Provider Partners
Provider Partners Health Plans (PPHP) is a privately held Medicare Advantage HMO operating Institutional Special Needs Plans (I-SNP) and Institutional Equivalent Special Needs Plans (IE-SNP) for Medicare beneficiaries in long-term care and assisted living facilities across eight U.S. states.
- Company typePrivate
- Founded-
- HeadquartersEllicott City, United States
- Headcount251–500
- GTM typeB2B
- OfferingServices
What Provider Partners does
Provider Partners Health Plans (PPHP) is a privately held Medicare Advantage HMO that contracts with the Centers for Medicare and Medicaid Services to deliver Institutional Special Needs Plans (I-SNP) to Medicare beneficiaries residing in long-term care facilities and Institutional Equivalent Special Needs Plans (IE-SNP) to eligible residents of assisted living facilities. The company operates across eight states — Illinois, Indiana, Kentucky, Maryland, Missouri, North Carolina, Pennsylvania, and Texas — and serves the dual customer surface of facility operators (long-term care and assisted living) and Medicare-eligible residents requiring a skilled nursing level of care.
The company's core technology stack is a tech-enabled, value-based care platform anchored by a partnership with Real Time Medical Systems, whose cloud-based interventional analytics software pulls live data directly from post-acute Electronic Health Records. This integration delivers timely alerts, early warning of emerging clinical risk, infection prevention and antibiotic surveillance, and accurate reimbursement support, with alerts surfacing to onsite Nurse Practitioners and RN Care Coordinators. The company exposes four partnership models to facility operators — Provider Partner, Equity Investor, Management Services, and Primary Care Physician participation in the Connect Care ACO REACH Program — calibrating engagement for different operator risk and capital preferences.
The revenue model is built on three streams: (i) recurring monthly Medicare premium payments per enrolled member replacing traditional Medicare A/B/D coverage with an all-in-one benefit including supplemental services; (ii) capitated facility payments flowing from Provider Partners to partner facilities on a monthly basis, creating a new recurring revenue line for facility operators; and (iii) year-end Pay-For-Performance bonuses calculated at 100% of savings from an 85% Medical Loss Ratio when quality metrics are met, aligning facility economics with cost-of-care reduction. The firm is led by Dr. Scott Rifkin (Executive Chairman) and Bruce R. (Rick) Grindrod, Jr. (CEO and President), maintains HIPAA-compliant plan administration, and operates with a workforce in the 251-500 range split across clinical, field sales, and administrative functions.
Provider Partners firmographics
Firmographics- Name
- Provider Partners
- Legal name
- Provider Partners Health Plans
- Website
- https://partnerwithpphp.com
- Company type
- Private
- Operating status
- Operating
- Headcount range
- 251–500 employees
- Short description
- Provider Partners Health Plans (PPHP) is a privately held Medicare Advantage HMO operating Institutional Special Needs Plans (I-SNP) and Institutional Equivalent Special Needs Plans (IE-SNP) for Medicare beneficiaries in long-term care and assisted living facilities across eight U.S. states.
- Ownership category
- akta.pro rank
Provider Partners industry classification
Industry- Product category
- Medicare Advantage Health Plans
- NAICS
- Direct Life, Health, and Medical Insurance Carriers (52411), Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)
- SIC
- Hospital & Medical Service Plans (6324)
- akta.pro primary industry
- Medicare Advantage (MA) Plans (FSAIAGAA)
- akta.pro secondary industries
- MA Provider-Sponsored/Payvider MA Plans (HLAEACAJ), Medicare Provider Networks & Delegated Medical Groups (MA-focused) (FSAIAGAK), MA-PD Plans (Medicare Advantage with Prescription Drug Coverage) (FSAIAGAG)
Keywords
Where Provider Partners is headquartered
LocationHeadquarters
- HQ city
- Ellicott City
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Provider Partners business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Marketing or Sales, Others
Revenue model
- Medicare Advantage Premium Revenue: Provider Partners Health Plans receives monthly premium payments from Medicare for each enrolled member. The plans are Medicare Advantage HMOs that replace traditional Medicare coverage with an all-in-one solution covering Part A (inpatient), Part B (outpatient/primary care), Part D (prescription drugs), and supplemental coordinated wellness services.
- Capitated Facility Payments: Provider Partners pays participating facilities an upfront capitated payment every month for each enrolled resident. This provides facilities with a new recurring monthly revenue stream.
