Health care and social assistance
This sector comprises establishments primarily engaged in providing health care by diagnosis and treatment, providing residential care for medical and social reasons, and providing social assistance, such as counselling, welfare, child protection, community housing and food services, vocational rehabilitation and child care, to those requiring such assistance. — Statistics Canada, NAICS 2022A
- Establishments · CanadaA
- 137,535
- Under 10 employeesA
- 73%
- Establishments · USA
- 976,418
- Employment · USA
- 21,171,232
- Payroll · USA
- $1.28T
Size and shape
How many businesses there are and how small they are. Fragmentation is the first thing an entrant — or anyone selling software into this industry — needs to know, and it is one of the few things that is actually measured.
Canadian establishments by number of employeesA
Of 137,535 Canadian establishments with employees, 73% have fewer than ten — mostly small operators.
Where they areA
Largest four provinces by establishment count. Establishments with employees only — sole operators with no payroll are not in this table, so in trades and personal services the true number of businesses is higher.
Measured, not forecast: the share of US establishments opening in one year that were still active later. It counts good operators and bad ones together, which is exactly why it is the honest answer to “what are the odds”. It is for the whole sector rather than this market, and the ten-year figure comes from an older cohort because no younger one has reached ten years.
Market screens and studies
Market-entry records filed along this branch of the hierarchy. A record at or beneath this code is about this industry; one above it is about something wider that contains it.
The buy-in price is set by someone else's cost of capital. Dentalcorp is buying into a $22B Canadian market that is only about 7% consolidated, reporting $409.4M, $435.2M and $420.1M across the first three quarters of 2025 at 9–12% growth, and it secured 70% of its annual acquisition target inside Q1. An associate buying a single practice bids against that. Note a data problem: a $1.1B full-year 2025 revenue figure circulates for Dentalcorp and cannot be reconciled with its own reported quarters, which already sum to about $1.26B by the end of Q3 — the quarters are used here and the annual figure is not.
Two forces squeeze the independent optometrist from opposite ends. Below, the optical chains sell the glasses that carry the margin — National Vision alone runs 1,250 stores on $1.99B of revenue, with an exam priced as a loss leader for the frame sale. Above, the elective procedures that would lift the average ticket are performed in surgical centres the practice does not own, and online lens retail keeps taking the repeat purchase. The exam is the least profitable part of the visit, and it is the only part an independent reliably controls. Note what the chain's own filing now shows: the footprint is no longer expanding quickly. After exiting its Walmart and AC Lens businesses in fiscal 2024, National Vision opened 33 stores and closed 23 in fiscal 2025 for a net gain of ten — 0.8% — and guides to 30–35 openings in fiscal 2026 against 69 in fiscal 2024. Growth is coming from the existing base instead: comparable store sales rose 5.9%, and managed care is now 42% of revenue.
The same consolidation story as dental, one rung down in ticket size and with a worse payer mix: extended-health benefits set the reimbursement ceiling, direct billing is table stakes, and the roll-ups — Lifemark inside Loblaw, pt Health and their regional equivalents — are buying the clinics with the best referral relationships. A single clinic's value walks out with its practitioners, who own their caseloads. The practice software at this code is screened separately.
Largest angel cluster after software — 99 companies across AB/ON/QC. Cut because Health Canada / FDA pathways, reimbursement dependency and 3–7 year clinical validation cycles put first revenue outside any window a small entrant can fund. The angel concentration here is a warning, not an invitation: it means the patient capital is already committed.
Demand is not in question, and where private entry is allowed the business exists at scale. Acadia Healthcare, a listed US pure-play in behavioural health, reported 2025 revenue of $3,312.8M, up 5.0%, across 277 facilities and over 12,500 beds, and added 1,089 licensed beds in the year [A]. The same release is a warning about the economics even where the door is open: adjusted EBITDA fell to $608.9M from $709.0M, capital expenditure was $571.8M, and the company booked a $996.2M goodwill impairment [A]. Beds are expensive to add and their return is set by payers and by regulators' scrutiny of admissions. In Canada the door is mostly closed, and that is the cut. An establishment in this code must be licensed as a hospital, and hospital status, global budgets and physician billing for psychiatric in-patient care sit inside provincial health systems. The count shows it: of 74 establishments, 20 employ 500 or more and another 14 employ 100 to 499 — the public mental-health centres — and the small remainder are units and affiliates, not start-ups. If capital were no object an entrant would still have no licence to apply for and no payer to bill. What a private operator can open in Canada is a residential treatment centre that is not a hospital, funded by private pay, employer benefits and some public contracts; that sits in 6232 and should be screened there. The hospital software sold to this industry is screened separately at 6221.
