Innovista Health Solutions

What Innovista Health Solutions does

Innovista Health Solutions is a value-based care enablement and management services organization (MSO) operating as a wholly-owned subsidiary of Health Care Service Corporation (HCSC), the nation's largest customer-owned health insurer. Founded in November 2013 and headquartered in Oak Brook, Illinois, the company supports 2,500+ primary care physicians across 61 unique payer contracts spanning Commercial, Medicare Advantage, and Medicaid lines in Illinois, New Mexico, and Texas, with 400,000 lives under management and $18.8M in annual value-based incentives delivered to physician partners. The platform is organized around six service modules — Care Management, Provider Enablement, Quality Performance & Improvement, Risk Adjustment, Performance Insights & Analytics, and ACO Enablement & Network Development — and operates three divisions: Value-based Care, Delegated Operations, and Care Delivery (through 10 Innovista Medical Center primary care clinics in Texas).

Underlying the service modules is a population health management platform that ingests and normalizes data from multiple payers, EMRs, hospice and home health (VITAS, Heart to Heart), diagnostic labs (Topcon), remote patient monitoring (CareBand, Life365), behavioral health (Magellan, Assurasource), SNFs, and community-based organizations to support risk stratification, care-gap identification, quality benchmarking, and care coordination across the managed population. The company holds a "Certified Management Service Organization" credential and runs an NCQA-aligned care model.

Innovista makes money through a combination of recurring managed services fees charged to physician practices and payer organizations for administrative services, care coordination, reporting, and infrastructure support under value-based contracts, performance-based revenue tied to quality metric achievement and shared savings distributions, and direct care delivery revenue from Innovista Medical Centers in Texas. Pricing is B2B and quote-based (not publicly disclosed). Go-to-market is sales-led, combining direct field sales to independent physician practices and ACOs, payer partnerships (anchored by parent HCSC), and owned clinic distribution. Leadership transitioned in September 2024 to Jigar Desai, an operator with 20+ years of managed care experience across Elevance Health, WellCare, Universal Health, and a PE-backed Medicare platform.

Name

Innovista Health Solutions

Legal name

Innovista Health Solutions

Website

https://innovista-health.com

Company type

Private

Founded year

2013

Operating status

Operating

Headcount range

51–100 employees

Short description

Innovista Health Solutions is a value-based care management services organization and wholly-owned subsidiary of Health Care Service Corporation, enabling 2,500+ primary care physicians across 61 payer contracts and 400,000 lives in Illinois, New Mexico, and Texas through analytics, care management, and 10 owned clinics.

Ownership category

akta.pro rank

Product category

Value-Based Care Management Services

NAICS

Computer Systems Design Services (541512)

SIC

Services-Health Services (8000), Hospital & Medical Service Plans (6324), Services-Offices & Clinics Of Doctors Of Medicine (8011)

akta.pro primary industry

Care Management & Population Health Program Administration (HLAEALAG)

Keywords

• Value-based care services
• Population health management
• Care coordination solutions
• Risk adjustment analytics
• Accountable care organization

Headquarters

HQ city

Westchester

HQ country

United States

HQ region

North America

Offices4 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Managed Services Fees: Recurring fees charged to physician practices and payer organizations for administrative services, care coordination, reporting, and infrastructure support under value-based care arrangements.
2. Performance-Based Incentives: Revenue tied to quality metric performance, clinical outcome achievements, and shared savings distributions under value-based contracts with payers.
3. Direct Care Delivery Revenue: Revenue generated from direct patient care services delivered through Innovista Medical Centers in Texas.

Go-to-market motion3 records

Distribution channels3 records

Marketing channels5 records

Core offering

Innovista Health Solutions is a value-based care management services organization that enables independent primary care physicians, IPAs, and ACOs to participate in payer risk arrangements. It delivers six integrated service modules—Care Management, Provider Enablement, Quality Performance & Improvement, Risk Adjustment, Performance Insights & Analytics, and ACO Enablement & Network Development—supported by an NCQA-aligned population health platform with multi-source data integration, risk stratification, and care coordination tools. The company also operates Innovista Medical Center, a network of 10 primary care clinics in Texas that provide direct patient care under the value-based model.

Product overview

Innovista Health Solutions is a complete value-based care enablement and management services organization offering a platform of integrated services. The core portfolio consists of six service modules: Care Management, Provider Enablement, Quality Performance & Improvement, Risk Adjustment, Performance Insights & Analytics, and ACO Enablement & Network Development. The company also operates Innovista Medical Center as a care delivery sub-brand with 10 primary care clinics in Texas. The three divisions are: Value-based Care (comprehensive enablement programs), Delegated Operations (claims processing, customer service, utilization management), and Care Delivery (Innovista Medical Center clinics).

