Report Code : CVMI2603252601442 | Published Date : March 30, 2025
Market Overview
Clinical Risk Grouping (CRG) solutions are advanced analytics platforms used to classify patient populations based on healthcare utilization, morbidity profiles, and cost risk. These tools assist healthcare providers, payers, and government agencies in identifying high-risk individuals, optimizing care management, and controlling medical costs. CRGs are increasingly integrated into value-based care models, accountable care organizations (ACOs), and population health initiatives to enhance outcomes and improve reimbursement alignment.
The market is gaining momentum due to increasing demand for predictive risk modeling, the expansion of chronic disease management programs, and the need for real-time, interoperable analytics systems. CRGs are widely adopted in the US, Canada, UK, and emerging EU countries with strong digital health ecosystems.
Market Size and Forecast
Year |
Market Value (USD Billion) |
Notes |
2019 |
1.21 |
Based on provider software contracts and payer platform deployments |
2024 |
2.08 |
Five-year CAGR 11.4% |
2031 |
4.42 |
Seven-year CAGR 11.6% (2024–2031) |
Growing regulatory backing for risk stratification and population health reporting could expand the market to over USD 4.5 billion by 2031.
Primary Market Drivers
• Shift to value-based care and capitation reimbursement models
• Rising burden of multimorbidity and high-cost chronic patients
• Government mandates for risk-adjusted outcomes and population stratification
• Expansion of integrated care delivery networks and ACOs
• Need for AI-enabled data normalization and care prediction platforms
Market Challenges
• Data integration and standardization hurdles across legacy systems
• Limited adoption outside advanced healthcare markets
• Privacy and data governance issues with longitudinal EHR datasets
• High setup costs and skill gaps for implementing advanced CRG analytics
• Complexity of coding and medical classification in dynamic patient cohorts
Competitive Landscape
Company / Organization |
2024 Share |
Core Strengths |
Recent Moves |
Optum |
24 % |
CRG modeling integrated with payer and provider workflow |
Expanded AI-powered predictive engine (Q1 2024) |
3M Health Information Systems |
21 % |
Proprietary CRG classification; deep hospital reach |
Integrated social determinants data layer (Q3 2024) |
Cerner Corporation |
16 % |
Embedded CRG analytics in EHR platform |
Launched chronic care risk dashboard (Q4 2024) |
Conduent |
9 % |
State Medicaid and public health focus |
Partnered with three state agencies for longitudinal analytics |
Others (IBM Watson Health, Health Catalyst, MedeAnalytics) |
30 % |
Niche analytics and payer-specific tools |
Scaling cloud-hosted CRG tools and dashboards |
Detailed Market Segmentation
By Deployment Mode
• On-Premise – 42 %
• Cloud-Based – XX %
By End User
• Payers & Health Insurers – 38 %
• Hospitals & Health Systems – XX %
• Public Health Agencies – XX %
• ACOs & Managed Care Organizations – XX %
By Application
• Population Health Management – 34 %
• Chronic Disease Risk Stratification – XX %
• Resource Utilization Optimization – XX %
• Claims and Cost Prediction – XX %
Regional Analysis
• North America (43%) – Strongest adoption driven by CMS, payers, and integrated delivery networks
• Europe (XX%) – Growth in NHS, German statutory insurers, and Nordic digital health pilots
• Asia-Pacific (XX%) – Early deployment in Australia, Singapore, and urban health zones in India
• Latin America & MEA (8%) – Public health programs in Brazil and South Africa integrating stratification tools
Technology and Innovation
• Natural language processing (NLP) for extracting risk insights from unstructured clinical notes
• AI-enhanced morbidity prediction engines using EHR and SDOH data
• FHIR-enabled CRG platforms for better interoperability
• Graph-based patient relationship models to visualize comorbid clusters
• Dashboards for risk tiering, provider performance, and utilization trends
Regulatory Environment
• CMS mandates for risk-adjusted metrics in ACO and Medicare Advantage programs
• ONC interoperability rules drive standardization of input data formats
• GDPR and HIPAA compliance for cross-institution data use in risk analysis
• EU AI Act standards impact CRG predictive tool validation in healthcare
Recent Developments (Q4 2023 – Q2 2025)
• Optum launched real-time care navigator with embedded CRG triggers (Q1 2024)
• 3M HIS integrated ZIP-code level SDOH datasets into CRG framework (Q3 2024)
• Cerner added predictive insights for pediatric cohorts (Q4 2024)
• Conduent enabled cross-agency data mapping for Medicaid CRGs (Q2 2025)
• Health Catalyst released population-level cohort builder module (Q1 2025)
Strategic Outlook
• Vendors must align CRG tools with value-based incentive programs and provider scorecards
• Public health payers should invest in explainable AI models for fair risk stratification
• Cloud-native platforms will be essential for multi-agency analytics scaling
• Collaboration with social services and behavioral health stakeholders can enrich CRG outputs
Methodology
Clearview Market Insights collected contract data, payer platform usage metrics, and surveyed 75 CRG technology buyers. Forecasts reflect evolving reimbursement policies, chronic disease prevalence, and population health funding trends.