In the United States this is one of the better businesses in health care. Encompass Health, which owns in-patient rehabilitation hospitals and nothing else, reported 2025 net operating revenue of $5,935.2M, up 10.5%, and adjusted EBITDA of $1,267.9M, up 14.9%, from 173 hospitals, and opened eight more in the year [A]. A focused hospital doing one thing at volume — stroke rehabilitation, hernia repair, orthopaedics — is cheaper and better than a general hospital doing it occasionally, and the US sector's 861 establishments average about 300 staff. The cut is that the Canadian version of this business cannot be started. Ontario's Private Hospitals Act allows a private hospital to operate only under a licence issued before 29 October 1973 or a renewal of one; none has been granted since, and the handful that survive, Shouldice among them, are grandfathered [B]. Elsewhere the rehabilitation, chronic-care and cancer hospitals in this code are arms of provincial health authorities: of 245 establishments, 118 employ 100 or more, and the 63 in Alberta and 31 in Saskatchewan are most plausibly publicly run auxiliary and continuing-care hospitals. Even a grandfathered licence is not a free asset — a change of ownership needs the minister's consent, and volumes and fees are set by the provincial insurer. The reachable adjacent proposition is the non-hospital surgical or diagnostic facility working under public contract, which belongs under ambulatory care (6214), not here. The hospital software sold to this industry is screened separately at 6221.
This is the rare traditional market where demand is proven by the operators' own numbers — Chartwell ended 2025 at 95.2% occupancy with property revenue up 34.9%, and Extendicare's long-term care segment ran at 98.0% occupancy on $892.1M — and it is still a screen, because the margin is regulated and the entry ticket is a building. Extendicare's LTC adjusted NOI margin was 10.9%: a thin, provincially funded return on an asset requiring tens of millions of capital, ongoing capex and licensed staffing a new entrant cannot recruit at scale.
The pre-screen called this a genuine operator business, and the count agrees: 4,091 establishments, 2,511 of them with 10 to 49 staff — which is what a house or a small cluster of houses with round-the-clock shifts looks like. Unlike the retirement and long-term care homes screened at 623110, the ticket is not a purpose-built building; a group home is an ordinary house, often leased. And the funded rate is substantial. Ontario's Financial Accountability Office puts developmental-services supportive living at $2,262 million in 2023-24 for approximately 18,000 people — $123,826 per client [A]. The cut is what that money is growing into. The FAO projects spending rising 4.4% a year to $2,804 million by 2028-29 with no growth in the number of clients served: the whole increase is cost per placement [A]. Meanwhile 28,128 people were waiting for a placement, up from 18,152 in 2017-18 [A]. Demand that large beside volume that flat means the payer has decided not to buy more places, and an entrant's growth can only come from taking an existing placement from an incumbent agency — agencies that hold their funding through long-standing transfer-payment agreements and, being largely non-profit, have no reason to sell. Growth that is pure wage pass-through is not growth an operator keeps. This is not a clean kill. It is an Ontario finding; a full study would test the provinces that contract for-profit providers more freely, and the private-pay addiction and mental-health residences that share this code and were not examined.
Private-pay retirement living is the part of elder care where the operator, not a ministry, sets the price — and demand is as certain as demography gets. The 623110 record screens the funded long-term-care acquisition; this is the other side of the building, and the numbers explain both why it attracts capital and why it is not an ordinary entrant's market. Chartwell, one of the largest Canadian operators at about 25,000 residents in four provinces, reported 2025 property revenue of $1,079.0M, up 34.9%, with same-property occupancy of 95.2% at year-end and a same-property adjusted operating margin of 41.7% [A]. That margin is earned on a real-estate base: Chartwell completed or announced more than $1.7B of acquisitions in the year [A], which is the price of growing in this industry. The business count says the same thing in another way — only 22% of the 3,493 Canadian establishments have fewer than ten employees, and 300 employ a hundred or more [A]. A residence is a purpose-built, licensed building staffed around the clock; it is financed like an apartment tower and operated like a hotel with a care obligation. The cut is the building. A small operator can lease or manage, but then the landlord holds the asset the margin is earned on.
