The vision
Own the front door
Lives are attributed at the PCP. Risk contracts are won or lost on primary-care performance. The relationship that makes a patient a stakeholder starts here. So primary care isn't a service line — it's the foundation the plan, the wellness center, and the data strategy all sit on.
The constraint The largest local group — Beaver Medical / Epic Management — is owned by Optum (UnitedHealth). We can't out-scale them overnight, and we shouldn't depend on them. Our path is to aggregate the physicians they don't own and give those physicians a better deal.
The decision
Build, partner, or acquire?
| Path | What it is | Pros | Cons |
|---|---|---|---|
| Build / employ | RCH-employed PCPs + APPs in RCH clinics. | Full control of model, data, referrals | Capital-heavy; recruitment is slow & competitive |
| Partner / align | Clinically-integrated network or IPA of independents. | Fast capacity; capital-light; goodwill with MDs | Less control; alignment takes governance |
| Acquire | Buy an independent group outright. | Instant panel & talent | Price, integration risk, culture |
Recommended — a hybrid A small employed core (the brand standard for the whole-person model) wrapped in a clinically-integrated network that aggregates independent PCPs. Differentiate from Optum on autonomy + AI tooling + better economics + a genuinely whole-person model — the things a payer-owned group can't easily offer its doctors.
Capacity math
How many physicians does each tier of lives need?
Team-based care (MD + APPs + RN care managers + health coaches) extends each physician's panel. Illustrative, at ~1,800 attributed patients per PCP-led team.
| Attributed lives | PCP-led teams | Build approach |
|---|---|---|
| 5,000 (pilot) | ~3 | Employed core only |
| 10,000 | ~6 | Employed core + first CIN partners |
| ~22,000 (full capturable) | ~12–15 | Core + full independent-physician alliance |
First analysis to run A physician-supply census of the service area: how many independent PCPs & key specialists practice outside Beaver/Optum, and who's nearing retirement / succession (acquisition or alignment targets). I can start this from the roster's medical-category businesses.
Partners
Who we'd partner with
- Independent PCPs & small groups not aligned with Optum — the core of the CIN.
- FQHCs / community clinics (e.g., SAC Health and peers) for Medicaid & access breadth.
- Direct-primary-care / concierge models for the membership/wellness tier.
- University of Redlands student/employee health and school-based clinics (ties to Workforce & Housing).
- Residency / GME pipeline (Loma Linda, regional programs) to grow our own PCPs.
Metrics & risks
How we measure it — and what could break it
Metrics
- Attributed lives & net new PCPs / quarter
- Access: third-next-available appointment < 7 days
- Continuity & panel fill rate
- Prevention: screening, A1c/BP control, ED-avoidable rate
Risks
- PCP recruitment in a tight market
- Optum/Beaver competitive response & referral lock-up
- Capital for employed core & clinic build-out
- Governance friction in the CIN