KFMC

What KFMC does

KFMC (legally Kansas Foundation for Medical Care, Inc., operating as KFMC Health Improvement Partners) is a Topeka, Kansas-based not-for-profit healthcare quality improvement organization founded in 1972. It delivers four core service lines: Quality & Performance Improvement, Practice Transformation, Health Services & Clinical Care Review, and Advisory & Consulting Services. KFMC holds federally and state-designated status as both a Quality Improvement Organization (QIO) and External Quality Review Organization (EQRO), providing independent utilization review, clinical care review, peer review, and quality measurement services primarily to state Medicaid agencies and healthcare providers. Its technology stack centers on data collection, analysis, and validation tools including an Online Data Collection Tool, a MIPS Calculator, and Health Information Exchange support services, supplemented by a Kiteworks Managed File Transfer system for secure document exchange. The organization maintains a URAC Independent Review Organization accreditation, DirectTrust Privacy and Security accreditation, SOC 2 Type 2 compliance, and HIPAA-aligned operations. KFMC was selected as a CMS NQIIC Prime awardee in 2019 and, in April 2021, was awarded both the EQRO and QIO contracts by the Oklahoma HealthCare Authority (with OFMQ subcontracted for inpatient/outpatient reviews), marking its first major expansion outside Kansas.

KFMC generates revenue through two primary streams: multi-year managed-services government contracts (QIO/EQRO work for state Medicaid programs in Kansas since 1995 and Oklahoma since 2021) and professional services engagements (fee-for-service and retainer-based consulting, including the Primary Care First Practice Support offering launched in 2021, billed as a fixed annual fee or hourly rate). Its go-to-market is enterprise field sales directed at healthcare providers, state agencies, and federal partners, supported by an ecosystem of strategic partnerships with the Kansas Healthcare Collaborative, Kansas Department of Health and Environment, Civitas Networks for Health, NAIRO, and the Immunize Kansas Coalition. The organization serves hospitals, nursing homes, physician practices, ambulatory surgical centers, state Medicaid agencies, federal health agencies, and community health organizations across the Midwest and, increasingly, nationwide.

Name

KFMC

Legal name

Kansas Foundation for Medical Care

Website

https://kfmc.org

Company type

Private

Founded year

1972

Operating status

Operating

Headcount range

101–250 employees

Short description

KFMC is a Kansas-based not-for-profit healthcare quality improvement organization providing QIO/EQRO services, clinical care review, practice transformation, and consulting to state Medicaid agencies, hospitals, and physician practices across the Midwest.

Ownership category

akta.pro rank

Product category

Healthcare Quality Improvement Services

NAICS

Management Consulting Services (54161), Other Management Consulting Services (541618)

SIC

Services-Management Consulting Services (8742), Services-Misc Health & Allied Services, Nec (8090)

akta.pro primary industry

Public Health Reporting, Dashboards & KPI Performance Management (HLAJANAO)

akta.pro secondary industries

Dashboarding & KPI/Performance Management (HDAEAMAF), Quality Management Systems (QMS) & GxP Documentation (HLAGAKAD)

Keywords

• Healthcare quality improvement
• Clinical care review
• Practice transformation
• External quality review
• Healthcare consulting services

Headquarters

HQ city

Topeka

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Government Contracts (QIO/EQRO): KFMC serves as Quality Improvement Organization (QIO) and External Quality Review Organization (EQRO) for state agencies, providing independent quality review, utilization review, and clinical care evaluation services under multi-year government contracts.
2. Advisory & Consulting Services: Fee-for-service or retainer-based consulting services provided to healthcare organizations including security risk assessments, infection prevention consulting, practice transformation support, and program evaluations.
3. Primary Care First Practice Support: Direct-to-provider consulting solution for PCF participating practices, billed as fixed annual fee or hourly rates.

Pricing tiers

Go-to-market motion1 record

Distribution channels3 records

Marketing channels8 records

Core offering

KFMC delivers healthcare quality improvement, practice transformation, clinical care review, and advisory consulting services to hospitals, nursing homes, physician practices, state Medicaid agencies, and community health organizations. Core offerings include Quality & Performance Improvement, Practice Transformation, Health Services & Clinical Care Review, and Advisory & Consulting Services, delivered as fee-for-service consulting, retainer engagements, and contracted QIO/EQRO programs. Supporting offerings include Peer Reviewer Program, HIE support services, and tools such as the MIPS Calculator.

Product overview

KFMC (Kansas Foundation for Medical Care) operates as a not-for-profit healthcare quality improvement organization offering a portfolio of professional services rather than a unified software product. The core offerings include four main service lines: Quality & Performance Improvement, Practice Transformation, Health Services & Clinical Care Review, and Advisory & Consulting Services. These services are delivered through consulting engagements, contracted state programs (EQRO and QIO), training programs (Project Firstline), and resource platforms (Health Equity Resource Hub). Supporting tools include the MIPS Calculator for quality payment programs and Health Information Exchange support services. KFMC transitioned from a grant-giving foundation to a performance improvement partner, with a new brand identity adopted in 2021.

