QMetrics

What QMetrics does

QMetrics is a privately held, certified woman-owned healthcare consultancy founded in 2006 and headquartered virtually in San Diego, California. The firm provides managed-care consulting services centered on healthcare quality measurement and regulatory compliance, serving health plans, provider organizations, managed service organizations (MSOs), hospitals, and data aggregators across the United States. Its portfolio spans HEDIS compliance auditing, regulatory-required survey administration (Provider Appointment Availability, After-Hours, Emergency Instructions, Enrollee Experience), encounter-data completeness assessment, quality management and value-based reporting, health equity consulting and NCQA Health Equity Accreditation support, and advanced analytics. QMetrics is best known operationally as the sole national validator for NCQA's Data Aggregator Validation Program, a role it has held since the program's inception in fall 2019 in which it co-developed the program's primary source verification (PSV) methodology and protocols alongside NCQA leadership; the program has grown to 50 validated organizations across 21 states with 137 validations and 56,000+ validated data sources, and 50% of HEDIS supplemental data now flows through QMetrics-validated aggregators.

The firm's underlying technology stack combines proprietary survey administration protocols, a prevalidation process for reconciling Health Plan Network Files, a real-time survey response-rate dashboard, and a domestic Contact Center handling over 55,000 calls annually for regulatory surveys and appointment scheduling. It operates a Kajabi-hosted training platform, QMetrics Academy (launched 2025), offering free and premium courses on data validation, NCQA programs, and survey readiness, and has integrated FHIR interoperability standards into Cohort 6 of the DAV program. AI/ML capabilities are deployed within the Advanced Analytics service line for risk-score and quality-measure prediction, targeting models, and predictive outreach, supported by SAS programming expertise and analytics leadership drawn from Change Healthcare's Risk Analytics Division.

QMetrics' revenue model is professional-services based with quote-based pricing for core consulting, auditing, and survey administration, supplemented by freemium/subscription revenue from QMetrics Academy. Distribution is multi-channel: direct enterprise engagement with California and national health plans, the NCQA partnership as the sole DAV validator, an inside-sales contact center for survey operations, and self-serve online course delivery. The firm has reported 2,000% growth over the trailing five years and is founder-led (Suzan Mora Dalen, CEO; James E. Dalen, CFO/Chief Health Economist) with no disclosed external venture or private equity investment, indicating organic, profitable scaling.

Name

QMetrics

Legal name

QMetrics, Inc.

Website

https://qmetrics.us

Company type

Private

Founded year

2006

Operating status

Operating

Headcount range

11–50 employees

Short description

QMetrics is a certified woman-owned healthcare consultancy providing HEDIS compliance auditing, NCQA Data Aggregator Validation, regulatory survey administration, health equity consulting, and advanced analytics to health plans, MSOs, hospitals, and data aggregators across the United States.

Ownership category

akta.pro rank

Product category

Healthcare Quality Management Consulting

NAICS

Agencies, Brokerages, and Other Insurance Related Activities (5242)

SIC

Accident & Health Insurance (6321)

akta.pro primary industry

On-Exchange Qualified Health Plans (QHPs) (HLAEABAA)

akta.pro secondary industries

Testing, QA & Release/Deployment Enablement (BPAEAAAN), Quality Assurance (QA), Coaching & Performance Management (EDABACAF)

Keywords

• HEDIS compliance auditing
• Healthcare data validation
• Quality management consulting
• Regulatory survey administration
• Health equity accreditation

