Western Massachusetts, a patchwork of rural communities and low-income cities, is a difficult place to find a primary care doctor if you don\u2019t already have one. Frustrated patients often turn to online forums, asking for leads or advice on how to find a practice that is accepting new patients. <\/p>\n
One name repeatedly crops up in these discussions: Valley Medical Group.<\/p>\n
With four locations in the Connecticut River Valley, the practice has been a mainstay of family medicine since the 1990s. Valley Medical\u2019s flagship office in Florence can be found right on Main Street, next door to a pizza restaurant and near a Friendly\u2019s.<\/p>\n
Valley has 90 medical providers \u2014 including doctors, nurse practitioners, and physician assistants \u2014 and on-site labs, X-rays, and vision care. With tens of thousands of patients, it\u2019s become one of the largest independent practices in western Massachusetts.<\/p>\n
It forms a key part of the region\u2019s health care infrastructure, yet Valley Medical has rarely been under more strain than it is now. In January, the practice laid off 40 employees \u2014 10% of its 400-person staff \u2014 mostly in support positions.<\/p>\n
Despite patient demand \u2014 there are waiting lists to be seen \u2014 primary care providers take on more clinical responsibilities, and for less pay, than most medical specialists, said the group\u2019s CEO, primary care physician Paul Carlan<\/a>. Rates are outlined in the group\u2019s contracts with insurance providers.<\/p>\n \u201cIt has to do with the fact that our contracts don\u2019t pay as well as we think they should,\u201d Carlan said. \u201cThe cost of everything is going up.\u201d<\/p>\n Valley Medical Group is far from alone in this predicament. Thousands of primary care practices, a key gateway to the medical system, are fighting to remain financially viable \u2014 and independent.<\/p>\n In response, many are banding together to form Independent Physician Associations,<\/a> or IPAs. The goal is to increase their market power, change the way they get paid, and retain control over how they treat patients.<\/p>\n Threats to Physician Autonomy<\/strong><\/p>\n Primary care practices in the U.S. are in serious trouble, according to workforce surveys. The American Association of Medical Colleges estimates a deficit<\/a> of up to 86,000 primary care doctors by 2036, as more primary care doctors retire and fewer enter the field.<\/p>\n The number of people who can\u2019t find a primary care doctor has grown by 20% in the past decade, according to a recent JAMA Internal Medicine report<\/a>.<\/p>\n Lower relative salaries and higher professional stress are disincentives when medical students consider a career in primary care. Newly minted doctors can earn more in specialties such as cardiology or surgery.<\/p>\n Financial stresses in U.S. health care, exacerbated by the covid pandemic, have led to the closure of many primary care practices, according to the AAMC.<\/p>\n The Massachusetts Health Policy Commission<\/a> released a report in 2025 partly blaming the crisis on the relatively low insurance reimbursement rates for primary care. The revenue problem for primary care is projected to get worse when the Republican-backed cuts to Medicaid start to take effect later this year.<\/p>\n As they seek financial security, many primary care practices have merged with large hospital systems, with doctors becoming employees of those systems.<\/p>\n But the doctors at Valley Medical Group were determined to avoid that fate. Joining a health system takes away the autonomy doctors need<\/a> to make the best clinical decisions for their patients, Carlan said. It also siphons off income into the larger hospital system.<\/p>\n \u201cOur priorities get muddled up,\u201d he said. \u201cAnd I think when you\u2019re part of a health system, you\u2019re constantly being asked to bend for the needs of the organization. Hospitals get paid when their beds are full.\u201d<\/p>\n By contrast, primary care providers need time and money to manage or prevent illness, Carlan said, and their insurance reimbursement rates should take that into account.<\/p>\n In December, Valley Medical Group announced it would be joining an Independent Physician Association<\/a>. Like a union, an IPA combines individual primary care offices, giving them power in numbers when negotiating contracts with Medicaid, Medicare, and private insurance companies.<\/p>\n \u201cIt\u2019s a moment of transition,\u201d said Lisa Bielamowicz, chief clinical officer of TrustWorks Collective<\/a>, an independent health care consultancy that works with health systems and physician groups.<\/p>\n IPAs are gaining momentum as older doctors retire, especially following the challenging years of the covid pandemic, Bielamowicz said. \u201cAs the baby boomers move out and younger physicians take leadership roles, these kinds of models become more attractive.