Health Network One

What Health Network One does

Health Network One is a specialty network management company that administers outpatient healthcare services for managed care organizations (MCOs) and health plans through delegated, full-risk capitated arrangements. Founded in 1999 and headquartered in Florida, the company operates across 37+ states with 250+ employees, managing provider networks for approximately 7-8 million covered lives via a contracted base of 30,000+ providers. Its service portfolio spans outpatient therapy, eye care, and four specialty verticals: dermatology, podiatry, gastroenterology, and urology.

The company's core technology is the proprietary Global Delivery System (GDS), a platform that supports utilization management, claims adjudication, provider network operations, and quality reporting across the delegated service categories. Revenue is generated through per-member-per-month (PMPM) capitated payments from health plan clients, under which Health Network One assumes financial risk for utilization within the contracted scope. This structure produces predictable recurring monthly revenue while transferring utilization risk from the health plan to the company, requiring actuarial precision and clinical oversight to manage margin.

Since entering a private equity partnership with H.I.G. Capital in October 2021, the company has pursued both inorganic and organic expansion. The January 2023 acquisition of Premier Eye Care added scale and 17 health plan relationships in the eye care line. Subsequent moves include entry into Behavior Analysis (ABA services) and Sleep, a major C-suite professionalization in 2024-2025 led by new CEO Heyward Donigan, and maintenance of NCQA accreditations and HITRUST CSF certification, both prerequisites for delegated risk arrangements with major health plan partners.

Name

Health Network One

Legal name

Health Network One, Inc.

Website

https://healthnetworkone.com

Company type

Private

Founded year

1999

Operating status

Operating

Headcount range

101–250 employees

Short description

Health Network One is a specialty network management company that operates full-risk capitated provider networks for 20+ managed care organizations, covering 7-8 million lives across 37+ states through its proprietary GDS platform and 30,000+ contracted providers.

Ownership category

akta.pro rank

Product category

Specialty Healthcare Network Management

NAICS

Ambulatory Health Care Services (621)

SIC

Hospital & Medical Service Plans (6324), Services-Health Services (8000)

akta.pro primary industry

Provider Network & Care Management for Commercial Members (HLAEAAAL)

akta.pro secondary industries

Network-Model HMOs (HLAEAMAC), Multi-Specialty PPO Provider Networks (HLAEANAC)

Keywords

• Specialty network management
• Value-based care solutions
• Managed care services
• Utilization management services
• Capitated healthcare networks

Headquarters

HQ city

Lauderdale

HQ country

United States

HQ region

North America

Offices3 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Capitated Payment Solution: Health Network One operates under full risk arrangements with health plans, receiving capitated per-member-per-month payments to manage specialty provider networks. The company assumes 100% of medical cost risk and typically receives delegation of Claims Management, Credentialing, Provider Network Management, and Utilization Management.
2. Alternative Payment Models: Value-based reimbursement methodologies including severity-adjusted bundled payments for therapy services, capitation for eye care, and episode-of-care payments. These alternative payment models align incentives between health plans, providers, and the company.
3. Administrative Services Delegation: Revenue derived from delegated administrative functions including utilization management, claims processing, and credentialing, all bundled into single capitated payments.

Pricing tiers

Go-to-market motion2 records

Distribution channels1 record

Marketing channels5 records

Core offering

Health Network One manages specialty provider networks (outpatient therapy, eye care, dermatology, podiatry, gastroenterology, and urology) under full-risk capitated arrangements with health plans and managed care organizations. The company assumes 100% of medical cost risk in exchange for per-member-per-month payments and provides delegated utilization management, credentialing, claims processing, and network management services. Its proprietary GDS platform supports these full-risk operations across more than 7 million covered lives.

Product overview

Health Network One is a specialty network management company operating as a platform-plus-affiliates architecture. The core offering includes three main network divisions: Outpatient Therapy (PT/OT/ST), Eye Care (Routine Vision and Medical Eye Care), and Specialty Networks (Dermatology, Podiatry, Gastroenterology, Urology). These are managed through the proprietary GDS (Global Delivery System) platform with delegated UM, Claims, Credentialing, and Network Management. The company operates through affiliated brands including Therapy Network, Premier Eye Care, Eye Management Inc., and HS1 Medical Management. Key clinical programs include the Melanoma Recall System and HEDIS EED Compliance Program. The Provider Web Portal and Provider Training Portal support provider engagement. The company covers over 7 million lives across 30,000+ providers, operating under full risk arrangements with health plans.

