Value based programs

PathfinderHealth’s network of providers and facilities is available through a number of payer products, including federally funded (Medicare) and commercial health benefits products.

Self-funded health plan partner and product 

UMR (a UnitedHealthcare Company)

Since January 1, 2015, PathfinderHealth has managed the Northern Arizona Healthcare self-insured employee population. Communication about the ACO Tier 1 providers is provided to NAH employees via the NAH employee portal. Employees are encouraged to thoughtfully consider Tier 1 providers when selecting care. Tier 1 providers are those who have joined the PathfinderHealth organization and are committed to improving the quality of care for NAH employees and their families. NAH has encouraged employees to consider quality of care, collaboration with other providers in the ACO and out-of-pocket costs when selecting their providers.

Commercial insurance partner and product

Since January 1, 2017, PathfinderHealth began managing the Blue Cross Blue Shield Neighborhood Network HMO population. The population consists of individuals and families purchasing PCP Coordinated Care HMO plans on or off the Exchange. The unique plan is designed to offer a supportive experience that helps its members get the most out of their healthcare plan.

Medicare ACO 

Medicare Shared Savings Program – MSSP

Starting January 1, 2022, PathfinderHealth began a partnership with Caravan Health to participate in the Medicare Shared Savings Program. The Shared Savings Program is committed to achieving better health for individuals, better population health, and lowering growth in expenditures. PathfinderHealth will be accountable for the quality, cost, and experience of care for our assigned Medicare fee-for-service (FFS) beneficiary population.