MetaStar

What MetaStar does

MetaStar, Inc. is a Wisconsin-headquartered nonprofit healthcare quality improvement organization founded in 1973-74 (originally as the Wisconsin Professional Peer Review Organization) and rebranded in the early 1990s under a Carver Model governance framework with a Board of Trustees. It operates through three service pillars: Healthcare Quality Consulting (practice facilitation, long-term care quality, Coverdell Stroke Program, Behavioral Health Connect, WiLQAL), External Quality Review (CMS-compliant evaluations of Medicaid managed care, HCBS, Birth to 3, Fee-for-Service Medicaid, and Medical/Health Home programs), and Performance Measurement (HEDIS Compliance Audits, URAC Accreditation Data Validation, Medicare Part C and D Data Validation, IVA, and Medicare Independent Audit Validation), complemented by the MetaStar Readiness Series of pre-audit services.

The company has built more than 50 custom internal software programs including an online Security Risk Assessment tool, a Medical Records Tracking System, an obstetric data tracker, IRIS program management tools, MCO scorecards, and audit management applications, with HIPAA and SOC 2 compliance posture. These systems support rules-based workflow automation rather than AI-driven analytics. MetaStar maintains NCQA HEDIS Compliance Audit Organization and URAC Approved Data Validation Vendor certifications, and meets CMS independence and competence requirements as an External Quality Review Organization with 45+ years of Medicaid experience.

MetaStar's revenue model is dominated by government contracts — Wisconsin Department of Health Services, CMS, and federal grants (including a $1M HRSA RCORP grant awarded in September 2021) — supplemented by fee-for-service performance measurement audits billed to health plans and Medicare Advantage organizations, and grant-funded no-cost technical assistance programs like Behavioral Health Connect. It operates across all 50 states with concentrated strength in Wisconsin and the Great Lakes Region, supported by 101-250 employees with a 90%+ retention rate and 9-year average tenure, achieving an NPS of 100 and a 9.7/10 customer recommendation score in its Medicare data validation services.

Name

MetaStar

Legal name

MetaStar, Inc.

Website

https://metastar.com

Company type

Private

Founded year

1974

Operating status

Operating

Headcount range

101–250 employees

Short description

MetaStar is a Wisconsin-headquartered, 50-year-old nonprofit healthcare quality improvement organization that delivers External Quality Review for Medicaid, HEDIS and URAC compliance audits, Medicare data validation, and consulting services to government agencies, health plans, and providers across all 50 states.

Ownership category

akta.pro rank

Product category

Healthcare Quality Improvement Services

NAICS

Computer Systems Design and Related Services (54151)

SIC

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

akta.pro primary industry

Clinical Operations & Monitoring FSP (CRA/CTM/Start-up) (HLAGAOAA)

Keywords

• Healthcare quality consulting
• External quality review
• HEDIS compliance audits
• Performance measurement audits
• Medicare data validation

Headquarters

HQ city

Madison

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

Revenue model

1. Government Healthcare Contracts: Primary revenue from contracted services with government agencies including CMS, state Medicaid programs, and public health departments for quality improvement, external quality review, and performance measurement services.
2. Healthcare Quality Consulting Services: Fee-for-service consulting engagements with healthcare organizations for quality improvement, practice facilitation, and compliance advisory services.
3. Performance Measurement Audits: HEDIS compliance audits, URAC data validation, Medicare Part C and D data validation services billed to health plans and healthcare organizations.
4. Behavioral Health Connect Grant: Grant-funded program from Wisconsin Department of Health Services Division of Medicaid Services providing no-cost technical support to behavioral health providers.

Pricing tiers

Go-to-market motion2 records

Distribution channels3 records

Marketing channels6 records

Core offering

MetaStar provides healthcare quality improvement consulting, independent External Quality Review for Medicaid and Medicare programs, and performance measurement audits (HEDIS, URAC, Medicare Part C/D data validation, IVA) to government agencies, health plans, and healthcare providers. It complements these core services with the MetaStar Readiness Series for pre-audit preparation, custom in-house software development for audit and data validation workflows, and grant-funded programs such as Behavioral Health Connect for Wisconsin behavioral health providers.

