# Independent Provider Network & Manageable-Lives Analysis
### Redlands Community Hospital (RCH) — Clinically Integrated Network (CIN) opportunity, San Bernardino → Banning I-10 corridor

*Compiled 2026-05-31 for the Redlands Market Intel side project. Companion data files: `independent_groups.json`, `independent_groups.csv` (38 independent groups + 3 flagged-excluded entities, all geocoded). Counts of independent PCPs come from a full pull of the CMS NPPES NPI Registry; group-level provider/panel figures are clearly labeled estimates where not directly sourced. Nothing is fabricated; where a value could not be confirmed it is null or marked "(est)".*

---

## 0. The strategic question

RCH is a 211-bed independent non-profit hospital boxed in by three dominant networks — **Kaiser Permanente** (closed network), **Optum / Beaver Medical Group** (payer-owned multispecialty + IPA gatekeeper), and **Loma Linda University Health** (academic system, trauma/peds monopoly, SAC Health FQHC). RCH cannot out-scale any of them. The viable counter-strategy is to **aggregate the region's still-independent physicians into a clinically integrated network (CIN)** — giving independent doctors the contracting, care-management, and value-based infrastructure they cannot build alone, while giving RCH an attributable primary-care base and a defensible referral stream.

This analysis answers two questions:
1. **Who are the independent groups** (not owned by the big three) that RCH could align with or aggregate?
2. **How many patient lives could that network manage**, and how do those lives split across a population-health risk pyramid?

---

## 1. Method & sources

- **CMS NPPES NPI Registry API** (`https://npiregistry.cms.hhs.gov/api/`, version 2.1) — full programmatic pull across all 12 corridor cities:
  - **Organizational providers (NPI-2):** 3,442 unique organizations harvested, filtered to ~742 medical-group/clinic/specialty entities, then classified by affiliation.
  - **Individual PCPs (NPI-1):** 3,449 unique clinicians harvested by taxonomy (Family Medicine 207Q, Internal Medicine 207R, Pediatrics 2080, Geriatrics, General Practice, Nurse Practitioner 363L, Physician Assistant 363A), then attributed to dominant networks vs. independent by **practice-location address fingerprinting**.
- **Group verification & ownership:** group websites, IEHP provider network, OPA/DMHC references, and local press (Record-Gazette, Community Forward Redlands) — used to confirm independence and correct stale affiliations.
- **Geocoding:** US Census geocoder (`geocoding.geo.census.gov`, Public_AR_Current) with OpenStreetMap Nominatim fallback. City-center placements (flagged in notes) used only where no rooftop match existed (4 records).
- **Prevalence:** San Bernardino County Community Indicators / Community Vital Signs; SHAPE Riverside; CDC / CMS Medicare chronic-condition data.

**Corridor (12 cities):** San Bernardino, Highland, Colton, Grand Terrace, Loma Linda, Redlands, Mentone, Yucaipa, Calimesa, Cherry Valley, Beaumont, Banning. (Beaumont, Banning, Calimesa, Cherry Valley are in **Riverside County**; the rest in **San Bernardino County**.)

**Caveat on NPPES:** the registry is the most complete provider census available but is noisy — it includes inactive/retired NPIs, telehealth-only and registration addresses, and clinicians whose listed practice address is a billing office rather than where they see patients. All counts below are therefore presented as **ranges with explicit haircuts**, not point estimates.

---

## 2. Who is independent vs. excluded (affiliation transparency)

### EXCLUDED — the three dominant networks RCH is working around
| Network | What it owns in-corridor | Why excluded |
|---|---|---|
| **Kaiser Permanente** | Fontana/Riverside/Moreno Valley hospitals + closed medical group | Closed network; lives are structurally unavailable |
| **Optum / Beaver Medical Group** | ~11 Beaver offices; **Optum Care Network–San Bernardino (formerly PrimeCare)**; **Inland Faculty Medical Group (IFMG)** — the region's largest Medi-Cal IPA, 900+ providers / 230K+ IEHP-Molina lives, now Optum/NAMM-owned; "Epic Management" | Payer-owned (UnitedHealth); the referral gatekeeper |
| **Loma Linda University Health** | LLUMC, Children's, Surgical/Behavioral/East campuses, LLU Faculty Medical Group, **SAC Health** (FQHC) | Academic competitor; explicitly out of scope |

> Two important reclassifications surfaced in this pull: **PrimeCare of San Bernardino is now Optum** (not independent), and **Inland Faculty Medical Group is now Optum/NAMM** (not independent). Both were flagged out. Academic faculty groups at **400 N Pepper Ave, Colton** belong to **Arrowhead Regional (county) / CU School of Medicine** and are likewise excluded as not-independent.

