TurningPoint Healthcare Solutions

What TurningPoint Healthcare Solutions does

TurningPoint Healthcare Solutions is a privately held, Florida-based healthcare technology company founded in 2015 by Eric Pezzi and headquartered in Lake Mary. The company operates a HITRUST CSF Certified, NCQA-accredited cloud platform that integrates utilization management, member engagement, and provider enablement into a single complex condition management solution. Its platform serves health plans (commercial, Medicare, Medicaid) across all 50 U.S. states, with stated coverage of more than 42 million lives and nearly $4 billion in annual healthcare costs across musculoskeletal, cardiology, wound care, ENT, and sleep conditions. Differentiated clinical infrastructure includes more than 100 board-certified procedural and surgical subspecialists performing peer-to-peer reviews within their subspecialty, proprietary evidence-based clinical guidelines updated quarterly, and clinical leadership drawn from past presidents of the American Academy of Orthopaedic Surgeons (AAOS) and American College of Cardiology (ACC). In May 2024 the company acquired Fairway Health, adding HIPAA-compliant LLM and Generative AI capabilities for clinical documentation processing.

The product surface spans the Complex Condition Management Platform (core), the Digital Joint & Spine consumer mobile application, TurningPoint Telehealth, web-based Provider and Payer portals, Prior Authorization services, and the recently acquired Fairway Health AI module. Distribution is primarily through direct enterprise contracts with health plans; member-level touchpoints (mobile app, telehealth) are delivered through partner health plans rather than direct-to-consumer sales. The company reports approximately 30% reductions in condition-specific spend for clients under its risk-sharing model.

TurningPoint's revenue model is built on managed services contracts with health plans under risk-sharing and guaranteed-savings arrangements, supplemented by outcomes-based performance economics across clinical categories. The primary customer segment is U.S. health plans; secondary segments include providers (via the provider portal) and individual members (via the Digital Joint & Spine app). Leadership includes CEO Eric Pezzi, Chief Commercial Officer Shawn Mobley, Chief Clinical Officer Dr. David Halsey, and Chief Medical Officer — Cardiology Dr. Erica Jones. The company closed a growth capital round in September 2021 with Summit Partners, Oak HC/FT, and Sopris Capital Associates, and completed a corporate rebrand in 2024 to reflect its repositioning beyond pure utilization management.

Name

TurningPoint Healthcare Solutions

Legal name

TurningPoint Healthcare Solutions LLC

Website

https://tpshealth.com

Company type

Private

Founded year

2015

Operating status

Operating

Headcount range

101–250 employees

Short description

TurningPoint Healthcare Solutions operates a cloud-based, NCQA-accredited complex condition management platform serving U.S. health plans across MSK, cardiology, wound care, ENT, and sleep. The platform covers 42 million-plus lives and roughly $4 billion in annual healthcare costs under risk-sharing contracts.

Ownership category

akta.pro rank

Product category

Healthcare Utilization and Complex Condition Management Services

NAICS

Home Health Care Services (62161), Computer Systems Design and Related Services (5415)

SIC

Services-Health Services (8000), Services-Prepackaged Software (7372)

akta.pro primary industry

Chronic Condition Virtual Care & Disease Management (Payer-Sponsored) (HLALACAE)

akta.pro secondary industries

Care Coordination, Referral Management & Transitions-of-Care Pathways (HLACAGAL), Adherence, Reminders & Engagement Automation (Medication/Follow-up) (HLACAEAJ), Medication Adherence, Digital Therapeutics & Remote Coaching (condition-specific programs) (HLALAFAF), Virtual Nursing, Telemonitoring & Command Center Platforms (HLACAFAH)

Keywords

• Utilization management services
• Complex condition management
• Musculoskeletal care management
• Prior authorization solutions
• Health plan clinical services

Headquarters

HQ city

Lake Mary

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Others

Revenue model

1. Health Plan / Payer Services (B2B): TurningPoint provides complex condition management and utilization management services to health plans on a contract basis. The company engages in risk arrangements that guarantee cost savings and provides financial predictability. Revenue is generated through contracts with health plans who pay for the company's services as part of their benefits administration.
2. Member-Facing Digital Program (via Health Plan Partners): The Digital Joint & Spine program is offered at no cost to eligible members of partner health plans. The program is funded through TurningPoint's contracts with health plan partners rather than directly billed to members.
3. Risk/Guaranteed Savings Arrangements: TurningPoint bears financial risk and guarantees cost savings across clinical categories, including musculoskeletal care. This risk-sharing model means the company is financially accountable for delivering measurable savings to health plan clients.

