This shift is fostering a greater emphasis on preventive care, risk assessment, and broader usage of health data. The growth trends in this segment are primarily influenced by the rising adoption of digital healthcare solutions and the need for efficient healthcare delivery systems. The demand for Risk Adjustment solutions is also notable, as payers seek to ensure accurate and fair reimbursements based on patient risk profiles. Concurrently, Patient Safety applications are gaining traction as hospitals and clinics prioritize the prevention of medical errors and adverse events, thus promoting patient-centered care and enhancing safety protocols.

    Healthcare Analytics (Dominant) vs. Patient Safety (Emerging)

    Healthcare Analytics is positioned as the dominant application in the Clinical Risk Grouping Solutions Market, characterized by sophisticated technologies that enable healthcare providers to derive actionable insights from vast amounts of patient data. This segment emphasizes predictive analytics, data visualization, and reporting tools, which are crucial for improving clinical outcomes and operational efficiency. On the other hand, Patient Safety is emerging as a significant focus, driven by regulatory requirements and an increasing commitment to quality care. This segment focuses on tools and processes aimed at minimizing risks and safeguarding patients during their treatment journey. As hospitals implement more rigorous safety protocols, the integration of patient safety solutions with analytics becomes increasingly relevant, highlighting a trend toward comprehensive risk management.

    By Deployment Model: Cloud-Based (Largest) vs. Hybrid (Fastest-Growing)

    The Clinical Risk Grouping Solutions Market is increasingly dominated by the cloud-based deployment model, which is favored for its scalability and cost-effectiveness. On-premises deployments, while still present, are progressively losing market share as healthcare organizations seek more flexible solutions to manage clinical data efficiently. The hybrid model, which combines both cloud and on-premises elements, is also gaining traction among organizations looking to balance control and innovation.

    Cloud-Based (Dominant) vs. Hybrid (Emerging)

    The cloud-based deployment model is becoming the dominant approach in the Clinical Risk Grouping Solutions Market due to its ability to allow remote access to critical data and analytics tools, facilitating improved decision-making processes. This model supports scalability and real-time updates, making it highly attractive for healthcare providers that require agility in operations. On the other hand, the hybrid model is emerging as a flexible alternative, enabling organizations to utilize both cloud and on-premises resources effectively. This appeals to institutions that have stringent regulatory requirements or existing IT infrastructure, allowing them to leverage their current investments while adopting innovative cloud solutions.

    By End User: Hospitals (Largest) vs. Healthcare Providers (Fastest-Growing)

    The Clinical Risk Grouping Solutions Market exhibits a diverse landscape concerning its end users. Hospitals hold the largest market share, benefiting from their extensive patient data and the need for efficient risk management solutions. Healthcare providers follow closely, as they are increasingly integrating these solutions to improve patient outcomes and streamline operations. The other segments, including payers and government organizations, also play vital roles but are comparatively smaller in market share, focusing on specific applications tailored for risk assessments and compliance.

    Hospitals (Dominant) vs. Healthcare Providers (Emerging)

    Hospitals represent the dominant end-user segment in the Clinical Risk Grouping Solutions Market, leveraging comprehensive patient information through Electronic Health Records (EHR). Their primary focus is on improving patient care quality while managing operational costs effectively. Emerging as a fast-growing segment, Healthcare Providers are rapidly adopting clinical risk solutions to enhance patient engagement and care coordination. This segment is particularly influenced by the push for value-based care, which necessitates greater emphasis on patient risk assessment. Both segments benefit from advances in technology, including artificial intelligence and data analytics, which significantly improve risk stratification and resource allocation.

    By Type of Solution: Software (Largest) vs. Services (Fastest-Growing)

    In the Clinical Risk Grouping Solutions Market, the distribution of market share between software and services reflects a dynamic landscape. Currently, software solutions dominate this sector, holding the largest share due to their advanced capabilities, integration features, and proven effectiveness in improving patient outcomes. With healthcare providers increasingly adopting technology-based solutions, software is positioned as the backbone of clinical risk management systems, providing essential tools for data analysis and decision-making. On the other hand, services are emerging as the fastest-growing segment in this market, propelled by increasing demand for customizable and scalable support. As healthcare organizations seek comprehensive solutions, the need for consulting, implementation, and training services has surged. This trend highlights a shift toward a more holistic approach to clinical risk management, where services complement software offerings, enhancing overall efficacy and user experience.

    Software (Dominant) vs. Services (Emerging)

    The software segment of the Clinical Risk Grouping Solutions Market is recognized as the dominant player due to its extensive functionalities, including real-time data processing, predictive analytics, and user-friendly interfaces. Software solutions not only streamline clinical workflows but also contribute to enhanced patient safety and care quality. As a result, healthcare providers view software as a vital investment in their technological infrastructure. Conversely, the services segment is classified as emerging, characterized by rapid growth and diversification. This segment encompasses a range of offerings, from advisory services to ongoing support, which are critical in ensuring the successful implementation and optimization of software solutions. As risks in healthcare evolve, the increasing reliance on tailored services to address specific clinical needs is shaping the future of the market.

    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 projected to grow at an 8.34% CAGR from 2024 to 2035, driven by technological advancements, regulatory changes, and increasing demand for value-based care.

    New opportunities lie in:

    • Integration of AI-driven analytics for predictive risk assessment.
    • Development of customizable risk stratification tools for diverse healthcare settings.
    • Expansion into emerging markets with tailored clinical risk solutions.

    By 2035, the market is expected to be robust, reflecting substantial growth and innovation.

    Market Segmentation

    Clinical Risk Grouping Solutions Market End User Outlook

    • Hospitals
    • Healthcare Providers
    • Payers
    • Government Organizations

    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

    MARKET SIZE 20242.24(USD Billion)
    MARKET SIZE 20252.427(USD Billion)
    MARKET SIZE 20355.407(USD Billion)
    COMPOUND ANNUAL GROWTH RATE (CAGR)8.34% (2024 - 2035)
    REPORT COVERAGERevenue Forecast, Competitive Landscape, Growth Factors, and Trends
    BASE YEAR2024
    Market Forecast Period2025 - 2035
    Historical Data2019 - 2024
    Market Forecast UnitsUSD Billion
    Key Companies ProfiledMarket analysis in progress
    Segments CoveredMarket segmentation analysis in progress
    Key Market OpportunitiesIntegration of artificial intelligence in Clinical Risk Grouping Solutions enhances predictive analytics and patient outcomes.
    Key Market DynamicsRising demand for data-driven healthcare solutions drives innovation in Clinical Risk Grouping methodologies and technologies.
    Countries CoveredNorth America, Europe, APAC, South America, MEA

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    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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