2025 Annual Conference

Deborah L. Bauer, Chief Financial Officer, Buffalo Medical Group; and Mark Mantei, Chief Executive Officer, The Vancouver Clinic; moderated by Katherine Flynn Henry, JD, Chief Administrative Officer, Austin Regional Clinic

Brief Summary:

This candid fireside chat brought together senior leaders from three independent, physician-owned medical groups to discuss how they are navigating financial pressures, staffing shortages, reimbursement cuts, and evolving care models. The conversation focused on how strong CEO-CFO partnerships, value-based diversification, physician alignment, and thoughtful use of technology are helping independent practices remain resilient and scalable in a volatile landscape.

Panelists shared insights into their real-world decision-making around capital planning, physician compensation, care delivery efficiency, payer contracting, and multi-generational workforce strategies.

Key Takeaways:

1. Retained Earnings Shield Organizations from Revenue Volatility
   Each organization underscored the importance of retaining earnings to weather tough financial cycles, rather than distributing all surpluses to physicians. This proactive fiscal strategy allowed them to absorb shocks like post-pandemic losses or inconsistent value-based payment timing without compromising care delivery or staff compensation. Vancouver Clinic turned around its first organizational loss by leaning on retained earnings and finished the year in its strongest financial position to date, while Austin Regional Clinic was able to provide physician bonuses during lean years, reinforcing morale and retention.

2. Value-Based Contracting Diversifies Revenue and Improves Predictability
   Buffalo Medical Group and Vancouver Clinic both highlighted a strategic shift toward quality-based commercial contracts and Medicare Advantage to offset unsustainable fee-for-service (FFS) declines. Buffalo’s CFO explained how shifting into commercial value contracts—using goals that mirrored their Medicare work—reduced friction and increased efficiency. Buffalo Medical Group used AI-enabled HCC coding to optimize documentation and expects $1 million in savings by reducing manual coders while improving risk adjustment accuracy—supporting both revenue integrity and payer performance bonuses.

3. Technology and Automation Drive Efficiency Without Job Cuts
   All three organizations emphasized using automation, self-scheduling, and centralized registration to drive administrative efficiency without laying off staff. Vancouver Clinic, for example, uses MyChart to enable patients to schedule over half of their appointments independently. Vancouver Clinic saved $6 million annually in call center labor through self-scheduling alone. AI tools and digital intake systems also allowed for rapid scale-up without increasing overhead, essential for clinics seeing 12%+ annual growth.

4. Ownership and Recruitment Models Attract and Retain Physicians Without Overpaying
   Instead of competing on salary alone, these physician-owned groups leaned on cultural values, equity structures, and flexibility to attract candidates. Offering shared ownership, work-life balance, and autonomy proved to be more appealing than inflated hospital compensation. Vancouver Clinic hired 7 of 12 residents from their new internal medicine program—trained in population health—with minimal onboarding costs and accelerated panel ramp-up times, reducing time-to-productivity and long-term recruitment expenses.

5. Risk-Tolerant Contracting and Strategic Capital Planning Strengthen Independence
   Buffalo Medical Group and others emphasized the value of independent risk tolerance—like terminating unviable Medicare Advantage contracts or opting out of loss-generating ancillary services. Meanwhile, new facilities are funded through retained earnings, bank loans, or innovative physician-backed equity instruments rather than third-party capital. Austin Regional Clinic avoided bank fees by paying physicians 6–6.5% returns on internal capital contributions, creating a win-win incentive loop that fueled real estate investments while keeping financial control within the practice.

Jeffry James, Chief Executive Officer, Wilmington Health

Brief Summary:

This engaging session explored how Wilmington Health—a fiercely independent multispecialty group in North Carolina—is building long-term organizational resilience in a rapidly consolidating healthcare market. Rather than reacting to threats like declining reimbursement, system consolidation, or regulatory changes, Wilmington Health proactively created a value-based, innovation-first culture with diversified revenue streams.

Jeff James emphasized anticipating "extinction events," embracing a “try it and figure it out” mindset, and relentlessly preparing for the future. Their success stems from operational discipline, alternative income models (like clinical research and consulting), and an intentional shift away from RVU-based growth—ensuring sustainability without asking physicians to see more patients.

Key Takeaways:

1. Value-Based Care Transformed Long-Term Viability—and Financial StabilityWilmington Health embraced value-based care over a decade ago as an antidote to the unsustainable nature of fee-for-service. Their foresight led to becoming one of the largest provider-owned ACO REACH networks in the country, with $156 million in gross savings in 2023 alone. Through this long-term strategy, they not only outperformed in Medicare savings but also maximized shared savings distributions to support physicians and reinvest in infrastructure—without depending on RVUs or increasing patient volumes.

