MacroHealth

What MacroHealth does

MacroHealth is a privately held healthcare information technology company founded in 2017 and headquartered in Kirkland, Washington, with a regional office in Vancouver, Canada. The company operates an Intelligent Health Market-as-a-Service (IHMaaS) cloud platform, branded as the MacroHealth Marketplace Platform, that connects healthcare payers (health plans, TPAs, brokers/consultants) with Health Market Partners including provider networks, specialty networks, payment integrity vendors, and pharmacy benefit managers. The platform ingests claims, eligibility, CMS, and machine-readable file (MRF) data through Azure-hosted, FHIR-based APIs and applies AI/ML-driven optimization algorithms to recommend partner configurations, automate connectivity, and surface cost-reduction opportunities, with MacroHealth reporting average customer outcomes of 6-8% reduction in total cost of care and 4:1 ROI.

The product surface has expanded through two 2025 acquisitions: Foundational Pharmacy Strategies (June 2025) added PBM performance oversight and pharmacy spend optimization capabilities, and ClearCost Health (July 2025) added member-facing price transparency and provider search tools with 3.5M+ prior users. Supporting modules include Network Solutions for out-of-area/out-of-network care, Member Care and Cost Search for consumer transparency, Data Connections for vendor integration, Customer Portal, and On-Demand Reporting. In 2025 the company also launched the MacroHealth Intelligent Exchange (MiX Platform) as a partner-side marketplace layer, and in January 2026 brokered a specialty PBM partnership between Gateway Business Health Coalition and Archimedes.

Revenue is generated through quote-based enterprise SaaS subscriptions on multi-year contracts, sold direct via field sales to health plans, TPAs, and brokers/consultants, with channel influence through broker and consultant intermediaries. The platform reports 300+ enterprise clients, 250+ implementations, 7.2M+ members served, and 45+ Health Market Partners including 30+ PBMs. Backed by NewSpring Capital and TT Capital Partners with Allumia Ventures as observer, MacroHealth is led by co-founder and CEO Virgil Bretz, COO/President Steve Suter, co-founder and CCO David Angelone, CTO Ryan Hamilton, CFO Matt Thorne, CGO Aarti Karamchandani, and CPO Jessica Nisenbaum, with board directors including former Cerner COO Michael Nill and former Sharp HealthCare CEO Mike Murphy.

Name

MacroHealth

Legal name

MacroHealth USA Ltd.

Website

https://macrohealth.com

Company type

Private

Founded year

2017

Operating status

Operating

Headcount range

51–100 employees

Short description

MacroHealth is a healthcare IT company operating a cloud-based Intelligent Health Market-as-a-Service platform that connects health plans, TPAs, and brokers/consultants with provider networks, specialty networks, and PBMs to optimize network and pharmacy spend, serving 300+ enterprise clients and 7.2M+ members across the US and Canada.

Ownership category

akta.pro rank

Product category

Healthcare Network Optimization Software

NAICS

Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (518)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Data Aggregation, Interoperability & APIs for RPM (FHIR/IoMT Gateways) (HLACAFAO)

Keywords

• Healthcare network optimization
• Healthcare marketplace platform
• Price transparency software
• Pharmacy benefit management
• Claims optimization SaaS

Headquarters

HQ city

Kirkland

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Software

Cost components

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

Revenue model

1. SaaS Platform Subscription: MacroHealth operates as an intelligent healthcare marketplace-as-a-service (IHMaaS) platform. The company provides a cloud-based software platform that enables Payers to optimize and connect their healthcare ecosystems. Revenue is generated through platform subscription fees, with customers achieving 4:1 return on investment and 6-8% reduction in total cost of care, indicating a value-based pricing model aligned with cost savings outcomes.

Pricing tiers

Go-to-market motion2 records

Distribution channels1 record

Marketing channels8 records

Core offering

MacroHealth provides a cloud-based Intelligent Health Market-as-a-Service (IHMaaS) platform that connects healthcare Payers (health plans, TPAs, and brokers/consultants) with Health Market Partners (provider networks, specialty networks, payment integrity solutions, and PBMs). The platform unifies payer eligibility and claims data with market intelligence to optimize partner selection, support price transparency compliance, and reduce total cost of care by 6-8%.

Product overview

MacroHealth offers the MacroHealth Marketplace Platform as its core cloud-based Intelligent Health Market-as-a-Service solution. This platform unifies the healthcare ecosystem by connecting Payers with Health Market Partners through data-driven optimization and a single integration point. The product architecture includes Network Solutions for out-of-area and out-of-network management, Pharmacy Solutions for PBM performance oversight and pharmacy spend optimization, and Member Care and Cost Search for member-facing price transparency and provider search. Supporting modules include Customer Portal for data access, Data Connections for vendor integration, and On-Demand Reporting for performance analytics. The company has expanded its capabilities through acquisitions of ClearCost Health (price transparency and provider search) and Foundational Pharmacy Strategies (pharmacy optimization). The MacroHealth Intelligent Exchange (MiX Platform) provides the enterprise marketplace infrastructure. All capabilities are designed to work within a unified ecosystem to help Payers reduce total cost of care while maintaining compliance with transparency regulations.

Differentiator

Problem solved

Functional benefit

Products and services

• MacroHealth Marketplace Platform A scalable, cloud-based intelligent marketplace platform that unifies data, connects Payers with Health Market Partners, and provides strategic intelligence for healthcare purchasing decisions, delivering transparency and optimization across medical and pharmacy spend for health plans, TPAs, and brokers/consultants.
• Network Solutions Comprehensive platform for out-of-area and out-of-network care network strategy, supporting smarter architecture, better member access, claims cost management, and payment integrity for healthcare payer organizations.
• Pharmacy Solutions Comprehensive pharmacy strategy platform bringing PBM performance oversight, integrated analytics, and pharmacy spend optimization into a single Payer-controlled environment with capabilities for specialty medication management.
• Member Care and Cost Search A member-facing price transparency and provider search tool that delivers real-time cost estimates, integrates MRF data, supports tiered networks, and enables compliant member-facing experiences across network arrangements for health plan members.
• MacroHealth Intelligent Exchange (MiX Platform) Enterprise healthcare marketplace platform that enables Health Market Partners to optimize and connect their ecosystems, providing access to new best-fit Payers through data-driven optimization analytics.

