Health Services Advisory Group

What Health Services Advisory Group does

Health Services Advisory Group (HSAG) is a Phoenix, Arizona-based private healthcare quality improvement organization founded in 1979, operating as a federal and state government contractor. The company is organized around four core programs—Medicare Quality Improvement (serving as CMS's West QIN-QIO for Region 7), Medicaid External Quality Review (the largest EQRO in the nation, designated by 19 states), Medicaid Waiver Evaluation (independent evaluator for 15 states across 1115 and 1915b waivers), and National Surveys (administering HOS, HCAHPS, MA & PDP CAHPS, CAHPS for MIPS, and CAHPS for Hospice). Underpinning these programs are five service lines: Data Science & Advanced Analytics (DSAA), Survey Administration & Analysis, Healthcare Consulting, Case Review, and Audits (including HEDIS Compliance Audits and AMP Audit Reviews).

The technology platform integrates HEDIS measurement, CAHPS survey administration, Medicaid waiver evaluation methodologies, and AI/ML capabilities (machine learning, NLP, and predictive analytics integrated since 2016). Nine HITRUST CSF v9.4 r2-certified platform environments support the work, including the Clinical Quality Management System (CQMS), ePASSR, HEDIS, HILOC, SAFE, SAS, Secure FTP, and Tableau. HSAG is one of only nine organizations NCQA has licensed to conduct HEDIS Compliance Audits and the only EQRO that is also an NCQA HEDIS Certified Survey Vendor.

Revenue is generated through professional services contracts with CMS, state Medicaid agencies, and commercial/Medicaid/Medicare Advantage health plans. The QIN-QIO contract (13SOW, awarded May 2025) and 19 state EQRO designations form the revenue backbone, while HEDIS audits, AMP audit reviews, case review (~50,000 medical record reviews per year), and survey administration (5M+ patient experience surveys over the past decade) provide additional fee-for-service revenue. The QIO Program is mandated by the Social Security Act, and the company serves 14% of the nation's Medicare population, 41.3 million Medicaid beneficiaries, and 23 million commercial health plan members.

Name

Health Services Advisory Group

Legal name

Health Services Advisory Group

Website

https://hsag.com

Company type

Private

Founded year

1979

Operating status

Operating

Headcount range

251–500 employees

Short description

Health Services Advisory Group (HSAG) is a private, Phoenix-based healthcare quality improvement organization founded in 1979, serving as the CMS West QIN-QIO and the largest External Quality Review Organization in the nation, designated by 19 state Medicaid agencies to deliver quality review, audit, survey administration, and advanced analytics services.

Ownership category

akta.pro rank

Headquarters

HQ city

Phoenix

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Federal Government Contracts (CMS): HSAG generates revenue primarily through federal contracts with the Centers for Medicare & Medicaid Services (CMS). As a QIN-QIO contractor, HSAG receives funding to improve healthcare quality for Medicare patients. The QIO Program is mandated by law as part of the Social Security Act and directed by CMS. HSAG was awarded the 13th Statement of Work (13SOW) five-year contract in May 2025.
2. State Medicaid EQRO Contracts: HSAG serves as the External Quality Review Organization (EQRO) for states operating Medicaid managed care programs. HSAG is the largest EQRO in the nation, officially designated by 19 states. These state contracts involve evaluating managed care organizations (MCOs), prepaid inpatient health plans (PIHPs), prepaid ambulatory health plans (PAHPs), and primary care case management programs as required by federal regulations.
3. Medicaid Waiver Evaluation Contracts: HSAG serves as an independent Medicaid waiver evaluator for states, providing rigorous quantitative and qualitative analyses to assess the impact of Medicaid waivers on healthcare quality, access, timeliness, and cost. HSAG has served as Medicaid 1915b Waiver Independent Evaluator for 8 states and Medicaid 1115 Waiver Independent Evaluator for 7 states.
4. HEDIS Compliance Audits: HSAG provides HEDIS compliance audits for commercial, Medicaid, and Medicare Advantage health plans. HSAG is one of only nine NCQA-licensed organizations to conduct HEDIS Compliance Audits. These audits assure accurate, reliable, and publicly reportable data for healthcare organizations.
5. Healthcare Quality Improvement Consulting: HSAG delivers consulting services to healthcare providers including hospitals, nursing homes, surgical centers, and physician practices for regulatory compliance and quality improvement. Services include strategic planning, implementation, and staff education.

