ComplexCare Solutions
ComplexCare Solutions is a U.S. healthcare services company that delivers clinician-led in-home and virtual health assessments and member engagement programs to Medicare Advantage, Medicaid, and ACA/Commercial health plans serving complex, high-risk populations.
- Company typePrivate
- Founded2010
- HeadquartersNew York, United States
- Headcount501–1,000
- GTM typeB2B
- OfferingServices
What ComplexCare Solutions does
ComplexCare Solutions is a U.S. healthcare services company that delivers clinician-led in-home and virtual health assessments for Medicare Advantage, Medicaid, and ACA/Commercial health plan members who are clinically complex, high-risk, or otherwise unresponsive to automated outreach. Founded in 2010 in New York as Enhanced Care Initiatives, the company has grown to operate through a national network of 2,500+ advanced practice clinicians (Nurse Practitioners and Physician Assistants) across 43+ states, having completed more than 5 million cumulative assessments with a 98% RADV coding validation rate and 96%+ member satisfaction.
The service platform is anchored by Health Assessments (in-home and virtual clinical evaluations that surface clinical, environmental, and social determinants missed in office-based encounters) and is supplemented by Ancillary Testing Services (point-of-care A1C testing, dual-component KED testing, and mail-in lab kits) for HEDIS gap closure, an Emergency Room Diversion program that has demonstrated approximately 10% ER utilization reduction versus control populations, and Continuity of Care and Encounter Facilitation programs that coordinate post-visit follow-through with primary care providers. Each program is configured to a contracting health plan's specific quality measures, Star Ratings priorities, and member populations rather than offered as a uniform product.
ComplexCare Solutions generates revenue through B2B managed services and professional services contracts with health plans, priced on a per-engagement or capitated basis tied to member assessments completed and quality outcomes delivered. Go-to-market is enterprise field sales targeting health plan quality, risk adjustment, and utilization management leadership. Following its January 2025 carveout acquisition from Inovalon by Vesey Street Capital Partners (VSCP's fifth carveout and first platform investment from Healthcare Fund II), the company operates as an independent entity headquartered in Nashville, Tennessee.
ComplexCare Solutions firmographics
Firmographics- Name
- ComplexCare Solutions
- Legal name
- ComplexCare Solutions
- Website
- https://complexcaresolutions.com
- Company type
- Private
- Founded year
- 2010
- Operating status
- Operating
- Headcount range
- 501–1,000 employees
- Short description
- ComplexCare Solutions is a U.S. healthcare services company that delivers clinician-led in-home and virtual health assessments and member engagement programs to Medicare Advantage, Medicaid, and ACA/Commercial health plans serving complex, high-risk populations.
- Ownership category
- akta.pro rank
ComplexCare Solutions industry classification
Industry- Product category
- Healthcare Member Engagement Services
- NAICS
- Home Health Care Services (621610)
- SIC
- Services-Home Health Care Services (8082)
- akta.pro primary industry
- Chronic Condition Virtual Care & Disease Management (Payer-Sponsored) (HLALACAE)
Keywords
Where ComplexCare Solutions is headquartered
LocationHeadquarters
- HQ city
- New York
- HQ country
- United States
- HQ region
- North America
Offices2 records
Markets served
ComplexCare Solutions business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Marketing or Sales, Others
Revenue model
- Health Plan Services - Clinical Assessments: B2B services to health plans including in-home health assessments, virtual assessments, and engagement programs. Revenue derived from contracted arrangements with Medicare Advantage, Medicaid, and ACA/commercial health plans based on member engagement and quality outcome delivery.
- Supplemental Testing Services: Ancillary testing services including in-home point-of-care testing (A1C, KED) and mail-in lab kits that support health plan quality measure closure.
Go-to-market motion1 record
Distribution channels3 records
Marketing channels5 records
ComplexCare Solutions product offering
Product offeringCore offering
ComplexCare Solutions delivers clinician-led in-home and virtual health assessments for health plans serving complex, elderly, special needs, and dually-eligible members (Medicare Advantage, Medicaid, ACA/Commercial). The company deploys a national network of 2,500+ Nurse Practitioners and Physician Assistants to conduct comprehensive assessments that surface clinical, environmental, and social insights, supported by point-of-care testing, mail-in lab kits, and emergency room diversion programs designed to close HEDIS and CMS Star Ratings quality gaps.
Product overview
ComplexCare Solutions offers a platform of clinician-led health assessment and member engagement services designed for complex populations. The core offering consists of Health Assessments (in-home and virtual evaluations by Nurse Practitioners and Physician Assistants), supplemented by Ancillary Testing Services including In-Home Point-of-Care Testing and Mail-In Lab Kits for HEDIS gap closure, and Emergency Room Diversion programs to reduce avoidable utilization. These services are unified by Continuity of Care and Encounter Facilitation programs that ensure assessment insights translate into coordinated care action. The company operates a national network of 2,500+ clinicians across 43+ states, delivering services to Commercial, Medicare, and Medicaid health plan members.