Differentiator

Problem solved

Functional benefit

Brands

• Innovista Medical Center: Primary care clinics operating in Dallas and Houston, Texas, offering in-house labs, diagnostic imaging, referral services, and care coordination under the company's care delivery division.

Products and services

• Care Management
• Provider Enablement
• Quality Performance & Improvement
• Risk Adjustment
• Performance Insights & Analytics
• ACO Enablement & Network Development
• Innovista Medical Center

Quantifiable outcome

• $18.8M in annual value-based incentives delivered to physician partners through quality performance and shared savings programs
• +3 more outcomes

Named customers9 records

Segments3 records

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature5 records

Partnerships

15 partnerships are on record, tiered minor and core.

• United WayminorOthers
• Family PlaceminorOthers
• Grant Halliburton FoundationminorOthers
• Dallas Behavioral Healthcare HospitalminorOthers
• Austin Street CenterminorOthers
• Presbyterian Night ShelterminorOthers
• Safe Kids Greater DallasminorOthers
• Rotary ClubminorOthers
• Spectrum of LoveminorOthers
• Carter's HouseminorOthers
• Cardboard ProjectminorOthers
• Magellan HealthcoreTechnology or IntegrationMagellan Health provides mental health and behavioral health services integration, supporting Innovista's holistic care management model that addresses behavioral health as part of comprehensive population health.
• VITAS HealthcarecoreStrategic or Co-development PartnerVITAS Healthcare provides hospice and end-of-life care services, integrated into Innovista's post-acute care coordination network for patients requiring hospice services.
• Heart to Heart HospicecoreStrategic or Co-development PartnerHeart to Heart Hospice provides hospice care services as part of Innovista's post-acute care network, enabling seamless transitions for patients with advanced illness.
• Topcon HealthcarecoreTechnology or IntegrationTopcon provides diagnostic laboratory services including diagnostics and testing, integrated into Innovista's care coordination platform for clinical data sharing and order/results workflows.

Scale indicators6 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• Privia Health Group: Public VBC enablement platform serving independent physician practices and ACOs across multiple states. Operates an MSO model closely analogous to Innovista's, with single-specialty/multi-specialty provider enablement, payer contracts, and delegated services.
• Aledade: Largest independent ACO enablement company in the US, partnering with independent primary care practices for value-based contracts across Medicare, commercial, and Medicaid. Directly competes for the same independent PCP and ACO customer base.
• Agilon Health: Public VBC platform partnering with primary care physicians serving Medicare Advantage members. Operates a partnership model with independent PCPs and risk-bearing entities, mirroring Innovista's MSO structure for senior populations.
• Evolent Health: Public value-based care services company providing specialty care management, network performance, and ACO/MSO enablement. Overlaps with Innovista's delegated operations and population health management service lines for payer and provider customers.
• Astrana Health: Public VBC platform (formerly Apollo Medical Holdings) managing IPAs, ACOs, and delegated payer services across multiple states. Closely comparable business model to Innovista: independent physician network, delegated operations, and risk-bearing contracts.
• P3 Health Partners: Public value-based care company focused on Medicare Advantage populations, partnering with PCPs and IPAs to manage risk arrangements. Comparable MSO-style infrastructure and population health focus for senior populations.

Broad incumbents

• VillageMD: Primary care platform majority-owned by Walgreens Boots Alliance operating owned clinics and VBC arrangements across multiple states. Overlaps with Innovista's care delivery division and value-based contracting capabilities, but at much larger scale.
• Oak Street Health: Value-based primary care company acquired by CVS Health, operating owned clinics for Medicare beneficiaries. Directly comparable to Innovista's Medical Center concept, with deeper geographic reach and integrated pharmacy services through its CVS parent.

Emerging players

• Carelon Health (formerly CareMore Health): Integrated care delivery and VBC platform owned by Elevance Health, focused on complex and senior populations. Comparable to Innovista in being a payer-owned MSO/care delivery subsidiary, with a similar parent-payer structure to HCSC.

Others

• Centene Corporation: Major US health insurer (Medicaid, Medicare, ACA focus) with value-based care strategy across multiple states. Analogous to Innovista's parent HCSC as a payer-aligned owner of provider enablement and care delivery assets.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat5 records

Key risks6 records

Key highlights6 records

Customer concentration

• YouTubeyoutube.com/channel/UCDWEMUMrQjV0BMT4ApO-PGA?app=desktop
• LinkedInlinkedin.com/company/innovista-health-solutions

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles6 records

Subsidiaries1 record

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 Innovista Health Solutions