Product overview

MetaStar offers a portfolio of healthcare quality improvement services organized around three core pillars: Healthcare Quality Consulting, External Quality Review, and Performance Measurement. These core services are complemented by the MetaStar Readiness Series (a suite of pre-audit support offerings), custom software development, and elearning modules. Healthcare Quality Consulting focuses on process redesign and population health improvement including programs like Behavioral Health Connect and WiLQAL. External Quality Review provides independent assessments for Medicaid programs including HEDIS compliance, URAC data validation, and various state program evaluations. Performance Measurement delivers audit and validation services including HEDIS Compliance Audits, Medicare Part C & D Data Validation, Initial Validation Audits, and Medicare Independent Audit Validation, supported by the Readiness Series for pre-audit preparation. The company also provides custom software solutions and educational resources to support these services.

Differentiator

Problem solved

Functional benefit

Brands

• Behavioral Health Connect: A no-cost technical support program for Wisconsin Medicaid-enrolled behavioral health providers and organizations to implement, optimize, and improve the quality of care through health information technology.
• MetaStar Readiness Series
• WiLQAL

Products and services

• Healthcare Quality Consulting Consulting services that work with healthcare professionals, communities, and researchers to redesign processes, deliver higher quality equitable care, and sustain positive changes. Includes long-term care quality improvement, practice facilitation, and community and population health initiatives such as the Coverdell Stroke Program, WI-INTUIT, WiLQAL, and Behavioral Health Connect.
• External Quality Review Independent CMS-aligned assessments evaluating the quality, timeliness, and access to care for Medicaid programs. Covers Birth to 3, Fee-for-Service Medicaid, HCBS, Medicaid Managed Care, Medical/Health Homes, and the Washington Wraparound with Intensive Services (WISe) program, using CMS External Quality Review Protocols.
• Performance Measurement Audits and Data Validation Performance measurement audits and data validation services including NCQA HEDIS Compliance Audits across commercial, Medicare, Medicaid, Exchange, and SNP product lines; URAC Data Validation for PBMs, mail service, specialty, community, and drug therapy management pharmacies; CMS Medicare Part C and D Data Validation; Initial Validation Audit (RADV IVA) for ACA Qualified Health Plans; and Medicare Independent Audit Validation following CMS Program Audits.
• MetaStar Readiness Series Suite of proactive pre-audit services offering gap assessment, mock audits, measure logic review, process mapping, audit simulation exercises, CMS audit preparedness consulting, HCC coding and compliance training, and scoring simulations to help health plans, providers, and healthcare organizations prepare for regulatory audits, data validation reviews, and performance reporting.
• Custom Software Development Tailored software development solutions including custom applications for security risk assessments, obstetric data tracking, IRIS program management, MCO scorecards, and data validation workflows. Built in-house with HIPAA and SOC 2 compliance, leveraging an IT team that has delivered over 50 custom software programs.

Quantifiable outcome

• 32.3% improvement in door-to-needle time for ischemic stroke patients (from 48% to 80.3%)
• +5 more outcomes

Named customers14 records

Segments4 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature4 records

Partnerships

Twelve partnerships are on record, tiered secondary and core.

• Sauk County Continuum of Care Consortium (S4C)secondaryStrategic or Co-development Partner · 17 August 2021S4C consortium including law enforcement, emergency medical services, healthcare, public health, social services, and others addressing the opioid epidemic in Sauk County. Funded by HRSA Rural Communities Opioid Response Program grant.
• Wisconsin Department of Health ServicescoreStrategic or Co-development Partner · 1 January 2012Partners with MetaStar since 2012 to implement the Paul Coverdell National Acute Stroke Prevention Program, facilitating improvement in stroke systems of care.
• Superior Health Quality AlliancecoreStrategic or Co-development PartnerMetaStar is a member organization of Superior Health Quality Alliance, designated as the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for the Great Lakes Region. The alliance advances CMS's mission to improve healthcare quality with initiatives designed to improve health outcomes, quality, access, and value for Medicare beneficiaries. The alliance includes 8 partner organizations.
• Superior Health Quality AlliancecoreStrategic or Co-development PartnerMetaStar is proud to be part of the Superior Health Quality Alliance, an organization powered by eight partners focused on innovative approaches to health care quality and safety improvement.
• University of Wisconsin-Madison (CAARN)coreStrategic or Co-development PartnerMetaStar is a proud partner of the Community-Academic Aging Research Network (CAARN) at the University of Wisconsin-Madison. Together they design and develop new programs to help older adults in Wisconsin communities become healthier, bringing healthcare partners together with community partners and academic researchers to conduct research to improve the health of older adults and decrease health disparities.
• Medical College of WisconsinsecondaryStrategic or Co-development PartnerPartner in the WI-INTUIT research program funded by the Agency for Healthcare Research and Quality to help primary care practices screen for and manage urinary incontinence in female patients.
• Wisconsin Department of Health ServicescoreStrategic or Co-development PartnerPrimary government partner for Medicaid quality improvement programs, external quality review, and various healthcare initiatives including Behavioral Health Connect, Coverdell Stroke Program, and Family Care programs.
• Comagine HealthsecondaryStrategic or Co-development PartnerPartnership in Washington state where MetaStar conducts record reviews for youth enrolled in the Wraparound with Intensive Services (WISe) program through Comagine Health.
• The Leapfrog GroupsecondaryStrategic or Co-development PartnerMetaStar partners with The Leapfrog Group for on-site data verification, supporting patient safety and healthcare quality transparency.
• Centers for Medicare & Medicaid Services (CMS)coreStrategic or Co-development PartnerFederal partner for Medicare quality programs, external quality review requirements, and healthcare quality improvement initiatives. MetaStar meets CMS independence and competence requirements as an EQRO.
• Centers for Disease Control and Prevention (CDC)secondaryStrategic or Co-development PartnerFunding partner for the Paul Coverdell National Acute Stroke Prevention Program, implemented in Wisconsin through MetaStar and DHS.
• URACcoreStrategic or Co-development PartnerMetaStar is a URAC-approved data validation vendor for URAC accredited pharmacy organizations including PBMs, mail service pharmacies, specialty pharmacies, community pharmacies, and drug therapy management programs.

