Valley Medical Group, a distinguished major care apply in western Massachusetts, has been struggling financially, however the docs there did not wish to promote the apply to a hospital system. As an alternative they lately joined an Unbiased Doctor Affiliation (IPA).
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Karen Brown/New England Public Media
Western Massachusetts, a patchwork of rural communities and low-income cities, is a troublesome place to discover a major care physician, in the event you do not have already got one.
Annoyed sufferers usually take to on-line boards asking for leads or recommendation on how you can discover a apply that’s accepting new sufferers.
One identify repeatedly crops up in these discussions: Valley Medical Group.
With 4 areas within the Connecticut River valley, the apply has been a mainstay of household drugs for the reason that Nineteen Nineties. Valley Medical’s flagship workplace in Northampton might be discovered proper off Most important avenue, subsequent door to a pizza restaurant and a Pleasant’s.
Valley has 90 medical suppliers — together with docs, nurse practitioners and doctor assistants — and on-site labs, x-rays, and imaginative and prescient care. With tens of 1000’s of sufferers, it is develop into one of many largest unbiased practices in western Massachusetts.
It kinds a key a part of the area’s well being care infrastructure — but Valley Medical has hardly ever been beneath extra pressure than it’s now.
In January, the apply laid off 40 staff – 10 p.c of its 400-person workers – principally in help positions.
Regardless of affected person demand for care — there are ready lists to be seen — major care suppliers tackle extra medical duties, and for much less pay, than most medical specialists, mentioned the group’s CEO, Dr. Paul Carlan.
“It has to do with the truth that our (insurance coverage) contracts do not pay in addition to we expect they need to,” Carlan mentioned. “The price of every little thing goes up.”
Valley Medical Group is much from alone on this predicament. 1000’s of major care practices, a key gateway to the medical system, are combating to stay financially viable — and unbiased.
In response, a lot of them are banding collectively to kind Unbiased Doctor Associations, or IPAs. The aim is to extend their market energy, change the best way they receives a commission, and stay answerable for how they deal with sufferers.
Threats to doctor autonomy
Main care practices within the U.S. are in deep trouble, in line with a number of workforce surveys. The American Affiliation of Medical Schools (AAMC) estimates a deficit of 86,000 major care docs by 2036, as extra major care docs retire, and fewer ones enter the sector.
The quantity of people that cannot discover a major care physician has grown by 20 p.c within the final decade, in line with a latest JAMA report.
Decrease relative salaries, and better skilled stress, are disincentives when medical college students take into account a profession in major care. Newly-minted docs can earn extra in specialties reminiscent of cardiology or surgical procedure.
Monetary stresses in U.S. well being care – exacerbated by the COVID pandemic — have led to the closure of many major care practices, in line with the AAMC.
The Massachusetts Well being Coverage Group launched a report in 2025 blaming the disaster, partially, on the comparatively low insurance coverage reimbursement charges for major care. The income downside for major care is projected to get even worse, when the Republican-backed cuts to Medicaid begin to enter impact later this 12 months.
As they search monetary safety, many major care practices have merged with giant hospital techniques, with the docs turning into staff of that system.
However the docs at Valley Medical Group had been decided to keep away from that destiny. Becoming a member of a well being system takes away the autonomy docs want to make the very best medical selections for his or her sufferers, Carlan mentioned. It additionally siphons off revenue into the bigger hospital system.
“Our priorities get muddled up,” he mentioned. “And I feel while you’re a part of a well being system, you are continually being requested to bend for the wants of the group. Hospitals receives a commission when their beds are full.”
Regardless of latest layoffs, Dr. Paul Carlan, president and CEO of Valley Medical Group, believes that becoming a member of an IPA will assist the apply get on extra steady monetary footing going ahead.
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In distinction, major care suppliers want money and time to handle or forestall sickness, Carlan mentioned, and their insurance coverage reimbursement charges ought to take that under consideration.
In December, Valley Medical Group determined to be a part of an Unbiased Doctor Affiliation. Like a union, an IPA combines particular person major care workplaces, giving them energy in numbers when negotiating contracts with Medicaid, Medicare, and personal insurance coverage firms.
“It is a second of transition,” mentioned Dr. Lisa Bielamowicz, chief medical officer of TrustWorks Collectivean unbiased healthcare consultancy that works with well being techniques and doctor teams.