Pricing tiers

Go-to-market motion2 records

Distribution channels4 records

Marketing channels5 records

Core offering

TurningPoint Healthcare Solutions delivers an integrated complex condition management platform combining utilization management, member engagement, and provider enablement for health plans across MSK, cardiology, wound care, ENT, and sleep conditions. Services include NCQA-accredited utilization management, prior authorization, subspecialty peer-to-peer review by 100+ board-certified specialists, the Digital Joint & Spine mobile application, and AI-powered clinical workflow automation acquired via Fairway Health, contracted under risk-sharing arrangements that guarantee cost savings.

Product overview

TurningPoint Healthcare Solutions offers a fully integrated complex condition management platform that unifies utilization management, member engagement, and provider enablement under one solution. The core platform is supplemented by the Digital Joint & Spine mobile application for MSK care management, Provider and Payer web portals for stakeholder access, and Fairway Health AI technology acquired in 2024 for AI-powered clinical workflow automation. The company manages over $4 billion in healthcare costs annually across MSK, cardiology, wound care, ENT, sleep, and other complex clinical conditions for health plans across all 50 states.

Differentiator

Problem solved

Functional benefit

Brands

• TurningPoint Digital Joint & Spine: Comprehensive musculoskeletal (MSK) management platform providing personalized recovery plans, exercise tutorials, live coaching, and support through a mobile app for joint and spine care.
• TurningPoint Telehealth

Products and services

• Complex Condition Management Platform Integrated platform combining utilization management, member engagement, and provider enablement for health plans across musculoskeletal (MSK), cardiology, wound care, ENT, sleep, and other complex conditions. Contracted under risk-sharing arrangements that guarantee cost savings.

Quantifiable outcome

• ~30% reduction in condition-specific spend
• +4 more outcomes

Named customers1 record

Segments4 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability2 records

Feature6 records

Partnerships

One partnership is on record.

• Fairway HealthcoreStrategic or Co-development Partner · 14 May 2024TurningPoint acquired Fairway Health, a pioneering health technology company specializing in AI-powered tools that streamline complex clinical workflows. Fairway Health uses Large Language Models (LLMs) and Generative AI to help decipher complex healthcare documentation. The acquisition enables TurningPoint to deploy AI-enabled workflow efficiencies across its suite of specialty conditions and nearly $4 billion in healthcare costs it manages, increasing speed to care and reducing administrative burdens on providers. Fairway Health was founded by Moses Im (CEO), Grace Wang (CTO), and Joseph Chen (CPO), and had received backing from Y Combinator.

Scale indicators7 records

Recent moves9 records

Expansion highlights7 records

Direct peers

• Evolent Health: Public specialty care management company serving health plans with value-based oncology, cardiology, MSK and other condition programs — the same payer-sponsored, condition-risk-bearing model TurningPoint operates.
• Cohere Health: Provides AI-powered prior authorization and specialty care management for health plans and providers, overlapping TurningPoint's utilization-management and specialty-condition focus areas such as MSK and cardiology.
• MedRisk: Specialty managed care organization focused on physical medicine and MSK for payers and workers' compensation — directly comparable in MSK condition management for payer populations.
• ProgenyHealth: Provides condition-specific (maternity and NICU) care management for health plans with risk-bearing arrangements — same payer-sponsored, full-condition-risk model TurningPoint uses, applied to a different specialty vertical.
• HSM (Health Systems Management): Independent utilization management and peer-review services company serving payers and providers — comparable B2B payer-services utilization-management business.
• Medical Review Institute of America: Independent peer review and utilization management organization providing specialty physician reviews for payers — overlaps TurningPoint's subspecialty peer-to-peer review model.

Broad incumbents

• AIM Specialty Health (Elevance Health): Elevance Health's specialty UM subsidiary providing radiology, oncology, cardiology and MSK utilization management to a broad payer base — a larger incumbent competing in TurningPoint's core specialty UM categories.
• eviCore (Evernorth/Cigna): Cigna/Evernorth's specialty benefits management arm delivering evidence-based utilization management across multiple specialties — directly competes with TurningPoint's payer-sponsored specialty UM model.
• Evernorth Health Services: Cigna's health services platform encompassing specialty pharmacy, care management and clinical solutions — a broad incumbent that competes with TurningPoint for payer condition-management budgets.

Emerging players

• Lantern: Specialty care management company focusing on oncology, fertility, and other high-cost conditions for payers and employers — adjacent condition-risk model with partial overlap in payer-sponsored specialty management.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks5 records

Key highlights6 records

Customer concentration

• LinkedInlinkedin.com/company/turningpoint-healthcare-solutions

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles5 records

Subsidiaries1 record

Funding overview

Funding rounds2 records

Investors3 records

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about TurningPoint Healthcare Solutions