Group homes, transition houses and residences for people with disabilities are small by design — a house on a residential street, staffed in shifts — and that makes the industry look reachable: 37% of the 2,028 Canadian establishments have fewer than ten employees [A]. The cut is who pays and how. Almost every bed is funded by a provincial ministry or a regional authority under a per-diem or a service agreement, so the operator's revenue is a rate it does not set, revised on the funder's schedule rather than when wages move. The cost side is nearly all labour: the US counterpart runs about 21 employees per establishment on a payroll of roughly $41,000 each [A], which is what round-the-clock direct care costs. An entrant therefore buys a house, carries staffing at a ratio fixed by licence, and is paid a rate negotiated by someone whose incentive is to hold it down. The 6243 record found the same mechanism in vocational rehabilitation: the contracts do not fund the service, and the organisations doing the work cover the gap from revenue earned elsewhere. Here there is no such arm to lean on. Operators that do well are non-profits with fundraising, or multi-site providers who spread overhead across dozens of homes.
The buyer is usually a government programme or a family in crisis, and neither pays well. Contracted services are funded per client at rates set in advance and rarely indexed, while the labour is credentialled and scarce. The non-profits already holding those contracts have fundraising and volunteer capacity a private operator does not. Adjacent to the home-care study at 621610, which found the same payer and a clearer wedge. What the funded rate does to a business is visible in the one listed operator of these services: BrightSpring's Personal Care line — non-medical home and community support, the private part of this code — served 16,079 people in 2025 against 15,879 in 2024, growth of 1.3%, while its Medicare-funded home health census rose 9.1% and its rehab line 8.0% [A]. Same company, same salesforce, same year; the line whose price is set by a social-services payer is the line that does not move.
Food banks, shelters and emergency relief are demand without a payer. The people served pay nothing, by definition, so every dollar of revenue is a grant, a government contract or a donation — and the organisations that do this work are charities because no other form fits. The pre-screen filed this as public; the more precise statement is that there is no customer, only funders, and a funder is not a market an entrant can price into. The counts show an industry of small local bodies with a few large ones: 1,348 Canadian establishments, 48% with fewer than ten employees and 46 employing a hundred or more [A]; the US has 16,002 establishments [A]. Rising demand does not change that: more need raises cost, not revenue. What is enterable sits beside the industry rather than inside it: logistics, software and fundraising services sold to these organisations, which the 8132 record screens from the software side and finds defended by an incumbent that monetises donation flow. Even there, the buyer's budget is whatever its donors gave last year.
2 more sit deeper in this branch — open a row under “Inside this industry” to reach them.
Software serving this industry
The vertical software markets filed along the same branch — who sells to these businesses and who they would have to displace — and then the generic categories every business buys whatever it does.
What this category is. The back office between a care provider and whoever pays: eligibility checks, claims and the clearinghouse that carries them, coding, denials and appeals, payer-to-provider payments, patient statements and collections, and the credentialing and enrolment that let a clinician bill a plan at all. The coded customer is ambulatory care (621): physician groups, clinics, labs and home health. But the largest buyers of several segments are hospitals and health systems (outsourced revenue cycle, inpatient coding) and health plans (payer payments, provider data, credentialing). How it differs from the neighbouring records. Electronic health records and practice management (6211) sells the chart and scheduling; athenahealth appears here only for its revenue-cycle business, and its funding is not re-researched. EHR+ patient engagement (6211) sells the portal and intake. Patient booking (6211) sells patient acquisition. HIPAA compliance (6211) sells security and audit. Medical imaging (621510) sells PACS. This record is the money and paperwork layer. Who owns the rails. Optum completed its combination with Change Healthcare on 3 October 2022 [A, Optum]. The February 2024 ransomware attack on Change touched about 192.7 million individuals, the largest US healthcare breach on record [B, CyberInsider citing the HHS OCR filing], and stopped claims for providers across the country. That shows how