Qualis Health

What Qualis Health does

Qualis Health is a Seattle-based, nonprofit healthcare quality improvement organization founded in 1974 that operates as Medicare's Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Idaho and Washington under a five-year CMS contract (effective July 18, 2014). The organization delivers consulting and care management services through four core service lines — Care Management, Health Information Technology (including the Washington & Idaho Regional Extension Center for EHR adoption), Practice Transformation (including NCQA PCMH Recognition support and Oral Health Integration), and Quality Improvement & Safety — anchored by a portfolio of proprietary frameworks such as the Safety Net Medical Home Initiative resource library, the Stepping Stones care-transitions model, the Behavioral Health Integration Implementation Guide, and the Hand Hygiene Huddle Toolkit. Its customer base is overwhelmingly government: CMS as QIO prime contractor, state Medicaid agencies in Alabama, Alaska, DC, Idaho, Nebraska, Washington, and New Mexico for utilization review and EQRO work, plus Washington Labor & Industries; the organization also engages directly with hospitals, primary care practices, and community health centers to drive adoption of value-based-care practices.

The business model is managed-services and professional-services revenue derived from multi-year government contracts and direct provider engagements, with no public pricing and no SaaS product. Distribution is direct enterprise/government sales with no third-party channel. In 2019, Qualis Health merged with HealthInsight under the Comagine Health name, forming a 500-person national organization that was also selected as a Prime awardee of the CMS Network of Quality Improvement and Innovation Contractors (NQIIC). The combined entity now operates across more than eleven states and serves 1.3 million Medicare beneficiaries in its core Idaho/Washington region; documented outcomes include prevention of more than 95,000 hospitalizations and 27,000 readmissions, support for 4,000+ providers in EHR adoption, and facilitation of more than $80 million in Medicare and Medicaid EHR incentives. URAC accreditations in Case Management and Health Utilization Management are held through October 1, 2024.

Name

Qualis Health

Legal name

Qualis Health

Website

https://qualishealth.org

Company type

Private

Founded year

1971

Operating status

Operating

Headcount range

251–500 employees

Short description

Qualis Health is a Seattle-based nonprofit healthcare quality improvement organization serving as the CMS QIN-QIO for Idaho and Washington, delivering consulting, care management, health IT, and practice transformation services to Medicare and Medicaid populations under multi-year government contracts.

Ownership category

akta.pro rank

Product category

Healthcare Quality Improvement Services

NAICS

Health Care and Social Assistance (62)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Health Equity, Access & Social Determinants Programs (BPAIAJAO)

Keywords

• Healthcare quality improvement
• Care management services
• Practice transformation consulting
• Health information technology
• Medicaid utilization management

Headquarters

HQ city

Seattle

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Medicare QIO Program Contracts: Five-year contracts with CMS to serve as Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Idaho and Washington, providing resources and support for healthcare providers and community partners
2. State Medicaid Agency Contracts: Contracts with state Medicaid agencies (Alabama, Alaska, DC, Idaho, Nebraska, Washington) for utilization reviews and quality improvement activities
3. Healthcare Consulting Services: Fee-for-service consulting engagements with healthcare providers, hospitals, nursing homes, and physician practices for quality improvement, health IT implementation, and practice transformation

Go-to-market motion1 record

Distribution channels3 records

Marketing channels8 records

Core offering

Qualis Health is a nonprofit healthcare quality improvement organization that delivers care management, health information technology consulting, practice transformation, and quality improvement services to Medicare and Medicaid populations. It operates as Medicare's QIN-QIO for Idaho and Washington under CMS contract and holds multi-state Medicaid utilization management and quality review contracts. Services are delivered through direct consulting engagements with healthcare providers, hospitals, nursing homes, and physician practices, supported by freely available implementation guide libraries such as the Safety Net Medical Home Initiative.

Product overview

Qualis Health is a nonprofit healthcare quality improvement organization offering a portfolio of consulting and care management services primarily focused on Medicare and Medicaid populations. The core service lines include Care Management, Health Information Technology (with the Regional Extension Center for EHR support), Practice Transformation (including NCQA PCMH Recognition), and Quality Improvement & Safety. The company operates under a government QIN-QIO contract for Idaho and Washington, provides practice transformation support, and maintains extensive free resource libraries including the Safety Net Medical Home Initiative implementation guides and the Oral Health Delivery Framework. Services are delivered through dedicated portals for Medicare, Medicaid (multiple states), and healthcare providers rather than a unified software product.

Differentiator

Problem solved

Functional benefit

Brands

• Qualis Health Medicare: Medicare QIN-QIO services for Idaho and Washington
• WIREC (Washington & Idaho Regional Extension Center)
• Safety Net Medical Home Initiative

