Medicaid Capability Build

Medicaid capability built across nine practices in seven months; $1.4M run-rate revenue, $800K EBITDA, and an entire pediatrics practice category newly accessible as M&A targets

THE SITUATION

A feasibility assessment concluded that building Medicaid capability was not financially viable: the administrative complexity would require approximately 10 additional FTEs at $500K+ in annual cost against $100K to $200K in projected revenue. Then two practice acquisitions changed the calculus. Both were pediatrics groups, a category the platform had not previously pursued. Pediatrics practices by nature carry large Medicaid panels: the acquired practices brought substantial Medicaid patient panels and existing Medicaid revenue onto a platform with no infrastructure to serve them. The platform now faced a binary choice: build Medicaid capability or exclude pediatrics from the M&A pipeline entirely, foreclosing access to 100+ practices in the market. The constraint was not just about these two practices. It was about whether an entire practice category would remain permanently out of reach.

WHAT I BUILT

• Strategic partnership: negotiated relationship with a Medicaid-focused care management network providing advanced care management capabilities across 3,700+ clinicians and 1,000+ practice locations, replacing a 10-FTE internal buildout with an external capability

• Payer contracting: led negotiations with all five Medicaid managed care health plans in the market

• Provider credentialing: credentialed providers at both acquired practices under the platform’s tax identification number

• Pilot infrastructure: developed standard operating procedures, compliance tools, and training modules at the two acquired practices

• Market mapping: mapped Medicaid patient density across the platform’s existing markets to prioritize the next locations for rollout

• Scalable rollout: expanded from pilot to nine practice locations using the infrastructure built at the acquired practices

THE RESULT

• Medicaid capability launched across nine practices in seven months

• $1.4M in run-rate revenue; approximately $800K in EBITDA

• Entire pediatrics practice category newly accessible as M&A targets: 100+ practices previously outside the addressable market due to structural Medicaid concentration in peds

• Repeatable infrastructure in place for expansion into high Medicaid density markets

The care management partnership, payer contracts, and credentialing infrastructure are maintained by the commercial and clinical operations teams. The pilot-derived playbook guides rollout to new locations. Medicaid participation is now a standard part of the platform’s M&A evaluation framework.

Where is the platform stuck?

Acquisition pipeline forcing a capability that doesn’t pencil on its own? Let’s talk.

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