MPRO

What MPRO does

MPRO, doing business as iMPROve Health, is an independent nonprofit healthcare quality improvement organization founded in 1984 and headquartered in Farmington Hills, Michigan, operating as a fully remote national service provider. The company delivers independent medical review, utilization review, quality improvement consulting, data analytics, independent dispute resolution, and virtual chief medical officer services to federal and state government healthcare programs (notably CMS and state Medicaid programs), accountable care organizations, and healthcare systems and providers. It has been URAC-accredited for more than 20 years and is a federally Certified Independent Dispute Resolution Entity under the No Surprises Act.

iMPROve Health's service portfolio is organized into two primary lines: Quality Improvement (encompassing ACO quality measure education, abstraction and reporting, cancer control, chronic disease management, mental health initiatives, and data analytics) and Review Services (including independent medical review, utilization review, dispute resolution, No Surprises Act IDR, and PACER independent review). Supporting infrastructure includes a Secure File Exchange capability (via a SendThisFile integration) for protected health information handling and a Virtual CMO offering that provides executive-level medical oversight on a remote basis. The company maintains strategic partnerships, notably with Superior Health Quality Alliance for CMS's 13th Scope of Work, and markets its multi-state and multi-issue expertise as a core differentiator.

Revenue is generated primarily through contract-based arrangements with government healthcare programs and professional services fees for quality improvement and review engagements with healthcare organizations and ACOs. The distribution model combines direct government contracting with CMS and state Medicaid programs, direct engagement with hospitals, health systems, and provider organizations, and channel partnerships with regional quality alliances. Pricing is not publicly disclosed and is structured around individual contract terms rather than published rate cards.

Name

MPRO

Legal name

iMPROve Health

Website

https://mpro.org

Company type

Private

Founded year

1984

Operating status

Operating

Short description

MPRO (iMPROve Health) is a Michigan-based independent nonprofit providing healthcare quality improvement, independent medical review, utilization review, and certified dispute resolution services to CMS, state Medicaid programs, ACOs, and healthcare systems nationally since 1984.

Ownership category

akta.pro rank

Headquarters

HQ city

Farmington Hills

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

Revenue model

1. Government Healthcare Program Contracts: Revenue from contracts with Medicare, Medicaid programs, and CMS-funded quality improvement initiatives
2. Quality Improvement Services: Professional services fees for quality improvement consulting, education, abstraction, and reporting for healthcare organizations including ACOs
3. Review Services: Independent review, dispute resolution, and IDR services provided to healthcare stakeholders including insurers and providers

Go-to-market motion1 record

Distribution channels3 records

Marketing channels4 records

Core offering

MPRO is an independent nonprofit healthcare quality improvement organization that provides quality improvement, independent medical review, utilization review, dispute resolution (including No Surprises Act IDR), data analytics, and Virtual CMO services. Its customers include CMS, state Medicaid programs, accountable care organizations, and healthcare systems across the United States.

Product overview

iMPROve Health offers a unified portfolio of healthcare quality improvement and review services. The core offerings consist of Quality Improvement (encompassing QI Solutions, QI Initiatives, and QI Experience) and Review Services (including Independent Review, Dispute Resolution, and No Surprises Act compliance). Supporting sub-products include PACER for independent review, Virtual CMO for executive medical consultation, and Data and Analytics services. The company leverages 40 years of experience in independent medical review, utilization review, Medicare and Medicaid programs, research methodologies, and outreach strategies to deliver these integrated services.

Differentiator

Problem solved

Functional benefit

Products and services

• Quality Improvement Quality improvement services for healthcare programs, providers, and ACOs focused on clinical quality and performance improvement.
• Independent Medical Review Independent clinical review services used by government payers and healthcare organizations to evaluate medical necessity and appropriateness of care.
• Utilization Review Utilization review services that assess the appropriateness, medical necessity, and efficiency of healthcare services for payers and providers.
• Data Analytics Data analytics services supporting quality measurement, utilization benchmarking, and performance improvement for healthcare programs and providers.
• Virtual CMO Virtual Chief Medical Officer service providing executive-level clinical leadership and medical direction on a contracted basis for healthcare organizations that need fractional CMO capacity.
• Dispute Resolution (No Surprises Act IDR) Dispute resolution services, including No Surprises Act independent dispute resolution, used by payers, providers, and other parties to resolve billing and payment disputes through an independent process.

Named customers4 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

Integration1 record

Feature5 records

Partnerships

One partnership is on record.

• Superior Health Quality AlliancecoreStrategic or Co-development PartneriMPROve Health continues partnership with Superior Health Quality Alliance for CMS's 13th Scope of Work. This partnership focuses on delivering quality improvement initiatives under federal healthcare quality improvement programs, leveraging combined expertise in healthcare quality measurement, data analysis, and outreach strategies.

Scale indicators5 records

Recent moves4 records

Expansion highlights5 records

Direct peers

• IPRO: IPRO is one of the longest-standing QIN-QIOs in the U.S., delivering independent medical review, utilization review, and CMS quality improvement programs - the same core service lines that iMPROve Health sells. Both organizations serve federal and state Medicaid programs through similar Scope of Work contracts.
• Health Services Advisory Group (HSAG): HSAG is a major QIN-QIO and healthcare quality consulting firm running multi-state CMS quality improvement initiatives, ACO support, and independent medical review - directly comparable to iMPROve Health's QI and Review Services portfolio.
• Telligen: Telligen operates as a QIN-QIO delivering CMS quality improvement, utilization management, and clinical review services across multiple states. Its federal/state healthcare quality improvement footprint overlaps with iMPROve Health's national scope.
• Keystone Peer Review Organization (KEPRO): KEPRO is a healthcare quality improvement and utilization review organization with state Medicaid contracts and federal quality initiatives, similar in mission and customer set to iMPROve Health.

Broad incumbents

• Maximus: Maximus is a large federal healthcare contractor operating across Medicaid, Medicare, and ACA programs with services spanning eligibility, independent medical review, and quality measurement. It is broader in scope but materially competes for the same federal healthcare reviews.
• Premier Inc. Premier is a large healthcare improvement company providing performance improvement, analytics, and quality measurement services to hospitals and health systems - adjacent to iMPROve Health's QI and analytics offerings, though serving a different mix of stakeholders.

Others

• Cotiviti: Cotiviti provides payment accuracy, claims review, and analytics for healthcare payers. Its utilization review and payment-integrity services overlap with iMPROve Health's review services on the payer side.
• NORC at the University of Chicago: NORC provides independent healthcare research, evaluation, and analytics for federal agencies including CMS - comparable in mission and client base (federal healthcare programs) to iMPROve Health.
• Mathematica: Mathematica delivers independent research and evaluation for CMS, Medicaid, and value-based care programs, providing policy analytics and quality measurement support comparable to parts of iMPROve Health's QI offerings.

Emerging players

• Performant Financial Corporation: Performant operates in healthcare payment integrity and audit/review services for government and commercial payers, comparable to iMPROve Health's utilization and review functions for insurers and providers.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

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 MPRO