### FLAGGED BUT INCLUDED — separate competitor, not one of the big three
- **Dignity Health / CommonSpirit** (St. Bernardine, Community Hospital SB). Any Dignity-aligned group is included but flagged; none of the *independent* groups below are Dignity-owned.

### INCLUDED — the independent set (38 groups; see data files)
By type: **1 multispecialty anchor, 5 medical groups/IPAs, 14 independent primary-care/peds practices, 13 independent specialty groups, 2 non-LLU FQHCs, 3 independent urgent cares.**

---

## 3. The named independent groups (rough size)

### Tier 1 — anchor aggregation targets (primary care / multispecialty)
| Group | Base city | Type | PCPs | Rough lives | Independence note |
|---|---|---|---:|---|---|
| **Community Alliance Medical Group (CAMG)** | Redlands | Multispecialty PC | 13 | 18k–26k | **Founded 2024 by Dr. John Steinmann explicitly to restore *local, independent* care after Optum/LLU consolidation.** Redlands + Yucaipa + Beaumont. The most strategically aligned target. |
| **Redlands-Yucaipa Medical Group (RYMG)** | Yucaipa/Redlands | Medical group/IPA | 30–45 (est) | 55k–80k | **LEFT OPTUM/Epic — now physician-owned independent again** (announced ~2024-25). 23 years local; own urgent care. Largest single independent PC bloc in the corridor. |
| **LaSalle Medical Associates IPA** | San Bernardino | Medi-Cal IPA | 1,500 network | 300k–360k network (8 counties) | Independent (physician-governed); **Astrana/APC holds only a ~25% minority stake** in the IPA line. Only a fraction of its lives sit in-corridor. |
| **Maren Medical Group** | Redlands | Primary care | 5–12 (est) | 9k–20k | New (June 2025), founded by Dr. Albert Arteaga (LaSalle's founder). Redlands/Beaumont/Yucaipa. |
| **All United Medical Group IPA** | Colton | PC IPA (IEHP) | 20–40 (est) | 20k–45k | Independent IEHP-contracted, risk-bearing. |
| **MedEx Health Network** (+ City/Specialty) | Redlands | PC/specialty IPA | 10–30 (est) | 15k–35k | Independent capitated RBO (DMHC list). |
| **SoCalHealth Inc. IPA** | Redlands | PC IPA | 10–25 (est) | 12k–30k | Independent capitated RBO (DMHC list). |

### Tier 2 — independent specialty groups (referral / co-management aggregation)
- **San Bernardino Medical Orthopaedic Group dba Arrowhead Orthopaedics** — Redlands HQ (1901 W Lugonia), **27+ surgeons across ~11 locations; the largest independent ortho group in the IE.** (NOT the county hospital despite the name; shares Dr. Steinmann with CAMG.) Top specialty target.
- **Inland Gastroenterology Medical Associates** (+ Inland Endoscopy Center ASC) and **San Bernardino Gastroenterology Associates** — Redlands GI/endoscopy.
- **Cardiovascular Specialists of Redlands & the IE** (on the RCH campus) and **Inland Empire Cardiovascular Consultants** (San Bernardino) — cardiology.
- **Inland Hematology-Oncology Medical Group** (complements RCH Cancer Care); **Inland OB-GYN Associates** (complements RCH Women's Health); **Inland Nephrology Medical Associates**, **Inland Arthritis Center** (rheum), **Inland Eye Institute** (ophtho), **Inland Empire Lung & Sleep Institute** (pulm), **Qazi Medical Group** and **Nephrology Associates** (Banning).

### Tier 3 — independent PC/peds practices and non-LLU safety net
- PC/IM/FM/peds: **Redlands Family Practice / Redlands Family Physicians (1520 Barton), Inland Primary Care, Exordium Medical Group, Premier Family / Premier Senior Medical Group (Medicare-heavy), VitaLink (Highland), Stallant (RHC, Highland), Terracina Medical Clinic, DLR Family Medicine, Oliverio (Banning), First Americans (Banning/Morongo), Pineapple Pediatrics, Loma View Pediatrics, New Millenium (peds, Banning).**
- **Non-LLU FQHCs:** **Neighborhood Healthcare-Beaumont** (opened Dec 2024, ~8k patients) and **Unicare Community Health Center** (Colton/SB, indep. 501(c)(3)).
- **Independent urgent care:** Stately (Redlands), Apex (Beaumont), Rapid Care (Banning).