About Clearview Market Insights
Clearview Market Insights provides trusted intelligence on healthcare IT, risk analytics, and payer-provider transformation. We serve strategy leaders, vendors, and regulators with evidence-based forecasts and market tracking.
Reasons To Buy
• Benchmark key CRG tools and platform vendors by performance and adoption
• Track reimbursement-driven demand for risk stratification analytics
• Identify innovation opportunities in predictive modeling and SDOH integration
• Understand regulatory and policy trends impacting CRG tool deployment
Scope
• Market forecasts from 2019 to 2031 segmented by end user, deployment mode, and region
• CRG technology roadmap with vendor capabilities and recent innovations
• Risk modeling trends for chronic care, value-based contracts, and population health
• Competitive benchmarking of CRG vendors and market shares
Key Players
- 3M Health Information Systems
- Optum
- Change Healthcare
- Conduent
- IBM Watson Health
- McKesson
- Cerner
- Medisolv
Global Clinical Risk Grouping Solution Market Report
- 1. Global Clinical Risk Grouping Solution Market Research Report
- 1.1 Study Objectives
- 1.2 Global Clinical Risk Grouping Solution Market - Overview
- 1.3 Reason to Read This Report
- 1.4 Methodology and Forecast Analysis
- 2.1 Global Clinical Risk Grouping Solution Market Research Report – Detailed Scope and Definitions
- 2.1.1 By Product Type
- 2.1.2 By Application
- 2.1.3 By End-User
- 2.1.4 By Distribution Channel
- 2.1.5 By Region
- 3.1. Drivers - Macro-Economic Based, Supply Side, and Demand Side Drivers
- 3.2. Restraints – By Product Type, By Application, By End-User, By Distribution Channel, By Country
- 3.3. Opportunities – By Product Type, By Application, By End-User, By Distribution Channel, By Country
- 3.4. Trends – By Product Type, By Application, By End-User, By Distribution Channel, By Country
- 3.5. PEST Analysis
- 3.6. Porters Five Rule Analysis
- 3.7. Company’s Share Analysis (CSA) by Region or By Country
- 3.8. Global Clinical Risk Grouping Solution Market Research Report – DROTs Impact Analysis
- 4.1. Market Performance Review & Future Outlook: Assessing 2019 - 2023 and Predicting 2024 - 2031 Trends (USD Millions)
- 4.2. Annual Market Trend Assessment – Year-on-Year (YoY) Growth Analysis (%)
- 4.3. Incremental Market Value/Volume Opportunity between 2019 - 2023 and 2024 - 2031
- 4.4. Market Shares Analysis in Years - 2019, 2023, 2024 and 2031
- 5.1 Standalone Software
- 5.1.1 Market Performance Review & Future Outlook: Assessing 2019 - 2023 and Predicting 2024 - 2031 Trends (USD Millions)
- 5.1.2 Annual Market Trend Assessment – Yearly Growth Observation (Y-O-Y)(%)
- 5.1.3 Incremental Market Value/Volume Opportunity between 2019 - 2023 and From 2024 to 2031
- 5.1.4 Market Shares Analysis in Years - 2019, 2023, 2024 and 2031
- 5.2 Integrated Solutions
- 5.2.1 Market Performance Review & Future Outlook: Assessing 2019 - 2023 and Predicting 2024 - 2031 Trends (USD Millions)
- 5.2.2 Annual Market Trend Assessment – Yearly Growth Observation (Y-O-Y)(%)
- 5.2.3 Incremental Market Value/Volume Opportunity between 2019 - 2023 and From 2024 to 2031
- 5.2.4 Market Shares Analysis in Years - 2019, 2023, 2024 and 2031
- 6.1 Population Health Management