much of the network runs through one company. Availity says it connects over two million providers to every US health plan and handles over 13 billion transactions a year; its shareholders include Anthem (Elevance), Humana, HCSC and GuideWell, and Novo Holdings bought Francisco Partners' stake in July 2021 [A, Novo Holdings]. Waystar (Nasdaq: WAY) earned $1,099M of revenue in 2025, up 17%, from about 30,000 clients representing over 1 million providers [A, Waystar release]. Experian Health sells patient access, eligibility and identity inside Experian plc. Zelis runs the payer-to-provider payment side: 725 payer clients, 850K+ providers and $300B+ of payment volume by its own count [C]. Bain Capital and Parthenon sold a minority stake to a Mubadala-led group that closed on 26 November 2024 [A, Kirkland & Ellis]; the reported $17B valuation is Bloomberg's, not opened here. Who owns the outsourced work. R1 RCM was taken private by TowerBrook and CD&R at about $8.9B, closing 19 November 2024 [A, CD&R]. Ensemble Health Partners began as Bon Secours Mercy Health's revenue-cycle arm; Golden Gate Capital bought 51% in 2019 in a deal reported at about $1.2B [B, Becker's]. athenahealth, bought by Bain Capital and Hellman & Friedman for $17B [B, Healthcare Dive], bundles billing with its ambulatory record. The AI wave is already funded. AKASA (inpatient coding for 500 hospitals, by its own count) raised a $60M Series B led by BOND in 2021 [A]. Adonis raised a $40M Series C led by Quadrille Capital in March 2026, over $95M in total, and claims more than 4x revenue growth in 2025 [A, company release]. Candid Health raised a $52.5M Series C led by Oak HC/FT, $99.5M in total [B, HLTH]. Infinitus raised a $51.5M Series C led by Andreessen Horowitz, $102.9M in total, for AI agents that call payers [B, Pulse 2.0]. In credentialing, Medallion has raised $130M (latest $43M led by Acrew Capital, August 2025) and has acquired Andros [A]. CertifyOS raised a $40M Series B led by Transformation Capital in June 2025 [A]. Uno Health (Medicaid and benefits enrolment) was bought by Findhelp in October 2025 [B]. Canada. Provincial plans pay physicians, so the US claims-and-denials problem mostly does not exist. Billing is bundled with the record: more than 40,000 Canadian health professionals use a TELUS Health EMR [A, TELUS], and TELUS's CHR files OHIP claims through MDBilling [A, TELUS help centre]. mdbilling.ca now redirects to Dr.Bill, which claims 13,000+ physicians across OHIP, MSP and AHCIP [C]. TELUS eClaims covers direct billing to private insurers for allied health. Why a newcomer cannot get in. The clearinghouse and payment rails are owned by Optum, Availity (owned by payers), Waystar and Zelis. Each depends on connections to thousands of payers and on volume pricing. The outsourced hospital work is owned by private-equity platforms worth billions. Every point task an AI startup might attack (coding, denials, payer calls, credentialing, patient billing) already has a venture-backed player with $50M–$130M raised, and the incumbents are buying or building the same AI. Waystar's acquisition of Iodine is one example. In Canada the pain is small and the record vendors bundle it. Incumbent vulnerability decides it.
What this category is. The layer of software the patient touches: the portal and app, digital intake and check-in, reminders and two-way texting, online bill pay and the personal health record. It sits on top of the chart and writes back into it. The coded customer is the physician's office (6211), but the biggest buyers are health systems and clinic networks, and the same products are sold to dentists, optometrists and specialists. How it differs from the neighbouring records. Electronic health records and practice management (6211) sells the record itself. Patient booking and doctor marketplaces (6211) sells patient acquisition: a marketplace of competing practitioners. Telehealth and remote patient monitoring (6219) sells the visit. This record covers what happens between a practice and the patients it already has. Two names the brief proposed fall into those neighbours. TELUS Health MyCare is a direct-to-consumer virtual clinic (telehealth, 6219). Medeo, owned by Loblaw through QHR Technologies, does offer booking, messaging and video visits for a patient's own clinic, so it stays on this record. The incumbent is the record vendor, not a portal company. Epic's MyChart says it serves over 190 million patients [A, mychart.org]. It comes with the Epic record, so a health system on Epic does not buy a separate patient portal. The ambulatory record vendors have done the same thing. eClinicalWorks ships healow. ModMed bought Klara in February 2022, and klara.com now redirects to ModMed's patient-engagement page [A/B]. Tebra sells patient experience alongside its record. In Canada, WELL Health bought CognisantMD's Ocean platform (booking, messaging, reminders, digital