Hines & Associates

What Hines & Associates does

Hines & Associates, Inc. is a US-based managed healthcare services company founded in 1987 by Registered Nurse Judy Hines and headquartered in Elgin, Illinois, with additional offices in West Dundee and St. Charles, Illinois, and ten other locations nationwide (11 offices as of November 2022, including Cedar Rapids, Iowa). The company delivers an integrated suite of healthcare management services organized around the OpusOne platform, which spans Payer (consultation, analytics, plan design, network development), Preventative (Maternity Management, Healthy Tomorrows wellness, predictive modeling, Optimal Health by Hines), Pre-Treatment (Utilization Management, StandbyMD directional care, Concierge Services, Medical Second Opinion), Treatment (Behavioral Health, Specialized Case Management, Nurse Consultation, Upfront Negotiations), and Post-Treatment (First Level Negotiations, Primary Network Access, Out-of-Network Solutions, Complex Claims Management, Reporting). The technology stack combines predictive analytics on claims, pharmacy, lab, and biometric data with licensed clinical workflows, an AI-driven member direction platform (StandbyMD), and a wearable-enabled wellness offering via the all.health partnership.

Name

Hines & Associates

Legal name

Hines & Associates, Inc.

Website

https://hinesassoc.com

Company type

Private

Founded year

1987

Operating status

Operating

Headcount range

101–250 employees

Short description

Hines & Associates is a URAC-accredited managed healthcare services firm providing utilization management, case management, cost containment, and wellness solutions to self-funded employers, TPAs, brokers, and stop-loss carriers across 11 US office locations.

Ownership category

akta.pro rank

Product category

Managed Healthcare Services

NAICS

Other Ambulatory Health Care Services (6219), Offices of Other Health Practitioners (6213)

SIC

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

akta.pro primary industry

Provider Network, Credentialing & Contracting Support (BPAAAFAI)

Keywords

• Managed healthcare services
• Utilization management
• Case management services
• Cost containment solutions
• Self-funded health plans

Headquarters

HQ city

Elgin

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. Healthcare Management Services: Hines generates revenue by providing comprehensive healthcare management services to self-funded employer plans, TPAs, and brokers. Services include Utilization Review, Case Management, Disease Management, Wellness Programs, and Cost Containment. These are likely billed as recurring managed services or per-engagement fees based on the scope of services provided to client health plans.
2. À La Carte Service Offerings: Hines offers services both as a complete bundled suite or à la carte, allowing TPAs to purchase specific components (UR only, CM only, DM only) based on client needs. This flexible pricing model allows tiered engagement based on employer group size and requirements.

Pricing tiers

Go-to-market motion3 records

Distribution channels4 records

Marketing channels5 records

Core offering

Hines & Associates is a nationwide managed healthcare services company that delivers utilization management, specialized case management, disease and wellness programs, maternity management, behavioral health services, and multi-level cost containment (including negotiations, Complex Claims Management, and Out-of-Network Solutions) to self-funded employer health plans, Third Party Administrators (TPAs), insurance brokers/consultants, Taft-Hartley Funds, and MGU/Stop Loss/Reinsurance Carriers. Services are delivered through the integrated OpusOne™ platform or as à la carte modules across the pre-treatment, treatment, and post-treatment stages of the patient journey. The company pairs licensed clinical staff (RNs, certified coders, in-house legal counsel) with predictive analytics and a 40+ negotiator team averaging 12+ years of tenure.

Product overview

Hines & Associates operates as a managed healthcare services company offering an integrated portfolio of solutions primarily organized around the OpusOne™ platform, which bundles Care, Cost and Risk Management services. The core product suite spans five solution categories aligned to the patient journey: Payer (consultation, analytics, plan design, marketing, network development), Preventative (Maternity Management, Wellness/Chronic Condition Management via Healthy Tomorrows™, Predictive Modeling, Optimal Health by Hines powered by all.health wearables), Pre-Treatment (Utilization Management, Directional Care via StandbyMD™, Concierge Services, Medical Second Opinion), Treatment (Behavioral/Mental Health, Specialized Case Management, Nurse Consultation, Upfront Negotiations), and Post-Treatment (Negotiations, Complex Claims Management, Out-of-Network Solutions, Primary Network Access, Reporting). The company emphasizes its 38+ years of experience, URAC accreditation, and hybrid approach combining data analytics with human clinical expertise.