Differentiator

Problem solved

Functional benefit

Brands

• Therapy Network: Affiliate managing Physical, Occupational, and Speech Therapy provider networks for health plans since 2005
• Premier Eye Care
• Eye Management Inc. (EMI)
• GDS (Global Delivery System)

Products and services

• Outpatient Therapy Network Full-risk network management for Physical, Occupational, and Speech Therapy (PT/OT/ST) provider networks using a severity-adjusted bundled payment model. The company assumes 100% of medical cost risk, delivers delegated Utilization Management, Credentialing, Claims, and Network Management, and has achieved 10-15% first-year savings growing annually, sub-1% denial rates, and 95%+ provider retention. Service is contracted to health plans across Medicaid, Medicare, Exchange, and Commercial lines of business.
• Eye Care Network Comprehensive eye care network management covering Routine Vision and Medical Eye Care through affiliates Premier Eye Care and Eye Management Inc. (EMI), reaching 37 states, 17 health plans, and nearly 2 million lives. Includes HEDIS quality programs, the Tele-SCREEN program, the HEDIS Provider Portal, and a multi-channel member outreach program delivering 5 STARs for eight consecutive years on the diabetic retinopathy exam measure.
• Specialty Networks (Dermatology, Podiatry, Gastroenterology, Urology) Single-specialty full-risk networks for Dermatology, Podiatry, Gastroenterology, and Urology, with delegated Utilization Management, Claims, Credentialing, and Network Management. Achieves 50-70% reduction in procedures and significant Part A and Part B cost savings through alternative payment models and clinical programs such as the Melanoma Recall System. Service is contracted to health plans nationwide.
• Therapy Network Affiliate brand managing Physical, Occupational, and Speech Therapy provider networks for health plans, operating under Health Network One's umbrella. Provides full-risk network management, alternative payment models, and a network of therapy providers for health plan members.
• Premier Eye Care Acquired eye care network managing ophthalmology and optometry services across 37 states for 17 health plans, covering nearly 2 million lives. Together with EMI, comprises Health Network One's market-leading eye care offering, providing full-risk network management for routine vision and medical eye care.
• Eye Management Inc. (EMI) The oldest continuously operating ophthalmology network in the country, covering 900,000 lives in Florida and Puerto Rico for more than 30 years. Provides routine vision and medical eye care network management under full-risk arrangements and jointly comprises the company's market-leading eye care offering with Premier Eye Care.
• HS1 Medical Management Wholly-owned subsidiary of Health Network One providing medical management services, including the company's GDS (Global Delivery System) platform operations and delegated UM, Claims, Credentialing, and Network Management functions. Led by President and COO Suzanne Dowling.
• Behavior Analysis Network Applied Behavior Analysis therapy services network expansion providing more comprehensive care for members with autism, delivered through contracted providers such as Jumping Step by Step and integrated into the company's therapy network offerings.

Quantifiable outcome

• 7M+ lives covered across 37 states with 30k+ providers
• +8 more outcomes

Named customers4 records

Segments2 records

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature4 records

Partnerships

Seven partnerships are on record, tiered minor and core.

