Clinical and care management is transitioning from fragmented, labor-intensive workflows to AI-enabled, platform-led operating models that orchestrate continuous, longitudinal care. Enterprises and payors are embedding generative AI, automation, interoperability, and workflow orchestration into utilization management, case management, appeals, and population health processes to improve throughput, consistency, and clinical outcomes. These models enable earlier risk identification, faster decision-making, and reduced administrative burden by automating intake, evidence extraction, documentation, and routing before clinical intervention. However, this transformation introduces new challenges, including regulatory constraints, AI governance requirements, workforce reconfiguration, and integration complexity across legacy systems. Despite these constraints, clinical and care management is evolving into an intelligence-driven, outcome-oriented model, where success depends on the ability to scale AI within governed workflows while maintaining clinical oversight and care quality.
These emerging trends are covered in our Clinical and Care Management Business Process Transformation 2026 Market Insights™ and Clinical and Care Management Services Business Process Transformation 2026 RadarView™.
The reports provide organizations with a view of the changing landscape of clinical and care management services, highlighting key enterprise and outsourcing trends and identifying service providers that enable AI-driven, scalable, and outcome-focused care delivery models.
Avasant evaluated 60 providers across two dimensions: practice maturity and future-proofing. Of these, we recognized 25 providers that delivered the most value to the market over the past 12 months.
The report recognizes service providers in five categories:
Figure 1 from the full report illustrates these categories:
“Rising cost pressures, regulatory mandates, and increasing patient complexity are forcing enterprises to move away from labor-intensive clinical models toward system‑led workflows,” said John Ruskey, associate director at Avasant. “Decision-making is increasingly shaped by real-time data and the need to manage utilization at scale.”
The reports provide several findings, including the following:
“Clinical and care management is shifting from labor-intensive workflows to models where systems preprocess much of the work before it reaches clinicians,” said Aditya Jain, associate director at Avasant. “The focus is on redistributing work across automation, analytics, and human expertise.”
The RadarView also features detailed profiles of 25 service providers, including their solutions, offerings, and experience in enabling clinical and care management transformation across payors and providers.
This Research Byte is a brief overview of Avasant’s Clinical and Care Management Services Business Process Transformation 2026 Market Insights™ and Clinical and Care Management Services Business Process Transformation 2026 RadarView™. (Click for pricing.)
Avasant’s research and other publications are based on information from the best available sources and Avasant’s independent assessment and analysis at the time of publication. Avasant takes no responsibility and assumes no liability for any error/omission or the accuracy of information contained in its research publications. Avasant does not endorse any provider, product or service described in its RadarView™ publications or any other research publications that it makes available to its users, and does not advise users to select only those providers recognized in these publications. Avasant disclaims all warranties, expressed or implied, including any warranties of merchantability or fitness for a particular purpose. None of the graphics, descriptions, research, excerpts, samples or any other content provided in the report(s) or any of its research publications may be reprinted, reproduced, redistributed or used for any external commercial purpose without prior permission from Avasant, LLC. All rights are reserved by Avasant, LLC.
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