PointCare
PointCare sells a Coverage Management SaaS platform to Community Health Centers and FQHCs, automating Medicaid/Medicare enrollment, redetermination monitoring, and patient re-coverage. The platform serves 90 CHC partners across 28 states managing coverage for 2 million-plus patients.
- Company typePrivate
- Founded2017
- HeadquartersSan Mateo, United States
- Headcount11–50
- GTM typeB2B
- OfferingSoftware
What PointCare does
PointCare (Pointcare) is a California-based healthcare technology company that sells a Coverage Management Platform to Community Health Centers (CHCs), Federally Qualified Health Centers (FQHCs), and related Medicaid-managed organizations. The company was founded around 2017 (operating entity: PointCare LLC, registered in California) and is led by CEO and Co-Founder Everett Lebherz. The platform addresses procedural Medicaid terminations — which the company cites as accounting for roughly 70% of all Medicaid terminations — by continuously monitoring patient coverage, detecting redetermination dates, automating multilingual patient outreach, and routing patients through re-enrollment workflows. The company's stated footprint is 90 CHC partners across 28 states managing coverage for over 2 million patients, with named customers including AltaMed (since 2017), CVHS Health Services, Jane Pauley CHC, and a Maryland-based IPA with approximately 80,000 Medicaid members.
The product portfolio centers on a proprietary Automation Engine branded as Coverage Intelligence, with four functional modules (Detect & Monitor, Adaptive Engagement, Multi-Path Retention & Recovery, Convert & Rescue). Complementary products include VANCE, a multilingual digital Medicaid navigator launched in 2022; Qualify, a 90-second eligibility screening tool; the Qualify API; and a Patient App available in English, Spanish, Chinese, Arabic, Tagalog, Vietnamese, and Russian. In May 2026 the company launched a new generation of the platform called the Coverage Advocacy Platform, expanding its positioning beyond CHC staff workflows toward direct consumer enrollment. The platform is HIPAA and SOC 2 Type II certified.
PointCare monetizes through subscription-based SaaS contracts priced per healthcare provider organization, with quote-based monthly billing and no publicly disclosed pricing. Go-to-market is primarily direct enterprise field sales complemented by channel partnerships, most notably with the National Association of Community Health Centers (NACHC) and state-level Primary Care Associations such as MPCA. Marketing is driven by content, conference presence at events such as FACHC 2026 and CHI 2026, and outcome-based case studies.
PointCare firmographics
Firmographics- Name
- PointCare
- Legal name
- PointCare LLC
- Website
- https://pointcare.com
- Company type
- Private
- Founded year
- 2017
- Operating status
- Operating
- Headcount range
- 11–50 employees
- Short description
- PointCare sells a Coverage Management SaaS platform to Community Health Centers and FQHCs, automating Medicaid/Medicare enrollment, redetermination monitoring, and patient re-coverage. The platform serves 90 CHC partners across 28 states managing coverage for 2 million-plus patients.
- Ownership category
- akta.pro rank
PointCare industry classification
Industry- Product category
- Healthcare Coverage Management Software
- NAICS
- Services for the Elderly and Persons with Disabilities (62412), Individual and Family Services (6241)
- SIC
- Services-Health Services (8000), Services-Misc Health & Allied Services, Nec (8090)
- akta.pro primary industry
- Eligibility & Benefits Verification (HLACACAD)
- akta.pro secondary industries
- Adherence, Reminders & Engagement Automation (Medication/Follow-up) (HLACAEAJ), Family Care Navigation & Care Coordination Platforms (multi-member care plans, referrals) (HLALAHAL)
Keywords
Where PointCare is headquartered
LocationHeadquarters
- HQ city
- San Mateo
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
PointCare business model
Business model- GTM type
- B2B
- Offering type
- Software
- Cost components
- Technology or R&D, Personnel, Marketing or Sales, Operations
Revenue model
- Coverage Management Platform Subscription: SaaS platform subscription for healthcare providers and CHCs to manage patient coverage, automate renewals, and prevent coverage gaps. Revenue likely recurring subscription-based with pricing tied to patient population size.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Monthly | Platform subscription for healthcare providers |
Go-to-market motion3 records
Distribution channels3 records
Marketing channels6 records
PointCare product offering
Product offeringCore offering
PointCare provides a SaaS Coverage Management Platform for healthcare providers and Community Health Centers that automates health insurance enrollment, redetermination monitoring, and coverage retention for patient populations. The platform continuously identifies coverage gaps and redetermination dates, runs multilingual patient outreach, and recovers revenue for providers through a Coverage Intelligence Automation Engine, complemented by a digital Medicaid navigator (VANCE) and a 90-second eligibility screening tool/API (Qualify).
