Independent physician practices are under pressure from nearly every direction. Reimbursement remains tight. Administrative requirements consume time and resources. Technology and data capabilities increasingly influence financial performance. At the same time, hospitals, health systems, insurers, and private equity-backed organizations continue to expand their footprint.
The numbers show how dramatically the market has changed. In 2012, 60.1% of physicians worked in private practices. By 2024, that figure had fallen to just 42.2% (AMA, 2025). Physicians cite inadequate payment rates, costly resources, and regulatory and administrative burden among the important reasons practices are sold.
For independent practices, however, consolidation does not have to be inevitable. Value-based care can provide another path, but succeeding in value-based care requires more than signing a new contract. Practices need the infrastructure and operational capabilities to manage performance, understand financial risk, coordinate care, and make informed decisions.
Independence Requires More Than Ownership
A practice can remain physician-owned and still lose control over the forces shaping its future.
If leaders cannot determine which payer contracts are profitable, where patients receive care outside the practice, which populations are driving avoidable utilization, or where revenue is being lost, they are making increasingly consequential decisions with incomplete information.
That matters as healthcare moves further toward financial accountability.
CMS reports that 14.3 million Medicare beneficiaries now receive coordinated care through Accountable Care Organizations, and 82.8% of Medicare Shared Savings Program ACOs are participating at levels that qualify as Advanced Alternative Payment Models (CMS, 2026). In the most recently reconciled performance year, Shared Savings Program ACOs earned $4.1 billion in shared savings while generating $2.5 billion in Medicare savings.
Value-based care is creating opportunity. It is also raising the operational expectations placed on participating organizations. The challenge for independent practices is making sure they have the capabilities to capture that opportunity.
Four Capabilities Strengthen Independence
Practices do not need the scale of a national health system to compete. They do need greater control over four areas that increasingly determine performance.
Contract performance. Practices need to understand how contract terms translate into actual financial results. That means identifying missed incentives, denials, payment delays, performance gaps, and the financial implications of taking additional risk.
Clinical and population performance. Value-based contracts reward organizations that can identify risk early, close care gaps, improve documentation, coordinate transitions, and prevent avoidable utilization. Those activities must become part of everyday workflows rather than additional tasks layered onto already overwhelmed clinicians.
Network performance. Where patients receive care matters. Referral patterns, specialist access, network leakage, utilization, and variation can all affect cost and quality. Independent organizations need visibility into those patterns so they can build networks intentionally rather than allowing them to evolve without strategy.
Operational execution. Data alone does not transform a practice. Leaders need workflows, accountability, performance monitoring, and change management that turn information into action without increasing burnout.
Together, these capabilities create something larger: the ability to make decisions from a position of knowledge rather than pressure.
You Don't Have to Build Everything Yourself
Preserving independence does not mean doing everything alone. Independent practices often operate with fewer financial, technical, and administrative resources than the organizations they compete against. Trying to recreate an enterprise-scale infrastructure internally may simply add another layer of expense and complexity.
Instead, practices can build capabilities in phases. Start by understanding where you are. Identify the contracts, workflows, data gaps, utilization patterns, and operational weaknesses creating the greatest financial or clinical risk. Quantify the opportunities. Then prioritize the changes most likely to produce measurable value.
Technology can support that work. So can analytics, automation, outside expertise, and strategic partnerships. But each should solve a defined problem rather than become another system your staff must manage.
If your practice wants to remain independent but you're unsure whether your current infrastructure can support the next stage of value-based care, talk with us. We can help you assess where you stand, identify the gaps that matter most, and build a practical path forward.
Independence Is Still a Choice
The healthcare market has changed, and independent practices cannot compete by operating exactly as they did a decade ago. However, adapting does not have to mean giving up what made the practice worth building in the first place.
With better visibility into contracts, patients, networks, and performance, physician leaders can make informed decisions about where to invest, what risk to accept, how to grow, and which partnerships make sense.
Independence is more than retaining ownership. It is maintaining the ability to choose your future.