- Pay For Performance (P4P) Bonus: Facilities can participate in year-end P4P bonuses calculated at 100% of savings from 85% Medical Loss Ratio when quality metrics are achieved. The facility shares in 100% of the revenue gained by lowering the cost of care.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Monthly | Custom partnership arrangements based on facility size and enrollment |
Go-to-market motion2 records
Distribution channels1 record
Marketing channels4 records
Provider Partners product offering
Product offeringCore offering
Provider Partners Health Plans operates Medicare Advantage Institutional Special Needs Plans (I-SNP and IE-SNP) for Medicare beneficiaries in long-term care and assisted living facilities. It sells four partnership models to facility operators, delivers onsite Nurse Practitioner and RN Care Coordinator staffing, and underpins its value-based care program with Real Time Medical Systems' interventional analytics integrated with post-acute EHRs. The company receives monthly Medicare capitation revenue and shares savings with partner facilities through capitated payments and Pay-for-Performance bonuses.
Product overview
Provider Partners Health Plans offers a portfolio of Medicare Advantage Institutional Special Needs Plans (I-SNP and IE-SNP) designed to improve care for Medicare beneficiaries residing in long-term care facilities or assisted living facilities. The core products are the I-SNP (for long-term care facility residents) and IE-SNP (for assisted living facility residents), both replacing traditional Medicare with all-in-one coverage. These plans are powered by a tech-enabled, value-based care model utilizing Real Time Medical Systems' interventional analytics software that pulls live data from post-acute EHRs to provide timely alerts, early warning of risks, and accurate reimbursements. The program includes onsite Nurse Practitioners and RN Care Coordinators who coordinate care using sophisticated technology and electronically tracked medical records.
Differentiator
Problem solved
Functional benefit
Products and services
- Institutional Special Needs Plan (I-SNP) All-inclusive Medicare Advantage plan for eligible Medicare enrollees residing in long-term care facilities. Replaces traditional Medicare with Part A (inpatient), Part B (outpatient/primary care), Part D (prescription drugs), and coordinated wellness services, supported by an onsite Nurse Practitioner and RN Care Coordinator. Sold to facility operators who enroll their residents.
- Institutional Equivalent Special Needs Plan (IE-SNP) Medicare Advantage plan for patients who live in an assisted living facility and require a skilled nursing level of care but choose a community setting. Combines Part A, Part B, Part D, and supplemental benefits (vision, dental, hearing, podiatry, OTC, medical transport) with an onsite Nurse Practitioner and RN Care Coordinator. Sold to assisted living facility operators.
- Real Time Medical Systems Interventional Analytics Post-acute analytics software that pulls live data directly from EHRs to deliver timely alerts, accurate reimbursements, early warning of emerging health risks, infection prevention and antibiotic surveillance, and care coordination insights. Reduces avoidable hospital admissions and supports clinical, financial, and operational outcomes for PPHP partner facilities.
- Tech-Enabled Value-Based Care Program Proprietary PPHP care delivery program that combines onsite Nurse Practitioner and RN Care Coordinator teams, Real Time analytics, and electronically tracked medical records to enable more timely treatment, reduce the need for acute care, and prevent unnecessary hospitalizations for enrolled Medicare beneficiaries. Sold as the operating model behind PPHP's I-SNP and IE-SNP plans to partner facilities.
Quantifiable outcome
- 100% of savings from 85% Medical Loss Ratio returned to facilities when quality metrics are achieved
- +2 more outcomes
Companies that use Provider Partners
Customer profileNamed customers2 records
Segments3 records
Ideal customer profiles3 records
Provider Partners technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Integration2 records
AI capability3 records
Feature2 records
Provider Partners partnerships and signals
Strategic signalPartnerships
One partnership is on record.
- Real Time Medical SystemscoreProvider Partners Health Plans clients can access Real Time Medical Systems' interventional analytics software. The cloud-based platform integrates with post-acute Electronic Health Records to provide Real Time data analysis, timely alerts for emerging health risks, infection prevention & control measures, and accurate reimbursement management. The partnership enables earlier intervention to prevent hospitalizations and improves clinical, financial, and operational outcomes.
Scale indicators2 records
Recent moves5 records
Expansion highlights6 records
Provider Partners competitors and assessment
Company assessmentDirect peers
- ATRIO Health Plans: Medicare Advantage carrier with a multi-state footprint and a meaningful I-SNP offering for long-term care residents. Comparable in operating model as a regional MA HMO with SNP specialization and facility-based partnerships.