forms, kiosks and eReferral) in December 2021. At the time Ocean supported about 8,000 physicians and had about $4M of annual SaaS revenue [B, WELL release]. The independents that have scale. Phreesia (NYSE: PHR) earned $480.6M of revenue in fiscal 2026, its first full year of GAAP net income. It averaged 4,514 healthcare-services clients that year [B]. Part of that revenue comes from pharmaceutical manufacturers who pay to reach patients at intake, not from the practices. Phreesia cut its fiscal 2027 outlook to $510–520M because of reduced visibility into that spending [B]. Weave (NYSE: WEAV) earned $239.0M in 2025, up 17%, from 39,625 customer locations. Most are small dental, optometry and medical practices [A, Weave release]. Luma Health raised a $130M Series C led by FTV Capital in November 2021, $160M in total, and claimed 550+ health systems and clinic networks [B]. Artera (formerly WELL Health Inc., renamed October 2022) had raised just under $100M by then and is reported to have added a $65M Series D led by Lead Edge Capital in December 2025 [B/C]. Relatient has been majority-owned by Brighton Park Capital since November 2019 and raised more than $100M of growth equity before buying Radix Health in 2021 [B]. Kyruus Health (provider search plus scheduling; it bought HealthSparq and Epion Health) and Solutionreach (Summit Partners since 2012) complete the field [B/C]. PocketHealth (Toronto; $33M Series B led by Round13 Capital in March 2024) is a niche: patients' access to their own medical images [B]. Why a newcomer cannot get in. The patient's login belongs to whoever holds the chart. For a health system on Epic, MyChart is already paid for, and any standalone tool must integrate with the record and justify itself on top of what is bundled. For a small practice, the record vendor bundles reminders and a portal, and Weave and Solutionreach already sell texting and payments. The standalone vendors with scale have found a second payer (Phreesia's pharma network) or a payments attach (Weave). That tells you a practice will not pay much for engagement on its own. Canada. Ocean (WELL Health) leads physician-office engagement and eReferral, Medeo is bundled with Loblaw's Accuro record, and portals from the provincial systems and hospitals cover the rest. The paying customer is a publicly funded practice with limited budget for add-ons, which is analyst judgment, not sourced. Incumbent vulnerability decides it: the record vendor owns the patient's login and bundles the layer, and the independent field is crowded and funded.
Epic holds 43.7% of acute hospitals and 56.9% of beds, and was the only vendor chosen by large health systems in 2025. Its position is reinforced by clinician training investment rather than contract terms, and certification (ONC in the US, provincial conformance in Canada) is a multi-year floor before a single seat is sold. There IS visible instability — roughly 30% of Oracle Health customers say the platform is not in their long-term plans and another 35% are considered vulnerable — but that displaced demand flows to Epic and Meditech, not to a new entrant. Note also that EHR purchase decisions fell 40% in 2025: the buying window itself is narrowing.
The control set is public, the regulator gives the artefact away, and the platforms that sell a dozen frameworks throw this one in — there is no ground here that can be held. The floor is zero: ONC, with OCR, publishes the Security Risk Assessment Tool free (v3.7, a 72.5MB Windows installer plus an Excel workbook), aimed in its own words at "medium and small providers" — the exact buyer a HIPAA-only vendor sells to — and NIST SP 800-66 Rev. 2 (February 2024) maps every Security Rule standard to CSF subcategories and SP 800-53r5 controls, machine-readable through NIST's CPRT. The ceiling is the multi-framework platform: Vanta, Secureframe and Scytale each list HIPAA as one item on a menu beside SOC 2, ISO 27001, PCI DSS, GDPR, ISO 42001 and CMMC (vendor pages opened 2026-09-20). A health-tech buyer who needs SOC 2 to close enterprise deals gets HIPAA out of the same control set, at no separate line on the quote. Between floor and ceiling sits a thin, transparent price: Accountable HQ publishes $2,028 to $8,148 a year for 15–20 employees, and its own navigation carries comparison pages against Vanta, Sprinto, Secureframe, consultants and spreadsheets — the pure-play conceding the squeeze on its own site. The one pure-play that ever reached a public market settles it. CynergisTek's revenue fell from $21.36M (2019) to $16.30M (2021); Clearwater Compliance, an Altaris portfolio company, took it private at $1.25 cash a share on 2022-09-01 — about $16.6M for the equity, roughly one times revenue, and below every outstanding option strike, so all options were cancelled for nothing. The honest screening outcome is that this is a framework inside a broader compliance product, not a standalone market.
