HealthMine, Inc.
HealthMine operates a SaaS member engagement and quality improvement platform (QRM) for U.S. health plans across Medicare, Medicaid, D-SNP, ACA, Commercial, and FEP markets, combining predictive analytics, behavioral outreach, and agentic AI scheduling.
- Company typePrivate
- Founded2008
- HeadquartersDallas, United States
- Headcount51–100
- GTM typeB2B
- OfferingSoftware
What HealthMine, Inc. does
HealthMine, Inc. is a Dallas-based, remote-first healthcare technology company founded in 2008 that operates a SaaS member engagement platform called Quality Relationship Management (QRM) for U.S. health plans across Medicare Advantage, Medicaid, D-SNP, ACA Marketplace, Commercial, and Federal Employee Program lines of business. The QRM platform unifies member data, outreach, rewards, and quality measurement into a single control tower, supported by modules for Member Engagement, Health Action Catalog, Smart Rewards Incentives, Digital HRA, and Member Experience surveys. The company monetizes primarily through annual enterprise SaaS subscriptions paired with Professional Services and Expert Advisory Services engagements led by former 5-Star health plan leaders.
HealthMine's technology stack combines predictive analytics (notably a four-tier CAHPS risk stratification model), behavioral science-driven messaging, RCS messaging, and QRM Connect, an agentic AI scheduling product that autonomously calls provider offices to book appointments in more than 40 languages. The platform claims measurable client outcomes including 83% of Star measures addressed, $248 in annual risk adjustment revenue uplift per member, 2x member satisfaction improvement, and 54% higher care gap closure among engaged members. Customer outcomes are delivered via a sales-led, direct enterprise go-to-market with value calculators, demos, and a content-heavy webinar and resource library focused on CMS Star Ratings, CAHPS, HEDIS, NCQA, and health equity topics.
HealthMine, Inc. firmographics
Firmographics- Name
- HealthMine, Inc.
- Legal name
- Healthmine, Inc.
- Website
- https://healthmine.com
- Company type
- Private
- Founded year
- 2008
- Operating status
- Operating
- Headcount range
- 51–100 employees
- Short description
- HealthMine operates a SaaS member engagement and quality improvement platform (QRM) for U.S. health plans across Medicare, Medicaid, D-SNP, ACA, Commercial, and FEP markets, combining predictive analytics, behavioral outreach, and agentic AI scheduling.
- Ownership category
- akta.pro rank
HealthMine, Inc. industry classification
Industry- Product category
- Healthcare Member Engagement Platform
- NAICS
- Custom Computer Programming Services (541511)
- SIC
- Services-Health Services (8000)
- akta.pro primary industry
- Quality Measurement, Reporting & Benchmarking (HEDIS/Stars/CQM) (HLACAHAC)
- akta.pro secondary industries
- Patient Engagement, Education & Messaging Platforms (portal/CRM integrated) (HLALABAJ), Cost of Care, Spend Analytics & Financial Performance Management (HLACAHAJ)
Keywords
Where HealthMine, Inc. is headquartered
LocationHeadquarters
- HQ city
- Dallas
- HQ country
- United States
- HQ region
- North America
Offices2 records
Markets served
HealthMine, Inc. business model
Business model- GTM type
- B2B
- Offering type
- Software
- Cost components
- Personnel, Technology or R&D, Marketing or Sales, Operations, Infrastructure
Revenue model
- SaaS Platform Subscription: Healthmine operates as a SaaS platform providing member engagement technology to health plans. The platform subscription includes access to QRM®, member engagement tools, data analytics, AI scheduling, and omnichannel outreach capabilities. Professional services and consulting are bundled or offered separately for implementation and strategic guidance.
