iCare Health Solutions

What iCare Health Solutions does

iCare Health Solutions, LLC is an integrated specialty network and third-party administrator of comprehensive ocular care services, headquartered in Tampa, Florida and operating as a wholly-owned subsidiary of VSP Vision Care since November 2021. Founded in 1984 by Sidney J. Stern, OD, the company contracts with Medicare Advantage, Medicaid, and dual-eligible health plans across Florida to deliver network management, utilization management, HEDIS diabetic retinal outreach, MSO services, and full administrative services (TPA) including claims processing, EDI transmissions, and provider credentialing. It serves a roster of more than 11 named health plan partners — including Aetna, Humana, United Healthcare Medica, Florida Blue, Molina, Optum, CarePlus, Coventry, and AvMed — covering 3 million+ managed members through 3,600+ contracted optometry and ophthalmology provider locations, 37+ MSO partnerships, three owned ambulatory surgery centers, and 56 Optical Outlets retail locations acquired in August 2023.

The company's technology stack centers on the eHealthDeck provider portal, a HIPAA-compliant diagnostic interpretation portal for teleretinal imaging, and a proprietary iCare clinical criteria system developed with board-certified sub-specialists. Its teleretinal screening program uses non-mydriatic fundus cameras to capture diabetic retinal images in primary care offices, clinics, health fairs, and member residences, with images uploaded for provider review via the diagnostic portal. The company holds NCQA Utilization Management Accreditation (2023, reaccredited March 2026), HITRUST Risk-based 2-year (r2) certification (November 2023), and full HIPAA compliance, and has helped five Florida Medicare Advantage plans earn CMS Five-Star ratings for the HEDIS Diabetic Retinal Exam measure in 2019 and 2020.

Revenue is generated through B2B managed services contracts with health plans — typically multi-year, fee-for-service or per-member-per-month arrangements covering network management, HEDIS outreach, UM, and TPA — supplemented by retail revenue from Optical Outlets and surgical revenue from the three owned ambulatory surgery centers in South Florida. Pricing is contracted individually with health plan partners and not publicly disclosed. The company is led by CEO Lee Stern, with a leadership team that includes a Chief Medical Officer, Chief Compliance Officer, and Chief Business Development Officer responsible for government-market managed care partnerships nationwide, indicating organizational intent to extend beyond its current Florida-only footprint under the VSP Vision Care umbrella.

Name

iCare Health Solutions

Legal name

iCare Health Solutions, LLC

Website

https://myicarehealth.com

Company type

Private

Founded year

1984

Operating status

Operating

Headcount range

501–1,000 employees

Short description

iCare Health Solutions, a VSP Vision Care subsidiary, is a Florida-based integrated eye care specialty network and third-party administrator serving Medicare Advantage, Medicaid, and dual-eligible health plans through 3,600+ providers, 56 retail locations, and HEDIS, UM, and TPA services.

Ownership category

akta.pro rank

Product category

Managed Ocular Health Services

NAICS

Offices of Optometrists (62132), Offices of All Other Health Practitioners (62139)

SIC

Ophthalmic Goods (3851), Services-Offices & Clinics Of Doctors Of Medicine (8011), Services-Specialty Outpatient Facilities, Nec (8093)

akta.pro primary industry

Ophthalmology & Vision Telemedicine Platforms (HLALAGAL)

akta.pro secondary industry

Virtual Specialty Care Platforms (tele-stroke, tele-ICU, tele-derm, tele-cardiology) (HLALABAD)

Keywords

• Ocular health management
• HEDIS outreach programs
• Utilization management services
• Third-party administration
• Vision care network management

Headquarters

HQ city

Miami

HQ country

United States

HQ region

North America

Offices3 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Third-Party Administration (TPA) Services: iCare provides comprehensive TPA services including claims processing, utilization management, compliance and delegation, customer care, EDI transmissions, membership management, and provider contracting to health plans on a fee-for-service or per-member-per-month basis.
2. Network Management Fees: Revenue generated from managing provider networks on behalf of health plans, including credentialing, contracting, and ongoing network maintenance for optometrists and ophthalmologists across Florida.
3. HEDIS Outreach and Diabetic Retinal Screening Programs: HEDIS diabetic retinal exam outreach and screening services provided to health plan partners to improve Star ratings and compliance measures, with no cost to contracted health plan members.
4. Utilization Management Services: Ophthalmologic utilization management services including prior authorization, medical review by sub-specialized ophthalmologists, and coverage criteria development, sold as a turnkey solution to health plans.

Pricing tiers

Go-to-market motion1 record

Distribution channels5 records

Marketing channels5 records

Core offering

iCare Health Solutions is an integrated specialty network and third-party administrator of comprehensive ocular care services for health plans serving Medicare Advantage, Medicaid, and dual-eligible populations. The company sells Network Management, HEDIS Diabetic Retinal Outreach Programs, NCQA-accredited Utilization Management, Administrative Services (TPA), and MSO Services to health plans, MSOs, and provider groups through contracted B2B relationships supported by its proprietary eHealthDeck provider portal and HIPAA-compliant teleretinal diagnostic platform.

Product overview

iCare Health Solutions is an integrated specialty network and administrator of comprehensive ocular care services. The company operates as a platform of interconnected managed care solutions for health plans and providers, comprising HEDIS Diabetic Retinal Outreach Program, Diabetic Retinal Health Programs & Services, Utilization Management, Network Management, Administrative Services (TPA), and MSO Services. The eHealthDeck portal serves as the provider-facing technology platform for prior authorization and coverage criteria access. Services are delivered through a statewide network of optometrists and ophthalmologists in Florida, serving Medicare Advantage, Medicaid, and dual-eligible populations.

