Fix Healthcare

What Fix Healthcare does

Fix Healthcare is a private employee benefits consulting and health plan administration firm headquartered in San Clemente, California. The company operates a sales-led, direct-to-employer model targeting mid-sized and large employers (75 to 1,000+ employees) seeking alternatives to traditional off-the-shelf health plans. Its flagship offering, the Care Nav Health Plan, integrates Care Coordination pods of approximately 25 nurses and plan advocates with optional point solutions including Virtual Primary Care, Cash Pay Pricing, Reference Based Pricing, Centers of Excellence, and Direct Primary Care. Care Coordination pods serve as the single point of contact for plan members and their medical providers, completely replacing traditional member services and delivering a 7.5-minute average call time versus a 1.5-minute industry standard.

The underlying technology platform is patented and centers on Real-Time Intercept™, a system that engages healthcare consumers 56 days earlier than competing models on average. The platform has been developed over nearly 20 years and supports patient advocacy, care management, nurse coaching, and healthcare navigation across a 1.5M+ plan member base with 17 years of actuarially validated outcomes. The company's product surface extends beyond plan administration to include Benefits Consulting and Compliance Services covering ERISA, ACA, COBRA, HIPAA, FMLA, Section 125, and 105(h) requirements. Reported outcomes include a 2.5% medical trend CAGR versus a 5.8% industry average (2013-2017), $641 in savings per employee per year, and Net Promoter Scores of 76 (Member), 75 (Employer), and 77 (Provider) versus an 18-point industry average.

The revenue model is professional services-based, with transparent consulting fees disclosed at point of sale, no back-end carrier bonuses, and no undisclosed revenue streams. The company accesses 30 A-rated insurance carriers for competitive bidding versus 4-15 for standard plans. Founded circa 2009-2020 (sources conflict: firmographic data cites 2009, company history and website copyright cite 2020), Fix Healthcare operates with 11-50 employees from a single California office and serves the domestic U.S. market exclusively.

Name

Fix Healthcare

Legal name

Fix Healthcare

Website

https://fixhealthcare.net

Company type

Private

Founded year

2020

Operating status

Operating

Headcount range

11–50 employees

Short description

Fix Healthcare is a private employee benefits consulting firm that delivers the Care Nav Health Plan — a self-funded employer health plan combining Care Coordinator pods with point solutions like Reference Based Pricing, Virtual Primary Care, and Direct Primary Care — targeting mid-sized and large U.S. employers seeking lower-cost alternatives to traditional insurance.

Ownership category

akta.pro rank

Headquarters

HQ city

San Clemente

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, Infrastructure

Revenue model

1. Benefits Consulting: Fix Healthcare provides employee benefit consulting services to employers, offering unique self-funded health plans and comprehensive compliance packages. Revenue appears to be generated through consulting fees for benefits strategy, plan design, implementation, and ongoing administration of the Care Nav Health Plan. The company emphasizes 100% transparent fees at point of sale with no back-end bonuses accepted and no undisclosed revenue.

Go-to-market motion1 record

Distribution channels1 record

Marketing channels1 record

Core offering

Fix Healthcare provides self-funded employer health plans through its Care Nav Health Plan platform, replacing traditional member services with dedicated pod-based Care Coordinators (nurses and plan advocates). The offering combines the patented Care Coordination platform with optional cost-control point solutions (Virtual Primary Care, Cash Pay Pricing, Reference Based Pricing, Centers of Excellence, Direct Primary Care) and complementary Benefits Consulting and Compliance Services for mid-sized to large employers.

Product overview

Fix Healthcare offers the Care Nav Health Plan, a unified employer health plan platform that combines Care Coordination (nurse and advocate pods) with optional modern point solutions including Virtual Primary Care, Cash Pay Pricing, Reference Based Pricing, Centers of Excellence, and Direct Primary Care. Traditional components such as PPO Networks and Pharmacy Plans are integrated alongside self-funded plan options. The company also provides Benefits Consulting and Compliance Services. The platform is designed to replace traditional member services with care coordination advocates while delivering industry-leading cost control (2.5% vs 5.8% industry average CAGR) and high Net Promoter Scores (76 vs 18 industry average).

Differentiator

Problem solved

Functional benefit

Brands

• The Care Nav Health Plan: A comprehensive health plan platform featuring Care Coordinators, insurance-partially self-funded options, cash pay pricing, centers of excellence, reference based pricing, and direct primary care.
• Care Coordination

