'A system of work': The tech that could keep practices independent

Running an independent practice in 2026 means fighting on several fronts at once: denied claims that don't surface for two weeks, payer contracts multiplying faster than the staff to manage them, and chronic shortages that leave one or two people juggling prior authorization, follow-up calls and after-hours issues.

Veradigm's 2026 State of Independent Practice report puts numbers to what physicians already feel: the operating environment keeps getting harder, and the technology most practices rely on hasn't kept pace.

Medical Economics sat down with Aaron Ledbetter, M.P.P., M.H.S.A., a solutions and growth strategist at Veradigm with deep roots in value-based care policy and payer contracting, to talk through where the survey says independent practices are most exposed, and where he thinks technology is finally close to delivering on long-standing promises.

Related content: 4 in 5 independent practices say this is what’s keeping them independent

Why are practices confident technology is essential but not in their own tools?

The report found that 79% of respondents consider technology essential to staying independent, but only 64% trust their current tools to deliver. Ledbetter attributes the gap partly to the pace of change.

"Some tools can age out before a practice has fully adopted them," he said, describing an "arms race" between the features practices deploy and the ones payers roll out in response. The other driver is payer contract complexity, which compounds as practices grow.

"Keeping all the terms straight across a growing book of payers is its own administrative workload," he said.

What brings practices to the brink of selling, and what pulls them back?

Twenty-six percent of practices reached serious acquisition negotiations before deciding to stay independent. What gets them to the table, Ledbetter said, is strain: administrative, operational and financial, often worsened by lagging data that aren't real-time enough to act on. What pulls them back is conviction.

"What pulls them back is their desire to keep practicing medicine in the way they believe is best for their patients and their community," he said, describing a recurring belief that the right tools can solve the problem without giving up independence.

Why do 40% of practices not learn about a denied claim for one to two weeks?

Ledbetter called the delay "a symptom of a lagging operating model." Detection, root cause analysis and resolution sit across different people and systems, much of it manual, and 58% of practices run a hybrid revenue cycle split between internal staff and outside vendors that don't always talk to each other.

Fixing it, he said, means moving detection earlier and getting data closer to real time. Because denial drivers are scattered across eligibility, coding, documentation, prior authorization and payer policy, he argued the only viable fix is coordinated across the full revenue cycle.

The common thread isn't one workflow but "a lack of early visibility and too many manual handoffs."

Are large and small practices facing different problems, or the same one?

Ledbetter sees financial volatility at larger practices and administrative overload at smaller ones as "different expressions of the same underlying problem," a margin for error that has shrunk across the board. In the survey, 82% reported increased financial pressure, and 60% called it significant. Scale doesn't insulate larger groups; more payer contracts mean more complexity. For solo practices, the vulnerability is human. "If one person is out, the practice can really feel it," he said. In both cases, the answer routes back to technology that reduces burden during and after clinic hours.

Physicians have heard the AI promise before. What's actually different now?

Eighty-eight percent of respondents said artificial intelligence and automation could meaningfully improve efficiency, but Ledbetter was candid that skepticism is warranted. What feels different, he said, is that newer solutions — ambient documentation, automation of prior auth and denial follow-up — can run in the background rather than adding another step.

That points to a larger shift he expects in the electronic health record: a move "from being a system of record, where they simply capture what happened, to a system of work, where they help with coding, claims and prior auth in real time." That, he said, "would be a game changer for independent physicians."

What can technology do about the administrative barriers to value-based care?

Nearly half of respondents cited administrative requirements as the top barrier to value-based care participation, ahead of clinical complexity and financial risk. Ledbetter, who negotiated these contracts inside an accountable care organization, said tracking their differences "almost requires a small army of people." The practical fix is automating quality-measure tracking, reducing manual abstraction and surfacing care gaps before the patient arrives. The work is already being done, he added; practices just aren't always getting credit. "The system needs to help them capture that credit so they can get paid for closing quality gaps, reducing total cost of care and earning shared savings."

Does technology matter if a practice can't solve its staffing problem?

Physicians ranked as the hardest position to recruit and retain, and the competition extends to nurses, medical assistants and APPs. Independent practices compete against employed settings offering a guaranteed paycheck; what they can offer is the freedom to practice medicine their way. But automation, Ledbetter argued, has become its own lever.

"If a physician is choosing between a place where documentation, prior auth and denial follow-up are all still manual, and a place where those tasks are automated, that absolutely affects recruiting and retention," he said. "More automation means better work-life balance, and that becomes a competitive advantage."

What does actively managing independence look like for a small practice?

For practices without dedicated operations teams, Ledbetter said the realistic answer isn't hiring more people but choosing technology that surfaces the right signals automatically, "days instead of weeks later," so operating discipline becomes part of the system rather than another task on the physician. He also expects more practices to band together through independent provider associations, pooling resources and gaining leverage with vendors and payers.

His closing point was about how tightly these problems are linked. "For a long time in health care, we have tended to throw people at problems that were already very manual," he said, an approach that often just added burden. What's changed is that technology is now fast enough to look across the entire system of work. "People have been saying for years that automation was going to change health care ... But it does feel different now."