Medical Groups - West Coast
Our Medical Groups Offer Best-in-Class Comprehensive Care
Prospect Medical Group's West Coast operations are comprised of owned and managed medical groups/independent physician associations. We offer a managed services organization operation that supports all health plan-delegated functions for medical groups/IPA affiliates and risk-taking entities that support our IPAs to participate in various risk models with health insurance plans for Medicare Advantage, Medicaid/Medi-Cal, and commercial products. This includes collaboration in new CMS models like accountable care organizations and direct contracting entities.
Our West Coast entities operate in California, Arizona, and Texas.
Our affiliated (owned and managed) medical groups 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 our markets and 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, while outsourcing certain medical management and administrative functions associated with those activities. For patients, our medical groups are able to coordinate all the medical services that are needed and create personalized care plans. Our groups include all the services that a patient would need, including physicians, labs, radiology, outpatient services, and facility services.
Our medical groups have been awarded Elite Status by America’s Physician Groups for nine years in a row, which illustrates that our medical groups drive high quality, cost-effective care for members.
We also offer culturally focused physician networks for Korean, Latino, Vietnamese, and other patient communities.
Managed Services Organization
Our managed services organization (MSO) provides administrative support to our owned affiliates and managed medical groups/IPAs. These support services include:
- Claims payment
- Comprehensive medical management
- Provider relationship management
- Customer service
- Utilization management
- Compliance programs
- Financial services
Over the past 25 years, Prospect Medical has demonstrated significant growth through a series of acquisitions and affiliations, which include:
- 2008: Expansion in Orange and San Bernardino counties with the acquisition of ProMed Health Care Administrators and its affiliated medical groups
- 2015: Texas IPA launched
- 2020: Three IPAs acquired in Southern California
- 2022: Arizon IPA will launch
Today, we arrange for the care for more than 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-centered model of care has evolved to a sophisticated network of providers. Our MSO care management supports 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. Our risk-taking abilities are portable and have been deployed to all of our markets 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.
For more information on our affiliated health plans, click here.