We manage the provision of healthcare to over 320,000 members through our network of more than 11,000 primary care physicians and specialists.
Through our Coordinated-Regional-Care model, our medical groups work closely with our hospitals to provide highly coordinated, personalized care to our patients in Southern California, South Central Texas, Rhode Island, New Jersey and Pennsylvania.
Based on enrollment, our combined medical groups are among the largest in Southern California, and have contracts with all of the major (non-Kaiser) health maintenance organizations (HMOs) operating in the region. We have 17 affiliated Independent Physician Associations (IPAs) in Southern California that are managed by two of our subsidiaries, Prospect Medical Systems and ProMed Health Care Administrators. These subsidiaries also manage several unaffiliated IPAs.
To provide for the health care services of enrolled plan members, the IPAs contract with medical groups, urgent care centers, medical laboratories, radiology centers and hospitals that are conveniently located across Los Angeles, Orange and Riverside Counties and in the Inland Empire.
In South Central Texas, Prospect Health Services Texas currently has a full network of primary care physicians and specialists. Contracted with Nix Health, Prospect’s San Antonio-based system, and Baptist Health System, it manages over 2,000 senior lives. Prospect Health Services Texas also offers multiple urgent care locations for its members.
In Rhode Island, CharterCARE Provider Group currently has over 100 primary care providers and a full specialty network. Contracted with Prospect’s two local hospitals – Roger Williams Medical Center and Our Lady of Fatima Hospital—it manages over 4,500 senior lives and 1,000 commercial lives. Prospect Provider Group, RI LLC also offers urgent care locations to its members.
In New Jersey, Prospect Provider Group of NJ, LLC currently has more than 130 primary care providers and specialists. And in Pennsylvania, Prospect Provider Group of PA, LLC currently has more than 100 primary care providers and a full specialty network.
Our affiliated medical groups in Southern California have been awarded “Elite” status by the California Association of Physician Groups, as well as 4- to 5-star ratings from CMS’ star system for Medicare Advantage plans. Their clinical outcomes and patient satisfaction scores are rated at the highest levels as a result of their constant focus on quality and value for both physicians and patients.
Management Services Organizations
Prospect Medical Systems and ProMed Health Care Administrators are our management services organizations. They provide knowledgeable support to our physicians and members through case management, authorization reviews, referrals, claims processing, member services, on-line tools, provider relations, health education resources and the latest in technological advances allowing our doctors to do what they do best – care for our members.
Smaller groups often do not have the resources, staff, and infrastructure to cover the additional overhead involved in daily operations. We assist with claims processing, referral processing, contracting, auditing, payment disputes, financial services and reporting, network management, member services, information systems and tech support, case management, utilization review, credentialing, Hierarchical Condition Coding (HCC) and Pay for Performance (P4P) training, strategic planning and other necessary functions. We also understand the ever-changing marketplace.
We help our IPA clients grow their business, not just manage their existing lives. We can create marketing collateral aimed at increasing the visibility and awareness of the managed group. And we have business development strategies to create opportunities for dual eligible conversions, primary care physician recruitment, and ethnic market development. By providing "turn-key" operations with integrated management services, both quality health care and cost savings are realized by the providers, patients, and payers.