Privia Health Group, Inc. (Privia Health) operates as a technology-driven, national physician-enablement company.
The company collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual care settings (the ‘Privia Platform’). The company directly addresses three of the most pressing issues facing physicians: the transition to the value-based care (‘...
Privia Health Group, Inc. (Privia Health) operates as a technology-driven, national physician-enablement company.
The company collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual care settings (the ‘Privia Platform’). The company directly addresses three of the most pressing issues facing physicians: the transition to the value-based care (‘VBC’) reimbursement model, the ever-increasing administrative requirements to operate a successful medical practice and the need to engage patients using modern user-friendly technology. The company seeks to accomplish these objectives by entering markets and organizing existing physicians and non-physician clinicians into a unique practice model that combines the advantages of a partnership in a large regional medical group (each, a ‘Medical Group’) with significant local autonomy for the physicians (collectively, ‘Privia Physicians’) and non-physician clinicians (collectively ‘Privia Clinicians’ and, together with the Privia Physicians, the ‘Privia Providers’) joining the company’s Medical Groups. The company’s Medical Groups are designated as in-network by all major health insurance payers in all of the company’s markets, and all Privia Providers are credentialed with such health insurance payers.
The company’s platform is purpose-built, organizing physicians into cost efficient, value-based and primary-care centric networks bolstered by strong physician governance, and promotes a culture of physician leadership. The Privia Platform is powered by the company’s Privia Technology Solution that integrates both Privia-developed and third-party applications into a seamless interface and workflow that manages all aspects of the company’s Privia Providers’ provision of healthcare services. The company enhances the patient experience, improve practice economics and influence point of care delivery through investments in data analytics, revenue cycle management (‘RCM’), practice and clinical operations and payer alignment. The Privia Platform is designed to succeed across demographic cohorts, acuity levels and reimbursement models, including traditional fee-for-service (‘FFS’) Medicare, the Medicare Shared Savings Program (‘MSSP’), Medicare Advantage, Medicaid, commercial insurance and other existing and emerging direct contracting programs with payers and employers. The Privia model is a highly scalable solution to help the company’s nation’s healthcare system achieve the quadruple aim of better outcomes, lower costs, improved patient experience, and happier and more engaged providers. The company’s customers have affirmed the company’s model, as Privia Health has rapidly become one of the nation’s leading independent physician companies since launching the company’s first Medical Group in 2013.
The intended result of the Privia model is engaged physicians and non-physician clinicians delivering virtual and in-person high quality healthcare to patients with superior clinical outcomes and experiences at lower costs. The Privia Platform is highly scalable, allowing the company to both rapidly build density in new geographic markets and guide those markets from FFS to VBC by shifting the reimbursement model and helping the company’s Privia Providers better manage the cost of care through a focus on quality and success-based reimbursement. This model is designed to enable significant growth, with significant revenue visibility, low invested capital and attractive margins. The Privia Platform aligns with the direction healthcare is headed, including (1) a macro shift towards VBC models that focus on delivering coordinated, high quality care at lower total costs, (2) a greater focus on the patient experience and (3) a focus on optimizing provider workflow and bringing back the joy of practicing medicine. The company’s approach is highly attractive to a broad spectrum of physician practices given the company’s significant value proposition and the company’s comprehensive solution set.
Privia operates in 13 states and the District of Columbia, covering over 160 target MPSAs (including 54 out of the largest 100 MPSAs), not including the company’s planned exit from Delaware. The company intends to build relevance in each of the company’s markets with all key constituents (physicians, non-physician clinicians, patients, government programs, commercial payers and employers). Privia started by partnering with small and large independent physician practices focused on primary care, pediatrics, women’s health, and select subspecialties focused on treating chronically ill patients. As of December 31, 2023, the company had more than 4,300 service professionals on its platform who are credentialed and bill for medical services, in both Owned and Non-Owned Medical Groups (as defined below), (‘implemented providers’). Once a provider signs an agreement to join Privia, there is a five-to-eight month period on average before that provider is implemented on the company’s platform. This time lag between signing and implementing a provider gives the company very high visibility into total practice collections over a forward twelve-month period. The company’s implemented providers operate in over 1,090 care center locations. Privia cares for over 4.8 million patients, including approximately 683,000 commercial patients who have selected one of the company’s Medical Groups as their provider of primary care services, as measured at the end of a particular period (‘attributed lives’), approximately 155,000 Medicare Advantage attributed lives, 197,000 Medicare Shared Savings / Maryland PCP+ Program attributed lives, and approximately 85,000 Medicaid attributed lives. In addition, the company has over 224,000 patients aging into Medicare over the next five years. The company’s confidence in its base business model is based on the company’s belief that the Privia Platform works across all geographies and will allow the company to enter many new markets across the country over the coming decades and fundamentally move those markets to VBC.