Differentiator

Problem solved

Functional benefit

Products and services

• Quality & Performance Improvement Expertise across all provider types facilitating clinical improvement, performance measurement, data collection, analysis and validation, population health management, and community engagement for healthcare providers and organizations.
• Practice Transformation Data-driven initiatives helping health organizations strategically transition to value-based care, introduce alternative care models, achieve greater interoperability, and mitigate data security risks.
• Health Services & Clinical Care Review Credentialed professionals provide independent review of health care information to ensure consumer access to timely, quality care and help states and health organizations transform their care delivery systems.
• Advisory & Consulting Services Consulting services for quality improvements, program evaluations, health data analytics, clinical care initiatives, and health information technology, delivered on fee-for-service or retainer basis.
• Primary Care First Practice Support Direct-to-provider, fee-for-service consulting solution for practices participating in the Primary Care First model, available as a fixed annual fee or hourly billing engagement.
• External Quality Review Organization (EQRO) Services Analysis and evaluation of aggregated information on quality, timeliness, and access to healthcare services for managed care organizations and state Medicaid programs.
• Quality Improvement Organization (QIO) Services Independent and objective post-payment utilization review of inpatient stays and outpatient observation services for state healthcare authorities.
• Peer Reviewer Program Provider peer review process for medical staff at healthcare facilities, including physician reviewers and healthcare professionals other than physicians.
• Health Information Exchange (HIE) Support Services Assistance connecting to Health Information Exchanges and optimizing HIE connections, including workflow development and data integration for patient care.
• Project Firstline Infection Prevention Training Facilitated infection prevention training program developed by CDC, provided as virtual and in-person sessions for healthcare workers in communal living settings.

Quantifiable outcome

• Helped over 1,600 Kansas providers implement Health Information Technology
• +2 more outcomes

Named customers6 records

Segments6 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Partnerships

Seven partnerships are on record, tiered core and minor.

• Kansas Healthcare Collaborative (KHC)coreStrategic or Co-development Partner · 7 December 2023KHC and KFMC partnered to bid on the CMS Quality Innovation Network-Quality Improvement Organization (QIN-QIO) 13th Scope of Work in Kansas. The organizations have a long history of co-hosting events including the annual Summit on Quality and Kansas Health Impact Conference.
• Oklahoma Foundation for Medical Quality (OFMQ)coreStrategic or Co-development Partner · 1 April 2021KFMC subcontracts with OFMQ for the Oklahoma EQRO and QIO contracts. While KFMC provides most EQRO services and oversight of utilization review, OFMQ is primarily responsible for Inpatient, Outpatient, and payment reviews. OFMQ brings extensive clinical care review and quality improvement experience from their Oklahoma healthcare delivery environment expertise.
• Civitas Networks for HealthcoreOthersNational collaborative of over 160 member organizations dedicated to advancing health improvement through data sharing, collaboration, and innovation. KFMC's President and CEO Sarah Irsik-Good was elected to the Civitas Networks for Health 2026 Board of Directors.
• NAIRO (National Association of Independent Review Organizations)coreOthersNational association for independent review organizations. KFMC maintains URAC accreditation as an Independent Review Organization.
• Kansas Department of Health and Environment (KDHE)coreStrategic or Co-development PartnerKFMC partners with KDHE on multiple initiatives including the Healthcare-Associated Infections & Antimicrobial Resistance Program, Project Firstline infection prevention training, and Rapid Response Staffing Support Center funded through KDHE's Epidemiology and Laboratory Capacity Cooperative Agreement.
• Kansas Health MattersminorOthersHealth data resource providing community health needs assessment data and health equity information for Kansas communities.
• Immunize Kansas CoalitionminorOthersCoalition focused on immunization improvement across Kansas. KFMC collaborated with the coalition on toolkit development for adult immunizations.

Scale indicators6 records

Recent moves7 records

Expansion highlights6 records

Direct peers

• MetaStar: Wisconsin's QIO providing external quality review, utilization review, and healthcare quality improvement consulting. MetaStar is closely comparable as a state-anchored EQRO/QIO of similar scale to KFMC.
• Health Services Advisory Group (HSAG): One of the largest US QIOs/EQROs, holding contracts in numerous states. HSAG is the most direct competitor to KFMC in the EQRO and QIO space, delivering nearly identical quality review, utilization review, and external quality review services to state Medicaid agencies.
• Stratis Health: Minnesota-based QIO offering quality improvement, EQRO, and clinical review services. Comparable in mission, customer base (state agencies, providers, nursing homes), and service mix to KFMC, with similar regional scale.
• IPRO: Long-standing QIO serving multiple states including New York, Ohio, and others. IPRO provides the same combination of QIO, EQRO, and clinical peer review services as KFMC and competes head-to-head for state Medicaid quality review contracts.
• QSource: Tennessee's EQRO delivering external quality review, utilization management, and quality improvement consulting to TennCare. Directly comparable to KFMC's Kansas EQRO role in service model and customer type.
• Health Quality Innovators (HQI): QIN-QIO for Virginia and Maryland with EQRO and practice transformation services. HQI competes in the same CMS program structures as KFMC and targets overlapping hospital, physician practice, and community health customers.
• Telligen (formerly Iowa Foundation for Medical Care): Telligen is a QIN-QIO prime contractor and EQRO that, like KFMC, evolved from a state medical foundation. It offers quality improvement, clinical care review, and health IT services with overlapping customer profile of state agencies and providers.

Broad incumbents

• Health Management Associates: National healthcare policy and consulting firm serving state agencies, health plans, and providers on Medicaid, value-based care, and quality programs. While broader in scope, HMA is a comparable buyer-side competitor for state Medicaid consulting mandates.
• Premier Healthcare Solutions: Large healthcare improvement company offering performance improvement, quality measurement, and supply chain services to hospitals and providers. Premier is a broader incumbent that competes with KFMC on provider-facing practice transformation and quality improvement mandates.

Others

• Mathematica Policy Research: Independent research and consulting firm doing program evaluation, quality measurement, and CMS contract work. Comparable as an evaluator/researcher supporting CMS quality programs, but operates in a different organizational form (for-profit).

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

• YouTubeyoutube.com/channel/UCdZB_pzJztvv2_XjxzIJAHQ
• Facebookfacebook.com/KFMC.org
• LinkedInlinkedin.com/company/kansas-foundation-for-medical-care
• Xx.com/_kfmc

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 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 KFMC