Go-to-market motion3 records

Distribution channels4 records

Marketing channels5 records

Core offering

HSAG provides healthcare quality improvement and external quality review services to federal and state agencies, health plans, and healthcare providers. Its core offerings include serving as a CMS-contracted Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Medicare, acting as the largest External Quality Review Organization (EQRO) in the nation serving 19 state Medicaid agencies, conducting independent Medicaid waiver evaluations, administering national CMS patient experience surveys, and performing NCQA-licensed HEDIS compliance audits and other healthcare audits.

Product overview

Health Services Advisory Group (HSAG) is a national healthcare quality organization offering a portfolio of four interconnected programs and five service lines. The core programs — Medicare Quality Improvement, Medicaid External Quality Review, Medicaid Waiver Evaluation, and National Surveys — are supported by a suite of services: Data Science & Advanced Analytics (which serves as the analytical engine across all programs), Survey Administration & Analysis, Healthcare Consulting, Case Review, and Audits. The programs and services are architecturally integrated: the Data Science & Advanced Analytics division provides machine learning, natural language processing, and predictive analytics capabilities that underpin quality measurement, program evaluation, and survey analytics across every program. Survey Administration & Analysis feeds patient experience data into both the Medicaid EQRO work and National Surveys program. Audits (HEDIS Compliance Audits, AMP Audit Reviews) are leveraged across Medicare and Medicaid quality programs. Together, these nine offerings form a unified quality improvement ecosystem serving government agencies, health plans, providers, and patients.

Differentiator

Problem solved

Functional benefit

Products and services

• Medicare Quality Improvement A federally mandated QIO Program initiative focused on improving healthcare quality for Medicare patients. HSAG works as a CMS-contracted Quality Improvement Organization serving as Region 7 QIN-QIO, partnering with doctors, nurses, providers, patients, and communities to drive positive health outcomes through data-driven quality improvement across hospitals, nursing homes, and outpatient practices.
• Medicaid External Quality Review Quality review services for state Medicaid managed care programs and fee-for-service programs. Activities include performance improvement project validation, performance measure validation, compliance monitoring, and network adequacy validation under federal regulations.
• Medicaid Waiver Evaluation Independent evaluation of Medicaid Section 1115 and 1915b waivers, applying rigorous quantitative and qualitative methods to assess waiver program impact on healthcare quality, access, timeliness, and cost.
• National Surveys CMS-funded national healthcare survey projects measuring patient experience of care or health outcomes. HSAG administers the Medicare Health Outcomes Survey (HOS), HCAHPS, MA & PDP CAHPS, CAHPS for MIPS, and CAHPS for Hospice Survey.
• Data Science & Advanced Analytics Advanced analytics service leveraging machine learning, natural language processing, and predictive analytics to evaluate healthcare programs and policies. The DSAA division integrates administrative, clinical, survey, and operational data to assess quality, access, outcomes, equity, and cost.
• Survey Administration & Analysis Comprehensive survey administration and analytic services for Medicaid member and provider experience surveys. HSAG is an NCQA-certified HEDIS CAHPS Survey Vendor and the only External Quality Review Organization (EQRO) with this designation.
• Healthcare Consulting Regulatory compliance and quality improvement consulting for healthcare providers including acute care hospitals, critical access hospitals, behavioral health hospitals, nursing homes, surgical centers, and physician practices. Services include evidence-based strategic planning, gap assessment, implementation planning, and staff education.
• Case Review Medical record reviews and abstractions including quality of care reviews, claims reviews, utilization reviews, and data abstraction. Services support fraud and abuse prevention, HEDIS accreditation, and compliance with federal and state Medicaid regulations.
• Audits Performance measure and network adequacy indicator validation audits. HSAG is one of only nine organizations NCQA has licensed to conduct HEDIS Compliance Audits and is a major market leader in AMP Audit Reviews. Services include CMS Part C and Part D Data Validation, information system assessments, readiness reviews, and network adequacy validation audits.

Quantifiable outcome

• 69.3 million beneficiaries touched by HSAG's quality improvement work
• +5 more outcomes

Named customers6 records

Segments6 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability4 records

Feature5 records

Partnerships

Five partnerships are on record, tiered core and major.