Differentiator

Problem solved

Functional benefit

Brands

• OpusOne: Integrated Care, Cost and Risk Management bundled package that returns control of healthcare back to the patient and the plan.
• Healthy Tomorrows™
• BABE Program
• StandbyMD™

Products and services

• OpusOne™

Quantifiable outcome

• Reduced hospital admissions by up to 30% in high-risk populations through structured chronic disease management programs
• +4 more outcomes

Named customers6 records

Segments5 records

Ideal customer profiles5 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability5 records

Feature5 records

Partnerships

Two partnerships are on record, tiered core and strategic.

• all.healthcoreTechnology or Integration · 1 April 2026Partnership with all.health powers the Optimal Health by Hines / Healthy Tomorrows wellness platform with wearable-enabled data tracking for activity, heart rate, sleep patterns, and vital health signals. This continuous data flow allows Hines clinicians to detect early signs of risk factors, tailor customized health plans, support sustainable behavior change, and monitor progress with real-time adjustments.
• WLT SoftwarestrategicTechnology or IntegrationStrategic partnership announced July 8, 2025 to deliver integrated care and cost solutions. WLT Software provides technology integration enabling Hines to offer enhanced solutions to TPAs and self-funded employer clients.

Scale indicators6 records

Recent moves7 records

Expansion highlights6 records

Direct peers

• GENEX Services: Provides medical case management, utilization review, and return-to-work services to workers' comp, auto, and group health payers; competes directly with Hines' Specialized Case Management and Utilization Management service lines.
• Lucent Health: Provides self-funded health plan administration with integrated care management, cost containment, and population health solutions for mid-market and large employers — directly comparable to Hines' OpusOne service bundle for self-funded plans.
• The Phia Group: Provides cost containment, provider negotiation, and plan management services specifically for self-funded employer health plans, Taft-Hartley funds, and stop-loss carriers — directly comparable to Hines' OpusOne cost containment and OON solutions. The Phia Group was even featured as a podcast guest on Hines' own Hinesight show, underscoring the close competitive overlap.
• Imagine360: Vendor-neutral, reference-based pricing administrator for self-funded employer health plans, combining cost containment with care management services — directly comparable to Hines' OON Solutions and bundled OpusOne model.
• HealthScope Benefits: TPA and cost containment specialist for self-funded employer plans and labor unions, offering reference-based pricing, OON negotiations, and clinical management — closely aligned with Hines' Taft-Hartley and self-funded employer focus.

Broad incumbents

• Zelis: Healthcare cost management and network provider offering claims cost containment, network solutions, and integrated payments to payers and self-funded employers — overlapping with Hines' post-treatment negotiations and OON capabilities.
• Evernorth (Cigna): Cigna's health services portfolio offering utilization management, case management, behavioral health, and specialty care management to payers and employers — overlapping with Hines' full care continuum but as part of a much broader vertically integrated stack.
• Sun Life U.S. (Stop-Loss and Health Solutions): Major stop-loss carrier and benefits provider that integrates care management and cost containment services for self-funded plans, including MGU capabilities — comparable to Hines' work with MGU/Stop Loss/Reinsurance carrier clients.
• Sedgwick: Major managed care and care management services provider serving employers, insurers, and TPAs with utilization review, case management, and disability management — overlapping substantially with Hines' full-suite OpusOne model but at much larger scale.
• MultiPlan: Large-scale provider of PPO networks, OON cost containment, and claim cost management services for payers and self-funded plans; competes with Hines' OON Solutions and primary network access offerings, though at significantly greater scale and broader scope.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/hines-associates-inc

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 Hines & Associates