Scale indicators9 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• Quality Insights: A QIN-QIO contracted by CMS covering West Virginia, Pennsylvania, Delaware, New Jersey, and Louisiana with quality improvement, EQR, and HIT services. Comparable to MetaStar in CMS contract-backed quality improvement, EQR work, and Medicaid program evaluation.
• Alliant Health Solutions: A QIN-QIO serving Georgia, North Carolina, Kentucky, Tennessee, and other states, focusing on quality improvement, patient safety, and care transitions under CMS contracts. Comparable to MetaStar's QIN-QIO/EQR work for Medicaid and Medicare populations.
• Attest Health Care Advisors: A specialized healthcare consulting firm performing NCQA HEDIS Compliance Audits, URAC data validation, and quality improvement consulting for health plans and providers. Directly comparable to MetaStar's Performance Measurement pillar and HEDIS audit business.
• IPRO: One of the largest External Quality Review Organizations in the U.S., performing HEDIS audits, Medicaid EQR, and quality improvement for state agencies and health plans. Directly comparable to MetaStar because both serve as CMS-recognized EQROs offering Medicaid managed care reviews and performance measurement audits nationwide.
• TMF Health Quality Institute: A QIN-QIO serving Texas, Arkansas, Mississippi, Missouri, and surrounding states, contracted by CMS to improve quality of care for Medicare beneficiaries. Directly comparable to MetaStar's role in the Superior Health Quality Alliance QIN-QIO for the Great Lakes Region.
• Qsource: A QIN-QIO serving Tennessee and other states, providing healthcare quality improvement, EQR, and HEDIS-related services. Directly comparable to MetaStar in mission, QIN-QIO structure, and CMS-backed quality consulting offering.
• Telligen: A QIN-QIO and healthcare quality improvement organization serving Iowa, Illinois, and other states, with services spanning Medicaid EQR, quality improvement consulting, and HIT support. Directly comparable in service mix (EQR + quality consulting + HIT) and customer segments (state Medicaid + health plans + providers).
• Comagine Health: A nonprofit healthcare quality consulting and EQRO organization operating across multiple states (including Washington where MetaStar subcontracts WISe record reviews to them). Directly comparable in mission, services (EQR, QIN-QIO), and target customers (state Medicaid, health plans, providers).
• Mountain-Pacific Quality Health: A QIN-QIO serving Montana, Wyoming, Alaska, Hawaii, Idaho, and the Pacific Northwest, providing quality improvement, EQR, and HIT services to Medicaid and Medicare populations. Directly comparable to MetaStar's CMS-aligned QIN-QIO mission and contract structure.
• Health Services Advisory Group (HSAG): The largest EQRO in the country, providing HEDIS compliance audits, CMS data validation, and Medicaid EQR for numerous state Medicaid agencies. Directly comparable to MetaStar across its three core pillars (Healthcare Quality Consulting, External Quality Review, Performance Measurement).

Market position

Strengths6 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/MetaStarInc

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 MetaStar