Prospect Medical Systems

What Prospect Medical Systems does

Prospect Medical Systems, doing business as Prospect Health, is a managed care organization and management services organization (MSO) headquartered in Orange, California. It coordinates healthcare delivery across a multi-county Southern California provider network spanning Orange, Los Angeles, Riverside, and San Bernardino counties. The network combines independent primary care and specialty physicians, urgent care centers, hospitals, medical labs, and radiology/imaging centers that collectively accept Medicare, Medicaid/Medi-Cal, Commercial, and Health Insurance Exchange plans.

The company's core offering is a coordinated care platform anchored by a searchable Provider Directory, five named Population Health Programs (Diabetes, Heart, Kidney, COPD, Asthma), an Outpatient Care Management Program, a Wellness Center with health content, a 24/7 Nurse Line, and a Patient Neighborhood member portal (powered by Medecision). It also delivers dedicated senior member services and a Disney-branded 'Red Carpet' employee program. The underlying technology stack is described as a healthcare coordination and population health management platform, with HEDIS measurement tools supporting network provider performance reporting.

Prospect Health generates revenue primarily through capitation payments from Medicare, Medicaid/Medi-Cal, Commercial, and Health Insurance Exchange plans on a recurring per-member basis, supplemented by MSO management services fees paid by affiliated physician practices and medical groups. Members are acquired through affiliated health plans, employer partnerships including Disney, a regional agent/broker network across Inland Empire, Los Angeles, Orange County, and San Diego, and direct-to-consumer channels. The company operates as a subsidiary of Astrana Health, a strategic value-based care parent.

Name

Prospect Medical Systems

Legal name

Prospect Health

Website

https://prospectmedicalsystems.com

Company type

Private

Operating status

Operating

Headcount range

251–500 employees

Short description

Prospect Health (formerly Prospect Medical Systems) is a Southern California managed care organization and MSO that coordinates care through an integrated network of independent physicians, urgent care centers, hospitals, labs, and imaging centers across Orange, Los Angeles, Riverside, and San Bernardino counties, serving Medicare, Medicaid, Commercial, and Exchange members as a subsidiary of Astrana Health.

Ownership category

akta.pro rank

Product category

Managed Care Services

NAICS

Offices of Physicians (62111), Health and Welfare Funds (525120)

SIC

Services-Health Services (8000), Hospital & Medical Service Plans (6324)

akta.pro primary industry

Value-Based Primary Care Organizations (Risk-Bearing) (HLAFAGAF)

akta.pro secondary industries

MA Chronic Condition Management & Supplemental Benefits (SSBCI) (HLAEACAI), Employer/Member Engagement Platforms for Provider-Sponsored Plans (HLACAEAM)

Keywords

• Managed care services
• Healthcare provider network
• Population health management
• Value-based care
• Care coordination

Headquarters

HQ city

Orange

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Capitation and Value-Based Care Payments: Receives capitation payments from Medicare, Medicaid/Medi-Cal, Commercial and Health Insurance Exchange health plans to coordinate care for enrolled members through their provider network.
2. Healthcare Management Services (MSO): Provides management services organization (MSO) services to physician practices and medical groups, offering administrative, operational, and clinical support.

Go-to-market motion1 record

Distribution channels4 records

Marketing channels5 records

Core offering

Prospect Health (formerly Prospect Medical Systems) is a managed care organization that coordinates healthcare delivery for enrolled members through an integrated Southern California provider network of primary care and specialty physicians, urgent care centers, hospitals, labs, and radiology centers. It accepts Medicare, Medicaid/Medi-Cal, Commercial, and Health Insurance Exchange plans and earns revenue via capitation/value-based care payments from health plans plus Management Services Organization (MSO) fees from affiliated physician practices. Its offerings include Population Health Programs (Diabetes, Heart, Kidney, COPD, Asthma), an Outpatient Care Management Program, senior-specific benefits, a member portal, and a 24/7 Nurse Line across Orange, Los Angeles, Riverside, and San Bernardino counties.

Product overview

Prospect Health (formerly Prospect Medical Systems) is a managed care organization operating a multi-county healthcare provider network in Southern California. The offering is a platform of coordinated care services spanning a large physician and facility network, population health management programs, outpatient care management, and member-facing digital self-service tools. The portfolio includes a searchable Provider Directory (primary care, specialty, urgent care, hospitals, labs, and imaging), five named Population Health Programs (Diabetes, Heart, Kidney, COPD, Asthma), an Outpatient Care Management Program, a Wellness Center with health content, Senior Benefits with dedicated support services, and a Patient Neighborhood member portal. All services are coordinated with independent physicians and support Medicare, Medicaid/Medi-Cal, Commercial, and Health Insurance Exchange plans across Orange, Los Angeles, Riverside, and San Bernardino counties.