Products and services

• Care Management Care coordination and management services for Medicaid, Medicare, and other populations, helping manage patient transitions and complex care needs.
• Health Information Technology (HIT) Consulting Health IT consulting services including electronic health record (EHR) implementation, meaningful use attestation, and health IT optimization support for healthcare providers.
• Regional Extension Center (REC) Services The Washington & Idaho Regional Extension Center (WIREC) helps eligible professionals achieve meaningful use of electronic health records, providing vendor-neutral EHR consulting.
• Practice Transformation Consulting Support for primary care practices transitioning to patient-centered medical home (PCMH) models, including workflow redesign and quality improvement implementation.
• NCQA PCMH Recognition Support Assistance for practices seeking National Committee for Quality Assurance Patient-Centered Medical Home recognition, including documentation and submission support.
• Oral Health Integration Services The Oral Health Delivery Framework provides practical guidance for integrating preventive oral healthcare into routine primary medical care.
• Quality Improvement & Safety Services Quality improvement initiatives including reducing healthcare-associated infections, readmissions, medication errors, and improving patient safety outcomes.
• Medicare QIN-QIO Program Quality Innovation Network-Quality Improvement Organization (QIN-QIO) contract serving Idaho and Washington Medicare beneficiaries, focusing on prevention, chronic disease, and care coordination.
• Safety Net Medical Home Initiative (SNMHI) A landmark five-year initiative (2008-2013) that developed implementation guides and resources for transforming safety net primary care practices into patient-centered medical homes; resources remain freely available.
• Stepping Stones: Bridging Healthcare Gaps
• Healthy Hearts Northwest
• Healthier Washington Practice Transformation Support Hub
• Award of Excellence in Healthcare Quality
• Alaska Medicaid Programs

Quantifiable outcome

• Reduced hospitalization rates by nearly 6% and readmission rates by nearly 7% in Whatcom County, Washington
• +5 more outcomes

Named customers7 records

Segments4 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature5 records

Partnerships

Ten partnerships are on record, tiered core and minor.

• HealthInsightcoreStrategic or Co-development PartnerHealthInsight merged with Qualis Health to form Comagine Health, creating a combined 500-person national organization dedicated to improving healthcare quality.
• Centers for Medicare & Medicaid Services (CMS)coreStrategic or Co-development PartnerCMS awarded five-year contracts to Qualis Health to serve as QIN-QIO for Idaho and Washington, working with providers and communities on data-driven quality initiatives.
• State Medicaid Agencies (Alabama, Alaska, DC, Idaho, Nebraska, Washington)coreStrategic or Co-development PartnerMulti-year contracts with state Medicaid agencies for utilization reviews, quality improvement activities, and care management services for Medicaid populations.
• MacColl Center for Health Care Innovation at Group Health Research InstitutecoreStrategic or Co-development PartnerLong-standing partnership in Safety Net Medical Home Initiative and Behavioral Health Integration Implementation Guide development.
• University of Washington AIMS CentercoreStrategic or Co-development PartnerCollaboration on Behavioral Health Integration Implementation Guide for integrating behavioral health care in primary care settings.
• Office of the National Coordinator for Health Information Technology (ONC)coreStrategic or Co-development PartnerONC funded Qualis Health Regional Extension Center to help primary care providers achieve meaningful use of EHRs.
• Harvard Medical School Center for Primary CareminorStrategic or Co-development PartnerCollaboration on learning collaborative to transform primary care education and practice in the greater Boston area.
• Agency for Healthcare Research and Quality (AHRQ)minorStrategic or Co-development PartnerFunded MacColl Center to lead Healthy Hearts Northwest project; Qualis Health provides training and technical assistance to participating practices.
• Oregon Health & Science University (OHSU)minorStrategic or Co-development PartnerPartnership through Oregon Rural Practice Research Network in Healthy Hearts Northwest initiative for cardiovascular health improvement.
• Institute of Translational Health SciencesminorStrategic or Co-development PartnerPartner in Healthy Hearts Northwest, a three-year project helping Northwest primary care practices improve cardiovascular health.

Scale indicators11 records

Recent moves7 records

Expansion highlights5 records

Direct peers

• HealthInsight: HealthInsight was the most directly comparable peer to Qualis Health as a fellow Medicare QIO operating across multiple western states; the two merged in 2019 to form Comagine Health.
• Health Services Advisory Group (HSAG): HSAG is one of the largest Medicare QIO contractors in the U.S. and a direct competitor for CMS QIN-QIO and Medicaid EQRO contracts, making it the closest functional peer to Qualis Health.
• Telligen: Telligen is a QIN-QIO serving Iowa and other states and a long-standing direct peer in CMS quality improvement, practice transformation, and Medicaid utilization review work.
• Stratis Health: Stratis Health is a Minnesota-based QIO providing quality improvement, utilization review, and practice transformation services comparable to Qualis Health's portfolio.
• IPRO: IPRO is a multi-state QIO and external quality review organization serving Medicaid and Medicare programs in the Northeast and Mid-Atlantic, directly comparable to Qualis Health's EQRO and QIO work.
• Alliant Health Solutions: Alliant Health Solutions (formerly Alliant GMCF) operates as a QIN-QIO and quality improvement consulting firm in the Southeast, providing directly comparable services to Qualis Health.
• Mountain-Pacific Quality Health: Mountain-Pacific Quality Health is a QIN-QIO serving Montana, Wyoming, Alaska, and Hawaii; its state-level QI and practice transformation work is highly comparable to Qualis Health's regional model.
• MetaStar: MetaStar is a Wisconsin-based external quality review organization and QIO affiliate providing Medicaid utilization management and QI consulting services, comparable in scope and mission to Qualis Health.
• Great Plains Quality Innovation Network: Great Plains QIN is a CMS QIN-QIO covering North Dakota, South Dakota, Nebraska, and Kansas; it is a regional peer competing for similar federal QI contracts in overlapping Medicaid geographies.

Broad incumbents

• Institute for Healthcare Improvement (IHI): IHI is a broader national healthcare quality improvement organization that develops improvement methodologies, training, and frameworks - overlapping with Qualis Health's practice transformation and patient safety content libraries.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xtwitter.com/comaginehealth
• YouTubeyoutube.com/user/QualisHealth
• Facebookfacebook.com/qualishealth
• LinkedInlinkedin.com/company/qualis-health

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles19 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 Qualis Health