- 6.1.1 Market Performance Review & Future Outlook: Assessing 2019 - 2023 and Predicting 2024 - 2031 Trends (USD Millions)
- 6.1.2 Annual Market Trend Assessment – Yearly Growth Observation (Y-O-Y)(%)
- 6.1.3 Incremental Market Value/Volume Opportunity between 2019 - 2023 and From 2024 to 2031
- 6.1.4 Market Shares Analysis in Years - 2019, 2023, 2024 and 2031
- 6.2 Financial Risk Assessment
- 6.2.1 Market Performance Review & Future Outlook: Assessing 2019 - 2023 and Predicting 2024 - 2031 Trends (USD Millions)
- 6.2.2 Annual Market Trend Assessment – Yearly Growth Observation (Y-O-Y)(%)
- 6.2.3 Incremental Market Value/Volume Opportunity between 2019 - 2023 and From 2024 to 2031
- 6.2.4 Market Shares Analysis in Years - 2019, 2023, 2024 and 2031
- 6.3 Clinical Decision Support
- 6.3.1 Market Performance Review & Future Outlook: Assessing 2019 - 2023 and Predicting 2024 - 2031 Trends (USD Millions)
- 6.3.2 Annual Market Trend Assessment – Yearly Growth Observation (Y-O-Y)(%)
- 6.3.3 Incremental Market Value/Volume Opportunity between 2019 - 2023 and From 2024 to 2031
- 6.3.4 Market Shares Analysis in Years - 2019, 2023, 2024 and 2031
- 7.1 Hospitals
- 7.1.1 Market Performance Review & Future Outlook: Assessing 2019 - 2023 and Predicting 2024 - 2031 Trends (USD Millions)
- 7.1.2 Annual Market Trend Assessment – Yearly Growth Observation (Y-O-Y)(%)
- 7.1.3 Incremental Market Value/Volume Opportunity between 2019 - 2023 and From 2024 to 2031
- 7.1.4 Market Shares Analysis in Years - 2019, 2023, 2024 and 2031
- 7.2 Insurance Companies
- 7.2.1 Market Performance Review & Future Outlook: Assessing 2019 - 2023 and Predicting 2024 - 2031 Trends (USD Millions)
- 7.2.2 Annual Market Trend Assessment – Yearly Growth Observation (Y-O-Y)(%)
- 7.2.3 Incremental Market Value/Volume Opportunity between 2019 - 2023 and From 2024 to 2031
- 7.2.4 Market Shares Analysis in Years - 2019, 2023, 2024 and 2031
- 7.3 Research Institutions
- 7.3.1 Market Performance Review & Future Outlook: Assessing 2019 - 2023 and Predicting 2024 - 2031 Trends (USD Millions)
- 7.3.2 Annual Market Trend Assessment – Yearly Growth Observation (Y-O-Y)(%)
- 7.3.3 Incremental Market Value/Volume Opportunity between 2019 - 2023 and From 2024 to 2031
- 7.3.4 Market Shares Analysis in Years - 2019, 2023, 2024 and 2031
- 8.1 Direct Sales
- 8.1.1 Market Performance Review & Future Outlook: Assessing 2019 - 2023 and Predicting 2024 - 2031 Trends (USD Millions)
- 8.1.2 Annual Market Trend Assessment – Yearly Growth Observation (Y-O-Y)(%)
- 8.1.3 Incremental Market Value/Volume Opportunity between 2019 - 2023 and From 2024 to 2031
- 8.1.4 Market Shares Analysis in Years - 2019, 2023, 2024 and 2031
- 8.2 Online Retail
- 8.2.1 Market Performance Review & Future Outlook: Assessing 2019 - 2023 and Predicting 2024 - 2031 Trends (USD Millions)
- 8.2.2 Annual Market Trend Assessment – Yearly Growth Observation (Y-O-Y)(%)
- 8.2.3 Incremental Market Value/Volume Opportunity between 2019 - 2023 and From 2024 to 2031
- 8.2.4 Market Shares Analysis in Years - 2019, 2023, 2024 and 2031
- 8.3 IT Vendors
- 8.3.1 Market Performance Review & Future Outlook: Assessing 2019 - 2023 and Predicting 2024 - 2031 Trends (USD Millions)
- 8.3.2 Annual Market Trend Assessment – Yearly Growth Observation (Y-O-Y)(%)