Differentiator

Problem solved

Functional benefit

Products and services

• Population Health Programs A suite of chronic disease management programs covering Diabetes Care, Heart Care, Protect Your Kidneys, COPD Care, and Asthma Care, focused on prevention, wellness, and coordinated member support across Prospect Health's network.
• Outpatient Care Management Program A care management program providing coordinated outpatient services to support members in managing their health between physician visits.
• Urgent Care Locations Walk-in urgent care facilities available throughout the service area for members needing immediate non-emergency medical attention.
• Hospital Network Hospitals within the Prospect Health network providing inpatient and emergency services to members across Orange, Los Angeles, Riverside, and San Bernardino counties.
• Labs and Imaging Services Medical laboratory and radiology/imaging centers integrated into the provider network for diagnostic testing ordered by network physicians.
• Healthcare Management Services (MSO) Management services organization (MSO) services delivering administrative, operational, and clinical support to affiliated physician practices and medical groups, including care coordination, utilization management, and grievance/appeals processes.
• Senior Benefits Program Additional benefits and services for senior members including a dedicated Senior Member Service Team, supplemental health resources, and assistance navigating healthcare options.
• Provider Network (Physician Directory) A combined, searchable network of primary care physicians, specialty physicians, urgent care centers, hospitals, labs, and radiology centers serving Orange, Los Angeles, San Bernardino, and Riverside counties.

Named customers3 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

Partnerships

Three partnerships are on record, tiered notable, minor and core.

• DisneynotableGTM or Marketing PartnerSpecial member portal and red carpet service program specifically designed for Disney employees enrolled in Prospect Health plans, with dedicated 'Red Carpet Usher' support services.
• DaehanminorOthersPartnership serving the Daehan member population with specialized healthcare coordination services.
• Affiliated Health PlanscoreChannel Partner/ Reseller/ DistributorPartnerships with Medicare, Medicaid/Medi-Cal, Commercial insurance, and Health Insurance Exchange plans that contract with Prospect Health's provider network to serve their members.

Scale indicators1 record

Recent moves1 record

Expansion highlights5 records

Direct peers

• Privia Health: Privia Health is a national physician enablement company that partners with medical groups to manage value-based contracts, including risk-bearing arrangements. Directly comparable business model and contract structure for affiliated independent PCPs.
• Heritage Provider Network: Heritage Provider Network is a large California-based risk-bearing IPA and MSO serving Medicare, Medicaid, and commercial members across multiple Southern California counties — a near-direct peer in geography, payer mix, and IPA/MSO business model.
• Astrana Health: Astrana Health is the publicly traded parent company of Prospect Health, operating a national value-based care platform with risk-bearing IPAs and MSO services. Direct parent and structural peer in capitation-based physician enablement.
• Agilon Health: Agilon Health partners with primary care physicians to take global risk on Medicare Advantage populations through partnerships with PCPs. Highly comparable value-based, risk-bearing primary care model with a focus on senior populations.
• P3 Health Partners: P3 Health Partners is a value-based care company focused on Medicare Advantage populations, managing risk through affiliated PCPs and population health programs. Comparable in risk-bearing MA focus and PCP partnership model.

Others

• DaVita Integrated Kidney Care: DaVita operates value-based care programs including risk-bearing arrangements for chronically ill populations, particularly those with kidney disease — overlapping with Prospect Health's Protect Your Kidneys program and chronic-condition focus.

Broad incumbents

• CareMore Health (part of Elevance Health): CareMore Health is an integrated care delivery organization focused on Medicare and complex-care populations, providing coordinated chronic disease management. Comparable population-health and senior-focused care model.
• Optum Health: Optum Health is the largest U.S. value-based care platform, operating risk-bearing physician groups and IPA-style networks nationwide. Functions as both a competitor for physician recruitment and a benchmark for scale economics.
• VillageMD: VillageMD operates risk-bearing primary care clinics, including value-based Medicare-focused senior care, with national expansion. Comparable in value-based PCP enablement and MA focus, though operating a clinic-ownership model rather than IPA.

Emerging players

• One Medical (now part of Amazon): One Medical operates a membership-based primary care platform with value-based contracts and a focus on technology-enabled care delivery. Comparable in PCP-led care coordination and risk-bearing capability, with a tech-forward delivery model.

Market position

Strengths5 records

Weaknesses4 records

Competitive moat5 records

Key risks5 records

Key highlights6 records

Customer concentration

• YouTubeyoutube.com/@prospectmedicalgroup7965
• Facebookfacebook.com/prospectmedicalgroup
• LinkedInlinkedin.com/company/prospect-medical-systems
• Instagraminstagram.com/prospectmedicalgroup

Revenue estimate

Valuation estimate

Number of profiles

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 Prospect Medical Systems