iMPROve Health

What iMPROve Health does

iMPROve Health, founded in 1984 as the Michigan Peer Review Organization (MPRO) and rebranded in 2024 to reflect its national footprint, is a 501(c)(3) nonprofit healthcare quality improvement organization headquartered in Grand Rapids, Michigan, and operating fully remotely with staff in 22 states. The company delivers an integrated portfolio of services across two core pillars: Quality Improvement (ACO quality measure education and reporting, cancer control, chronic disease management, mental health programs, and the Governor's Award of Excellence recognition program) and Review Services (utilization review, independent external review, peer review, long-term services and support determinations, Virtual CMO engagements, and dispute resolution including state IDR/IIDR and Federal Independent Dispute Resolution under the No Surprises Act). Its technology stack centers on proprietary web-based portals for IDR case management and a 400+ physician peer reviewer network that provides specialty-matched clinical assessments across nearly every medical and surgical specialty. The organization has maintained URAC accreditation as an Independent Review Organization since 2002, is certified as an Independent Dispute Resolution Entity under the No Surprises Act (IDREApp-151), and serves as Michigan's designated CMS Quality Improvement Organization.

The business model combines recurring government contract revenue (CMS Quality Innovation Network-QIO work via the Superior Health Quality Alliance covering six Midwest states, plus direct state health department contracts) with transaction-fee services (per-case IDR arbitration and peer review fees), subscription-style quality improvement engagements, and professional services (Virtual CMO contracts for small and critical access hospitals). The 2025-2030 CMS 13th Scope of Work contract anchors multi-year revenue predictability. Customers are predominantly government entities (CMS, VA, state Medicaid and health departments) with a secondary base of healthcare providers (hospitals, health plans, nursing facilities, physician groups) across 34 states. Pricing is quote-based and not publicly disclosed, with administrative fees per dispute case for Federal IDR work. The organization has grown to 90+ employees with approximately 24% headcount expansion in the most recent year and reports voluntary turnover of ~7% versus a 25% national average.

Name

iMPROve Health

Legal name

iMPROve Health

Website

https://improve.health

Company type

Private

Founded year

1984

Operating status

Operating

Headcount range

101–250 employees

Short description

iMPROve Health is a 501(c)(3) nonprofit healthcare quality improvement organization delivering independent medical review, CMS quality improvement, IDR arbitration, and Virtual CMO services to hospitals, health plans, and government agencies across 34 states.

Ownership category

akta.pro rank

Product category

Healthcare Quality Improvement Services

NAICS

Voluntary Health Organizations (813212), Social Assistance (624)

SIC

Services-Health Services (8000), Services-Misc Health & Allied Services, Nec (8090)

akta.pro primary industry

Health Systems Performance & Quality Measurement (Public Sector) (HLAJANAK)

akta.pro secondary industries

Community Health, Prevention & Health Education (BPAGACAC), Quality Measurement, Reporting & Benchmarking (HEDIS/Stars/CQM) (HLACAHAC), Health Systems Strengthening & Universal Health Coverage (UHC) Partnerships (HLAJAOAL)

Keywords

• Healthcare quality improvement
• Independent medical review
• Utilization review services
• Peer review services
• Healthcare dispute resolution

Headquarters

HQ city

Grand Rapids

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Quality Improvement Contracts: Government-funded contracts with CMS through Quality Innovation Network-QIO programs. Services include quality measure education, abstraction, reporting, and technical assistance to healthcare providers.
2. Independent Review Services: URAC-accredited independent review organization providing utilization reviews, external reviews, and peer reviews to hospitals, health plans, and state agencies. Revenue generated through per-case or contract fees.
3. Independent Dispute Resolution (No Surprises Act): Certified IDRE providing arbitration services for payment disputes between out-of-network providers and health plans under the No Surprises Act. Administrative fees charged per dispute.
4. Virtual CMO Services: Professional medical leadership services for small and critical access hospitals, with associated costs potentially offset by Medicare reimbursement formulas.

