Serving Medicare Beneficiaries — With and Without Chronic Conditions
Better Outcomes
Begin with a
Better Care Model
A Better Plan
for Every
Medicare Beneficiary
Champion Health Plan offers a full suite of Medicare Advantage Prescription Drug (MAPD) options tailored to meet the needs of members with and without chronic conditions:
- Chronic Special Needs Plans (C-SNP): Designed for individuals with ESRD, CKD, Diabetes, cardiovascular disease, behavioral health, and other qualifying chronic conditions who benefit from specialized care.
- Traditional MAPD Plan: Built for beneficiaries who may not have chronic conditions but want a plan that emphasizes personalized support, preventive care, and proactive coordination.
Across thirteen markets in California and Nevada, we integrate advanced analytics, coordinated clinical teams, and strong community partnerships to deliver better outcomes, improved member experiences, and lower overall costs.
The goal of Champion Health Plans USA, LLC is
to be the solution for improved care.
Solving Fragmentation and High-Cost Utilization
Traditional fee-for-service approaches often fail Medicare beneficiaries—especially those with multiple conditions or limited support. Many face barriers like transportation needs, food insecurity, financial strain, or limited in-home assistance.
Champion Health Plan closes these gaps through:
- Aligned incentives across nephrology, primary care, and specialty care
- Team-based, coordinated care that integrates medical, behavioral, and social support
- Outcome-driven provider partnerships that reward improvement
- Member engagement programs that reduce avoidable hospitalizations and complications
The result: better outcomes, stronger quality of life, and lower total cost of care.
The Problem
- Treatment is expensive, demanding and complex
- Incentives are misaligned
Patients with advanced kidney disease often have many co-morbidities (e.g. diabetes, congestive heart failure, obesity)
In addition to a multitude of serious medical conditions, many patients face inadequate home support, insufficient cash for medical co-pays, challenges accessing safe housing and lack of nutritious food and transportation to needed care
Existing fee-for-service-based Medicare reimbursement models curtail nephrologists’ ability to tailor patient care programs to address complex underlying social determinants of health
These medical and social determinants of health, and health equity issues, result in a higher cost to the system and lead to fragmented care
The Solution
- A Medicare Advantage Prescription Drug Special Needs Plan (MAPD-SNP) for ESRD Patients
Economic Alignment with Nephrologists
Improved Health Outcomes
Lower Overall Cost of Care
Champion Payer Solutions — Extending Impact Beyond Our Plans
ESRD is life-threatening and irreversible
Patients have two options for survival: dialysis or kidney transplant
Impact of Missed Dialysis
Increased likelihood of hospitalization after 1 missed dialysis visit(1)
Avoidable
Costs
>$20,000
Estimated cost to a MAPD plan for each hospitalization(3)
Dialysis treatment requires careful adherence to often complicated treatments
Increase in chance of hospitalization (within a month) after more than 2 missed visits(1)
1.75 per year
Number of times a dialysis patient is hospitalized each year
Non-adherence inevitably leads to hospitalization, adverse health effects and death
Increased risk of death in the week following a single missed treatment(2)
$10,000
Annual cost savings per patient from lower hospitalization rates attributable to Champion Health Plan’s incentive-aligned model(4)
(1) Anderson, Amanda H et al. “Missed dialysis sessions and hospitalization in hemodialysis patients after Hurricane Katrina.” Kidney international vol. 75,11 (2009): 1202-1208.
(2) Obialo, Chamberlain I et al. “Relationship of missed and shortened hemodialysis treatments to hospitalization and mortality: observations from a US dialysis network.” Clinical kidney journal vol. 5,4 (2012): 315-9.
(3) Includes the cost of the hospital’s DRG-based fee, emergency room and hospital physicians and emergency ambulance transfers.
(4) Assumes success of Champion Health Plans USA, LLC’s one-year operating goal of lowering average annual hospitalization rate of dialysis patients to 1.25. Source: Centers for Medicare & Medicaid Services (CMS).
Champion Payer Solutions, LLC—our plan-agnostic MSO—extends this model to partners serving complex populations nationwide. We provide the infrastructure, analytics, and operational support needed to coordinate high-quality, cost-effective care at scale.
Technology-Enabled,
Human-Centered Care
We combine advanced technology with the personal touch members deserve.
Powered by AI-driven analytics, predictive triggers, and real-time data, our care teams deliver early interventions that reduce hospitalizations and improve adherence—whether a member has multiple chronic conditions or simply wants proactive support.
Our capabilities include:
- AI-powered insights to identify risks and opportunities early
- Telehealth and remote monitoring that expand access
- Medication and polypharmacy management to reduce complications
- Local, dedicated case managers who offer hands-on, personalized support
Aligned Incentives
Sustainable Value
Champion’s value-based care model rewards providers for delivering coordinated, high-quality care. By aligning incentives across nephrologists, primary care providers, dialysis centers, and specialists, we achieve:
Better member outcomes with fewer acute events
Higher provider satisfaction and financial stability
Optimized dialysis utilization including in-home modalities
Lower overall costs for health systems and payers
Balance Health Plan — Providing extra help for Medicare beneficiaries with dementia
Balance Health Plan partners with the Centers for Medicare & Medicaid Services (CMS) as an approved GUIDE contractor, delivering specialized support for Medicare Fee-for-Service beneficiaries living with dementia.
Through the CMS GUIDE model, Balance provides comprehensive care management, caregiver education, and respite services designed to reduce burden, prevent crises, and improve quality of life for both patients and their families. By coordinating medical, social, and in-home support, Balance Health Plan helps individuals with dementia maintain independence longer while giving caregivers the structured relief and guidance they need to confidently navigate the challenges of dementia care.
The Champion Difference
Champion Health Plan offers more than Medicare coverage—we offer a care experience built to support every type of Medicare beneficiary.
We call it Championed Care: our commitment to simplifying the care journey, strengthening coordination, and giving every member—whether managing chronic conditions or focused on prevention—the support they need to live their best life.