Prominence Health

What Prominence Health does

Prominence Health is a Reno, Nevada-based value-based care organization operating as a wholly-owned subsidiary of Universal Health Services, Inc. (UHS), a publicly traded Fortune 500 healthcare conglomerate. Founded in 1993 as a health maintenance organization and acquired by UHS in 2014, the company runs a multi-product platform spanning Medicare Advantage plans (CMS 4.5-star rated for 2026), commercial group health insurance, self-funded administrative services, and provider-facing value-based care enablement. It operates four Accountable Care Organizations (CALi ACO, Silver State ACO, South Texas Clinical Partners ACO, and NTCP ACO) and serves members across Texas, Nevada, and Florida.

The company's technology stack centers on population health management and care coordination tools delivered through a Provider Services platform (phproviders.com). Capabilities include EMR integration, health information exchange, hospital admission/discharge/transfer (ADT) alerts, remote patient monitoring, performance analytics, and coding audit and education services. Its revenue model is predominantly subscription-based, generated through Medicare Advantage premiums, commercial group health premiums, and Association Health Plans, supplemented by ACO shared savings distributions and provider consulting services. In 2024, Prominence's ACOs generated more than $100 million in shared savings and over $600 million in cumulative Medicare program savings.

Prominence pursues a sales-led go-to-market strategy combining licensed agent direct sales for Medicare Advantage with employer group sales for commercial lines, provider referral networks, and distribution through UHS's affiliated health system channel. The company earned a 4.5/5 CMS star rating for 2026 (achieved by fewer than 10% of MA plans), a 97% average ACO quality score, and three 2026 industry designations including Becker's Hospital Review "ACOs to Know" and U.S. News & World Report "Best Medicare Advantage Plans."

Name

Prominence Health

Legal name

Prominence Health

Website

https://prominencehealth.com

Company type

Private

Founded year

1993

Operating status

Operating

Headcount range

1–10 employees

Short description

Prominence Health is a value-based care subsidiary of Universal Health Services operating Medicare Advantage plans, commercial health insurance, and four ACOs across Texas, Nevada, and Florida, serving Medicare beneficiaries, employer groups, and physician provider networks.

Ownership category

akta.pro rank

Product category

Value-Based Healthcare (Medicare Advantage and ACO Services)

NAICS

Offices of Physicians (6211)

SIC

Hospital & Medical Service Plans (6324), Insurance Agents, Brokers & Service (6411), Services-Misc Health & Allied Services, Nec (8090)

akta.pro primary industry

Medicare Advantage (MA) Plans (FSAIAGAA)

akta.pro secondary industries

MA Care Coordination & Utilization Management (UM) Programs (HLAEACAK), Quality Measurement, Reporting & Benchmarking (HEDIS/Stars/CQM) (HLACAHAC), Employer Wellness & Population Health Programs (HLAEAAAH)

Keywords

• Value-based care
• Medicare Advantage plans
• Accountable care organizations
• Provider enablement services
• Commercial health insurance

Headquarters

HQ city

Reno

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

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

Revenue model

1. Medicare Advantage Premiums: Revenue from Medicare Advantage health plan premiums for coverage provided to Medicare beneficiaries
2. ACO Shared Savings: Shared savings generated from Medicare ACO performance. In 2024, Prominence ACOs generated over $100 million in shared savings, demonstrating successful value-based care cost management
3. Commercial Health Plan Premiums: Group-sponsored commercial health insurance solutions for businesses of all sizes, including Association Health Plans
4. Provider Consulting Services: Value-based care enablement services including business development, coding audits, clinical extenders, and practice management support

Pricing tiers

Go-to-market motion1 record

Distribution channels4 records

Marketing channels5 records

Core offering

Prominence Health is a value-based care organization that offers Medicare Advantage health plans, commercial group health plans (including Association Health Plans), self-funded administrative services, and ACO administration across four ACOs. It delivers provider enablement services such as care coordination, remote patient monitoring, EMR/HIE integration, hospital ADT alerts, coding audits, and performance analytics to physicians, provider groups, and health systems across Texas, Nevada, and Florida.

Product overview

Prominence Health is a value-based care organization operating as a multi-product platform spanning healthcare insurance and care delivery services. The portfolio includes three primary insurance products: Prominence Medicare Advantage (CMS 4.5-star rated Medicare plans), Prominence Health Plan commercial insurance (flexible group-sponsored health solutions), and Prominence Administrative Services (self-funded plan administration). The organization also operates a robust Provider Services platform offering centralized support, data integration tools, and value-based venture solutions for physicians and medical groups. Its Accountable Care Organization (ACO) administration services support primary care providers in value-based care arrangements, managing multiple ACOs nationwide including CALi ACO, Silver State ACO, South Texas Clinical Partners ACO, and NTCP ACO. Founded in 1993 as an HMO and acquired by Universal Health Services in 2014, the company serves members across Medicare, Medicare Advantage, ACOs, and commercial payer partnerships.