- Longevity Health Plan: An I-SNP-focused Medicare Advantage plan operator serving residents of skilled nursing facilities and assisted living communities. Closest direct competitor to Provider Partners given shared LTC/ALF target market and SNP-only product strategy.
- SCAN Health Plan: Mission-driven Medicare Advantage plan with strong focus on seniors and dual-eligible populations, including SNP products. Comparable as a senior-focused MA specialist with SNP expertise and a value-based care orientation.
- Clover Health: Tech-enabled Medicare Advantage carrier using its Clover Assistant software and data platform to drive value-based care. Comparable to PPHP's tech-enabled positioning within MA, though focused on broader populations rather than the I-SNP niche.
- Alignment Health: Tech-enabled Medicare Advantage plan leveraging a proprietary technology platform (AVA) for care coordination, member engagement, and clinical analytics. Comparable in MA tech-enabled value-based care focus, though broader in target population than PPHP's I-SNP niche.
Broad incumbents
- Elevance Health (Anthem): Major national Medicare Advantage carrier with SNP products and a multi-state Blue plan footprint. Competes with PPHP in overlapping states for SNP enrollment and has the scale to expand institutional SNP offerings rapidly.
- Aetna (CVS Health): National Medicare Advantage carrier with a growing institutional and dual-eligible SNP portfolio. CVS Health's care delivery footprint (HealthHUB, Oak Street) provides competitive pressure and partnership potential for the same LTC/ALF population.
- Humana (CenterWell): One of the largest Medicare Advantage insurers in the US with deep senior care focus and a growing SNP portfolio. CenterWell senior-focused primary care and I-SNP products overlap with PPHP's facility-based model and represent meaningful competitive pressure.
- UnitedHealth Group / Optum: Largest US Medicare Advantage carrier with Optum-owned care delivery assets. Operates dual-eligible and institutional SNPs and can leverage scale, capital, and provider-network ownership to compete for the same LTC/ALF population.
Others
- Convey Health Solutions: Technology and services provider specializing in Medicare Advantage, particularly Medicare Advantage-Prescription Drug plans and SNPs. Adjacent rather than directly competitive; relevant because Convey powers back-office operations for many SNP sponsors that overlap with PPHP's market.
Market position
Strengths4 records
Weaknesses5 records
Competitive moat4 records
Key risks6 records
Key highlights7 records
Customer concentration
Provider Partners social profiles
Digital presenceProvider Partners compliance and trust
Trust signalCompliance1 record
Provider Partners financial estimates
Financial estimateRevenue estimate
Valuation estimate
Provider Partners leadership team
Management profileNumber of profiles
Profiles2 records
Provider Partners funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Provider Partners M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Provider Partners
What does Provider Partners do?
Provider Partners Health Plans operates Medicare Advantage Institutional Special Needs Plans (I-SNP and IE-SNP) for Medicare beneficiaries in long-term care and assisted living facilities. It sells four partnership models to facility operators, delivers onsite Nurse Practitioner and RN Care Coordinator staffing, and underpins its value-based care program with Real Time Medical Systems' interventional analytics integrated with post-acute EHRs. The company receives monthly Medicare capitation revenue and shares savings with partner facilities through capitated payments and Pay-for-Performance bonuses.
Is Provider Partners a public or private company?
Provider Partners is a private company. It is classified as unknown and is currently operating.
When was Provider Partners founded?
Provider Partners was founded in -1. It employs 251 to 500 people.
Where is Provider Partners based?
Provider Partners is headquartered in Ellicott City, United States, in the North America region.
How does Provider Partners make money?
Three revenue lines are on record. Medicare Advantage Premium Revenue is the primary driver. The others are capitated Facility Payments and pay For Performance (P4P) Bonus.
Who are Provider Partners's main competitors?
Direct peers on record are ATRIO Health Plans, Longevity Health Plan, SCAN Health Plan, Clover Health and Alignment Health. Broad incumbents are Elevance Health (Anthem), Aetna (CVS Health), Humana (CenterWell) and UnitedHealth Group / Optum. Convey Health Solutions is listed as an others.
Does Provider Partners have an API?
No public API is recorded for Provider Partners.
What industry is Provider Partners in?
Provider Partners's product category is Medicare Advantage Health Plans. Its primary akta.pro industry code is FSAIAGAA, Medicare Advantage (MA) Plans, with a secondary code of HLAEACAJ, MA Provider-Sponsored/Payvider MA Plans. Its NAICS code is 52411 and its SIC code is 6324.