What this category is. These are online booking marketplaces. A patient searches by specialty, location and insurance, reads reviews and books a slot. The practice pays a subscription that bundles its public profile, an online calendar, reminders that cut no-shows and light practice-management software. The coded customer is the physician's office (6211), but the same product is sold to dentists, physiotherapists, psychologists and other independent practitioners. How it differs from the neighbouring records. Electronic health records and practice management (6211, Epic and the ambulatory EHRs) sell the clinical record. A booking marketplace sells patient acquisition, and scheduling is the hook that gets it into the practice. The marketplace holds the patient demand, not the chart. Telehealth (6219) sells the visit itself. The dental (621210), chiropractic (621310) and behavioural-health (621330) records cover single-profession practice software. Jane appears there as a multi-discipline clinic system, and its online booking serves the clinic's own patients rather than a marketplace of competing practitioners. The leaders are regional, and each holds its own geography. Docplanner (Warsaw) runs ZnanyLekarz in Poland, Doctoralia in Spain and Latin America, MioDottore in Italy and jameda in Germany across 13 countries. It claims 300,000 active doctors and 100 million monthly patient visits [C, vendor]. It merged with Doctoralia in 2016 alongside a $20M Series C led by Target Global, raised a €15M Series D in 2017 (ENERN lead) and an €80M Series E in 2019 (One Peak and Goldman Sachs Private Capital), then took a 2021 round at more than $1B whose amount was not disclosed [B]. By its own account it had raised about €300M by November 2021, when it bought jameda from Hubert Burda Media [B]. Its Polish subsidiary filed PLN 212.5M of 2024 revenue and PLN 50.7M of net profit, and management talks of about $300M of group revenue in 2026 and a listing in two to three years [B, wirtualnemedia.pl]. Doctolib (Paris) holds France, Germany and Italy. It raised €150M at $1.13B in 2019 (General Atlantic) and €500M of equity and debt at €5.8B in 2022 (Eurazeo lead), about $815M in all [B]. It now claims 520,000 health professionals [C, vendor], and a reported 2026 secondary priced it near €3.6B [C, via secondary report]. Zocdoc (New York) holds the US: $130M at $1.8B in 2015 (Baillie Gifford and Atomico) and $150M of growth financing from Francisco Partners in 2021, when it said it was profitable after moving from flat subscriptions to a fee per booking [B]. Practo (Bengaluru) holds India and sells its Ray clinic software alongside the marketplace [A for the product; B for the $55M 2017 and $32M 2020 rounds]. Why a newcomer cannot get in. The practice pays for patients, so a marketplace with no patient traffic has nothing to sell. Building that traffic means years of consumer search and review content, and each incumbent's moat is one country's patients. Below the marketplaces the field is crowded with scheduling-and-reminder software that has no demand side of its own: Jane (North Vancouver, valued at about $1.8B), Cliniko (Melbourne, bootstrapped, $45 to $395 a month), Tebra (Kareo plus PatientPop), NexHealth ($125M Series C at $1B) and Solv (urgent care, over $80M raised) [B/C]. The Canadian gap is structural, not open. No national doctor-booking marketplace leads in Canada. Medically necessary physician services are publicly insured, so a GP cannot pay a marketplace to buy demand the way a private practice in Warsaw, Paris or New York can. The paying customers are allied-health and private clinics, and Jane already serves them. This is analyst judgment, not sourced. Distribution decides it: the asset is the patient audience, and every geography that pays for one already has a funded owner.
The buyer changed. There are ~2,000 dental service organisations where there were ~100 in 2010, and they acquire practices running incompatible systems — creating the same migration wedge as insurance brokerage, but in a market that is growing rather than shrinking.
How chiropractic differs from rehab therapy (621340). Rehab software is built around insurance: WebPT and its rivals compete on documentation that survives payer and Medicare review, and the visit is billed to a third party. A chiropractic office sells many more short visits, usually as a care plan: a course of adjustments scheduled ahead and often paid up front or as a monthly membership. Part of the profession runs cash-only. That changes what the software has to do. It needs recurring card billing for memberships and prepaid plans, a ledger for plan balances, fast spinal-adjustment SOAP templates, and personal-injury and auto-accident case files alongside ordinary insurance claims. Discounting is also a compliance problem: charging cash patients less than insurers invites dual-fee-schedule trouble. A whole product, ChiroHealthUSA, exists to sell practices a 'compliant membership model' as a discount medical plan; it claims 7,700+ providers [C, vendor]. These are analyst framings of the workflow; the vendor pages confirm