In some instances, the company also moves into and expands in new and existing markets through the company’s Privia Care Partners model. Privia Care Partners offers a more flexible affiliation model to providers who are looking solely for VBC solutions without the necessity of joining one of the company’s Medical Groups and changing EMR platforms. Providers participating in Privia Care Partners are clinically integrated to allow for joint contracting with payers, and the company furnishes population health services, reporting and analytics to such providers along with a menu of management services from which providers may choose. As of January 1, 2024, approximately 1,350 providers with approximately 200,000 attributed lives were participating in the Privia Care Partners model. During 2023, several Privia Care Partners’ providers transitioned to the company’s Privia Medical Group model, which demonstrates the flexibility of the company’s operating model and technology platform, as well as the ability to support physicians wherever they are in their transition value-based care.
Under the company’s standard Privia Medical Group model, Privia Physicians join the Medical Group in their geographic market as an owner of the Medical Group. The company owns a majority interest in certain of its Medical Groups (each, an ‘Owned Medical Group’), with Privia Physicians collectively owning a minority interest, and the company owns no interest in certain other Medical Groups (each, a ‘Non-Owned Medical Group’). In those markets in which state regulations do not allow the company to own Medical Groups, the Non-Owned Medical Groups are either (a) 100% owned by the Privia Physicians or (b) majority owned, indirectly through a professional entity (‘Nominee PC’), by a licensed physician holding a Privia leadership position (such physician leader, a ‘Nominee Physician’ and each such Non-Owned Medical Group owned in this manner, a ‘Friendly Medical Group’), and in those markets where the company partners with health systems, the company’s health system partner owns a majority interest in the Non-Owned Medical Groups, with Privia Physicians owning a minority interest. The company’s Owned and Non-Owned Medical Group Privia Physicians, who owned their own practices prior to joining Privia, continue to own their historical practice entities (‘Affiliated Practices’) but those Affiliated Practices no longer furnish healthcare services and Privia Physicians are contractually obligated to furnish all healthcare services through their Medical Group. The Medical Groups have no ownership in the underlying Affiliated Practices, but the Affiliated Practices do provide certain services to the Medical Groups, such as use of space, non-physician staffing, equipment and supplies.
The company provides management services to each Medical Group though a local management services organization (each, a ‘MSO’) established with the objective of maximizing the independence and autonomy of the company’s Privia Physicians, while providing Medical Groups with access to VBC opportunities either directly or through Privia-owned accountable care organizations (each, an ‘ACO’). The company has national committees that distribute quality guidance, and the company employs Chief Medical Officers who provide clinical oversight and direction over the clinical affairs of the Owned Medical Groups. Additionally, the company holds the provider contracts, maintain the patient records, set reimbursement rates, and negotiate payer contracts on behalf of the Owned Medical Groups.
The company principally derives its revenues from the following three sources: (i) FFS-patient care revenue generated from providing healthcare services to patients through Privia Providers of Owned Medical Groups and Friendly Medical Groups, in addition to management and administrative services earned for administrative services provided to Non-Owned Medical Groups (‘FFS-administrative services’), (ii) VBC revenue collected on behalf of the company’s Privia Providers in the form of (a) capitated revenue and (b) management and administrative fees, which, at this time, are primarily in the form of shared savings, which includes quality bonuses, and per member per month (‘PMPM’) care management fees, and (iii) other revenue from additional services offered by Privia to its Privia Providers or directly to patients or employers.
Privia Health Operating Model
The Privia Platform is powered by the Privia Technology Solution, which optimizes provider workflow across the full continuum of reimbursement arrangements. The platform supports multiple provider types (56 specialties represented), enables scalable operations, and delivers patient centric in-person and virtual access to care, attractive quality metrics, and lower cost of care. It efficiently integrates multiple data points to build a single view of the patient, allowing the company’s Privia Providers to serve patients across demographics and medical complexities. The company’s platform scales across different markets by succeeding in all reimbursement models and delivering next generation VBC capabilities. The company seeks to continuously enhance the Privia Technology Solution to improve provider well-being and patient satisfaction.