- 8.3.3 Incremental Market Value/Volume Opportunity between 2019 - 2023 and From 2024 to 2031
- 8.3.4 Market Shares Analysis in Years - 2019, 2023, 2024 and 2031
- 9.1 North America
- 9.1.1 Market Performance Review & Future Outlook: Assessing 2019 - 2023 and Predicting 2024 - 2031 Trends (USD Millions)
- 9.1.2 Annual Market Trend Assessment – Yearly Growth Observation (Y-O-Y)(%)
- 9.1.3 Incremental Market Value/Volume Opportunity between 2019 - 2023 and From 2024 to 2031
- 9.1.4 Market Shares Analysis in Years - 2019, 2023, 2024 and 2031
- 9.2 Europe
- 9.2.1 Market Performance Review & Future Outlook: Assessing 2019 - 2023 and Predicting 2024 - 2031 Trends (USD Millions)
- 9.2.2 Annual Market Trend Assessment – Yearly Growth Observation (Y-O-Y)(%)
- 9.2.3 Incremental Market Value/Volume Opportunity between 2019 - 2023 and From 2024 to 2031
- 9.2.4 Market Shares Analysis in Years - 2019, 2023, 2024 and 2031
- 9.3 Asia-Pacific
- 9.3.1 Market Performance Review & Future Outlook: Assessing 2019 - 2023 and Predicting 2024 - 2031 Trends (USD Millions)
- 9.3.2 Annual Market Trend Assessment – Yearly Growth Observation (Y-O-Y)(%)
- 9.3.3 Incremental Market Value/Volume Opportunity between 2019 - 2023 and From 2024 to 2031
- 9.3.4 Market Shares Analysis in Years - 2019, 2023, 2024 and 2031
- 9.4 Latin America
- 9.4.1 Market Performance Review & Future Outlook: Assessing 2019 - 2023 and Predicting 2024 - 2031 Trends (USD Millions)
- 9.4.2 Annual Market Trend Assessment – Yearly Growth Observation (Y-O-Y)(%)
- 9.4.3 Incremental Market Value/Volume Opportunity between 2019 - 2023 and From 2024 to 2031
- 9.4.4 Market Shares Analysis in Years - 2019, 2023, 2024 and 2031
- 9.5 Middle East & Africa
- 9.5.1 Market Performance Review & Future Outlook: Assessing 2019 - 2023 and Predicting 2024 - 2031 Trends (USD Millions)
- 9.5.2 Annual Market Trend Assessment – Yearly Growth Observation (Y-O-Y)(%)
- 9.5.3 Incremental Market Value/Volume Opportunity between 2019 - 2023 and From 2024 to 2031
- 9.5.4 Market Shares Analysis in Years - 2019, 2023, 2024 and 2031
- 9.6 Global Clinical Risk Grouping Solution Market - Opportunity Analysis Index, By Product Type, By Application, By End-User, By Distribution Channel, and Region, 2024 - 2031
- 10.1 By Product Type Analysis 2019 - 2023 and Forecast, 2024 - 2031 by Market Assessment (USD Mn), Yearly Growth Rate (%), and Market Presence (%)
- 10.1.1 Standalone Software
- 10.1.2 Integrated Solutions
- 10.2.1 Population Health Management
- 10.2.2 Financial Risk Assessment
- 10.2.3 Clinical Decision Support
- 10.3.1 Hospitals
- 10.3.2 Insurance Companies
- 10.3.3 Research Institutions
- 10.4.1 Direct Sales
- 10.4.2 Online Retail
- 10.4.3 IT Vendors
- 10.5.1 United States
- 10.5.2 Canada
10.7 Regional Trends Analysis
10.8 North America Global Clinical Risk Grouping Solution Market Research Report - Company Profiles- 10.8.1 Company 1 (United States)
- 10.8.2 Company 2 (Canada)
- 10.8.3 Company 3 (Canada)
- 11.1 By Product Type Analysis 2019 - 2023 and Forecast, 2024 - 2031 by Market Assessment (USD Mn), Yearly Growth Rate (%), and Market Presence (%)
- 11.1.1 Standalone Software
- 11.1.2 Integrated Solutions
- 11.2.1 Population Health Management
- 11.2.2 Financial Risk Assessment
- 11.2.3 Clinical Decision Support
- 11.3.1 Hospitals
- 11.3.2 Insurance Companies
