Independent Physician Associations (IPAs) today are navigating one of the most complex landscapes in the history of modern healthcare. Between tightening regulatory changes, unpredictable Medicare Advantage dynamics, and shrinking margins, many IPA leaders are searching for new ways to stabilize revenue and drive sustainable growth.
Medicare Advantage Headwinds and Risk Adjustment Pressures
Medicare Advantage (MA) has long been the bread and butter for many IPAs—but it’s no longer the stable, lucrative business it once was. Recent political scrutiny and regulatory investigations, including oversight by the Department of Justice and the Office of Inspector General, have placed increasing pressure on health plans. With audits intensifying and allegations of overbilling surfacing, plans are passing the burden downstream to IPAs and their providers.
This evolving oversight environment has made doing business in Medicare Advantage riskier and more complicated. Many IPAs are now forced to navigate more stringent reporting requirements, aggressive clawbacks, and reduced flexibility in contract negotiations with plans.
Adding to the challenge, the transition to CMS-HCC Version 28 (V28) is creating major disruptions in how risk scores are calculated for Medicare Advantage populations. This update removed over 2,000 diagnosis codes from the model and is significantly reducing risk scores across the board. For IPAs that rely heavily on accurate risk adjustment to support capitation rates and quality performance, V28 represents a real threat to profitability.
Even IPAs with strong risk coding practices are feeling the impact, as payers shift benchmarks and reduce payments in response to the updated model. As a result, many groups are experiencing tighter margins, forcing them to seek new revenue streams that can buffer against these regulatory headwinds.
The Overlooked Revenue Opportunity in Medicare FFS
While most IPA leaders focus heavily on Medicare Advantage, they often overlook a large patient population that is already under their care—traditional Medicare Fee-for-Service (FFS) beneficiaries. These patients are unlikely to convert to Medicare Advantage due to regional preferences, physician loyalty, or other personal factors. In fact, recent reports show a growing number of beneficiaries are choosing to remain in traditional Medicare due to concerns about network limitations, prior authorization barriers, and denials of necessary care in MA plans.
Unfortunately, IPAs receive no revenue from these FFS patients unless they participate in a Medicare ACO. That means substantial dollars are being left on the table by both the IPA and its network providers.
By not engaging with an ACO, IPAs forgo the opportunity to earn shared savings for improving care coordination and reducing costs for this population. As margins tighten elsewhere, these missed savings represent a significant gap in the revenue strategy.
Why Now—and Why with Advanced Management USA
Many forward-thinking IPAs across the country have already recognized this opportunity and are actively participating in MSSP ACOs—either by creating their own or joining a high-performing existing ACO. As the healthcare landscape shifts, IPAs that fail to diversify into the ACO space risk falling behind. Not participating in a Medicare ACO may mean losing market share to competitor IPAs that are more aligned with value-based innovation and offering their physicians access to shared savings from a previously untapped FFS population.
This is where Advanced Management USA steps in.
We are not in the Medicare Advantage business—we are solely focused on the ACO space. That means we are not your competitor. Instead, we’re your ally in helping you maximize the value of your Medicare Fee-for-Service population—the same patients you likely cannot convert into Medicare Advantage. We work with your IPA to build a new, incremental revenue stream from the patient base you already serve.
What makes this transition even more accessible is that most IPAs already have the foundational infrastructure in place to successfully operate their own ACO. From care coordination teams to provider engagement strategies, the operational building blocks are already embedded in their organizations. With minimal lift, and our support, spinning up your own ACO can be a seamless process.
We help IPAs unlock a new revenue stream through Medicare ACO participation and commercial ACO contracts—without disrupting your existing operations. Whether you want to join one of our nationally ranked ACOs or build your own with our support, we provide the infrastructure, insights, and hands-on support you need.
Advanced Management USA is built on the success of our sister company, Palm Beach ACO, which has been ranked #1 nationally in the MSSP program 5 out of the last 8 years. We’ve also demonstrated the effectiveness of our model through California Clinical Partners ACO, ranked #2 in the California market.
Our expertise in efficient practice workflows, data analytics, and utilization management has helped numerous IPAs improve quality, reduce costs, and achieve sustainable growth—regardless of the payment models they operate within.
By partnering with Advanced Management USA, IPAs gain access to proven risk coding strategies, compliance oversight, and performance optimization tools that help them navigate both FFS and capitated models effectively. Our workflows, initiatives, technology, and support resources are specifically designed to make practices more efficient by eliminating administrative burden. This frees up your providers and staff to focus more on patient care and performance improvement across all contracts—Medicare FFS, Medicare Advantage, and commercial plans alike.
And perhaps most importantly—a rising tide lifts all boats. The population health and quality improvement initiatives we implement with your practices through the ACO will positively impact all patients, not just those in traditional Medicare. Because physicians generally treat patients consistently regardless of payer, your Medicare Advantage contracts will benefit from the same improved workflows, documentation practices, and care coordination strategies. That means better outcomes and stronger performance across the board.
Let’s Build the Future of Value-Based Care, Together
If your IPA is feeling the pressures of today’s regulatory and reimbursement landscape, you are not alone. But you don’t have to face these challenges without a plan.
Advanced Management USA can help you:
- Capture shared savings from Medicare FFS through MSSP ACO participation
- Navigate the challenges of V28 and Medicare Advantage oversight
- Improve performance metrics across your network
- Diversify your revenue through commercial ACO contracts
- Stay competitive as more IPAs enter the ACO space
- Enhance care delivery across all payer types
- Launch your own ACO with minimal operational disruption
- Free your team to focus on what matters most: patient care
Whether you’re looking to join an existing ACO or create your own, we provide the infrastructure and expertise needed to thrive in a value-based care environment.
Contact us today to explore how we can help your IPA succeed.
Centers for Medicare & Medicaid Services (CMS). (2023).
Advance Notice of Methodological Changes for Calendar Year 2024 for MA Capitation Rates and Part C and D Payment Policies.
Available at: https://www.cms.gov/
U.S. Department of Justice (DOJ). (2024).
DOJ Announces Medicare Advantage Investigations and Settlements to Address Overbilling Concerns.
Available at: https://www.justice.gov/
National Association of ACOs (NAACOS). (2023).
Trends in ACO Participation and Performance: 2023 Annual Report.
Available at: https://www.naacos.com/
MedPAC. (2023).
Report to Congress: Medicare Payment Policy.
Available at: https://www.medpac.gov/
Avalere Health. (2023).
Impact of CMS-HCC Version 28 on Medicare Advantage Risk Scores and Payments.
Available at: https://avalere.com/