Privia Health is changing healthcare: The company meets providers where they are on the value continuum and partner with health plans, health systems, and employers to align reimbursements to quality, outcomes, and performance. The company’s model has proven to be successful and replicable across multiple geographies. The company’s platform is led by top industry talent, exceptional physician leadership, and consists of scalable operations, and end-to-end, cloud based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.
The company’s tailored solutions are designed to enable providers to practice medicine efficiently and effectively, thrive in both FFS and VBC environments, and improve the quality of their patient interactions, all of which lead to improved patient outcomes. The company further enables its Medical Groups to succeed as the payer, patient and employer needs shift over time in each of the company’s markets.
Privia’s intention is to reimagine the approach to managing physician organizations and optimize their performance by creating a platform that caters to their unique needs. The company does this through five key elements of its platform: (i) focusing on technology and population health, (ii) establishing a single-TIN Medical Group and governance model in each geographic market, (iii) owning and operating a MSO in each local market, (iv) building ACOs to capture VBC opportunities, and (v) offering a high quality, low cost provider network for purchasers and payers.
The Privia Platform is Designed to Transform the Way Physicians Practice Medicine
Technology and Population Health: Too often technology works against, rather than for, providers and patients. The Privia Technology Solution is designed with the company’s physicians’ and patients’ input to enhance their workflows in both FFS and VBC settings, increasing patient engagement across all stages of a visit, including patient access, pre-visit, at the point of care (both in person and virtual) and post-visit. The company seeks to optimize its Privia Providers’ technology and marketing so patients can easily find a provider online, schedule an appointment and receive appointment reminders, all of which have been shown to improve patient retention and minimize costly no-shows. On the company’s MyPrivia app, patients can schedule and complete a virtual visit, securely message providers and their care teams, schedule an office appointment, find care options within the Privia network, and access the patient portal. The company’s technology and tools embed workflow and insights directly into the company’s EMR system so providers can seamlessly assess patients’ health, review their practice performance and provide a superior experience at the point of care (in-person or virtually). Most physician groups deal with an onslaught of disparate information coming from different sources—such as multiple payers and hospitals—resulting in confusion and disorganization for providers at the point of care. Unlike other peers, Privia manages the complexity in the background in order to create a unified workflow and experience for the company’s Medical Groups, Privia Providers, their staff and patients. For example, Privia uses APIs with systems and data exchanges so that the company’s Privia Providers do not need to access other systems during a patient visit. After the visit, the company’s providers follow up with patients using automated education, transitional and chronic care management, care plans, behavioral health and more. The company also uses patient-satisfaction feedback to continuously improve the patient experience, refine care protocols and increase the company’s Privia Providers’ online visibility. In 2019, the company received the HIMSS Innovation Award for the company’s exceptional PRQD program that collects required quality data directly from patients and automatically loads the results into patient records. The company’s proprietary virtual visit technology is fully integrated into the company’s platform. As of December 31, 2023, the company’s virtual visit platform had logged over 3.0 million visits, conducted by over 4,000 providers, across more than 50 medical specialties. The Privia Technology Solution is the cornerstone to the company’s Medical Groups and ACOs’ ability to succeed across patient demographic cohorts and multiple lines of business (Medicare, Medicare Advantage, MSSP, commercial, etc.).
Single-TIN Medical Group: In each of the company’s Privia Medical Group markets, the company establishes a primary care centric single-TIN Medical Group that facilitates payer negotiation, clinical integration and alignment of financial incentives. The company’s Medical Group governance structure allows Privia Providers to build a clinical culture that adapts to consumers’ and a region’s unique and evolving needs. Privia Providers in the company’s Medical Groups collaborate in physician-organized delivery meetings to review performance data, share best practices, create an environment of accountability, and advance evidence-based medicine while maintaining significant autonomy. At the local leadership level, Privia Physicians across different practice locations, or care centers, meet regularly with support from Privia performance team members to drive local population health initiatives, engagement and performance. At the market Medical Group level, Privia Physicians, along with Privia team members, advise on priorities, set annual objectives, and approve payer contracts and performance distribution. Finally, at the national level, the company’s Privia Physicians receive input from each market and establish priorities for operational improvements and clinical priorities. This integrated governance structure allows the company’s Privia Physicians to focus on what is most important, taking care of patients, while having a voice in the strategic direction of business operations. The structure also allows previously disconnected providers to share ideas in a broader forum, sharing best practices with each other.
