The Mihalik Group

What The Mihalik Group does

The Mihalik Group (TMG) is a privately held, Chicago-based healthcare consultancy founded in 1994 that specializes in NCQA, URAC, and Joint Commission accreditation support, quality improvement, and regulatory compliance for health plans, provider groups, and vendors. The firm operates a vertically segmented go-to-market across three core buyer categories — Health Plans, Provider Groups, and Vendors/Delegated Entities (including MBHOs) — offering accreditation expertise, operational consulting, HEDIS/CAHPS/Star Ratings improvement, training, experience surveys, and data integration solutions.

TMG's technology stack centers on three NCQA-certified proprietary products: Zenith HEDIS Certified Analytics (a certified analytics engine for clinical quality measurement with monthly benchmarking and gaps-in-care reporting), HCC and HEDIS Retrieval and Abstraction Services (medical record retrieval and abstraction using coders and supporting technology), and Health Check 20|20 (a proprietary member health appraisal tool). These products complement a primarily professional-services revenue model delivered through quote-based, customized consulting engagements by a team that includes former NCQA surveyors, former Joint Commission surveyors and faculty, and senior healthcare quality leaders drawn from Elevance, Cambia, Community Health Plan of Washington, NCQA itself, AmeriHealth Caritas, and Centene.

TMG's business model is a hybrid of professional services and recurring/certified software. Revenue is generated through direct enterprise consulting engagements, with pricing determined per engagement rather than via public list pricing. The firm markets through an educational webinar program and content library covering HEDIS, Stars, NCQA standards, Health Equity, TJC, and AI topics, using these as top-of-funnel demand generation to enterprise healthcare buyers. Operating for 30+ years with 11-50 employees and no disclosed outside funding rounds, TMG maintains a boutique, self-funded posture with decades of accumulated regulatory expertise as its primary differentiator.

Name

The Mihalik Group

Website

https://themihalikgroup.com

Company type

Private

Founded year

1994

Operating status

Operating

Headcount range

11–50 employees

Short description

The Mihalik Group is a privately held, Chicago-based healthcare consultancy founded in 1994 that provides NCQA, URAC, and Joint Commission accreditation support, NCQA-certified analytics software, and quality improvement services to enterprise health plans, provider groups, and vendors.

Ownership category

akta.pro rank

Headquarters

HQ city

Chicago

HQ country

United States

HQ region

North America

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Healthcare Consulting Services: Professional consulting services for healthcare organizations seeking NCQA, URAC, and The Joint Commission accreditation. Services include readiness assessments, roadmap development, compliance support, and operational streamlining delivered by expert consultants.

Go-to-market motion1 record

Distribution channels1 record

Marketing channels2 records

Core offering

The Mihalik Group is a healthcare consultancy and software firm that helps health plans, provider groups, and healthcare vendors achieve and maintain regulatory accreditation (NCQA, URAC, The Joint Commission) and improve quality performance across HEDIS, CAHPS, and Medicare Star Ratings. Its offerings combine senior-advisor consulting engagements with proprietary NCQA-certified software products, including the Zenith HEDIS Certified Analytics engine, HCC/HEDIS record retrieval and abstraction services, the Health Check 20|20 health appraisal tool, and complementary data integration and member survey solutions.

Product overview

The Mihalik Group is a specialized healthcare consultancy offering a portfolio of services organized around five core areas: Accreditation (NCQA, URAC, and The Joint Commission), NCQA Certified Products (Zenith HEDIS Certified Analytics, HCC and HEDIS Retrieval and Abstraction, and Health Check 20|20), Data Integration (EMR/HIE feeds, HL7 conversion, ECDS enablement), Quality Improvement (HEDIS, CAHPS, and Star Ratings optimization), and Training programs. The company's proprietary NCQA-certified products—Zenith analytics software, record retrieval/abstraction services, and health appraisal tools—complement their consulting services to deliver comprehensive quality and compliance solutions for health plans, providers, and vendors.

Differentiator

Problem solved

Functional benefit

Brands

• Zenith HEDIS Certified Analytics: A Certified HEDIS Analytics Engine that enables payers and providers to track, improve, and report clinical quality outcomes.
• HCC and HEDIS Retrieval and Abstraction
• Health Check 2020