---

## 4. The lives estimate

### Step 1 — Count independent PCPs in the corridor (NPPES)
After harvesting 3,449 individual PCP/NP/PA NPIs and excluding those whose **practice address** maps to a Kaiser, Optum/Beaver, LLU, SAC Health, county-Arrowhead, or Dignity location, the independent-eligible counts with a practice address **inside the 12 corridor cities** are:

| Role | Independent (corridor) | Dominant-network (excluded, corridor) |
|---|---:|---:|
| **Physicians** (FM / IM / Peds / GP) | **320** | 519 |
| **Nurse Practitioners** | 378 | 248 |
| Physician Assistants | 278 | 277 |
| **Physicians + NPs** | **698** | 767 |

The **320 independent physicians** are the solid, defensible core. NP/PA counts are inflated by registration/telehealth addresses and by specialty NPs/PAs who don't carry primary-care panels, so they are discounted heavily below.

> **Defensible independent panel-carrying PCP count: ~270–490 PCP-FTEs.**
> - Conservative: physicians only, 15% NPPES-noise haircut ≈ **272 PCP-FTE.**
> - Base: physicians + 40% of independent NPs, 15% haircut ≈ **400 PCP-FTE.**
> - Expansive: physicians + 60% of independent NPs ≈ **490 PCP-FTE.**

### Step 2 — Manageable lives ≈ PCP-FTE × attributable panel
**Assumption:** ~**1,800 attributable lives per PCP-FTE** (industry planning norm; range **1,500–2,000**). This is the *theoretical market capacity* of the independent PCP base — i.e., the lives those PCPs collectively touch, not the lives a CIN would capture on day one.

| PCP-FTE scenario | × 1,500 | × 1,800 (base) | × 2,000 |
|---|---:|---:|---:|
| Conservative (272) | 408,000 | **490,000** | 544,000 |
| Base (400) | 603,000 | **720,000** | 804,000 |
| Expansive (490) | 738,000 | **886,000** | 984,000 |

> **Theoretical manageable-lives capacity of the independent PCP base: ~0.5M–0.9M lives**, centered near **~700,000** (base case, 400 PCP-FTE × 1,800).

**Realistic CIN ramp (planning guidance, not a model output):** no network aggregates every independent PCP, and the dominant networks already hold most commercial/Medicare-Advantage attribution. A credible RCH CIN that lands the Tier-1 anchors (CAMG, RYMG, the IPAs) plus a slice of Tier-3 practices would manage a **realistic first-wave panel of roughly 80,000–150,000 lives**, scaling toward the larger capacity ceiling over time. The ~700k is the *addressable ceiling*; the ~80k–150k is the *near-term landing zone.*

### Step 3 — Healthy vs. unhealthy split (population risk pyramid)
Applying a standard risk pyramid, **adjusted upward at the top tiers** for the Inland Empire's elevated chronic-disease burden:

**Inland Empire prevalence (sourced):**
- **San Bernardino County:** diabetes **17.0%**, hypertension **30.2%** (2023), obesity **36.5%** (2024) — each the **highest among neighboring counties and above the California average.**
- **Riverside County** (Pass corridor): diabetes **14.6%** (2023-24).
- **Medicare context (national):** **68.4%** of beneficiaries have **2+ chronic conditions**, **36.4%** have **4+**; ~half of adults 65+ have prediabetes (CDC). The corridor skews older in Yucaipa/Calimesa/Beaumont, pushing the high-risk tier up.

| Risk tier | Share | On ~490k (conservative) | On ~720k (base) | On ~886k (expansive) |
|---|---:|---:|---:|---:|
| **Low-risk / healthy** | ~77.5% | ~380,000 | ~558,000 | ~687,000 |
| **Rising-risk** (1–2 chronic conditions) | ~15% | ~73,500 | ~108,000 | ~133,000 |
| **High-risk / complex multimorbid high-utilizers** | ~5% | ~24,500 | ~36,000 | ~44,000 |
| *(of which very-high-cost, ~top 2.5%)* | ~2.5% | ~12,000 | ~18,000 | ~22,000 |

> Given IE prevalence runs hotter than the US baseline, the **rising-risk and high-risk tiers should be treated as the upper end of these bands** (closer to 16–17% rising / 5–6% high). The ~5% high-risk tier is where a CIN earns its keep: in value-based contracts that 5% typically drives ~50% of total cost, so even capturing the **~24k–44k high-utilizers** under managed care is the financial engine of the network.

