Multi-site physician services platform
Medicaid Capability Build
The commercial and clinical operations teams now run Medicaid across nine practices, generating roughly $1.5M run-rate revenue and $800K EBITDA, with 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
• The commercial and clinical operations teams launched Medicaid across nine practices in seven months
• They run it at roughly $1.5M in run-rate revenue and $800K in EBITDA
• They opened the entire pediatrics practice category as M&A targets: 100+ practices previously outside the addressable market because of structural Medicaid concentration in peds
• They hold repeatable infrastructure for expansion into high Medicaid density markets
The commercial and clinical operations teams maintain the care management partnership, payer contracts, and credentialing infrastructure. They run rollout to new locations from the pilot-derived playbook. Medicaid participation is now a standard part of the platform’s M&A evaluation framework.
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