Management Services Organization: Privia enables the company’s Privia Providers to focus on their patients, not paperwork. The company’s market-level MSOs leverage the company’s scale to reduce administrative work, increase efficiency, and lower direct costs for the company’s Privia Providers. The company’s payer contracting team works with multiple private and government payers across markets to construct and participate in VBC programs. As a seven-time recipient of the prestigious HFMA MAP Award, the company’s RCM team meets the high standards for financial results and patient satisfaction. The company’s team of performance consultants conduct business operations reviews and audits to optimize its Privia Physicians’ finances and productivity. The company’s procurement team develops opportunities to reduce provider expenses through participation in group purchasing. The company’s analytics team enables its Privia Providers to make more data-driven decisions on financial, operational, and clinical initiatives, resulting in same store practice growth across both FFS and VBC programs. The company’s clinical operations and informatics team ensures the ‘doctor’s voice’ is present in the company’s technology solutions to drive savings and optimize patient outcomes. The company’s technology improves data security, bolsters the patient-provider relationship, and offers patients a seamless, coordinated experience.
Accountable Care Organizations: Privia has created consistent value across multiple markets and reimbursement models. The company’s physician-led, local market-based ACOs lower costs, engage patients, reduce inappropriate utilization, and improve coordination and patient quality metrics to drive VBC. The company’s scale and demonstrated quality metrics allow the company to enhance reimbursements for delivering high-quality care. The Privia Technology Solution identifies quality gaps, sends patient satisfaction surveys, automates patient outreach and education, and generates reports and alerts to improve care coordination. The company’s platform proactively shares critical information at various points along the continuum of care to advance population health and streamline provider workflow. The company’s integrated tools result in cost savings for Privia Providers in both commercial and federal programs by diverting costly patient encounters. Patients who meet with a Privia Provider annually for wellness and preventive care experience on average 61% lower hospitalizations, 47% lower emergency room visits, and 25% lower risk-adjusted total cost of care.
In 2022, Privia operated seven ACOs that delivered high-value care to more than 163,000 Medicare beneficiaries.
Privia expanded its number of ACOs in 2023, with a total of ten ACOs serving over 198,000 Medicare beneficiaries across the District of Columbia and eleven states, including California, Connecticut, Delaware, Florida, Georgia, Maryland, Montana, North Carolina, Tennessee, Texas, and Virginia. Out of the ten ACOs, five were participating in the MSSP Enhanced Track with potential upside and downside financial risk. For the 2024 MSSP performance year, Privia will have nine ACOs participating in the MSSP serving approximately 192,000 Medicare beneficiaries following its planned exit from the Delaware ACO. Five of the nine ACOs are participating in the MSSP Enhanced Track in the 2024 MSSP performance year.
Network for Purchasers and Payers: Privia strives to bring all parts of the care delivery system together for an integrated care plan that is designed to lead to improved outcomes at lower cost. The company’s Medical Groups enable providers to connect across the company’s platform to better understand the holistic needs of each patient and connect them with other aligned and informed providers to address their individual medical needs. This is accomplished by leveraging data from numerous sources and utilizing provider input based on local knowledge to develop aligned virtual narrow networks that are designed to address the unique needs of government and commercial payers as well as individual employers. The company builds these networks within the company’s platform to enhance both the provider and the patient experience by removing administrative burden and enhancing efficient and coordinated patient communication. This capability also allows the company to work with forward thinking health systems to increase alignment with employed, affiliated and independent physicians to optimize resource utilization through the company’s clinically aligned model.
The Privia Technology Solution: The company’s Purpose-Built, End-to-End Technology-Enabled Platform
The company’s end-to-end, cloud-based technology-enabled platform streamlines the provider, patient and care team workflows focusing on each of the following aspects: (i) patient access through various avenues (patient portal, mobile app and search engine optimization), (ii) pre-visit analytics and preparation, (iii) in-person or virtual care delivery and (iv) post visit analytics, care-coordination and reporting. The company’s technology-enabled platform enables the company to scale operations across over 4,300 implemented providers in multiple markets, enhance performance across multiple payer contracts and deliver superior quality care to patients across the demographic spectrum.
The company’s technology-enabled platform supports providers by leveraging machine learning and artificial intelligence to reduce or automate tasks that needlessly create administrative burden. In addition, the company’s technology-enabled platform helps the company scales operationally, as its product designers and engineers collaborate closely with clinical and operational teams to optimize workflows as the company enters new markets and new payer contracts. The company’s platform is built on a modern cloud-based technology stack employing agile development cycles. The company’s technology architecture utilizes API standards for ease of implementing new functionalities and integrating with multiple external systems.
