Serving Medicare Beneficiaries and their champions
Better Outcomes
Begin with a
Better Care Model
The Champion Difference
Champion delivers more than Medicare coverage—we deliver a differentiated care experience that simplifies the care journey, strengthens coordination, and improves outcomes for every member.
Championed Care reflects our commitment to:
Proactive, coordinated care across settings
Early identification and intervention for rising-risk members
High-touch, community-based support for complex populations
A superior member and provider experience
Get to Know Our Brands
Champion Health Plan
Champion Health Plan is a locally operated, provider-aligned Medicare Advantage organization purpose-built to partner with Medical Groups, IPAs, and Health Systems. Champion integrates proven Chronic Special Needs Plan (C-SNP) expertise, provider ownership, high-touch care management, and modern technology.
Champion Payer Solutions
Champion Payer Solutions, LLC (CPS) is Champion Health Plan’s dedicated managed care services organization (MSO), providing end-to-end administrative, operational, and regulatory support to partner physician groups, IPAs, and health systems operating in value-based arrangements.
Balance
Health Plan
Balance Health Plan is Champion’s platform for the CMS GUIDE Model (Guiding an Improved Dementia Experience), a Medicare-funded initiative that improves care for individuals living with dementia and provides meaningful support to unpaid family caregivers.
About Champion Health Plans USA, LLC
Our Mission
Champion Health Plans USA, LLC is dedicated to delivering quality health programs and services that help individuals with complex medical conditions achieve improved outcomes and quality of life.
Financial Value for Providers
Champion supports provider partners by:
- Optimizing risk adjustment accuracy
- Driving Star performance and quality outcomes
- Reducing the total cost of care
- Creating predictable, shared revenue and margin opportunities
Provider Alignment and Ownership
Champion is provider-aligned. Shareholders include founders and hundreds of practicing physicians. Provider partners are offered the opportunity to invest prior to institutional capital, creating:
- Long-term alignment
- Shared governance
- Meaningful participation in enterprise value creation
- Potential upside ahead of a future IPO
Ideal Partner Profile
Champion partners with Medical Groups, IPAs, and Health Systems seeking:
- Scalable Medicare Advantage growth
- Leadership in chronic and complex populations
- Transparent, aligned economics
- Local execution with accountable leadership
- Equity participation and long-term value creation
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
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
Newsroom
- Press Release
- EIN Presswire
Our Leaders
Champion Health Plans USA, LLC is led by an executive and clinical leadership team with over 225 years of combined experience in managed care. Collectively, the team built and operated the third-largest C-SNP platform in the U.S., culminating in Bright Health Group’s 2020 acquisition of Brand New Day.