- 11.3.3 Research Institutions
- 11.4.1 Direct Sales
- 11.4.2 Online Retail
- 11.4.3 IT Vendors
- 11.5.1 Germany
- 11.5.2 United Kingdom
- 11.5.3 France
- 11.5.4 Spain
- 11.5.5 Italy
- 11.5.6 Russia
- 11.5.7 Netherlands
- 11.5.8 Poland
- 11.5.9 Rest of Europe
11.7 Regional Trends Analysis
11.8 Europe Global Clinical Risk Grouping Solution Market Research Report - Company Profiles- 11.8.1 Company 1 (Germany)
- 11.8.2 Company 2 (United Kingdom)
- 11.8.3 Company 3 (United Kingdom)
- 12.1 By Product Type Analysis 2019 - 2023 and Forecast, 2024 - 2031 by Market Assessment (USD Mn), Yearly Growth Rate (%), and Market Presence (%)
- 12.1.1 Standalone Software
- 12.1.2 Integrated Solutions
- 12.2.1 Population Health Management
- 12.2.2 Financial Risk Assessment
- 12.2.3 Clinical Decision Support
- 12.3.1 Hospitals
- 12.3.2 Insurance Companies
- 12.3.3 Research Institutions
- 12.4.1 Direct Sales
- 12.4.2 Online Retail
- 12.4.3 IT Vendors
- 12.5.1 China
- 12.5.2 Japan
- 12.5.3 India
- 12.5.4 South Korea
- 12.5.5 Australia & NZ
- 12.5.6 ASEAN
- 12.5.7 Rest of Asia-Pacific
12.7 Regional Trends Analysis
12.8 Asia-Pacific Global Clinical Risk Grouping Solution Market Research Report - Company Profiles- 12.8.1 Company 1 (China)
- 12.8.2 Company 2 (Japan)
- 12.8.3 Company 3 (Japan)
- 13.1 By Product Type Analysis 2019 - 2023 and Forecast, 2024 - 2031 by Market Assessment (USD Mn), Yearly Growth Rate (%), and Market Presence (%)
- 13.1.1 Standalone Software
- 13.1.2 Integrated Solutions
- 13.2.1 Population Health Management
- 13.2.2 Financial Risk Assessment
- 13.2.3 Clinical Decision Support
- 13.3.1 Hospitals
- 13.3.2 Insurance Companies
- 13.3.3 Research Institutions
- 13.4.1 Direct Sales
- 13.4.2 Online Retail
- 13.4.3 IT Vendors
- 13.5.1 Brazil
- 13.5.2 Mexico
- 13.5.3 Argentina
- 13.5.4 Peru
- 13.5.5 Colombia
- 13.5.6 Rest of Latin America
13.7 Regional Trends Analysis
13.8 Latin America Global Clinical Risk Grouping Solution Market Research Report - Company Profiles- 13.8.1 Company 1 (Brazil)
- 13.8.2 Company 2 (Mexico)
- 13.8.3 Company 3 (Mexico)
- 14.1 By Product Type Analysis 2019 - 2023 and Forecast, 2024 - 2031 by Market Assessment (USD Mn), Yearly Growth Rate (%), and Market Presence (%)
- 14.1.1 Standalone Software
- 14.1.2 Integrated Solutions
- 14.2.1 Population Health Management
- 14.2.2 Financial Risk Assessment
- 14.2.3 Clinical Decision Support
- 14.3.1 Hospitals
- 14.3.2 Insurance Companies
- 14.3.3 Research Institutions
- 14.4.1 Direct Sales
- 14.4.2 Online Retail
- 14.4.3 IT Vendors
- 14.5.1 Saudi Arabia
- 14.5.2 UAE
- 14.5.3 South Africa
- 14.5.4 Egypt
- 14.5.5 Israel
- 14.5.6 Rest of Middle East and Africa
14.7 Regional Trends Analysis
14.8 Middle East & Africa Global Clinical Risk Grouping Solution Market Research Report - Company Profiles- 14.8.1 Company 1 (Saudi Arabia)
- 14.8.2 Company 2 (UAE)
- 14.8.3 Company 3 (UAE)
- 15.1 Strategic Dashboard of Top Market Players
15.2 Company Profiles (Introduction, Financial Assessments, Portfolio of Offerings, Milestones and Achievements, Strategic Initiative, and SWOT Analysis)- 15.2.1 3M Health Information Systems
- 15.2.2 Optum
- 15.2.3 Change Healthcare
- 15.2.4 Conduent
- 15.2.5 IBM Watson Health
- 15.2.6 McKesson
- 15.2.7 Cerner
- 15.2.8 Medisolv
17. Principal Presumptions and Acronyms