City Care Partners
Better care. Coordinated for you.
City Care Partners works with specialty practices, health systems, and community organizations to build a more connected care experience for Medicare beneficiaries.
Coordinated care doesn't stop at the primary care office. It extends into specialty clinics, hospitals, rehabilitation facilities, and the community organizations that address the social drivers of health. City Care Partners is building a network of partners who share our commitment to better outcomes for Medicare beneficiaries.
Historically, specialists have been on the outside of accountable care arrangements — receiving referrals from ACOs but rarely sharing in their success. The LEAD Model changes that.
Through the CMS Administered Risk Arrangements (CARA) framework, City Care Partners offers structured ways for cardiology, nephrology, orthopedics, oncology, and other specialty groups to participate in episode-based value-based arrangements. CARA templates standardize the legal and operational frameworks that previously took years to build, allowing your practice to focus on care delivery rather than contracting.
Why CARA matters: Instead of negotiating custom, one-off contracts for each specialty relationship, CARA provides pre-built episode definitions, performance benchmarks, and compliance frameworks — significantly reducing the time and legal cost of getting started.
City Care Partners works with hospital and health system partners to ensure that hospital-based care fits seamlessly into the larger care continuum we are building for our attributed beneficiaries.
Real-time ADT (Admit, Discharge, Transfer) integration so our care team knows when an attributed beneficiary enters or leaves the hospital — enabling timely follow-up and transitions support.
Structured handoff protocols for high-risk discharges, ensuring patients leave the hospital with clear follow-up plans, medication reconciliation, and primary care connections.
Collaborative programs focused on readmission reduction, emergency department utilization, and post-acute care optimization — aligned incentives that benefit patients and partners alike.
Secure, HIPAA-compliant data exchange to support population health management, care gap identification, and real-time decision support across settings.
Many of the factors that determine a patient's health happen outside the doctor's office: food security, housing stability, transportation, social connection, and access to community resources. City Care Partners partners with community-based organizations to address these social drivers of health.
Our care management team works to identify patients who could benefit from community-based support and connect them with trusted local organizations — closing the gap between clinical care and the real-world conditions that shape health outcomes.
Whether you're a specialty practice, health system, or community organization, we'd like to hear from you. Our team can discuss partnership models that align with your goals.