• Medicaid Health Plans of AmericaminorGTM or Marketing Partner · 11 June 2025Co-hosting partnership for specialty care management webinar featuring HN1's Chief Medical Officer and Senior Medical Director. Partnership positions HN1 as thought leader in value-based specialty care for Medicaid health plans.
• Premier Eye CarecoreStrategic or Co-development Partner · 4 January 2023Acquisition of Premier Eye Care in January 2023 expanded HN1's eye care network to 37 states covering nearly 2 million lives. Premier operates vision and ophthalmology networks for 17 health plans and brings over 20,000 optometrists and ophthalmologists. Premier and EMI jointly comprise the company's market-leading eye care offering.
• Therapy Network (Affiliate)coreStrategic or Co-development PartnerAffiliate company managing therapy and physiatry provider networks. Therapy Network has operated for more than 20 years managing therapy provider networks for largest health plans. Brand consolidation announced to bring all therapy networks under singular Therapy Network brand.
• Eye Management Inc. (EMI)coreStrategic or Co-development PartnerAffiliate and oldest continuously operating ophthalmology network in the country, covering 900,000 lives in Florida and Puerto Rico for more than 30 years. EMI and Premier Eye Care jointly comprise the company's market-leading eye care offering.
• Jumping Step by Step (Provider)minorOthersPediatric therapy provider in Florida recognized for pioneering integrated approach combining physical therapy, occupational therapy, speech therapy, and behavior analysis. HN1 expanding network to include behavior analysis in 2024 based on positive impact observed.
• NUC UniversityminorOthersPartnership with NUC University in Puerto Rico for physical therapy assistant licensing exam preparation program. Therapy Network launched island's first educational program at NUC's Bayamon campus to address shortage of physical therapy assistants.
• CORA Physical TherapyminorOthersNationwide outpatient therapy provider featured in HN1 webinar on value-based specialty care, sharing provider perspective on episode-of-care model and how providers respond to value-based payment arrangements.

Scale indicators15 records

Recent moves7 records

Expansion highlights6 records

Emerging players

• agilon health: Value-based care company partnering with primary care physicians to manage Medicare Advantage populations under global capitation. Comparable to HN1 in PMPM full-risk economics with delegated clinical management, though focused on primary care rather than specialty networks.

Broad incumbents

• Optum (UnitedHealth Group): Largest healthcare services platform in the US, with risk-bearing specialty care management capabilities, network management, and clinical programs. Comparable to HN1's broader operating model but at vastly greater scale and with health plan ownership (UnitedHealthcare).
• Carelon Health (Elevance Health): Healthcare services arm of Elevance Health (Anthem), providing specialty care management, behavioral health, and advanced primary care for the parent payer's members and external customers. Comparable to HN1 as a delegated specialty manager, but embedded within a vertically integrated payer.
• Versant Health (MetLife): Vision benefits management company owned by MetLife, providing vision network administration for health plans and employers. Overlaps with HN1's eye care division but operates as a benefits administrator/payer rather than a risk-bearing specialty manager.
• EyeMed Vision Care: Vision insurance and benefits provider owned by Luxottica, serving health plans and employer groups. Comparable to HN1's Premier Eye Care in commercial vision network management, though EyeMed is primarily an insurer rather than risk-bearing network operator.

Direct peers

• Landmark Health: Risk-bearing in-home medical group serving complex Medicare and dual-eligible patients through delegated arrangements with health plans. Comparable to HN1 in operating under full-risk arrangements delegated by managed care plans, though Landmark focuses on longitudinal primary care rather than specialty networks.
• VSP Global: Largest vision insurance and eye care services company in the US, managing vision networks for health plans and employers. Directly comparable to HN1's Premier Eye Care and EMI subsidiaries given parallel focus on risk-bearing ophthalmology/optometry network management.
• Zelis Healthcare: Healthcare cost management and claims/network management platform serving health plans and providers. Comparable to HN1 in providing delegated network and claims administration, though Zelis focuses more on payment integrity and cost containment than risk-bearing specialty care.
• myNEXUS: Post-acute and specialty network management company providing delegated utilization management and network administration for health plans, notably in therapy and home health. Directly comparable to HN1's Therapy Network and outpatient therapy product line; CMO Dr. Riley previously held leadership at myNEXUS.
• Evolent Health: Public value-based specialty care management company that partners with health plans to manage oncology, cardiology, and other specialty networks under risk-based arrangements. Most directly comparable to HN1 given shared focus on delegated specialty network management with PMPM/full-risk economics.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xtwitter.com/gptw_us
• LinkedInlinkedin.com/company/28924

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles17 records

Subsidiaries5 records

Funding overview

Funding rounds

Investors

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

M&A1 record

Investments

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

Frequently asked questions about Health Network One