Healthcare Management Solutions

What Healthcare Management Solutions does

Healthcare Management Solutions, LLC (HMS) is a Fairmont, West Virginia–headquartered, 100% employee-owned (ESOP since June 2022) government contractor that has delivered healthcare regulatory services to the Centers for Medicare and Medicaid Services (CMS) for over 20 years. Founded in 2002 by Leah Heimbach and Patricia Hodges, the firm now operates across six core capabilities: health facility surveys and certification inspections; state operations support (training, policy development, workflow optimization, operations audits); health insurance marketplace compliance reviews for CCIIO; payment-model support for CMMI; medical record review; and information technology solutions including custom software development, cloud services, BI/data analytics, and emerging AI/automation capabilities.

HMS generates revenue through professional-services contracts with federal agencies — primarily CMS, CCIIO, and CMMI — and direct contracts with state health agencies across more than half of U.S. states. Its go-to-market is enterprise field sales into government procurement channels, supplemented by prime- and subcontractor teaming on larger vehicles. The technology stack is built on Microsoft-anchored cloud and development tooling (AWS, Azure, SharePoint, Microsoft Power Platform, .NET, SQL Server, Angular) with BI delivery through Tableau and Power BI, supported by DevOps/CI-CD practices; a proprietary Angular-based State Survey Agency Platform is the most visible productized asset. Pricing is contracted and not publicly disclosed.

The leadership bench is unusually deep for a 101–250-employee firm: CEO Laura Reeder (appointed June 2022, internal succession from CFO); President/Founder Leah Heimbach (JD, RN, EMT-P); CFO Douglas Kelly (CPA); CTO Jason Cunningham (PMP, 25+ years); and Independent Board Member Karen Jackson, retired CMS Deputy COO who oversaw more than $1 trillion in annual healthcare spending. A second independent director, Susan Kildahl, brings prior ESOP transition experience from NHS Northstar. No revenue figure, app, API, patents, or public funding events are disclosed.

Name

Healthcare Management Solutions

Legal name

Healthcare Management Solutions, LLC

Website

https://hcmsllc.com

Company type

Private

Founded year

2002

Operating status

Operating

Headcount range

101–250 employees

Short description

Healthcare Management Solutions is a 100% employee-owned government contractor providing healthcare regulatory services — facility surveys, state operations support, marketplace compliance, medical record review, and IT solutions — to CMS, CCIIO, CMMI, and state health agencies across more than half of U.S. states.

Ownership category

akta.pro rank

Product category

Healthcare Regulatory Consulting and Government Contracting

NAICS

Administration of Public Health Programs (92312)

SIC

Services-Health Services (8000)

akta.pro primary industry

Care Management & Population Health Program Administration (HLAEALAG)

akta.pro secondary industry

EHR Implementation, Optimization, Training & Managed Services (HLACAAAL)

Keywords

• Healthcare consulting services
• Health facility surveys
• Medicare Medicaid compliance
• State survey agency support
• Government healthcare contracting

Headquarters

HQ city

Fairmont

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, Others

Revenue model

1. Federal Government Contracts: Primary revenue stream from direct contracts with federal agencies, primarily the Centers for Medicare and Medicaid Services (CMS). Contracts include health facility surveys, CMS program support, and compliance reviews for federally facilitated exchanges.
2. State Government Contracts: Revenue from contracts with state health agencies, supporting state operations, survey agency training, and healthcare quality and safety initiatives. Since 2014, the company has collaborated with more than half of U.S. states.
3. Healthcare Consulting Services: Provides specialized consulting including medical record review, policy development, workflow optimization, training, and data analysis for federal and state agencies.

Go-to-market motion1 record

Distribution channels3 records

Marketing channels3 records

Core offering

Healthcare Management Solutions is a government healthcare contractor that conducts health facility surveys and certification inspections, provides state operations support and surveyor training, performs medical record reviews, executes compliance reviews of Qualified Health Plans, supports CMMI payment models, and delivers information technology solutions including custom software, cloud services, and data analytics for federal and state agencies.

Product overview

Healthcare Management Solutions offers a portfolio of healthcare consulting services organized around six core capabilities: Health Facility Surveys (Inspections) for quality and safety assessments; State Operations Support for policy development and agency training; Health Insurance Marketplace Compliance and Payment Model Support for regulatory oversight; Medical Record Review for data validation; and Information Technology Solutions for software development and data services. The company partners primarily with the Centers for Medicare and Medicaid Services (CMS) and state health agencies to advance healthcare quality, safety, and access across the U.S. healthcare system.

