Medical Groups

We manage the provision of healthcare to more than 500,000 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, Connecticut, New Jersey, Pennsylvania, Rhode Island and Texas.

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. Our Independent Physician Associations (IPAs) in Southern California that are managed by Prospect Medical Systems, which 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/San Bernardino (Inland Empire) as well as San Diego county.

In Connecticut, Prospect CT Medical Foundation, Inc. currently has more than 700 primary care providers and specialists, and manages over 46,000 senior lives.

In New Jersey, Prospect Provider Group of NJ, LLC currently has more than 120 primary care providers and specialists, and manages over 9,00 lives. In Pennsylvania, Prospect Provider Group of PA, LLC currently has more than 600 primary care providers and specialists, and manages more than 81,000 lives.

In Rhode Island, CharterCARE Provider Group RI currently has more than 500 primary care providers and specialists. Contracted with Prospect’s two local hospitals – Roger Williams Medical Center and Our Lady of Fatima Hospital—it manages over 63,000 lives. CharterCARE Provider Group RI also offers urgent care locations to members.

In South Central Texas, Prospect Health Services Texas currently manages more than 2,000 senior lives as a full network of primary care physicians and specialists. Prospect Health Services Texas also offers multiple urgent care locations for its members.

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.

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Members Enrolled

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Medical Groups

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4 to 5

Star Ratings

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Management Services Organizations

Prospect Medical Systems and 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.

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