Partners Health Plan

What Partners Health Plan does

Partners Health Plan LLC (PHP) is a privately held, Bronx-based managed care organization that contracted with CMS and the New York State Department of Health to operate the PHP Care Complete FIDA-IDD Plan, a Fully Integrated Duals Advantage demonstration for adults with Intellectual and Developmental Disabilities who are dually eligible for Medicare and Medicaid. PHP coordinated Medicare Parts A, B, and D with New York State Medicaid benefits and OPWDD Home and Community-Based Services waivers into a single integrated plan, providing each member with a dedicated Care Manager and a person-centered Life Plan. The organization covered nine New York counties (Bronx, Brooklyn, Manhattan, Nassau, Queens, Rockland, Staten Island, Suffolk, and Westchester) with a provider network spanning medical, behavioral health, pharmacy, dental, vision, durable medical equipment, transportation, and long-term supports and services.

PHP's technology stack was built on standard healthcare infrastructure rather than proprietary systems. The member- and provider-facing web portals were powered by HealthSmart (CareVu clearinghouse) for claims, eligibility, and authorization management; ECHO Health Inc. processed provider payments and 835 ERA remittances via ACH/EFT, virtual card, and paper check; and Optum served as an electronic claims submission clearinghouse effective March 11, 2024. Telehealth was delivered through Vonage video calls, and the clinical program included Comprehensive Medication Therapy Reviews, provider education webinars, and trauma-informed care initiatives. The organization maintained a Compliance Program with an anonymous reporting hotline and offered multi-language interpreter services in 17 languages.

PHP's revenue was generated through Medicare-Medicaid capitation payments on a per-member-per-month basis, with no consumer-facing pricing or commercial sales channels. Member acquisition occurred passively through New York Medicaid Choice, CMS enrollment processes, and referrals from OPWDD, Care Design NY, and provider networks — there was no traditional sales or marketing function. On December 31, 2025, the FIDA-IDD Demonstration program ended due to CMS non-renewal, with members given a special enrollment period through February 28, 2026 to select new Medicare plans, while their Medicaid coverage and OPWDD services remained unchanged. The organization continues to operate through the transition period.

Name

Partners Health Plan

Legal name

Partners Health Plan LLC

Website

https://phpcares.org

Company type

Private

Founded year

2015

Operating status

Operating

Headcount range

101–250 employees

Short description

Partners Health Plan is a Bronx-based managed care organization that operated the FIDA-IDD Demonstration plan in New York State, integrating Medicare and Medicaid benefits for dual-eligible adults with Intellectual and Developmental Disabilities; the program ended December 31, 2025 due to CMS non-renewal.

Ownership category

akta.pro rank

Product category

Managed Care Services for Individuals with Developmental Disabilities

NAICS

Direct Life, Health, and Medical Insurance Carriers (52411)

SIC

Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321)

akta.pro primary industry

D-SNP Medicare–Medicaid Integration & State Contracting (HLAEAFAH)

akta.pro secondary industry

D-SNP Behavioral Health Integration (HLAEAFAE)

Keywords

• Managed care services
• Medicaid managed care
• Dual eligible plans
• Developmental disability care
• Integrated healthcare plans

Headquarters

HQ city

New York

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Infrastructure, Others, Marketing or Sales

Revenue model

1. Medicare-Medicaid Capitation Payments: Partners Health Plan operates as a Fully Integrated Duals Advantage (FIDA-IDD) Demonstration plan. As a Medicare-Medicaid managed care organization, PHP receives capitation payments from both Medicare and the New York State Department of Health (Medicaid) to provide comprehensive healthcare benefits to dual-eligible participants with intellectual and developmental disabilities. The plan covers Medicare Part A, Part B, and Part D services, as well as Medicaid-funded OPWDD waiver services and long-term supports and services. This capitation model provides predictable per-member-per-month revenue in exchange for delivering all covered benefits.