Differentiator

Problem solved

Functional benefit

Products and services

• Health Facility Surveys (Inspections) Onsite observations, interviews, and record reviews of nursing homes, hospitals, and outpatient facilities to evaluate compliance with Medicare/Medicaid certification requirements; delivered to CMS and state survey agencies.
• State Operations Support Expert support services to state and federal agencies including policy development, workflow optimization, business process automation, operations audits, and customized training for survey agencies.
• Health Insurance Marketplace Compliance Compliance reviews of Qualified Health Plans (QHPs) offered through the Federally Facilitated Exchange, assessing network adequacy, consumer notices, and regulatory adherence under the Affordable Care Act; delivered to CCIIO.
• Payment Model Support Programmatic compliance reviews and quality monitoring for CMMI payment models including beneficiary medical record reviews, virtual site visits, and desktop audits.
• Medical Record Review Medical record reviews ensuring accuracy and integrity of data submitted to government agencies, employing advanced review methodologies, robust records management systems, and meticulous data collection processes.
• Information Technology Solutions Innovative IT solutions for federal and state agencies including software development and deployment, cloud services, data analytics, business intelligence reporting, and emerging technologies such as AI-driven analytics and cybersecurity.

Named customers5 records

Segments3 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Partnerships

Five partnerships are on record, tiered core and minor.

• Centers for Medicare and Medicaid Services (CMS)coreStrategic or Co-development PartnerPrimary federal partner for over 20 years. HMS supports CMS in its mission to improve healthcare across the U.S. healthcare system through health facility surveys, certification inspections, and various compliance and quality initiatives.
• State Health AgenciescoreStrategic or Co-development PartnerSince 2014, HMS has collaborated with more than half of U.S. states through direct contracts with state health agencies, providing survey support, training, policy development, and operational efficiency services.
• Centers for Consumer Information and Insurance Oversight (CCIIO)coreStrategic or Co-development PartnerHMS supports CCIIO in safeguarding consumer access to affordable, high-quality health coverage by enforcing health insurance standards through compliance reviews of Qualified Health Plans.
• Center for Medicare and Medicaid Innovation (CMMI)coreStrategic or Co-development PartnerHMS partners with CMMI to advance healthcare quality and cost-efficiency through innovative payment model support, including compliance reviews and program monitoring.
• Leading Non-Profit Cardiothoracic Surgery OrganizationminorOthersHMS is proud to have supported a leading non-profit cardiothoracic surgery organization in advancing healthcare quality and safety initiatives.

Scale indicators3 records

Recent moves7 records

Expansion highlights6 records

Direct peers

• IMPAQ International: IMPAQ International provides healthcare policy research, program evaluation, and survey support to CMS and other federal agencies. Directly comparable to HMS in CMS research, evaluation, and quality-measurement contracts.
• BerryDunn: BerryDunn's Healthcare Practice Group provides consulting to state Medicaid agencies, state survey agencies, and CMS, including surveyor training and compliance work. Closely comparable to HMS's state health agency service line.
• Telligen: Telligen is a non-profit federal contractor providing healthcare quality improvement, survey and certification support, and CMS-facing program services. It is the closest direct competitor to HMS in state survey agency training and CMS quality oversight work.
• The Bizzell Group: Bizzell is a federal contractor providing healthcare quality, public health, and survey/certification support to CMS and state agencies. Comparable to HMS in federal health regulatory contracting and survey workforce services.
• Atlas Research: Atlas Research is a federal healthcare consulting firm supporting CMS, VA, and HHS with quality measurement, program evaluation, and operational improvement. Comparable to HMS in mid-sized federal healthcare services scope and CMS client base.

Broad incumbents

• Westat: Westat is a large employee-owned (ESOP) research firm providing survey research, evaluation, and statistical support to CMS and HHS. Notable as a structural and cultural peer given its ESOP status and federal health survey capabilities.
• MAXIMUS: MAXIMUS is a leading government services company operating major CMS and state Medicaid contracts including eligibility, enrollment, and program integrity. Overlaps with HMS in CMS-facing operational support and competes for adjacent state health contracts.
• ICF International: ICF is a large public-sector consulting firm with a significant health practice supporting CMS, HHS, and state agencies on research, evaluation, and IT. Competes with HMS for the same federal health-services RFPs at a larger scale.
• Booz Allen Hamilton: Booz Allen Hamilton operates a large federal health consulting practice serving CMS, HHS, and the VA with strategy, analytics, and technology services. Competes with HMS for premium federal health advisory work and partnership roles on large procurements.
• Mathematica: Mathematica is a major non-profit policy research firm with deep CMS and Medicaid evaluation work, including quality measurement and program assessment. Directly comparable to HMS in CMS research, evaluation, and data analytics services.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/hcmsllc
• Xx.com/hcmsllc

Revenue estimate

Valuation estimate

Number of profiles

Profiles16 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 Healthcare Management Solutions