Multi-site physician services platform
Medicaid Capability Build
Medicaid capability built across nine practices in seven months, generating roughly $1.5M in run-rate revenue, with a 5pt CIN fee schedule increase that swung Medicaid EBITDA from a projected ($810K) loss to roughly breakeven, 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 launched across nine practices in seven months
Roughly $1.5M in run-rate revenue, with a 5pt CIN fee schedule increase that swung Medicaid EBITDA from a projected ($810K) loss to roughly breakeven
The entire pediatrics practice category opened as M&A targets: 100+ practices previously outside the addressable market because of structural Medicaid concentration in peds
Repeatable infrastructure remained for expansion into high Medicaid density markets
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