the features (ChiroSpring sells 'Memberships', ChiroTouch's CT Pay sets up recurring payments, ClinicMind sells a 'Cash-Only / Private Pay' plan) [C, vendor]. The incumbent is ChiroTouch, and it now sits inside a private-equity roll-up. It claims 12,500+ chiropractic practices [C, vendor]. K1 bought it in 2014, Waud Capital Partners took a stake in 2017 [B, socaltech], and in September 2023 Waud's platform (Integrated Practice Solutions, whose chiropractic line is ChiroTouch) merged into PracticeTek under Lightyear Capital majority ownership, with Greater Sum Ventures and Waud keeping stakes [B, Lightyear release]. PracticeTek also owns ChiroSpring, the cloud challenger that sells memberships; ChiroSpring's founder is quoted on PracticeTek's site, and the two share a San Diego address [C]. So the incumbent and one of the best-reviewed challengers have the same owner. Second consolidator: ClinicMind, which absorbed Genesis Chiropractic Software (its homepage now offers 'ClinicMind EHR 1.0 formerly Genesis') and sells EHR plus outsourced billing [A for the merger; date January 2024 from search summary, not opened]. The best-funded challengers. ChiroHD (Atlanta, founded 2017) raised $26M of growth capital from Mainsail Partners in April 2025 [B]. Jane (North Vancouver) is multi-discipline rather than chiropractic-only. It raised under $10M of primary capital, including $2M of CIBC debt in 2019 [B], and was valued at about $1.8B in a May 2025 secondary of $500M-plus led by TCV with JMI Equity and Tidemark [B]; reported revenue was about US$100M [B, The Logic via techcouver]. Practice Better (Toronto; US$27M led by Five Elms, April 2023, and US$13M of CIBC growth debt, November 2024) [B] named chiropractors as a target vertical when it raised. A new entrant would face a PE-owned incumbent that already bundles payments and recurring billing, a venture-funded cloud challenger aimed squarely at it, and a Canadian multi-discipline platform worth more than any of them. Incumbent vulnerability decides it. No vendor publishes revenue except Jane's reported figure.
How this differs from general EHR and practice management (6211). The general record is about Epic and the hospital market, where certification and clinician training decide who wins. An optometry office is a clinic with a shop attached. The software has to run the eye exam (refraction, pre-test device data, retinal imaging) and also an optical store: frame and contact-lens inventory, a point-of-sale counter, and lens orders sent to labs. The money side runs on two tracks. Routine eye exams and eyewear are paid through vision plans (VSP, EyeMed and others), which have their own eligibility checks, authorizations and claims. Medical eye care is billed to ordinary health insurance. Generic EHRs do not do frames, lab orders or vision-plan claims, which is why the category exists. The incumbent is a payer. Eyefinity is part of VSP Vision, the largest vision plan, and sells the only optometry software with a direct connection to VSP for real-time eligibility, authorizations and claims [C, vendor]. That claims link is the moat. In October 2025 NextGen Healthcare licensed it too: its ophthalmology and optometry customers now get Eyefinity's VSP claims, frame inventory, point of sale and lab ordering [B, NextGen release]. The independents are old and private. RevolutionEHR (Madison, founded 2006, majority-owned by the RevOptix investor group since 2014 [B]) claims 13,000+ eye care professionals [C]. Crystal PM (Austin) claims 8,000+ independent optometry providers [C]. Compulink (since 1985) also sells to ophthalmology and other specialties. Sightview, formerly Eye Care Leaders, was sold to unnamed owners in July 2024 and carries My Vision Express alongside iMedicWare, Medflow and ManagementPlus [B]. Ocuco (Dublin; €60M minority investment from Accel-KKR in 2023 [B]; 6,750+ sites in 88 countries [C]) sells optical retail and lab software, and its Canadian arm grew out of the EMRlogic acquisition. The one funded newcomer is small. Barti raised a $12M Series A led by Five Elms Capital in August 2025, with AOAExcel (the American Optometric Association's for-profit arm) as an investor [B]. It sells an AI-first all-in-one system and has onboarded about 200 practices [C]. Patient messaging is a separate layer owned by Weave (NYSE: WEAV; $239.0M revenue in 2025, 39,625 customer locations across dental, optometry and other verticals [A]), and Eyefinity lists Weave as an integration partner. The buyer is consolidating. By the end of 2023, private-equity platforms ran hundreds of offices each: MyEyeDr 842, AEG Vision 400+, EyeCare Partners 385+, Keplr Vision 278 [B, Vision Monday]. Those groups standardise on one system and negotiate enterprise terms, which leaves a shrinking independent market split among 25-year-old vendors that each claim thousands of providers. A new entrant would need the vision-plan claims link the payer owns, the device and lab integrations the incumbents built over two decades, and a buyer that is not being acquired. Incumbent vulnerability decides it. No optometry software vendor publishes revenue.