• Centers for Medicare & Medicaid Services (CMS)coreOthersHSAG operates under a formal five-year QIN-QIO (Quality Innovation Network-Quality Improvement Organization) contract with CMS, serving as the West QIN-QIO (Region 7) since May 2025. HSAG also conducts CMS-funded national healthcare survey projects including HOS, HCAHPS, MA & PDP CAHPS, CAHPS for MIPS, and CAHPS for Hospice. The QIO Program is mandated by law as part of the Social Security Act.
• State Medicaid Agencies (19 states)coreOthersHSAG is officially designated as the External Quality Review Organization (EQRO) by 19 states, providing independent quality review services for Medicaid managed care programs as required by federal regulations (42 CFR Part 438, Subpart E). HSAG evaluates managed care organizations (MCOs), prepaid inpatient health plans (PIHPs), prepaid ambulatory health plans (PAHPs), and primary care case management programs.
• NCQA (National Committee for Quality Assurance)coreTechnology or IntegrationHSAG holds dual NCQA designations: (1) HEDIS Certified Survey Vendor - one of only a few organizations with this certification for CAHPS survey administration; (2) HEDIS Compliance Audit Licensed Organization - one of only nine organizations licensed to conduct HEDIS Compliance Audits. This partnership enables HSAG to provide unique analytical perspectives combining survey expertise with Medicaid policy knowledge.
• California Department of Public Health (CDPH)majorStrategic or Co-development PartnerCDPH and HSAG co-host quarterly statewide nursing home update webinars, providing California nursing homes with the latest updates on infection prevention, regulatory changes, and quality improvement support. Partners in this initiative include Los Angeles County Department of Public Health, California Association of Health Facilities, California Association of Long Term Care Medicine, and LeadingAge California.
• Healthcare Providers (Hospitals, Nursing Homes, Outpatient Practices)coreOthersUnder the QIN-QIO contract, HSAG works in partnership with doctors, nurses, providers, patients, local communities, and healthcare stakeholders in every setting where care is delivered. HSAG provides free technical assistance, one-on-one coaching, data portals, and educational resources to over 300 hospitals, 1,000+ nursing homes, and numerous outpatient practices.

Scale indicators18 records

Recent moves5 records

Expansion highlights5 records

Direct peers

• Press Ganey: Press Ganey is a leading patient experience survey vendor and healthcare performance improvement firm, directly competing with HSAG in CAHPS survey administration, HEDIS reporting, and provider quality consulting for hospitals and health systems.
• IPRO: IPRO is one of the largest QIO and EQRO organizations in the US, directly competing with HSAG for federal QIN-QIO contracts and state Medicaid EQRO designations. Both firms serve as federally-designated quality review organizations with similar service portfolios spanning EQRO, HEDIS audits, and quality improvement consulting.
• Telligen: Telligen is a CMS-designated QIN-QIO contractor serving other geographic regions and provides healthcare quality improvement consulting, population health analytics, and HEDIS-related services. Directly comparable as a federal healthcare quality improvement prime contractor competing with HSAG for QIO work.
• Quality Insights: Quality Insights is another QIN-QIO contractor serving CMS-designated regions, providing healthcare quality improvement, patient safety, and care coordination services. Direct competitor to HSAG in the federal QIO program and adjacent quality improvement engagements.
• NRC Health: NRC Health is a healthcare experience and analytics company that competes with HSAG in patient experience surveys, healthcare consumer insights, and quality measurement for hospitals, health systems, and health plans.

Broad incumbents

• RTI International: RTI International is a major nonprofit research institute conducting healthcare quality measurement, program evaluation, and analytics for federal agencies including CMS. Overlaps with HSAG's DSAA, Medicaid waiver evaluation, and quality measurement work, but operates at significantly larger scale across many domains.
• Mathematica: Mathematica is a major policy research firm with a substantial healthcare practice conducting CMS-funded quality measurement, program evaluation, and analytics. Directly comparable to HSAG's waiver evaluation and quality analytics work, but at much broader organizational scale.
• Merative: Merative (formerly IBM Watson Health) provides healthcare analytics, quality measurement, and population health solutions to health plans, providers, and government agencies. Overlaps with HSAG's DSAA capabilities but serves a broader commercial market at much larger scale.
• Guidehouse: Guidehouse is a major management consulting firm with a large healthcare practice providing advisory services to federal agencies including CMS, state Medicaid agencies, health systems, and payers. Competes with HSAG for federal healthcare consulting and analytics engagements at greater scale.
• Deloitte: Deloitte's healthcare practice provides consulting, audit, and analytics services to CMS, state Medicaid programs, health plans, and providers. Overlaps with HSAG's healthcare consulting, HEDIS audit, and analytics offerings but at vastly larger scale and broader service breadth.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks5 records

Key highlights7 records

Customer concentration

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles3 records

Funding overview

Funding rounds

Investors

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M&A

Investments

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

Frequently asked questions about Health Services Advisory Group