Differentiator
Problem solved
Functional benefit
Products and services
- Health Assessments Comprehensive in-home and virtual health assessments conducted by advanced practice clinicians (Nurse Practitioners and Physician Assistants) to evaluate complex, high-risk members and uncover clinical, environmental, and social insights often missed in traditional care settings.
Quantifiable outcome
- 5M+ completed assessments across Medicare Advantage, Medicaid, and ACA populations
- +6 more outcomes
Companies that use ComplexCare Solutions
Customer profileNamed customers3 records
Segments4 records
Ideal customer profiles3 records
ComplexCare Solutions technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Feature5 records
ComplexCare Solutions partnerships and signals
Strategic signalScale indicators11 records
Recent moves7 records
Expansion highlights5 records
ComplexCare Solutions competitors and assessment
Company assessmentEmerging players
- MedZed: MedZed delivers in-home care and telehealth services for high-risk, high-cost members of health plans, overlapping with CCS on payer-sponsored, home-based complex care.
- Vesta Healthcare: Vesta Healthcare delivers24/7 in-home and virtual care for complex and dual-eligible populations, comparable to CCS in payer-sponsored, home-based complex care delivery.
- Healthmine: Healthmine provides member engagement and quality measure solutions for health plans, comparable to CCS on payer-sponsored population health and quality programs.
- ConcertoCare: ConcertoCare provides in-home primary and complex care for seniors and dual-eligibles, comparable to CCS in serving complex, high-risk populations in the home with multidisciplinary clinical teams.
Direct peers
- Signify Health: Signify Health (acquired by CVS Health in 2023) operates a national in-home health evaluation network for Medicare Advantage plans—the closest direct competitor to ComplexCare Solutions on model, customer base, and use cases.
- Matrix Medical Network: Matrix Medical Network delivers in-home health assessments and care management for Medicare Advantage and Medicaid plans, directly competing with CCS on in-home risk adjustment and quality measure closure.
Broad incumbents
- Inovalon: Inovalon was the prior parent of ComplexCare Solutions before the 2025 carveout to VSCP. It remains a broadly incumbent healthcare data and analytics platform serving payers with risk adjustment, quality, and member engagement capabilities.
- Optum (UnitedHealth Group): Optum is a scaled payer-services and care delivery incumbent with in-home assessment and complex-care capabilities serving MA plans, providing a vertically integrated competitive threat to CCS.
- Evernorth (Cigna): Evernorth is Cigna's health services portfolio including care management and specialty services, broadly comparable as a payer-aligned services platform competing for MA/Medicaid engagement spend.
- CareCentrix: CareCentrix (an Optum company) coordinates post-acute and home-based care for payers and is comparable as a payer-aligned care coordination and home-based services platform serving complex populations.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat5 records
Key risks5 records
Key highlights6 records
Customer concentration
ComplexCare Solutions social profiles
Digital presenceComplexCare Solutions financial estimates
Financial estimateRevenue estimate
Valuation estimate
ComplexCare Solutions leadership team
Management profileNumber of profiles
Profiles12 records
ComplexCare Solutions funding detail
Funding detailFunding overview
Funding rounds1 record
Investors1 record
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
ComplexCare Solutions 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 ComplexCare Solutions
What does ComplexCare Solutions do?
ComplexCare Solutions delivers clinician-led in-home and virtual health assessments for health plans serving complex, elderly, special needs, and dually-eligible members (Medicare Advantage, Medicaid, ACA/Commercial). The company deploys a national network of 2,500+ Nurse Practitioners and Physician Assistants to conduct comprehensive assessments that surface clinical, environmental, and social insights, supported by point-of-care testing, mail-in lab kits, and emergency room diversion programs designed to close HEDIS and CMS Star Ratings quality gaps.
Is ComplexCare Solutions a public or private company?
ComplexCare Solutions is a private company. It is classified as private equity controlled and is currently operating.
When was ComplexCare Solutions founded?
ComplexCare Solutions was founded in 2010. It employs 501 to 1,000 people.
Where is ComplexCare Solutions based?
ComplexCare Solutions is headquartered in New York, United States, in the North America region.
How does ComplexCare Solutions make money?
Two revenue lines are on record. Health Plan Services - Clinical Assessments are the primary driver. The others are supplemental Testing Services.
Who are ComplexCare Solutions's main competitors?
Emerging players on record are MedZed, Vesta Healthcare, Healthmine and ConcertoCare. Direct peers are Signify Health and Matrix Medical Network. Broad incumbents are Inovalon, Optum (UnitedHealth Group), Evernorth (Cigna) and CareCentrix.
Does ComplexCare Solutions have an API?
No public API is recorded for ComplexCare Solutions.
What industry is ComplexCare Solutions in?
ComplexCare Solutions's product category is Healthcare Member Engagement Services. Its primary akta.pro industry code is HLALACAE, Chronic Condition Virtual Care & Disease Management (Payer-Sponsored). Its NAICS code is 621610 and its SIC code is 8082.