Products and services

• Accreditation Expertise Services Comprehensive accreditation consulting that supports healthcare organizations across NCQA and URAC standards, including readiness assessments, roadmap development, and ongoing support for compliance and lasting quality. Targeted at health plans, providers, and vendors seeking accreditation success.
• The Joint Commission (TJC) Consulting Expert consulting for Joint Commission accreditation including staff education, mock surveys, environment of care and life safety services, and life safety drawing creation. Targeted at hospitals, behavioral health organizations, and VA/Military medical facilities pursuing Joint Commission accreditation.
• Quality Improvement Services End-to-end quality improvement support for HEDIS, CAHPS, and Medicare Star Ratings including member engagement programs, provider engagement programs, and predictive analytics for population health interventions. Targeted at health plans seeking to improve quality scores and member outcomes.
• Data Integration Solutions Strategic data solutions including EMR/HIE feeds, HL7 conversion for ECDS measures, and integration of data from multiple sources into unified platforms with actionable reporting. Targeted at health plans and providers requiring integrated clinical and quality data for reporting.
• Experience Surveys Customized member and practitioner satisfaction surveys that assess service delivery, care coordination, and accessibility, enabling precise interventions and strategic improvements. Targeted at health plans measuring CAHPS, member, and practitioner experience.
• Operational Consulting Organizational capability enhancement through evaluation of data and operational structure, covering operational excellence, value-based care, provider network management, and regulatory compliance. Targeted at health plans seeking operational transformation.
• Training and Education Programs Customized training programs for health plans and health systems covering NCQA standards, HEDIS, CAHPS, Star Ratings, and quality measures, tailored to organizational needs. Targeted at healthcare organizations building internal accreditation and quality capability.
• Zenith HEDIS Certified Analytics An NCQA-certified HEDIS analytics engine that enables payers and providers to track, improve, and report clinical quality outcomes with monthly benchmarking, provider feedback reports, gaps-in-care reporting, actionable insights, and certified HEDIS reporting. Targeted at health plans and providers requiring NCQA-certified quality measurement.
• HCC and HEDIS Retrieval and Abstraction Medical record retrieval and abstraction services for HEDIS, HCC, and RADV projects across Medicare, Medicaid, and Commercial health plans, delivered by experienced coders using technology-enabled workflows. Targeted at health plans requiring outsourced record retrieval and clinical abstraction for quality and risk-adjustment reporting.
• Health Check 20|20 A proprietary, secure, online health appraisal tool that helps members evaluate their current health, lifestyle, and family history and provides personalized recommendations for healthier living. Targeted at health plans offering members an NCQA-certified self-assessment resource.
• Provider Network Accreditation NCQA provider network accreditation consulting that ensures appropriate client agreements, provider credential verification, quality evaluation, and timely access to appointments. Targeted at provider organizations seeking NCQA provider network accreditation.
• Credentialing Accreditation Provider credentialing accreditation support to verify qualifications of licensed medical professionals and ensure safe, effective care delivery. Targeted at healthcare organizations pursuing NCQA credentialing accreditation.
• Utilization Management Accreditation NCQA utilization management accreditation support that helps organizations implement evidence-based criteria for fair, timely, and clinically sound determinations. Targeted at health plans, MBHOs, and delegated UM entities seeking NCQA UM accreditation.
• MBHO Accreditation Managed Behavioral Health Organization accreditation support across the full range of activities to strengthen quality and operational performance. Targeted at MBHOs and behavioral health vendors pursuing NCQA MBHO accreditation.
• LTSS/CM Accreditation Long-Term Services and Supports and Case Management accreditation consulting for efficient, cost-effective patient care and seamless transitions across care settings. Targeted at health plans and care management organizations pursuing NCQA LTSS/CM accreditation.

Quantifiable outcome

• Higher quality scores across HEDIS, CAHPS, and Star Ratings
• +2 more outcomes

Named customers5 records

Segments3 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Scale indicators2 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• Pershing Yoakley & Associates (PYA): Healthcare-focused consulting and accounting firm providing NCQA, URAC, and Joint Commission accreditation support, quality improvement, and HEDIS consulting. Closely mirrors TMG's payer-provider accreditation advisory model and serves a comparable mid-size health plan customer base.
• The Chartis Group: Healthcare consulting firm advising providers, payers, and systems on strategy, population health, and quality performance. Overlaps with TMG on health plan quality improvement, accreditation advisory, and operational consulting engagements.
• BDC Advisors: Healthcare strategic consulting firm advising health systems, health plans, and providers on strategy, operations, and value-based care. Comparable in scale, advisory focus, and payer/provider client mix to TMG's consulting practice.
• The Lewin Group: Healthcare policy and management consulting practice advising federal, state, and commercial clients on quality, payment, and delivery-system reform. Comparable to TMG on health plan regulatory, quality policy, and accreditation-related work.
• Sellers Dorsey: Healthcare consulting firm focused on Medicaid, Medicare, and value-based care transformation for plans, providers, and states. Competes with TMG on Medicaid health plan accreditation readiness, quality improvement, and operational consulting engagements.

Broad incumbents

• Inovalon: Cloud-based healthcare data analytics platform offering quality measurement, risk adjustment, and compliance solutions to payers and providers. Overlaps with TMG's HEDIS analytics, HCC abstraction, and survey offerings as a much larger technology-enabled incumbent in the same buyer workflows.
• Cotiviti: Large-scale healthcare analytics and payment-accuracy platform serving payers and providers with HEDIS, HCC/RADV, and quality-measurement solutions. Competes directly with TMG's Zenith HEDIS Analytics and HCC/HEDIS abstraction services at meaningfully greater technology scale and customer footprint.

Others

• Mathematica Policy Research: Independent research and analytics firm conducting health policy, quality measurement, and program evaluation work for federal and state agencies. Adjacent to TMG through shared quality and compliance measurement expertise, though operating in a research rather than implementation/consulting model.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat5 records

Key risks5 records

Key highlights6 records

Customer concentration

Revenue estimate

Valuation estimate

Number of profiles

Profiles12 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 The Mihalik Group