SimplePractice has the solo and small-group therapist market at scale and sits behind EQT's balance sheet, but the harder problem is the payer-network model: Headway and Alma give practice software away because they earn on the claim. Competing with free-plus-revenue against a buyer who is also being offered patient flow is not a wedge. Nothing is disclosed here. Every vendor named on this record is private, or sits inside a parent that does not break the line out, so no revenue floor can be built and the market size is genuinely unknown rather than estimated.
WebPT is entrenched and Prompt is well funded. Insurance billing and documentation compliance are the core, and both are covered. Jane's Canadian success suggests the opening is geographic rather than functional. Nothing is disclosed here. Every vendor named on this record is private, or sits inside a parent that does not break the line out, so no revenue floor can be built and the market size is genuinely unknown rather than estimated.
42 CFR Part 2 governs substance-use records more tightly than HIPAA governs the rest of health care, and state licensure, accreditation and utilisation-review integration all precede the first sale. The buyer set — residential and outpatient programmes — is also consolidating into chains that standardise on Netsmart or Kipu at the group level. Nothing is disclosed here. Every vendor named on this record is private, or sits inside a parent that does not break the line out, so no revenue floor can be built and the market size is genuinely unknown rather than estimated.
Software attached to imaging hardware — the same razor-and-blade structure that decided the veterinary study, with a regulatory floor on top: PACS and any diagnostic AI are regulated medical devices requiring FDA clearance or Health Canada licensing. Capital and clearance timelines both sit outside a small entrant's runway. Sourced update: the money in this market is in the scanners, not the software. GE HealthCare's imaging line alone is $9.24B and Philips' Diagnosis & Treatment €8.5B, while the leading independent imaging-IT vendor, Sectra, turns over roughly a tenth of that — and its growth is in cloud recurring revenue, up 49%.
And what every business buys · 25 generic categories
Sold to every industry rather than this one, so they are filed against the software industry's own code. The same few vendors recur across most of them.
Companies in this industry · 197
Every company this research names that is filed here or beneath — the operators, and the vendors that sell to them — largest disclosed revenue first. The rank is within the company’s own six-digit industry.
| Company | Filed under | Revenue | Rank |
|---|---|---|---|
| Universal Health ServicesNYSE:UHS | Psychiatric and substance use hospitals6222 | $17.4B | 1/4 |
| BrightSpring Health ServicesPrivate | Residential facilities for persons with an intellectual or developmental disability, a mental health or substance use condition6232 | $12.9B | 1/2 |
| Quest DiagnosticsNYSE:DGX | Medical and diagnostic laboratories621510 | $11.0B | 1/10 |
| GE HealthCarePrivate | Medical and diagnostic laboratories621510 | $9.2B | 2/10 |
| Encompass HealthNYSE:EHC | Specialty hospitals (except psychiatric and substance use)6223 | $5.9B | 1/1 |
| Acadia HealthcareNASDAQ:ACHC | Psychiatric and substance use hospitals6222 | $3.3B | 2/4 |
| KinderCare Learning CompaniesPrivate | Child day-care services624410 | $2.7B | 1/10 |
| Teladoc HealthNYSE:TDOC | Other ambulatory health care services6219 | $2.5B | 1/7 |
| National VisionNASDAQ:EYE | Offices of optometrists621320 | $2.0B | 1/16 |
| DentalcorpPrivate | Offices of dentists621210 | $1.3B | 1/13 |
| Chartwell Retirement ResidencesTSX:CSH-UN | Nursing care facilities623110 | $1.1B | 1/5 |
| US Physical TherapyNYSE:USPH | Offices of physical, occupational, and speech therapists and audiologists621340 | $781M | 1/9 |
| Sienna Senior LivingTSX:SIA | Community care facilities for the elderly6233 | $1.0B | 1/3 |
| EpicEPOR | Offices of physicians6211 | — | 1/48 |
| JanePrivate | Offices of chiropractors621310 | — | 1/8 |
And 182 more on the companies page.
Who works here
The occupations employed in Health care and social assistance, most concentrated in it first. The share is measured against the whole sector, not this industry — the published cross-tabulation stops there.
Tagged to this industry
Concentrated in this sectorA
These jobs are mostly done here. An operator in this industry is competing for them against others in the same industry, not against the whole economy.
And the jobs every business has
Found across at least fourteen of the twenty sectors. But note the shape of this industry: 73% of establishments have fewer than ten employees, and at that size most of these roles are one person wearing several hats, or bought in from outside.
Inside this industry
4 rows sit directly beneath 62, and 89 in all once every level is counted. Each has a base report of its own.