Headquarters

HQ city

San Diego

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. Regulatory Compliance & Auditing Services: QMetrics provides HEDIS compliance auditing, performance measure validation, data validation, and regulatory compliance consulting to health plans, provider organizations, MSOs, and hospitals. Services include delegation oversight, policy development, and audit readiness.
2. Survey Administration Services: QMetrics conducts regulatory-required surveys (Provider Appointment Availability, Provider Satisfaction, After-Hours, Emergency Instructions, Enrollee Experience) and customized surveys for health plans. Services include prevalidation, administration, validation, and Plan-to-Plan compliance reviews.
3. Data Aggregator Validation: As the official validator for NCQA's Data Aggregator Validation Program, QMetrics conducts validation audits for data aggregators. Organizations must undergo validation to contribute standard supplemental data for HEDIS reporting.
4. Quality Management & Value-Based Reporting: Consulting services for improving HEDIS and STARS scores, benchmarking, targeting measures, implementing interventions, and audit readiness. Includes quality measure reporting and continuous quality improvement approaches.
5. Health Equity Consulting & Accreditation Support: DEI strategy integration, organizational design, staff coaching, data analytics, quality improvement programming, and NCQA Health Equity Accreditation support services.
6. QMetrics Academy: Training academy offering complimentary and premium courses on data validation, NCQA programs, compliance operations, PAAS Survey Readiness, After-Hours Survey Readiness, and PSV in Practice.
7. Advanced Analytics: Analytics services including ROI models, targeting models for quality and risk score improvement, predictive models for outreach and revenue recovery, and statistical analysis for healthcare performance.

Pricing tiers

Go-to-market motion3 records

Distribution channels4 records

Marketing channels7 records

Core offering

QMetrics is a managed healthcare consultancy providing HEDIS compliance auditing, data validation, regulatory survey administration, and quality management consulting to health plans, provider organizations, MSOs, and hospitals. As the sole national validator for NCQA's Data Aggregator Validation Program, the company conducts data validation audits, administers regulatory surveys through a domestic contact center, and supports health equity accreditation initiatives across the U.S.

Product overview

QMetrics is a managed healthcare consultancy offering a comprehensive suite of services organized around survey administration, data validation, quality management, and health equity consulting. The core portfolio includes Survey Services (PAAS, enrollee surveys, provider satisfaction surveys), a Contact Center handling over 55,000 annual calls, the QMetrics Academy training platform (launched 2025), the NCQA Data Aggregator Validation Program (as sole national validator since 2019), Health Equity Consulting & Accreditation Support, Quality Management & Value-Based Reporting, Encounter Data Completeness services, and Advanced Analytics. Founded in 2006 and headquartered virtually in San Diego, CA, QMetrics serves over 20 health plans across up to 58 counties and has experienced 2,000% growth over five years.

Differentiator

Problem solved

Functional benefit

Brands

• QMetrics Academy: A training and education platform established in 2025 offering complimentary and premium courses focused on data validation, NCQA's Data Aggregator Validation and HEDIS programs, compliance operations, PAAS survey readiness, and after-hours survey training.

Products and services

• Survey Services Comprehensive survey administration services including Provider Appointment Availability Survey (PAAS), Provider Satisfaction Language Assistance Survey, After-Hours Survey, Emergency Instructions Survey, Enrollee Experience Survey, Data Accuracy Survey, Data Accuracy with Advanced Access Assessment, and Expanded Appointment Set Survey. Services include prevalidation, administration, and validation components, and serve U.S. health plans needing DMHC/DHCS/CMS regulatory compliance surveys.
• Contact Center Domestic contact center conducting regulatory-required surveys, customized surveys, and serving as an extension of client call centers for appointment scheduling including annual wellness visits. Handles over 55,000 calls annually with a dedicated team of customer service experts serving health plans and provider organizations.
• QMetrics Academy Online training platform offering complimentary and premium courses focused on data validation, quality improvement, NCQA's Data Aggregator Validation and HEDIS programs, compliance operations, PAAS Survey Readiness, After-Hours Survey Readiness, and PSV in Practice training. Hosted on Kajabi and targets healthcare professionals seeking NCQA, HEDIS, and compliance operations education.
• Data Aggregator Validation Program Validation program operated as the sole national validator for NCQA's Data Aggregator Validation Program since 2019. Validates data aggregators that collect, aggregate, and transform electronic data from original sources for use as standard supplemental data for HEDIS reporting. Includes FHIR interoperability standards and Provider Portal integration. Serves 50+ data aggregator organizations across 21 states.
• Health Equity Consulting & Accreditation Support

Quantifiable outcome

• 50 organizations across 21 states have completed Data Aggregator Validation process, resulting in 137 validations since Summer 2021
• +5 more outcomes

Named customers5 records

Segments5 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration1 record

AI capability2 records

Feature5 records

Partnerships

Seven partnerships are on record, tiered flagship and minor.

