Welcome to Prospect Medical.
Prospect Medical has a long history as a respected leader in managed healthcare.
Prospect Medical is comprised of owned and managed medical groups/IPAs, a managed services organization (MSO) operation supporting all health plan delegated functions for medical groups / IPA Affiliates and risk-taking entities that allow our IPAs to participate in various risk models with health insurance plans for Medicare Advantage, Medicaid/Medi-Cal, and Commercial products as well as new CMS models like Accountable Care Organizations (ACOs) and Direct Contracting Entities (DCE).
Combined, our affiliated medical groups, including the medical groups that we manage, are a significant provider of managed care services. Each of our medical groups is a network of independent physicians that contracts with HMOs. In diverse areas, HMOs often find it more efficient to outsource the responsibility of providing physician services through medical groups. This collaboration between HMOs and medical groups is a well-established model in the markets we serve and is designed to motivate physicians to practice preventive medicine and reduce unnecessary procedures.
Affiliation with a medical group allows independent physicians to build their practices and HMOs to more efficiently contract for physician services and outsource certain medical management and administrative functions associated with those activities.
Awarded Elite status by America’s Physician Groups for 9 years in a row, our medical groups drive high quality, cost effective care for the members that we care for.
Our managed services organization (MSO) provides administrative support to our owned affiliates and managed medical groups/IPA. These support services include claims payment, comprehensive medical management, credentialing, provider relationship management, customer service, utilization management, compliance programs and financial services.
Through our over 25 years of history, Prospect Medical has demonstrated significant growth through a series of acquisitions and affiliations. This included our expansion from California-based Orange and San Bernardino counties with the acquisition of ProMed Health Care Administrators and its affiliated medical groups in 2008, the start of our Texas IPA in 2015, our acquisition of three IPAs in Southern California in 2020 and the creation of our Arizona IPA in 2022. Today, we arrange for the care for over 400,000 members in our owned or managed networks and partner with thousands of doctors.
Prospect Health Plan, our restricted Knox-Keene license in California, was created in 2015 to allow Prospect IPAs to assume global/institutional risk from health plans for a more holistic approach to patient care. Since that time, our patient-center model of care has evolved to a sophisticated network of providers, MSO care management supports including inpatient, outpatient and pharmacy medical teams and rich analytics that enable us to react, predict, and prevent high-cost events while increasing quality and access to care for our members. Our risk-taking abilities are portable and have been deployed to all of our markets that we operate in today.
Prospect Medical contracts with most major health plans, and we serve all product lines, including commercial, Medicare Advantage, Medicaid, Medicare/Medicaid (Medi-Medi) and Health Insurance Exchange.
Prospect Medical is here to serve you. Get in touch with us to see how we can meet your healthcare needs.