Go-to-market motion1 record

Distribution channels2 records

Core offering

Partners Health Plan operates the PHP Care Complete FIDA-IDD Plan, a Fully Integrated Duals Advantage managed care plan that contracts with Medicare and the New York State Department of Health (Medicaid) to deliver integrated healthcare benefits to dual-eligible adults with Intellectual and Developmental Disabilities (I/DD). The plan unifies Medicare Parts A, B, and D with New York State Medicaid and OPWDD Home and Community-Based Services waiver coverage, providing medical, behavioral health, pharmacy, dental, vision, transportation, durable medical equipment, and long-term supports and services through dedicated Care Managers and a person-centered Life Plan process.

Product overview

Partners Health Plan offers the PHP Care Complete FIDA-IDD Plan as its core product, a managed care plan that contracts with Medicare and New York State Medicaid to provide fully integrated dual-eligible benefits to adults with Intellectual and Developmental Disabilities. The plan coordinates Medicare, Medicaid, and OPWDD waiver services through a network-based model. Supporting modules include the HealthSmart Provider Portal for provider access to patient information and claims, ECHO Payment Services for provider reimbursements, Telehealth Services for 24/7 medical consultation, Vonage Video Calls for remote Care Manager meetings, a Provider Ticket Submission System for network support, a Compliance Hotline for anonymous reporting, Provider Webinars for continuing education, and Multi-language Interpreter Services for member communication.

Differentiator

Problem solved

Functional benefit

Products and services

• PHP Care Complete FIDA-IDD Plan A Fully Integrated Duals Advantage (FIDA) managed care plan for adults with Intellectual and Developmental Disabilities (I/DD) that coordinates Medicare Parts A, B, and D with New York State Medicaid benefits and OPWDD Home and Community-Based Services waiver coverage into a single integrated plan. Available to dual-eligible adults with I/DD in New York State through New York Medicaid Choice and CMS enrollment.

Quantifiable outcome

• PHP members have 24/7 access to telehealth with emergency room physicians, which the organization states can prevent unnecessary emergency room visits.
• +1 more outcomes

Segments1 record

Ideal customer profiles1 record

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration6 records

Partnerships

Five partnerships are on record, tiered core.

• HealthSmart (CareVu Clearinghouse)coreTechnology or IntegrationHealthSmart serves as PHP's primary clearinghouse for electronic claims submission (837 claims) and provider portal services. PHP's Submitter ID is 14966. Providers can submit claims directly to HealthSmart's CareVu clearinghouse at no cost. The HealthSmart portal also supports web-based claims submission for professional and institutional claims in PDF format (CMS 1500 or UB-04). HealthSmart previously provided 835 ERA remittance services but transitioned that function to ECHO Health Inc. as of April 2022.
• ECHO Health Inc.coreTechnology or IntegrationECHO Health Inc. is HealthSmart's payment vendor and serves as PHP's primary payment processor, connecting over one million providers to health plans and TPAs. ECHO processes claims payments for PHP providers via ACH/EFT, virtual card, or paper check. The company also delivers 835 Electronic Remittance Advice (ERA) and provides the provider payments portal (providerpayments.com). ECHO payments appear on bank statements as 'HNB - ECHO' (Huntington National Bank). Providers can enroll in PHP-specific single-payer arrangements to receive payments without fees.
• OptumcoreTechnology or IntegrationPHP went live with Optum as an additional electronic claims submission option effective March 11, 2024. Providers who previously submitted via Change Healthcare were directed to switch to Optum for 837 institutional and professional claims submissions. Providers receiving 835 ERA through ECHO were also instructed to select 'Optum' as their trading partner for PHP-specific transactions.
• Care Design NYcoreStrategic or Co-development PartnerCare Design NY is a key collaborative partner referenced across PHP's provider and member education programs. The two organizations regularly co-host provider webinars on topics including Medicaid eligibility, IDD care management, the Life Plan process, and clinical best practices. Care Design NY and PHP share escalation processes and coordinate on care management for individuals with I/DD. Both organizations co-present on maintaining Medicaid benefits and managing the FIDA-IDD wind-down transition.
• Independent Consumer Advocacy Network (ICAN)coreOthersICAN is a Participant Ombudsman Program created by the State of New York to provide free, confidential assistance to PHP Care Complete FIDA-IDD Plan participants. ICAN can be reached toll-free at 1-844-614-8800 (TTY: 711) or online at icannys.org. Operating hours are Monday through Friday, 8:00 AM to 6:00 PM. ICAN assists members with any issues related to PHP services and is referenced throughout member communications, grievance processes, and disenrollment policies.