Pricing tiers

Go-to-market motion2 records

Distribution channels5 records

Marketing channels6 records

Core offering

iMPROve Health is a nonprofit healthcare quality improvement organization that provides independent medical and peer review services, utilization review, independent dispute resolution under the No Surprises Act and for state survey citations, and Virtual CMO leadership to hospitals, health plans, state agencies, and CMS quality improvement programs. Its services are delivered by a multidisciplinary staff and a 400+ physician peer reviewer network, supported by URAC accreditation since 2002.

Product overview

iMPROve Health is a nonprofit healthcare quality improvement organization offering an integrated portfolio of services built around independent review, quality improvement, and dispute resolution. The core product suite includes Review Services (Utilization Review, Independent External Review, Peer Review, and Long-term Services and Support), Dispute Resolution services (IDR/IIDR for state survey citations and Federal IDR under the No Surprises Act), and Virtual CMOTM for hospital medical leadership. Supporting the core are specialized Quality Improvement programs including Cancer Control, Mental Health, Chronic Disease Management, and ACO Quality Measure reporting. The Governor's Award of Excellence recognizes provider achievements. All services leverage the organization's URAC accreditation and network of 400+ clinical peer reviewers.

Differentiator

Problem solved

Functional benefit

Products and services

• Quality Improvement Comprehensive healthcare quality improvement services including ACO quality measure education, abstraction and reporting, cancer control programs, chronic disease management, mental health initiatives, and the Governor's Award of Excellence recognition program. Delivers evidence-based and data-driven solutions across the care continuum to healthcare providers and government agencies.
• Review Services URAC-accredited independent review services including Utilization Review (prospective, concurrent, and retrospective prior authorization reviews), Independent External Review (appeals of adverse determinations), Peer Review (same specialty-matched clinical peer reviewer evaluations), and Long-term Services and Support (Level of Care determinations for Medicaid beneficiaries). Serves hospitals, health plans, state agencies, and provider organizations.
• Virtual CMO Medical leadership services for small and critical access hospitals providing quality assurance reviews, Ongoing Professional Practice Evaluation (OPPE), denial management, and Emergency Treatment (EMTALA) compliance reviews. Delivers cost-effective professional services commonly associated with a fully staffed medical leadership team.
• Dispute Resolution (IDR/IIDR) Informal Dispute Resolution (IDR) and Independent Informal Dispute Resolution (IIDR) services for providers disputing federal and state citations following surveys. Conducts reviews for Skilled Nursing facilities, ICF/IID, Assisted Living Facilities, Hospice, and Home Health Agencies. Includes state-specific Texas IDR services through contract with Texas Health and Human Services Commission.
• Independent Dispute Resolution (No Surprises Act) Federally certified Independent Dispute Resolution Entity (IDRE) services under the No Surprises Act. Provides IDR case initiation and management, expert arbitrator assignment, comprehensive evidence evaluation, regulatory compliance oversight, and custom reporting for payment disputes between out-of-network providers and health plans, accessed via the Federal IDR Portal.

Quantifiable outcome

• 74.9% average Relative Improvement Rate across Governor's Award of Excellence program measures
• +5 more outcomes

Named customers6 records

Segments3 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature4 records

Partnerships

Eleven partnerships are on record, tiered core and minor.

