Strategic plan example for a multispecialty medical group

The group has 92 clinicians, 96,000 active patients and $118 million in net revenue, with an operating margin of 1.4% after clinician compensation. Primary care is full: 19 of 34 primary care clinicians are closed to new patients and the wait for a new-patient visit is 38 days. Risk contracts cover 26,000 patients, yet we earned $2.1 million of a possible $7.5 million in shared savings last year. The four-room surgery center runs at 52% of capacity while our own surgeons take cases to the hospital. Medical assistant turnover is 34%, and four primary care physicians plan to retire by 2029.

• Closed panels turn away about 400 new-patient requests a month. Those patients join the hospital system's employed practices and take their specialty referrals with them.
• Fee schedules from our two largest commercial payers have risen more slowly than our wage costs for three years, so visit volume alone no longer protects the margin.
• Clinicians spend 11 hours a week on notes and messages outside clinic hours, the reason given most often by those who have left.

• Remain physician-owned and fund growth from operations and equipment finance. No outside equity through 2029.
• Grow primary care by building teams, not only by recruiting physicians: each physician works with an advanced practice clinician, two medical assistants and a shared nurse.
• Move revenue toward risk contracts where we have the data and care management to perform, starting with Medicare Advantage.
• Bring our own surgical and endoscopy cases to our own surgery center before courting outside surgeons.
• Hold the specialty mix at eight and deepen the three that primary care refers to most: orthopedics, gastroenterology and cardiology.

• Build a care team around each of the 22 primary care physicians, adding eight advanced practice clinicians
• Hold a quarter of each day's primary care slots for same-day and next-day booking
• Move refills, forms and routine results to nurse and pharmacist protocols
• Recruit four physicians ahead of the retirements, each with a six-month panel handover

• Assign a nurse care manager to the 1,800 patients with the highest predicted cost
• Call every attributed patient within two days of a hospital discharge and see them within seven
• Close quality gaps at the visit, using a pre-visit checklist prepared by the medical assistant
• Convert the second commercial contract to shared savings at its 2028 renewal

• Release unused block time ten days ahead and reassign it to surgeons with a waiting list
• Start outpatient hip and knee replacement with the three orthopedic surgeons already credentialed
• Move the group's screening endoscopy from the hospital to two dedicated room days a week
• Renegotiate surgery center rates with the two commercial payers, using site-of-care savings as the case

• Introduce a three-step medical assistant ladder with pay tied to certified skills
• Roll out speech-to-note documentation to all clinicians after a 20-clinician trial
• Route patient portal messages to the care team first, with clinician review only where needed
• Offer the partnership decision at three years of service, down from five