2. Diversification Protected Against Industry Volatility
   Instead of relying solely on clinical revenues, Wilmington Health developed parallel verticals including clinical research, employer consulting, national partnerships, and strategic services. These ventures generated revenue independent of patient visits.This diversified income enabled the group to build $40 million in reserves, which they are now using to purchase property and reduce future overhead—ensuring long-term stability while competitors face lease cost pressures.

3. Cultural Realignment Increased Retention and Protected Physician Well-Being
   Rather than overworking clinicians to generate growth, the group aligned compensation with quality and value. New physicians—even those requesting part-time roles—were welcomed into a culture that values impact over volume. Physician productivity was maintained without burnout. As one physician put it, “I haven’t been asked to see one more patient”—a retention strategy that eliminated costly turnover and boosted satisfaction.

4. Crisis Management Experience Created Institutional Agility
   Learning from Hurricane Florence and COVID-19, Wilmington Health developed redundant data centers, on-site crisis response teams, and decentralized command structures. Their ability to operate through multi-day system failures reinforced a culture of readiness. This operational agility allowed for continued care delivery and business continuity during crises—saving millions in losses from service disruptions and protecting inventory, like chemotherapy drugs, during outages.

5. Financial Discipline and Long-Term Planning Prevented Extinction Events
   By adopting a C-Corp model, halting legacy payout models, and building reserves, Wilmington Health shed outdated practices that rewarded physicians for exiting rather than staying. They reinvested in infrastructure and future talent. Eliminating physician “exit payouts” preserved capital for reinvestment, while building equity in real estate and tech. Their approach allowed the group to weather downturns and retain control in a market dominated by consolidation.

Larry Garber, MD, Medical Director Informatics and Research, Reliant Medical Group; Philip Ciampa, MD, MPH, Medical Director of Digital Health and Innovation, Atrius Health; Brett Daniel, MD MHA, Chief Medical Informatics Officer, Optum PNW and West Region

Brief Summary:
This session showcased how three different healthcare organizations—Reliant Medical Group, Atrius Health, and Optum Washington — adopted an EHR-integrated, AI-powered symptom checker to streamline patient access, reduce staff burden, and enable timely, appropriate care.

Designed as a “digital front door,” the tool allows patients to self-triage based on symptoms, receive evidence-based recommendations, and automatically schedule visits or access e-visits when appropriate. Deep integration with EHRs ensures a seamless experience, pulling known patient data and generating clinical notes that reduce redundancy and documentation time. The tool is helping health systems meet patient demand without increasing staffing, while boosting satisfaction and cutting operational costs. 

Key Takeaways:

1. The Symptom Checker Reduced Demand on Clinical Teams Without Sacrificing AccessEach organization faced the same problem: a surge in patient demand that far outpaced staffing capacity. Instead of hiring more staff, they introduced the symptom checker as a triage layer to direct patients to the right level of care—from self-care to e-visits, urgent care, or emergency intervention. At Optum Washington, almost 2,000 patients complete the tool each month with no marketing—one quarter of whom ultimately self-manage their symptoms without any provider interaction, reducing unnecessary visits, portal messages, and calls. This significantly lightens staff workload and preserves clinician time for higher-acuity patients.

2. AI Integration Reduced Clinician Documentation Time by 3 Minutes Per Encounter The symptom checker automatically populates a well-structured note into the EHR, including risk factors and decision logic behind the AI’s recommendations. For e-visits or scheduled appointments, this note forms the base of the encounter documentation. Clinicians save an average of three minutes per patient message and providers interact with 85% fewer messages compared to a typical patient portal message, freeing up thousands of clinical hours annually and reducing burnout.

3. E-Visit Conversion Drove Revenue While Lowering Cost of Care
   When appropriate, patients were routed into asynchronous e-visits, which required no live interaction but still offered timely diagnosis and treatment. The organizations billed insurers or offered a self-pay option for these encounters, often at a significantly lower cost to the patient compared to traditional visits.

4. The Tool Reduced Misuse of Emergency and In-Person Services
   Patients often start the journey believing they need an in-person or emergency visit, but the AI-guided tool redirects them to more appropriate, lower-cost options like virtual care or self-treatment. At Atrius, 94% of users required no follow-up within 2 weeks. In some cases, it correctly escalates care when needed. Four patients were triaged from self-care to emergency care, resulting in hospitalization for serious conditions. The tool reduced both overuse and underuse of care, improving clinical outcomes and reducing system-wide costs.

5. Centralized Review Teams Enhanced Efficiency Without Overburdening PCPs
   While workflows varied, each system leveraged centralized teams (e.g., PCP department nurses or organization-wide virtual care teams) to review symptom checker notes and manage follow-up. This ensured quality oversight and avoided increasing the workload on primary care providers. By routing non-scheduled messages to centralized pools, provider in-basket volume was reduced, and digital hybrid care teams operated with lower overhead while maintaining responsiveness, reducing pressure on in-clinic teams and preserving physician satisfaction.