Differentiator

Problem solved

Functional benefit

Brands

• Prominence Medicare Advantage: Medicare Advantage health plans offered by Prominence Health
• Prominence Health Plan (commercial)
• Prominence Administrative Services
• Prominence Accountable Care

Products and services

• Prominence Medicare Advantage Medicare Advantage health plans providing premium coverage at no cost to Medicare beneficiaries, with 4.5-star CMS rating for 2026 and U.S. News & World Report 'Best Medicare Advantage Plans' recognition. Available across Texas, Nevada, and Florida.
• Prominence Health Plan (Commercial) Flexible group-sponsored commercial health insurance plans for businesses of all sizes, offering employer-sponsored coverage and Association Health Plans (e.g., through Nevada Builders Alliance).
• Prominence Administrative Services Self-funded plan administration services for employers and organizations managing their own health benefits.
• Provider Services Platform Comprehensive provider support platform offering centralized services (patient panel attribution, clinical extenders, coding audit/education, chronic care management, referral management, remote patient monitoring), data integration (EMR access, HIE, hospital ADT alerts, state immunization registries, performance analytics), office support (business insights, group purchasing power, legal support, productivity analysis), and value-based ventures (clinically integrated networks, Medicare Advantage joint venture, risk-based contracting) for physicians and medical groups.
• Accountable Care Organization (ACO) Administration ACO administration services supporting primary care providers in succeeding with value-based care, including expert teams helping providers grow, learn, and embrace preventative care and personalized medicine. Operates four ACOs nationwide: CALi ACO, Silver State ACO, South Texas Clinical Partners ACO (STCP), and NTCP ACO.
• Value-Based Enablement Services Value-based care enablement services including consulting and navigation, centralized services, office-based support, mission-driven ventures, and data platforms for providers and health systems.
• ACO/DCE Consulting Consulting services for Accountable Care Organizations and Direct Contracting Entities, supporting provider organizations in value-based care arrangements.

Named customers5 records

Segments4 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature6 records

Partnerships

Nine partnerships are on record, tiered core and minor.

• Universal Health Services (UHS)coreOthers · 1 January 2014Prominence Health is a subsidiary of Universal Health Services (UHS), one of the nation's largest healthcare providers. UHS operates 400 acute care hospitals, behavioral health facilities, and ambulatory care centers across the U.S., Puerto Rico, and United Kingdom. Prominence Health was acquired by a UHS subsidiary in 2014.
• Independence Physician ManagementcoreOthersUHS subsidiary managing physician networks. Part of UHS's integrated healthcare delivery system that includes Prominence Health Plan and Independence Physician Management.
• CALi ACOcoreStrategic or Co-development PartnerOne of four Prominence Health Accountable Care Organizations operating nationwide, participating in value-based care shared savings programs.
• Silver State ACOcoreStrategic or Co-development PartnerNevada-based Accountable Care Organization participating in Medicare shared savings and value-based care delivery.
• South Texas Clinical Partners ACO (STCP)coreStrategic or Co-development PartnerPhysician-led ACO in South Texas focused on bringing health system resources to physician-led ACOs and delivering high-quality, cost-effective patient care.
• NTCP ACOcoreStrategic or Co-development PartnerOne of four Prominence Health Accountable Care Organizations participating in value-based care and population health management programs.
• EpisourceminorOthersVendor of Prominence Health that experienced a cybersecurity event. Episource provides health risk adjustment services to health plans.
• Nevada Builders AllianceminorChannel Partner/ Reseller/ DistributorAssociation partnership providing Association Health Plans to member businesses like KD Electric, enabling small businesses to offer health coverage through group purchasing power.
• Rebuilding Together Northern NevadaminorOthersCommunity sponsorship partner; Prominence Health is an ongoing sponsor supporting community rebuilding initiatives.

Scale indicators8 records

Recent moves6 records

Expansion highlights5 records

Broad incumbents

• Centene: Centene is a major government-sponsored health plan operator with a large Medicare Advantage and Medicaid footprint. Competes with Prominence in MA markets and shares exposure to CMS policy and Star rating dynamics.
• Oak Street Health (CVS Health): Oak Street Health, owned by CVS Health, operates value-based primary care clinics serving primarily Medicare Advantage members. Comparable in patient population and value-based economics, though larger and part of a diversified incumbent.
• Molina Healthcare: Molina Healthcare is a government-focused health plan with significant Medicare Advantage and Medicaid membership, particularly in lower-income and dual-eligible populations. Comparable MA/government payer exposure to Prominence.
• Humana: Humana is the second-largest Medicare Advantage insurer in the U.S. with deep value-based care partnerships through its CenterWell primary care clinics. A major incumbent that competes head-to-head with Prominence in MA markets and ACO enablement.

Direct peers

• Devoted Health: Devoted Health is a Medicare Advantage insurer targeting seniors with a tech-enabled, provider-partnered care model and a strong focus on quality and member experience. Comparable to Prominence in target market, value-based approach, and growth-stage scale.
• Clover Health: Clover Health is a Medicare Advantage insurer using a tech-enabled, provider-aligned model with a focus on care coordination for seniors. Similar in scale, target market, and value-based care orientation to Prominence.
• Privia Health: Privia Health operates a national physician network with value-based care arrangements spanning MA, ACO, and commercial payer contracts. Comparable to Prominence's physician-enablement and ACO administration platform, with a similar multi-state approach.
• agilon health: Agilon health partners with independent primary care physician groups to operate value-based care arrangements, including Medicare Advantage and ACO REACH models. Highly comparable to Prominence's physician-led ACO and MA enablement model across multiple states.
• Alignment Healthcare: Alignment Healthcare is a tech-enabled Medicare Advantage insurer focused on senior care with a heavy emphasis on care coordination, quality scores, and provider partnerships. Highly comparable to Prominence's MA plan + ACO model.
• Evolent Health: Evolent Health provides value-based care enablement services, including specialty care management, ACO administration, and MA performance support to providers and health plans. Overlaps directly with Prominence's Provider Services and ACO administration offerings.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks5 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/prominence-health

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles8 records

Subsidiaries4 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 Prominence Health