- Professional Services & Consulting: Expert Advisory Services including regulatory expertise in Star Ratings, CAHPS, health equity and risk adjustment. Implementation and support services for health plan clients.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Annual | Enterprise health plan platform with tiered capabilities |
Go-to-market motion2 records
Distribution channels2 records
Marketing channels6 records
HealthMine, Inc. product offering
Product offeringCore offering
HealthMine sells a SaaS platform called Quality Relationship Management (QRM®) that helps U.S. health plans engage members, close care gaps, improve CMS Star Ratings, CAHPS scores, and HEDIS performance through personalized omnichannel outreach, AI-powered scheduling, predictive analytics, and behavioral science-driven incentives. The offering is complemented by Professional Services and Expert Advisory Services for regulatory and quality improvement consulting.
Product overview
Healthmine offers a unified member engagement platform called Quality Relationship Management™ (QRM®) that consolidates member engagement, risk adjustment, and quality improvement into a single integrated system. The platform is designed specifically for health plans and includes core modules for Member Engagement (omnichannel outreach), Health Action Catalog (interventions paired with rewards), QRM Connect™ (AI-powered appointment scheduling), Smart Rewards Incentives, Digital HRA, and Member Experience (surveying). Supporting services include Professional Services (high-touch outreach) and Expert Advisory Services (regulatory consulting). The platform leverages AI, predictive analytics, and behavioral science to help Medicare, Medicaid, D-SNP, ACA, Commercial, and FEP health plans improve Star Ratings, CAHPS scores, and member outcomes.
Differentiator
Problem solved
Functional benefit
Products and services
- Quality Relationship Management™ (QRM®) Core integrated SaaS platform that consolidates member engagement, risk adjustment, and quality initiatives into a single control tower, enabling health plans to eliminate vendors and improve cross-organizational coordination.
- Member Engagement Personalized, omnichannel outreach solution that captures member preferences in outreach method and language to tailor every interaction and increase care gap closure.
- Health Action Catalog A library of health actions and interventions that can be paired with rewards to drive better health outcomes and motivate members to complete specific health activities.
- QRM Connect™ (Agentic AI Scheduling) AI-powered provider matching and appointment scheduling platform that notifies members due for a provider visit, helps them find a provider, choose appointment windows, and uses a conversational AI agent to autonomously call provider offices and schedule appointments.
- Smart Rewards Incentives Rewards and incentive management solution that tailors the right reward type for each program and member without overspending, helping to motivate members to close care gaps.
- Digital HRA Digital Health Risk Assessment tool that helps health plans understand their member population and lay the groundwork for personalized experiences through smart surveying.
- Member Experience Member relationship nurturing solution that includes mock-CAHPS surveys and Pulse Surveys to gauge member sentiment and improve plan perception and retention.
- Professional Services Higher-touch, cost-effective outreach services for reaching specific health plan populations, conducted by HealthMine's expert teams.
- Expert Advisory Services Consulting services partnering health plans with industry experts in Star Ratings, CAHPS, health equity, and risk adjustment to navigate regulatory requirements and performance improvement.
Quantifiable outcome
- 54% more care gap closure for members who receive Healthmine communications vs unengaged members
- +7 more outcomes
Companies that use HealthMine, Inc.
Customer profileSegments6 records
Ideal customer profiles1 record
HealthMine, Inc. technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
AI capability3 records
Feature7 records
HealthMine, Inc. partnerships and signals
Strategic signalPartnerships
One partnership is on record.
- ComplexCare SolutionscoreStrategic partnership for aligning quality improvement and risk adjustment at health plans. Joint webinar collaboration and co-development of strategies to help health plans bridge quality and risk silos. ComplexCare Solutions focuses on in-home assessments and risk score accuracy for health plan members. The partnership enables coordinated member engagement programs serving specific quality improvement and risk score accuracy requirements.
Scale indicators8 records
Recent moves6 records
Expansion highlights5 records
HealthMine, Inc. competitors and assessment
Company assessmentDirect peers
- Icario: Direct competitor in member engagement, rewards, and quality improvement for health plans. Sara Hong, HealthMine's SVP of Product, previously held senior leadership at Icario, evidencing direct product and customer overlap.
- mPulse Mobile: Direct competitor offering omnichannel member engagement (SMS, mobile, IVR) for health plans, with overlap on behavioral science-driven outreach and CAHPS improvement use cases.