Patient Access: The company optimizes practices’ web presence so patients can easily find and schedule an appointment with a provider online and receive appointment reminders to fortify patient retention and avoid costly no-shows. The company offers a seamless experience through the company’s mobile app and patient portal that amplifies the patient and provider relationship. The company’s tools empower patients to access personal health information and stay connected with their providers by equipping physicians with the tools they need to deliver quality, affordable care when, where, and how patients need it.
Capabilities: Practice Websites with Online Reputation Management (ORM) and Search Engine Optimization (SEO), Online Self-Scheduling and Physician Search, Mobile App, Online Check-in, Appointment Reminders, Secure Patient Messaging, 24/7 Nurse Triage Call Center, and 24/7 On-demand Virtual Visits for immediate or primary care.
Outcomes: Approximately 570 practice websites managed; approximately 2,000 providers on online scheduling; approximately 390,000 distinct mobile app users annually, over 90% mobile and 80% email collection rates; over 75% email open rate.
Pre-visit: The Privia Platform prepares providers to more efficiently see patients, and facilitates improved outcomes before the patient enters the examination room. The company’s technology and tools embed insights directly into the company’s EMR so providers can seamlessly assess both patients’ health and practice performance. The company acquire data from across the healthcare ecosystem for a single view of the patient. Privia’s solutions preemptively identify opportunities before the patient visit, using huddle reports and patient stratification. The company’s platform allows providers to proactively identify patient attribution, open quality gaps, open coding gaps, assess patient risk level and determine care management eligibility.
Capabilities: Interoperability, Interface Management, Patient Portal, Online Check-In, Kiosks, Huddle Reports, and Chart Preparation.
Outcomes: over 1,000 file exchanges with payers per month on average, over 65% patient portal adoption rate.
During Visit: Whether an appointment is in-person at one of the company’s more than 1,090 care centers or through the company’s leading telehealth platform, the company’s platform ensures a streamlined provider and patient interaction. Privia integrates the quality workflow within the point-of-care in the EMR. The company’s solutions allow providers and care teams to close quality gaps during the patient visit by leveraging external data and enlisting patients for self-gap closure. The solutions are built on evidence-based guidelines managed by committees of physicians. Furthermore, the company prioritizes key risk adjustment gaps, recapture prior diagnoses and embed suspect medical conditions within the EMR.
Capabilities: Embedded Virtual Visit Technology, Embedded Quality and Risk Gaps, Referral Decision Support, Virtual Scribes.
Outcomes: Average quality score exceeded 85% across all seven ACOs in the MSSP 2022 performance year, and exceeded the quality performance standard to share in savings at the maximum sharing rate.
Between Visits: After the visit, the company supports treatment with patient education tools, automated standing orders based health event data triggers, transitional and chronic care management, care plans, and more. The company also uses patient-satisfaction feedback to increase practices’ online visibility. The company’s system sends secure messages to patients within the patient portal and messages are sent on behalf of the provider and care team. The company’s proprietary care team application is integrated within the EMR and patient portal enabling clinical assessments and templates to guide care team’s workflows. Privia Connect, the company’s proprietary provider community application, is a resource hub and training platform for all provider needs.
Capabilities: Patient Portal, Patient Satisfaction Surveys, PRQD, Automated Patient Outreach, Care Plans, Care Management Application, Analytics Platform.
Outcomes: Privia conducts approximately 67,000 patient surveys per week. 13% survey response rate. Remediation of any negative feedback commenced within 24 hours. Over 75% email open rate on all emails sent to patients; more than 49,000 gaps closed in 2023. 96% provider adoption of Privia Connect application; ~3,500 self-service knowledge-based articles; over 620 online courses available.
Virtual Visit Capabilities
Privia’s proprietary virtual health platform is fully integrated with the company’s patients’ EMR so its primary care providers can readily access data from virtual visits. The company’s patients can also use the telehealth platform to schedule a virtual visit with a provider of their choice, an in-person follow-up visit or a referral to a specialist. Therefore, the company’s patients do not need to choose between a telehealth visit at their convenience and seeing a trusted provider.