• Superior Health Quality AlliancecoreStrategic or Co-development Partner · 30 June 2025iMPROve Health continues partnership with Superior Health Quality Alliance for CMS's 13th Scope of Work (SOW) as a Quality Innovation Network-QIO. This five-year contract (May 28, 2025–May 27, 2030) covers Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin. Superior Health is an eight-partner organization focused on improving care for Medicare beneficiaries.
• Michigan Health and Hospital Association (MHA) Keystone CentercoreStrategic or Co-development Partner · 12 September 2024Annual partnership to administer the Governor's Award of Excellence program recognizing Michigan healthcare providers for quality improvement achievements. The 2024 ceremony honored 96 facilities with 124 awards achieving a 74.9% Relative Improvement Rate.
• Civitas Networks for HealthcoreStrategic or Co-development Partner · 6 September 2024iMPROve Health joined Civitas Networks for Health, the largest national network of its kind with over 170 member organizations. Civitas focuses on health information exchange, health data, and multi-stakeholder approaches to improve health.
• Illinois Health and Hospital AssociationminorStrategic or Co-development Partner · 1 January 2022Partner in Superior Health Quality Alliance for CMS quality improvement efforts covering Illinois.
• MetaStarminorStrategic or Co-development Partner · 1 January 2022Partner in Superior Health Quality Alliance for CMS quality improvement efforts covering Wisconsin.
• Midwest Kidney NetworkminorStrategic or Co-development Partner · 1 January 2022Partner in Superior Health Quality Alliance focused on kidney disease quality improvement.
• Minnesota Hospital AssociationminorStrategic or Co-development Partner · 1 January 2022Partner in Superior Health Quality Alliance for CMS quality improvement efforts covering Minnesota.
• Stratis HealthminorStrategic or Co-development Partner · 1 January 2022Partner in Superior Health Quality Alliance for CMS quality improvement efforts covering Minnesota.
• Wisconsin Hospital AssociationminorStrategic or Co-development Partner · 1 January 2022Partner in Superior Health Quality Alliance for CMS quality improvement efforts covering Wisconsin.
• My Community Dental Centers (MCDC)minorStrategic or Co-development Partner · 1 January 2021Partnership with statewide dental clinic network (34 sites) to address the link between hypertension and oral health. iMPROve Health provided train-the-trainer presentations and resources for blood pressure screening in dental settings.
• Department of Veterans Affairs (VA)coreStrategic or Co-development Partner · 1 January 2019Multi-million dollar peer review contract awarded in 2019 for specialty clinical peer reviews. iMPROve Health conducts reviews on more than 100 patient-care cases monthly using VA's Electronic Health Record system.

Scale indicators8 records

Recent moves6 records

Expansion highlights6 records

Direct peers

• MetaStar: Wisconsin-based QIO serving as a Superior Health Quality Alliance partner. Peer to iMPROve Health in CMS QIN-QIO service delivery and external quality review.
• Comagine Health: QIO formed from the merger of Oregon Health Care Quality Corp and Acumentra Health, providing QI consulting, utilization review, and external quality review. Direct peer in multi-state QIO work.
• Stratis Health: Minnesota-based QIO and Superior Health Quality Alliance partner. Directly comparable to iMPROve Health's regional QI work and a fellow SHQA alliance member.
• Telligen: Multi-state QIO providing CMS quality improvement, utilization management, and population health services across several states. Directly comparable to iMPROve Health's CMS QIN-QIO work.
• atom Alliance: Multi-state QIO providing quality improvement services across CMS regions. Direct peer in the QIN-QIO landscape serving providers on quality measure reporting and improvement.
• Health Services Advisory Group (HSAG): QIO providing CMS quality improvement contracts, external quality review, and analytics for Medicaid and Medicare. Comparable QIO operating model to iMPROve Health.
• Alliant Health Solutions: QIO serving multiple CMS regions with quality improvement, utilization review, and patient safety services. Directly comparable peer in the QIN-QIO ecosystem.
• KEPRO: Healthcare quality management and utilization review organization serving government and commercial clients. Competes with iMPROve Health in independent medical review and peer review services.
• IPRO: One of the largest national QIOs, providing utilization review, peer review, and quality improvement services across multiple CMS contracts. Most direct competitor to iMPROve Health in the QIO space.

Broad incumbents

• Superior Health Quality Alliance: Eight-partner QIN-QIO alliance through which iMPROve Health delivers CMS work across six states. Functions both as a partnership channel and a broader industry peer in the QIO ecosystem.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/iMPROveHealthMI
• LinkedInlinkedin.com/company/improvehealth

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles6 records

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 iMPROve Health