Management Services Organization
Delivering Exceptional Value
Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.
Founded more than 30 years ago, Prospect Medical Systems has demonstrated its ability to responsibly and effectively manage costs without compromising quality of care. Leveraging our best-practice, results-driven administrative services for our primary care and specialist physicians, Prospect delivers value to our members and providers.
With the ownership of 17 hospitals by our parent organization we are highly experienced in provider-hospital partnerships and in the optimization of this critical relationship.
What Makes Prospect Medical Systems Unique
- Coordinated care model to drive higher quality/improve outcomes/lower costs
- Economics of scale resulting in better client costs
- Compliance with all state audits and health plan audits/guidelines
- Manages professional and institutional risk for multiple payers
- Extensive physician alignment and healthcare data expertise
- Experience with all insurance products, including commercial, Medicare, Medicaid, PPO and ACO
- Successful transformation and expansion into new markets
Key Facts
- 28 IPAs in six states: CA, CT, NJ, PA, RI and TX
- More than 600,000 managed members
- More than 20,000 primary care and specialist physicians
- Ownership of 17 hospitals via Prospect Medical Holdings
- Successful culturally focused networks (Korean, Latino, Vietnamese, etc.)
- West and East Coast operations
- America’s Physician Groups Elite status for nine years in a row
- Admits/cases below Milliman guidelines
Services Include
- Comprehensive, state-of-the-art medical management for care at home transition of care; risk stratification
- Provider relationship management
- Credentialing
- Contracting (health plan and provider)
- Claims adjudication
- Customer service
- RAF/quality optimization programs
- Financial services
- Compliance
- Sophisticated, user-friendly systems portals and data analytics
- In-network retention and utilization control
Our results include 7.1% readmission rate, 3.5 Medicare LOS, 90% generic prescribing rate, and 2.3% abandonment rate for member calls.
If you'd like to learn more, call us (800) 708-3230 or email us. We are located at 600 City Parkway West, Suite 800, Orange, CA 92868.