Differentiator

Problem solved

Functional benefit

Products and services

• HEDIS Diabetic Retinal Outreach Program Customized HEDIS outreach program providing Eye Exams for Patients with Diabetes (EED) to non-compliant members, including dilated exams via vision care providers and non-dilated teleretinal screenings across multiple access points. Designed for Medicare Advantage and Medicaid health plans to close HEDIS DRE gaps and improve Star ratings.
• Diabetic Retinal Health Programs & Services Suite of retinal screening and analysis services for provider practices and MSOs, including the Eye Exam for Patient with Diabetes (EED) at the practice, a camera loan program for MSOs and large practices, and diagnostic interpretation services for practices with existing camera equipment. Targeted at MSOs, large ophthalmology/optometry practices, and health plan partners.
• Utilization Management NCQA-accredited ophthalmologic utilization management service delivering ocular clinical utilization benchmarks, prevention of service duplication, monitoring of medically necessary criteria, and coverage criteria development and implementation. Sold as a turnkey solution to Medicare Advantage, Medicaid, and other health plans.
• Network Management Turnkey specialty network of eye health professionals providing comprehensive eye care management combining routine eye care, medical eye care, and surgical care through board-certified, fellowship-trained optometrists and ophthalmologists. Sold to health plans serving Medicare Advantage, Medicaid, and dual-eligible populations.
• Administrative Services (TPA) Comprehensive third-party administration services including claims processing, utilization management, compliance and delegation, customer care, EDI transmissions, membership management, and provider contracting, delivered through proprietary software. Sold to health plans on a fee-for-service or per-member-per-month basis.
• MSO Services Management Services Organization services partnering with Florida MSOs to extend specialty care and management cycles including optometry, ophthalmology, emergency eye care services, HEDIS screenings, and telemedicine. Sold to MSOs seeking integrated specialty ocular care delivery.
• eHealthDeck Secure web portal where providers access prior authorization lists by health plan, iCare Criteria documentation, and utilization management determinations; also serves as the iCare member sign-in platform. Sold as the technology interface underpinning iCare's contracted provider network.

Quantifiable outcome

• 5 health plan partners achieved CMS Five-Star rating for HEDIS DRE measure for two consecutive years (2019–2020)
• +3 more outcomes

Named customers11 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

AI capability3 records

Feature4 records

Partnerships

13 partnerships are on record, tiered core and minor.

• Optical OutletscoreStrategic or Co-development Partner · 9 August 2023iCare acquired Optical Outlets in August 2023. As one of Florida's largest optometric retailers with 56 locations and 550+ employees, Optical Outlets operates as part of iCare, strengthening iCare's retail presence. Ron Amster named General Manager. Founded in 1987 by Dr. Robert Lewenson.
• AetnacoreChannel Partner/ Reseller/ DistributorHealth plan partner using iCare's network and HEDIS management services. Aetna's Director of Network Development cited iCare's innovative HEDIS management capabilities for improving diabetic vision outcomes for members.
• HumanacoreChannel Partner/ Reseller/ DistributorKey health plan partner using iCare's integrated HEDIS programs and diabetic retinal outreach. Humana's Vice President of Provider Partnership cited iCare as an industry leader with technical innovation to improve vision outcomes.
• CoventrycoreChannel Partner/ Reseller/ DistributorMedicare Advantage health plan partner that achieved CMS Five-Star rating for HEDIS DRE measure through iCare's outreach program. Partner in diabetic retinal exam patient outreach.
• United Healthcare Medica HealthcarecoreChannel Partner/ Reseller/ DistributorMedicare Advantage partner that achieved CMS Five-Star rating for HEDIS DRE measure through iCare's diabetic retinal exam outreach program.
• CarePluscoreChannel Partner/ Reseller/ DistributorFlorida-based Medicare Advantage partner that earned CMS Five-Star rating for HEDIS Diabetic Retinal Exam measure with help from iCare's DRE patient outreach program.
• Preferred Care PartnerscoreChannel Partner/ Reseller/ DistributorMedicare Advantage partner that benefited from iCare's customized outreach DRE solutions, contributing to Five-Star quality ratings.
• AvMedminorChannel Partner/ Reseller/ DistributorHealth plan partner listed on iCare's partner page, providing health insurance plans in Florida.
• Florida BlueminorChannel Partner/ Reseller/ DistributorHealth plan partner listed on iCare's partner page, Florida's largest health insurer.
• Molina HealthcareminorChannel Partner/ Reseller/ DistributorHealth plan partner listed on iCare's partner page, serving Medicaid and Medicare populations.
• Clear Health AllianceminorChannel Partner/ Reseller/ DistributorHealth plan partner listed on iCare's partner page, serving Florida markets.
• OptumminorChannel Partner/ Reseller/ DistributorHealth plan partner listed on iCare's partner page, part of UnitedHealth Group.
• AvailityTechnology or IntegrationHealth information network and technology partner listed on iCare's partner page for EDI transmissions and data exchange.

Scale indicators13 records

Recent moves6 records

Expansion highlights6 records

Market position

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/MyiCareHealth

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles10 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 iCare Health Solutions