Products and services

• Care Nav Health Plan The Care Nav Health Plan is the central employer health plan platform integrating Care Coordination, point solutions, and traditional plan components (PPO Network, Pharmacy Plan) into a unified self-funded arrangement with industry-leading cost control for mid-sized to large employers.
• Care Coordination Pod-based service of approximately 25 nurses and plan advocates who provide patient advocacy, care management, nurse coaching, and act as the single point of contact for plan members and their medical providers, completely replacing traditional member services for employer health plans.
• Cash Pay Pricing Optional payment method for scheduled procedures where employers achieve 25-50% cost savings, providers receive simplified claims submission and payment before the procedure date, and plan members share in savings up to $3,000.
• Reference Based Pricing (RBP) Cost-control mechanism that reimburses medical facilities at 140-200% of Medicare rates instead of standard rates, with approximately 95% of facilities accepting this reimbursement.
• Centers of Excellence Network of hospitals and facilities employing Six Sigma/lean production methods to deliver superior outcomes for high-ticket elective surgeries at significantly lower costs, with physician incentives based on outcomes rather than volume.
• Direct Primary Care Employer-direct contracting model for primary care that reduces doctor patient loads from 30-40 to approximately 15 patients per day, improving access and allowing chronic conditions to be managed before becoming acute.
• Self-Funded Health Plans Self-funded insurance solutions allowing employers to control their health plan architecture, receive claims data for management, install best-in-class components, and access 30 A-rated insurance carriers for competitive bidding.
• Benefits Consulting Employee benefit consulting services specializing in self-funded health plans, including plan design and strategy, core and voluntary benefits, benefits technology, enrollment management, compliance, and vendor integration for employer clients.
• Compliance Services Benefit regulation compliance assistance covering ERISA, ACA, COBRA, HIPAA, FMLA, Section 125, and 105(h), including SPD WRAP, Form 5500, 125 Premium Only documentation, and custom employee notice packages.
• Virtual Primary Care Primary care access solution offering 60% average engagement rate compared to traditional telemedicine at 3%, providing members with enhanced access and concierge-level service within the Care Nav Health Plan.

Quantifiable outcome

• Medical trend reduced to 2.5% CAGR vs. 5.8% industry average (2013-2017) and 8.8% industry average (2000-2017)
• +11 more outcomes

Segments2 records

Ideal customer profiles1 record

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Scale indicators11 records

Recent moves6 records

Expansion highlights3 records

Direct peers

• Collective Health: Collective Health is a benefits and care-navigation platform purpose-built for self-funded employers. It combines claims administration, point-solution curation, and member navigation — directly parallel to Fix Healthcare's Care Nav Health Plan with Care Coordination pods and integrated RBP / virtual care add-ons.
• Accolade: Accolade provides personalized healthcare advocacy and navigation for employers and health plans, including nurse-led guidance and integrated virtual primary care. It directly overlaps with Fix's Care Coordinator pod model and Virtual Primary Care engagement positioning, serving similar mid-sized and large employer buyers.
• Centivo: Centivo is a health plan for self-funded employers built around primary care-led navigation and curated networks with significant cost savings. It mirrors Fix's emphasis on Direct Primary Care, navigation, and reference-based pricing-style cost control aimed at employers seeking off-the-shelf plan alternatives.
• Included Health: Included Health combines virtual primary care, behavioral health, and care navigation for employer-sponsored plans. Its integrated advocacy-plus-virtual-care model competes head-to-head with Fix's Care Coordination pod + Virtual Primary Care bundle for large employer contracts.
• Quantum Health: Quantum Health is a care navigation and coordination company serving self-funded employer health plans via single-point-of-contact nurse models. Its pod-based "Real-Time Intercept" style navigation directly parallels Fix Healthcare's patented Care Coordination architecture.

Emerging players

• HealthJoy: HealthJoy is a benefits navigation platform that combines virtual care, second opinions, and advocacy for employer-sponsored plans. It overlaps with Fix's Care Coordination positioning but emphasizes a virtual-first, AI-augmented delivery model rather than high-touch nurse pods.
• Virgin Pulse / Marigold Health (personify Health): Personify Health (formerly Virgin Pulse) bundles wellness, navigation, and condition management for self-funded employers. It addresses the same employer pain points as Fix (cost trend + member experience) but through a wellness-led, broader-engagement motion.
• Premise Health: Premise Health operates on-site, near-site, and virtual primary care clinics for employers and integrates them with health plan navigation. It shares Fix's Direct Primary Care and Virtual Primary Care components, though it leans on physical access points rather than nurse-pod navigation.

Broad incumbents

• Rally Health (UnitedHealth Group / Optum): Rally Health is UnitedHealth Group's consumer engagement and navigation platform for employer-sponsored plans. As an incumbent with significantly greater distribution, it competes with Fix's Care Navigation and Virtual Primary Care offerings as part of a broader benefits-administration portfolio.
• Mercer / Marsh & McLennan Benefits Practice: Mercer is one of the largest global benefits consultancies, advising mid-sized and large employers on self-funded plan design, vendor selection, and ongoing governance. Fix competes directly with Mercer in the benefits consulting motion, but Mercer operates a far broader practice across retirement, health, and workforce.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/fixhealthcareca
• Facebookfacebook.com/fixhealthcareca
• LinkedInlinkedin.com/company/fix-healthcare

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 Fix Healthcare