\u201d<\/p>\n The American Academy of Family Physicians<\/a>, a trade group, is hearing from practice owners who joined hospital systems but now want to break off and return to being a smaller practice.<\/p>\n \u201cSo if independent IPAs can create the infrastructure support to make independent practice viable, then that\u2019s a good thing,\u201d said Karen Johnson<\/a>, a vice president at AAFP.<\/p>\n IPAs can bring more clout to the table when negotiating rates with insurance companies. Some insurers say they like working with these partnerships because they help stabilize primary care practices, maintaining access and options for insured patients.<\/p>\n Otherwise, some doctors shift their business model to \u201cdirect primary care,\u201d which bypasses insurance altogether.<\/p>\n \u201cWe\u2019re looking at independent practices that aren\u2019t buoyed by \u2026. these large health systems and can support members in the community in the ways that they want to be supported,\u201d said Lisa Glenn<\/a>, a vice president with Blue Cross Blue Shield of Massachusetts<\/a>.<\/p>\n A Different Payment Model<\/strong><\/p>\n When those independent practices band together, Glenn said, Blue Cross can offer \u201cvalue-based\u201d contracts<\/a>. Instead of getting a payment for each visit or procedure, the medical practice is given a budgeted amount for each patient\u2019s care, which provides an incentive to keep them healthy so they need fewer treatments.<\/p>\n Medical providers \u201cmake different kinds of choices than they would if they\u2019re paid for every procedure, every visit, every widget,\u201d TrustWorks\u2019 Bielamowicz said.<\/p>\n If there is money left at the end of the year, it\u2019s split between the practice and the insurer.<\/p>\n The catch, Glenn said, is that a value-based contract works only if there\u2019s a big enough pool of patients to spread out the risk, in case a few get really sick. Otherwise, she said, \u201cthe risk of ending up above or below the budget becomes somewhat subject to random variation rather than performance.\u201d<\/p>\n Value-based contracts were supposed to be the next big thing when the Affordable Care Act passed in 2010, an innovative way to bring costs down for the health system as a whole.<\/p>\n But they were slow to catch on; the traditional fee-for-service payment model was too entrenched. Experts say that could still change, if enough primary care providers work together to build market power through IPAs.<\/p>\n \u201cIf we keep people out of the ER, keep them out of unnecessary hospitalizations, we save money for the system,\u201d said Chris Kryder, CEO of Arches Medical IPA<\/a> in Cambridge, Massachusetts, the IPA specializing in value-based contracts that Valley Medical joined. \u201cAnd we create more income for the PCPs [primary care providers], which is dreadfully needed.\u201d<\/p>\n These contracts also allow more flexibility in staffing, Kryder said, because nurses, physical therapists, and medical assistants can take on some of the less complex medical tasks, saving the practice money.<\/p>\n IPAs Can Help, Depending on Who\u2019s in Charge<\/strong><\/p>\n But IPAs are not a panacea for primary care\u2019s problems, according to some health care leaders.<\/p>\n There are hundreds of IPAs, but not all offer the independence and autonomy that many doctors crave. Some IPAs are actually owned by hospital systems, or even private equity companies, and they\u2019re less focused on preventive care.<\/p>\n The American Academy of Family Physicians advises its members to seek out IPAs with \u201cintegrity,\u201d ones that give doctors a strong role in decision-making.<\/p>\n \u201cWho\u2019s calling the shots, who\u2019s making the decisions, and is it really focused on the best interests and long-term benefit of physicians in practice and their patients?\u201d asked AAFP\u2019s Johnson.<\/p>\n Arches Medical is owned entirely by physicians and focused specifically on primary care, Kryder said. But to be more effective, Arches needs to recruit more practices that want value-based contracts.<\/p>\n That can be a hard sell, said Glenn, of Blue Cross. Under that payment model, doctors might see a lag of more than a year from the time they provide care to the moment they realize savings.<\/p>\n \u201cIt doesn\u2019t happen overnight, and it does take an investment,\u201d she said.<\/p>\n That lag is one reason Valley Medical Group had to lay off staff after joining the Arches IPA, said CEO Carlan. But he has faith that, after some time, the practice will become more financially stable, be able to offer higher salaries, and, most important, keep the doctors in charge.<\/p>\n This article is from a partnership with <\/em>New England Public Media<\/em><\/a> and <\/em>NPR<\/em><\/a>.<\/em><\/p>\n\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n