Practice roll-ups aren't dead, but the underwriting that built them is

Barry Alexander examines the current state of physician practice roll-ups, arguing that while the model remains viable, many platforms are facing mounting operational and financial pressures driven by flawed underwriting rather than a failure of the concept itself. He identifies key challenges, including physician retention, rising financing costs, stagnant reimbursement, regulatory scrutiny and outdated operational infrastructure, while outlining the characteristics that distinguish successful platforms from struggling ones. Alexander concludes that long-term success will depend on strengthening physician engagement, reevaluating governance and compensation structures, investing in operational improvements and remaining adaptable as market conditions continue to evolve.