Product overview
PointCare offers a unified Coverage Management Platform with multiple integrated products and modules. The core platform provides automated coverage monitoring, enrollment management, and renewal services through its proprietary Automation Engine powered by Coverage Intelligence. The product portfolio includes VANCE (digital Medicaid navigator for patient self-enrollment), Qualify (eligibility screening tool available as software and API), and a Patient App. The platform serves healthcare providers including FQHCs, with a Coverage Advocacy Platform launched in 2026 as the latest GA product.
Differentiator
Problem solved
Functional benefit
Products and services
- Coverage Management Platform SaaS platform for healthcare providers (FQHCs and CHCs) that automates insurance coverage monitoring, renewal workflows, and gap prevention across patient populations. Built on the proprietary Coverage Intelligence Automation Engine, it includes Detect & Monitor, Adaptive Engagement, Multi-Path Retention & Recovery, and Convert & Rescue capabilities. Targets Federally Qualified Health Centers, Community Health Centers, and similar safety-net providers.
- Coverage Advocacy Platform Patient-centric coverage management platform launched in May 2026 that provides real-time coverage visibility, household enrollment management, and proactive renewal services for Americans on Medicaid, Medicare, Marketplace plans, or who remain uninsured.
- VANCE (Digital Medicaid Navigator) Digital Medicaid navigator that lets patients rapidly self-enroll in Medicaid, with multilingual capability and step-by-step re-enrollment guidance usable with or without clinic staff assistance. Targeted at patient populations served by FQHCs/CHCs and accessible via QR code.
- Qualify 90-second eligibility screening product that uses a nationally curated database of insurance and benefit programs to screen patients for coverage options and Social Determinants of Health programs, returning results via email, text, or print. Offered to clinics and individuals.
- Qualify API Stand-alone API that allows developers to embed PointCare's 90-second eligibility screening and Social Determinants of Health screening capabilities into external applications and workflows.
- Patient App Multilingual (English, Spanish, Chinese, Arabic, Tagalog, Vietnamese, Russian) patient-facing application that enables individuals to manage their own enrollment and coverage.
Quantifiable outcome
- 104% improvement in patient retention rates
- +4 more outcomes
Companies that use PointCare
Customer profileNamed customers4 records
Segments3 records
Ideal customer profiles2 records
PointCare technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- Yes
- API docs
- API detail
Core technology
AI maturity
App detail
Feature7 records
PointCare partnerships and signals
Strategic signalPartnerships
Three partnerships are on record, tiered core and flagship.
- MPCA (Michigan Primary Care Association)corePartnership with Michigan Primary Care Association announced in June 2026, described as 'A Partnership Built for This Moment'. MPCA represents and supports Michigan's FQHCs.
- NACHC (National Association of Community Health Centers)corePointcare has a strategic partnership with NACHC, described as a 'Game-Changing Partnership for CHCs'. This partnership provides market access to the national network of Community Health Centers and positions Pointcare as a preferred coverage management solution for CHCs.
- AltaMedflagshipAltaMed, one of the nation's largest FQHCs, has been a Pointcare customer since 2017. They have achieved a 104% improvement in patient retention rates using Pointcare's automated systems and are frequently referenced as a flagship case study.
