For IPAs, MSOs, and provider groups taking risk
Take the risk. Keep control of the network.
Taking downside risk changes what your network has to do. The contracts, the delegated functions, and the provider data all have to hold up to a payer's audit and to your own economics.
No pitch. If it fits, the next step is a two-week diagnostic: fixed fee, no commitment past it.
Where it usually breaks
Sound familiar?
- Payer negotiations where you're the smaller party at the table
- Delegation is on the table but you're not audit-ready
- Provider rosters and attribution don't reconcile
- Vertical integration is squeezing independent groups
What we take off your plate
One team for the whole build.
- Payer contracting strategy
- Rate posture and terms negotiated from a defensible position.
- Delegated credentialing readiness
- Policies, files, and committee governance that pass a delegation audit.
- Network & provider data ops
- Rosters, attribution, and directory data that reconcile cleanly.
- Value-based terms
- Quality and total-cost arrangements you can actually operate.
The plan
Three steps, with dates.
- 1
Diagnose
Contracts, delegation gaps, and data readiness.
- 2
Build
Negotiate, remediate, and stand up the functions.
- 3
Hand back
Your team runs it; we step out.
What success looks like
- Payer agreements that reflect what you bring
- Delegation earned and sustained under audit
- Independence preserved in a consolidating market
Not sure where your build stands?
Eight questions, two minutes. See your weak spots and what we'd fix first. No email required.
From our playbook
Before you take on more risk.
- Strategy · 7 min readWhen your IPA isn't ready for the risk it's taking onIPAs that accept financial risk before their infrastructure can support it are the most common failure mode we see. Here's what readiness actually looks like.Read it
- Strategy · 14 min readVertical Integration: A Playbook for Independent IPAsHow payer-provider vertical integration is reshaping provider networks, and a practical playbook for independent IPAs to preserve leverage and contract terms.Read it
- Strategy · 8 min readValue-based contracts require a different networkMoving from fee-for-service to value-based arrangements changes who you contract with and what they need to be able to do — not just how you pay them.Read it
- Operations · 7 min readDelegated credentialing: what the contract actually saysDelegation agreements with hospitals and health systems can accelerate credentialing — or create compliance problems. The difference is in what you're actually delegating.Read it
- Strategy · 14 min readAfter ACO REACH: What the 2026 Sunset Means for Your NetworkACO REACH ends after performance year 2026. An accurate look at the LEAD Model, MSSP, ACO PC Flex, and MA contracting, and how your network changes.Read it
- Contracting · 8 min readContracting with health systems is a different gameLarge health systems operate on different contracting timelines, with different internal decision-making structures. What works for independent physicians rarely works here.Read it
Talk to the founder
I've watched a lot of builds go quiet around week six. Usually it isn't strategy. It's that nobody owns the hard middle. Tell me where yours is stuck and I'll tell you straight whether we can help, and what I'd do first.
Dave Smith
Founder, Kearny Street Management
Building provider networks since 2002, for payers and for providers.
A 20-minute call. No pitch and no slides, just a straight read on where your build stands.