Navigating Uncertainty and Unlocking Innovation: Clinical and Care Management State of the Market 2025

Clinical and Care Management (CCM) is becoming a strategic priority for healthcare enterprises, driven by the need to improve outcomes, contain costs, and comply with intensifying regulatory demands. Once seen primarily as a cost-control function, CCM is now a foundation to deliver proactive, personalized, and value-based care. The report explores how enterprises are expanding CCM initiatives beyond traditional models, fueled by rising medical loss ratios, declining STAR ratings, and mandates for equity-driven care. It details how care management is evolving into a digitally enabled function underpinned by automation, analytics, and AI.

Healthcare organizations are increasingly turning to intelligent technology solutions, including generative and agentic AI, to drive precision and scale in clinical decision-making and care coordination. The report examines how value-based care models, risk-sharing arrangements, and RegTech convergence are reshaping the CCM landscape. It also outlines the implications for providers, who must deliver AI-augmented clinical services, platform-based offerings, and delegated care models to remain competitive. For enterprises, this research provides a roadmap to align clinical operations with business goals and regulatory expectations in a rapidly evolving market.