Scale indicators2 records

Recent moves5 records

Expansion highlights4 records

Direct peers

• Amida Care: Amida Care is a New York-based nonprofit Medicaid HIV Special Needs Plan (SNP) serving dual-eligible members with complex care needs under a CMS-approved demonstration. Like PHP, it operates a SNP model focused on a specialized dual-eligible population, integrates Medicare and Medicaid benefits, and relies on state/CMS contracting authority — making it one of the closest functional analogs to PHP's FIDA-IDD model.
• VNSNY CHOICE Health Plans (VNS Health): VNSNY CHOICE is a NY-based health plan serving dual-eligible and long-term care populations through MLTC, MAPD, and D-SNP products. It directly competes for the same dual-eligible members PHP serves, integrates Medicare and Medicaid benefits, and provides care management — closely aligned to PHP's FIDA-IDD value proposition.
• Centers Plan for Healthy Living: Centers Plan is a New York-based managed care organization offering Medicaid Managed Long-Term Care (MLTC) and dual-eligible plans to complex populations. It directly overlaps with PHP on integrated care delivery for dual-eligibles in NY and operates under similar NY DOH regulatory frameworks, including integrated products for members with disabilities.

Broad incumbents

• Humana D-SNP: Humana is one of the largest D-SNP carriers nationally and offers dual-eligible plans in multiple states. It is comparable as a broad incumbent in the same Medicare-Medicaid integrated care market that PHP operates in, though at vastly greater scale and without IDD-specific specialization.
• Anthem (Elevance Health) D-SNP: Anthem, part of Elevance Health, operates D-SNP products across more than a dozen states and serves millions of dual-eligible members. It is comparable as a broad incumbent in the Medicare-Medicaid integrated care market, representing the scaled national players against which PHP's specialized IDD model could be benchmarked or acquired.
• UnitedHealthcare Dual Complete: UnitedHealthcare operates the largest D-SNP footprint in the United States and serves dual-eligible populations across New York. It is comparable as a potential successor for PHP members post-FIDA-IDD and represents the broader national D-SNP market into which PHP's expertise could be deployed.
• Aetna (CVS Health) D-SNP: Aetna, owned by CVS Health, offers D-SNP products across many states including New York and is one of the largest dual-eligible carriers in the country. It competes for the same dual-eligible members PHP serves and represents the broader national integrated-care landscape PHP could partner with or compete against.

Regional players

• Fidelis Care: Fidelis Care is a New York-based health insurer offering Medicare, Medicaid, and dual-eligible products across the same NY counties PHP serves. While broadly comparable in product mix and geography, Fidelis operates as a much larger general-purpose plan rather than PHP's specialized IDD niche.
• MetroPlus Health Plan: MetroPlus is a NYC-based public-option health plan serving Medicaid, Medicare, and dual-eligible populations, operating in much of the same geography as PHP. It is comparable as a regional managed care plan serving complex populations, though without PHP's I/DD specialization.
• Healthfirst: Healthfirst is a large New York-based nonprofit health plan offering Medicare Advantage, D-SNP, Medicaid, and integrated products for low-income and dual-eligible populations. It is comparable in geography (NY-only) and member profile but operates at significantly greater scale and breadth than PHP, making it more of a broader regional competitor.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat3 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/PHPCareComplete
• Facebookfacebook.com/PartnersHealthPlan

Revenue estimate

Valuation estimate

Number of profiles

Profiles18 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Partners Health Plan