• National Committee for Quality Assurance (NCQA)flagshipStrategic or Co-development Partner · 1 September 2019QMetrics has been the official Validator for NCQA's Data Aggregator Validation Program since its inception in fall 2019. QMetrics worked closely with NCQA to develop program protocols and standards, develop primary source verification (PSV), and conduct validation audits. QMetrics is the sole national validator for the program, which has validated 50 organizations across 21 states with over 56,000 data sources.
• Feeding San DiegominorOthersFeeding San Diego, part of the national Feeding America network, is dedicated to ending hunger through food rescue and equitable distribution. QMetrics has been supporting this cause for over five years and has helped provide over 11,000 meals.
• Emilio Nares FoundationminorOthersThe Emilio Nares Foundation helps low-income families navigate their child's cancer journey by providing transportation, resources, and compassionate support. QMetrics has been a proud contributor for three years.
• Covenant HouseminorOthersCovenant House offers safety, shelter, and support to young people facing homelessness and human trafficking. Their programs provide pathways to education, employment, and independence.
• Mel and Enid Zuckerman College of Public Health (MEZCOPH)minorOthersMEZCOPH at the University of Arizona is committed to advancing health equity through education, research, and community partnerships. Their dedication aligns with QMetrics' vision for better outcomes across all communities.
• Phoenix Children's HospitalminorOthersPhoenix Children's Hospital is one of the nation's largest pediatric healthcare systems, providing world-class care to children facing illness, injury, and complex medical conditions.
• Arizona Cardinals FoundationminorOthersArizona Cardinals Charities focuses on improving the lives of children, women, and underserved populations across Arizona through education, health, safety, and community development programs.

Scale indicators11 records

Recent moves11 records

Expansion highlights6 records

Direct peers

• Health Catalyst: Healthcare analytics and outcomes-improvement platform serving health systems and payers. Comparable in analytics, quality measurement, and value-based reporting services to providers and plans.
• Edifecs: Healthcare data interoperability and FHIR-focused platform with payer-facing solutions. Directly comparable in data aggregation, validation, and interoperability services for HEDIS supplemental data workflows.
• Cotiviti: Healthcare analytics and payment-accuracy firm serving health plans with quality measurement, HEDIS analytics, and risk adjustment solutions. Comparable in its focus on HEDIS quality reporting, payer analytics, and supplemental data workflows.
• Inovalon: Healthcare technology platform offering HEDIS quality measurement, risk adjustment, and analytics to health plans. Directly competes with QMetrics in quality measurement, supplemental data validation, and value-based reporting for payers and providers.
• Milliman (MedInsight): Actuarial and healthcare analytics consultancy with strong HEDIS, risk adjustment, and value-based-care analytics practices. Comparable in healthcare analytics, quality measurement, and payer-facing consulting.
• SCIO Health Analytics (now emids): Healthcare analytics and consulting firm serving payers and providers with HEDIS, risk adjustment, and quality improvement services. Directly comparable in payer-focused quality auditing and analytics engagements.

Broad incumbents

• Optum (UnitedHealth Group): Largest healthcare-services platform offering HEDIS, risk adjustment, quality measurement, and consulting at massive scale. Overlaps with QMetrics in HEDIS auditing and quality analytics but as part of a much broader payer-services and technology portfolio.
• Change Healthcare (now part of Optum): Healthcare technology and analytics provider (now within Optum) with risk-adjustment and revenue-optimization products. Several QMetrics directors previously held leadership roles in Change Healthcare's Risk Analytics Division, indicating deep operational overlap.
• Accenture (Healthcare): Global consulting and technology firm with a dedicated healthcare practice serving payers, providers, and regulators. Comparable in regulatory compliance, quality reporting, and transformation consulting to health plans.
• Deloitte (Healthcare Consulting): Global consulting firm with a large healthcare practice covering HEDIS, value-based care, regulatory compliance, and payer transformation. Broad incumbent that overlaps with QMetrics' audit and consulting work but at enterprise scale across all lines of business.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/profile.php?id=61572290495094
• LinkedInlinkedin.com/company/qmetrics-inc
• Instagraminstagram.com/qmetricsconsulting?igshid=YmMyMTA2M2Y%3D

Revenue estimate

Valuation estimate

Number of profiles

Profiles26 records

Funding overview

Funding rounds

Investors

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 QMetrics