Quantifiable outcome

• 6-8% reduction in total cost of care for customers using the platform
• +4 more outcomes

Named customers6 records

Segments6 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

AI capability4 records

Feature9 records

Partnerships

Nine partnerships are on record, tiered flagship, core and minor.

• ArchimedesflagshipStrategic or Co-development Partner · 14 January 2026Strategic partnership through Gateway Business Health Coalition where Archimedes provides specialty pharmacy benefit management (PBM) solutions to coalition members. Archimedes delivers average savings of 30-54% in the first year for specialty drug management. This partnership emerged from Foundational Pharmacy Strategies' PBM Innovation Forum hosted by Gateway BHC.
• ClearCost HealthcoreTechnology or Integration · 22 July 2025Acquisition of ClearCost Health, a leader in provider search and price transparency solutions. ClearCost Health provides payers, plan sponsors, and consumers with personalized insights into access, cost, and quality when choosing care. The acquisition enhances MacroHealth's network optimization capabilities, improves member experience with unified provider directories, and supports regulatory compliance through MRF analytics.
• Foundational Pharmacy StrategiescoreTechnology or Integration · 1 June 2025Acquisition of Foundational Pharmacy Strategies to enable health plans, employers, and benefit advisors to identify opportunities to optimize pharmacy and medical spend through one unified platform. The acquisition expands MacroHealth's offerings into the pharmaceutical space and was led by Foundational Pharmacy Strategies' PBM Innovation Forum process.
• Gateway Business Health CoalitioncoreStrategic or Co-development PartnerGateway BHC (formerly Saint Louis Area Business Health Coalition) partnered with Archimedes through MacroHealth's facilitation, introducing specialty PBM options for coalition's employer members with over 40,000 covered lives.
• Aetna Signature AdministratorscoreStrategic or Co-development PartnerSelected by PacificSource Health Plans as national network partner with MacroHealth helping navigate implementation process and necessary data exchanges. MacroHealth expertise helped keep momentum and led to smooth rollout for PacificSource.
• Azure Cloud InfrastructurecoreTechnology or IntegrationMicrosoft Azure provides the cloud infrastructure for MacroHealth's intelligent healthcare marketplace platform, enabling scalability, high performance, and enterprise-grade security for healthcare data.
• FHIR Interoperability StandardscoreTechnology or IntegrationHealth Level Seven International's FHIR (Fast Healthcare Interoperability Resources) standards enable secure and efficient exchange of patient data across healthcare entities, improving care coordination and enabling MacroHealth's interoperability capabilities.
• AffirmedRXminorStrategic or Co-development PartnerFeatured in MacroHealth's Innovation Stories roundtable on Transparency in Pharmacy, discussing role of data visibility in pharmacy benefit pricing with CEO Greg Baker.
• Plotkin HealthcoreStrategic or Co-development PartnerCo-founding partner of MacroHealth in 2017 when Plotkin Health and VIDA Health merged. Shaun Plotkin serves as President and Board Director. Part of founding ecosystem that created MacroHealth's marketplace approach.

Scale indicators11 records

Recent moves6 records

Expansion highlights6 records

Direct peers

• Waystar: Waystar delivers healthcare payment and revenue-cycle SaaS to payers and providers, intersecting with MacroHealth on claims, transparency, and payment-integrity workflows.
• HealthEdge: HealthEdge offers payer core administration, claims, and care management software; it is the closest adjacent peer in B2B health-plan SaaS, competing for IT modernization and network strategy budgets.
• Zelis: Zelis provides healthcare cost management, network optimization, and claims/pricing integrity solutions to payers — overlapping directly with MacroHealth's payer marketplace, network optimization, and price transparency modules.
• MultiPlan: MultiPlan is a network and cost-management vendor for payers, including network access, repricing, and analytics — directly competing with MacroHealth's network solutions and Data Factory capabilities.
• Lyric (formerly ClaimsXten / Cotiviti): Cotiviti/Lyric provides claims editing and payment-integrity analytics for payers; the platform competes with MacroHealth's optimization, analytics, and provider-search experiences.

Broad incumbents

• R1 RCM: R1 RCM provides enterprise revenue cycle and healthcare payment workflow automation at scale; a broader incumbent competing for payer/payer-adjacent technology budgets.
• Optum (UnitedHealth Group): Optum combines claims, analytics, network, and pharmacy at scale for payers and self-funded employers; it is the dominant incumbent whose bundling power most threatens MacroHealth's standalone positioning.

Emerging players

• Turquoise Health: Turquoise Health is a price-transparency platform focused on MRF data and shoppable care, directly adjacent to MacroHealth's Member Care and Cost Search and ClearCost Health capabilities.
• Definitive Healthcare: Definitive Healthcare offers commercial intelligence and analytics across the healthcare ecosystem, providing market and provider data that overlaps with MacroHealth's Data Factory and partner-evaluation use cases.
• Cohere Health: Cohere Health provides intelligent prior authorization and utilization management for payers, touching on MacroHealth's optimization and AI-driven decision-support theme.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/macrohealth

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles16 records

Subsidiaries4 records

Funding overview

Funding rounds1 record

Investors2 records

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

M&A2 records

Investments

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

Frequently asked questions about MacroHealth