Scale indicators8 records
Recent moves6 records
Expansion highlights6 records
PointCare competitors and assessment
Company assessmentDirect peers
- HealthSherpa: Health insurance enrollment platform for ACA Marketplace plans, with agent- and consumer-facing enrollment tools. Directly comparable to PointCare as a coverage/enrollment technology platform targeting subsidy-eligible populations.
- GetInsured: Government health-insurance exchange platform and enrollment SaaS serving state-based marketplaces, brokers and consumers. Closely comparable in providing eligibility, enrollment and redetermination infrastructure for Medicaid/Marketplace populations.
- Connecture (Zipari): Insurance enrollment, member engagement and CRM software for health plans and brokers. Comparable to PointCare in automating coverage selection, enrollment and renewal workflows across Medicare, Medicaid and commercial lines.
- Phreesia: Patient intake, eligibility verification and engagement platform deployed at the point of care. Comparable to PointCare in automating insurance eligibility, registration and patient outreach inside provider workflows.
Broad incumbents
- Experian Health: Large healthcare data and RCM vendor offering eligibility verification, coverage detection and patient access solutions. Overlaps with PointCare's eligibility/coverage detection capabilities but operates as a broader enterprise suite rather than a CHC-focused product.
- Waystar: Healthcare revenue cycle management platform with eligibility, coverage detection and patient estimation tools. Comparable in addressing coverage gaps and eligibility workflow, though broader in scope than PointCare's CHC/Medicaid focus.
Emerging players
- Cedar: Patient financial engagement and billing platform with personalized coverage and payment experiences. Adjacent to PointCare on patient-facing coverage and financial engagement, but focused on post-visit billing rather than enrollment/redetermination.
- Pyx Health: Medicaid member engagement platform addressing social determinants of health and coverage retention. Comparable to PointCare's VANCE and engagement modules targeting Medicaid populations at risk of coverage loss.
Market position
Strengths5 records
Weaknesses4 records
Competitive moat5 records
Key risks6 records
Key highlights7 records
Customer concentration
PointCare social profiles
Digital presencePointCare compliance and trust
Trust signalCompliance2 records
PointCare financial estimates
Financial estimateRevenue estimate
Valuation estimate
PointCare leadership team
Management profileNumber of profiles
Profiles4 records
PointCare funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
PointCare 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 PointCare
What does PointCare do?
PointCare provides a SaaS Coverage Management Platform for healthcare providers and Community Health Centers that automates health insurance enrollment, redetermination monitoring, and coverage retention for patient populations. The platform continuously identifies coverage gaps and redetermination dates, runs multilingual patient outreach, and recovers revenue for providers through a Coverage Intelligence Automation Engine, complemented by a digital Medicaid navigator (VANCE) and a 90-second eligibility screening tool/API (Qualify).
Is PointCare a public or private company?
PointCare is a private company. It is classified as founder individual operated bootstrapped and is currently operating.
When was PointCare founded?
PointCare was founded in 2017. It employs 11 to 50 people.
Where is PointCare based?
PointCare is headquartered in San Mateo, United States, in the North America region.
How does PointCare make money?
One revenue line is on record: coverage Management Platform Subscription.
Who are PointCare's main competitors?
Direct peers on record are HealthSherpa, GetInsured, Connecture (Zipari) and Phreesia. Broad incumbents are Experian Health and Waystar. Emerging players are Cedar and Pyx Health.
Does PointCare have an API?
Yes. PointCare offers Qualify API as a stand-alone product in addition to their Total Enrollment Management platform. The API allows developers to integrate eligibility screening capabilities. No additional technical details (protocol, auth method, rate limits, versioning, sandbox) are specified in the available source data.
What industry is PointCare in?
PointCare's product category is Healthcare Coverage Management Software. Its primary akta.pro industry code is HLACACAD, Eligibility & Benefits Verification, with a secondary code of HLACAEAJ, Adherence, Reminders & Engagement Automation (Medication/Follow-up). Its NAICS code is 62412 and its SIC code is 8000.