- Virgin Pulse (formerly Welltok): Direct peer in health plan member engagement, rewards/incentives, and population health communications, with comparable customer base of large national and regional health plans.
- Pulse8: Competitor in risk adjustment analytics and quality reporting for health plans, overlapping with HealthMine's $248/member risk adjustment revenue lift value proposition and Stars/HEDIS work.
- Health Dialog: Direct peer providing health engagement, shared decision-making, and population health services to health plans and payers; comparable in member outreach and quality improvement offerings.
Broad incumbents
- Cotiviti: Larger incumbent offering payment integrity, risk adjustment, quality andStars analytics, and member engagement. Competes with HealthMine on quality, risk, and increasingly on member outreach as a broader bundled suite.
- Inovalon: Large incumbent in healthcare data analytics and quality/risk platforms; HealthMine's President previously led sales there to top 25 health plans, evidencing tight competitive overlap on Stars, HEDIS, and risk.
- Optum (UnitedHealth Group): Largest incumbent in payer services, offering member engagement, risk adjustment, quality, and advisory services. Multiple HealthMine executives (Sara Hong, others) came from Optum, indicating direct competitive recruitment and overlap.
- HMS Holdings (now Gainwell Technologies): Incumbent in payment integrity, risk adjustment, and quality analytics for Medicaid and Medicare plans, with overlapping member engagement and population health capabilities.
Emerging players
- Health Catalyst: Healthcare data and analytics platform serving health systems and payers with quality, population health, and value-based care analytics; less member-engagement native than HealthMine but adjacent on quality measurement and benchmarking.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat5 records
Key risks5 records
Key highlights6 records
Customer concentration
HealthMine, Inc. social profiles
Digital presenceHealthMine, Inc. compliance and trust
Trust signalCompliance1 record
HealthMine, Inc. financial estimates
Financial estimateRevenue estimate
Valuation estimate
HealthMine, Inc. leadership team
Management profileNumber of profiles
Profiles13 records
HealthMine, Inc. funding detail
Funding detailFunding overview
Funding rounds2 records
Investors1 record
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
HealthMine, Inc. M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about HealthMine, Inc.
What does HealthMine, Inc. do?
HealthMine sells a SaaS platform called Quality Relationship Management (QRM®) that helps U.S. health plans engage members, close care gaps, improve CMS Star Ratings, CAHPS scores, and HEDIS performance through personalized omnichannel outreach, AI-powered scheduling, predictive analytics, and behavioral science-driven incentives. The offering is complemented by Professional Services and Expert Advisory Services for regulatory and quality improvement consulting.
Is HealthMine, Inc. a public or private company?
HealthMine, Inc. is a private company. It is classified as venture growth investor backed and is currently operating.
When was HealthMine, Inc. founded?
HealthMine, Inc. was founded in 2008. It employs 51 to 100 people.
Where is HealthMine, Inc. based?
HealthMine, Inc. is headquartered in Dallas, United States, in the North America region.
How does HealthMine, Inc. make money?
Two revenue lines are on record. SaaS Platform Subscription is the primary driver. The others are professional Services & Consulting.
Who are HealthMine, Inc.'s main competitors?
Direct peers on record are Icario, mPulse Mobile, Virgin Pulse (formerly Welltok), Pulse8 and Health Dialog. Broad incumbents are Cotiviti, Inovalon, Optum (UnitedHealth Group) and HMS Holdings (now Gainwell Technologies). Health Catalyst is listed as an emerging player.
Does HealthMine, Inc. have an API?
No public API is recorded for HealthMine, Inc..
What industry is HealthMine, Inc. in?
HealthMine, Inc.'s product category is Healthcare Member Engagement Platform. Its primary akta.pro industry code is HLACAHAC, Quality Measurement, Reporting & Benchmarking (HEDIS/Stars/CQM), with a secondary code of HLALABAJ, Patient Engagement, Education & Messaging Platforms (portal/CRM integrated). Its NAICS code is 541511 and its SIC code is 8000.