---

## 5. Best aggregation targets & whitespace

**Top 5 aggregation targets (in priority order):**
1. **Community Alliance Medical Group (CAMG)** — purpose-built independent ally; same founder/leadership orbit as Arrowhead Ortho; strategically the natural CIN nucleus. Small now (13 PCPs) but fast-growing and ideologically aligned with "keep it local."
2. **Redlands-Yucaipa Medical Group (RYMG)** — the single largest independent PC bloc and **newly free of Optum**; landing RYMG roughly doubles the network's PCP base and brings its own urgent care.
3. **San Bernardino Medical Orthopaedic Group / Arrowhead Orthopaedics** — anchors the specialty/surgical side (27+ surgeons, 11 sites); recaptures elective ortho volume and feeds the RCH Spine & Joint Institute.
4. **The independent IPAs — All United, MedEx, SoCalHealth** (and the in-corridor slice of **LaSalle**) — these already hold risk-bearing/capitated IEHP-Medi-Cal lives; they bring *attribution and infrastructure*, not just bodies. LaSalle/Maren also open a relationship with Dr. Arteaga's broader network.
5. **Non-LLU FQHCs (Neighborhood Healthcare-Beaumont, Unicare) + Pass-corridor PC (Oliverio, First Americans, New Millenium peds)** — secure the Medi-Cal/safety-net base and the under-served Beaumont/Banning growth lane.

**Whitespace:**
- **The Pass corridor (Beaumont/Banning/Calimesa/Cherry Valley)** is thin on independent PC and has only one small district hospital — the clearest geographic growth lane. Independent assets there (CAMG-Beaumont, RYMG-Beaumont, Maren, Oliverio, Neighborhood Healthcare, the Banning peds/IM groups) are aggregation-ready before LLU/Kaiser entrench.
- **Medicare-heavy senior panels** (Premier Senior Medical Group; the aging Yucaipa/Calimesa population) are high-value for Medicare-Advantage/ACO risk contracts and under-consolidated by the independents.
- **Specialty co-management** (GI/endoscopy, cardiology on-campus, oncology, OB/GYN, nephrology) maps cleanly onto RCH's existing service lines and ASC strategy — a CIN can keep these referrals in-network and out of LLU/Optum.

---

## 6. Bottom line

There are **~38 genuinely independent provider organizations** in the corridor and a **defensible base of ~270–490 panel-carrying independent PCP-FTEs** (anchored by **320 independent physicians** counted in NPPES). That base touches a **theoretical ~0.5M–0.9M lives** (centered ~700k), of which a realistic RCH-led CIN could plausibly manage **~80k–150k in a first wave** — split roughly **~77% healthy / ~15–17% rising-risk / ~5–6% high-risk complex**, with the IE's elevated diabetes/hypertension/obesity burden pushing weight toward the top of the pyramid. The **anchor moves are CAMG and a now-independent RYMG**, with **Arrowhead Orthopaedics** for specialty depth and the **independent IPAs** for risk-bearing attribution.

---

### Source list (key)
- CMS NPPES NPI Registry API — https://npiregistry.cms.hhs.gov/api/
- Community Alliance Medical Group — https://camghealth.com/about ; https://www.communityforwardredlands.com/community-alliance-medical-group-restores-local-healthcare-in-the-inland-empire/
- Redlands-Yucaipa Medical Group — https://www.rymg.com/about-us/ ; Record-Gazette
- LaSalle Medical Associates — https://www.lasallemedicalassociates.com/about/
- Maren Medical Group — https://maren.com/maren-medical-group-founded-in-san-bernardino-and-riverside-counties/
- Arrowhead Orthopaedics (San Bernardino Medical Orthopaedic Group) — https://www.arrowheadortho.com/
- Inland Faculty Medical Group (now Optum/NAMM) — https://www.ifmgipa.com/
- PrimeCare → Optum Care Network–San Bernardino — https://www.primecare.com/en/locations-nav/locations/san-bernardino.html
- Neighborhood Healthcare (Beaumont FQHC) — https://www.nhcare.org/
- Unicare Community Health Center — https://unicarechc.org/about-us/
- San Bernardino County prevalence — https://indicators.sbcounty.gov/wellness/chronic-disease/ ; https://communityvitalsigns.org/chronic-disease/
- Riverside County prevalence — https://www.shaperivco.org/ (diabetes indicator)
- Medicare multimorbidity — CDC / CMS Chronic Conditions data

*Estimates are labeled "(est)" and assumptions are stated inline. Provider/panel figures for individual groups should be confirmed directly with each group before any outreach or modeling.*