IPAs are gaining momentum as older docs retire, particularly following the difficult years of the COVID pandemic, Bielamowicz mentioned. “Because the child boomers transfer out and youthful physicians take management roles, these sorts of fashions develop into extra engaging.”
The American Affiliation of Household Physiciansa commerce group, is listening to from apply house owners who joined hospital techniques however now wish to break off and return to being a smaller apply.
“So if unbiased IPAs can create the infrastructure help to make unbiased apply viable, then that is a superb factor,” mentioned AAFP Vice President Karen Johnson.
IPAs can carry extra clout to the desk when negotiating charges with insurance coverage firms. However, some insurers say they like working with these partnerships, as a result of they assist stabilize major care practices, sustaining entry and choices for insured sufferers.
In any other case, some docs shift their enterprise mannequin to “direct major care,” which bypasses insurance coverage altogether.
“We’re taking a look at unbiased practices that are not buoyed by …. these giant well being techniques and may help members in the neighborhood within the ways in which they wish to be supported,” mentioned Lisa Glenna vice chairman with Blue Cross Blue Defend of Massachusetts.
Can a unique fee mannequin save major care?
When these unbiased practices band collectively, Glenn mentioned, Blue Cross can provide what are known as “value-based contracts.” As an alternative of getting a fee for every go to or process, the medical apply is given a budgeted quantity for every affected person’s care, which supplies an incentive to maintain them wholesome in order that they want fewer therapies.
“(Medical suppliers) make completely different sorts of decisions than they might in the event that they’re paid for each process, each go to, each widget,” mentioned Bielamowicz from TrustWorks Collective.
If there may be cash left over on the finish of the 12 months, it is break up between the apply and the insurer.
The catch, Glenn mentioned, is {that a} value-based contract solely works if there is a sufficiently big pool of sufferers to unfold out the danger, in case just a few get actually sick. In any other case, she mentioned, “the danger of ending up above or under the finances turns into considerably topic to random variation somewhat than efficiency.”
Medical assistants Emily Osgood (left) and Stephanie Fugler (proper) work within the Greenfield, Mass., location of Valley Medical Group on January 27, 2026.
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Worth-based contracts had been imagined to be the following huge factor when the Inexpensive Care Act handed in 2010, an progressive solution to carry prices down for the well being system as an entire.
However they had been sluggish to catch on; the standard fee-for-service fee mannequin was too entrenched. Consultants say that would nonetheless change, if sufficient major care suppliers work collectively to construct market energy via IPAs.
“If we maintain folks out of the ER, maintain them out of pointless hospitalizations, we lower your expenses for the system,” mentioned Chris Kryder, CEO of Arches Medical IPA in Cambridge, Mass., an IPA specializing in value-based contracts. “And we create extra revenue for the PCPs (major care suppliers), which is dreadfully wanted.”
These contracts additionally enable extra flexibility in staffing, Kryder mentioned, as a result of nurses, bodily therapists and medical assistants can tackle among the much less complicated medical duties,, saving the apply cash.
IPAs might help — but it surely relies on who’s in cost
However IPAs will not be a panacea for major care’s issues, in line with some well being care leaders. There are a whole bunch of IPAs throughout the nation, however not all provide the independence and autonomy that many docs crave. Some IPAs are literally owned by hospital techniques, and even non-public fairness firms, and so they’re much less centered on preventative care.
The American Affiliation of Household Physicians advises its members to hunt out IPAs with “integrity,” that give docs a powerful function in decision-making.
“Who’s calling the pictures, who’s making the choices, and is it actually centered on the very best pursuits and long run advantage of physicians in apply and their sufferers?” mentioned AAFP’s Karen Johnson.
The IPA that Kryder leads, Arches Medical, is owned totally by physicians and centered particularly on major care, he mentioned. However to be more practical, Arches must recruit extra practices that need value-based contracts.
That may be a tough promote, mentioned Lisa Glenn of Blue Cross. Beneath that fee mannequin, docs would possibly see a lag of greater than a 12 months, from the time they supply care to the second they understand the financial savings.
“It does not occur in a single day, and it does take an funding,” she mentioned.
That lag is one cause Valley Medical Group needed to lay off workers after becoming a member of the Arches IPA, mentioned CEO Paul Carlan. However he has religion that, after a while, the apply will develop into extra financially steady, have the ability to provide larger salaries, and most significantly, maintain the docs in cost.
This story comes from NPR’s well being reporting partnership with New England Public Media and KFF Well being Information.