At the end of 2019, approximately 250 Privia Providers conducted ~350 virtual visits per week. In March 2020, Privia’s virtual visit volumes increased from ~100 per day to more than 6,000 per day on average without operational disruption and zero downtime on Privia’s proprietary virtual visit platform. Virtual visit volume increased rapidly, from approximately 0.3% of all visits prior to the COVID outbreak to more than 45% by the beginning of April 2020. Privia Providers representing more than 50 medical specialties continued delivering care to patients via the company’s proprietary telehealth platform through 2023. The company further launched its 24/7 Virtual Clinic, providing on demand access to Privia Providers for immediate care if a patient’s primary care provider is not available.
As of December 31, 2023, over 1.0 million distinct Privia patients have completed over 3.0 million virtual visits. Of all patients seen by a Privia Provider virtually, 94% did not return to the same doctor or another doctor in the same specialty for a follow up visit within seven days. During the year ended December 31, 2023, approximately 10% of the company’s visit volume was delivered virtually across the company’s markets and specialties and the company anticipates that to hold steady in the post-COVID 19 PHE landscape.
With the company’s virtual visit capability fully embedded in the company’s provider workflows and technology stack, Privia practices across the company’s markets have leveraged the virtual health platform to drive improvements in provider productivity, new patient volume and market share.
Provider Partnership Approach
The company is transforming healthcare by empowering physicians. The company knows that providers are uniquely positioned to reshape healthcare, but they need the right organization, tools, technology, talent and governance to support them. That is where Privia comes in. The company’s high-performance medical groups, proprietary technology, physician leadership and team-based approach help the company’s providers manage the health of their communities through exceptional patient experiences. The company follows a proven process to move providers and markets to value through the following:
High-Performing Medical Groups: Privia forms high performing medical groups in almost all of its markets. The company’s structure allows providers to practice medicine as part of a larger clinically and financially integrated medical group while maintaining their legacy ownership structure and affiliations. Privia’s top-performing providers work together to optimize utilization and costs, improve the patient experience, and advance population health.
Superior Management Services Organization: Privia is a purpose-built organization that arms physicians with key expertise and assistance in crucial practice needs such as contract negotiations, RCM, clinical operations, information technology and administrative support so that physicians can focus on what matters: delivering high-quality care to patients across the continuum of care.
Enabling Transition to and Success in VBC: The company partners with all provider types across all reimbursement programs including Medicare, Medicare Advantage, Medicaid, and Commercial to successfully navigate the transition to VBC. The company enables providers to run a more fulfilling, financially viable practice while providing superior patient experiences.
Enhanced Patient Experience: The company empowers and engages patients with tools and technology, such as the company’s MyPrivia mobile app, patient portal and telehealth capabilities. This approach prioritizes the patient-provider relationship and helps deliver care when, where, and how patients want to connect with their providers.
Superior Clinical Quality: Privia enables better clinical quality by putting patient outcome data in front of providers that they never had before and providing additional clinical programs, such as care management and behavioral health.
Delivering Financial Rewards: Ultimately, the company’s model results in significant financial rewards for the company’s providers by (i) enhancing provider efficiency and increasing patient panel sizes, (ii) increasing revenue from FFS and value-based contracts and (iii) reducing overall direct and indirect cost to provide care and manage their practices.
Governance and Physician Leadership Culture
The company’s multipurpose governance model includes a local governance structure to meet each market’s needs and continuously improves various aspects of the company’s patient, physician and payer relationships. Privia Physicians hold the majority of board positions in the company’s Owned Medical Groups and ACOs, including sole authority over matters related to the practice of medicine, and the company either has exclusive authority over certain strategic issues such as mergers and acquisitions, and termination of the company’s MSA or veto authority relative to certain strategic decision making. The intent being to balance physician leadership on clinical matters while acknowledging that certain matters will require action by Privia given the fact that Privia contributed the capital and intellectual knowledge to establish the Owned Medical Groups and ACOs. In addition, the company’s National Physician Advisory Council (‘NPAC’) brings together the clinical and executive local market leadership across the country to provide valuable input to improve the company’s common technology-enabled platform, physician facing data reporting, common quality initiatives, marketing and product performance.
Under the auspices of the NPAC, various individual specialty collaboratives meet both locally and nationally to address common issues, bring best practices and models of success to the forefront. As an example, Privia Women’s Health focuses on advancing VBC and performance in women’s health, including participation in building VBC-contracting models with bundled payments and episodes of care, and including remote patient monitoring in pregnancy. The pediatric collaborative successfully brings forward strategies to engage patients and families in continuing pediatric care through continuous education, information, structural changes and innovative ways of keeping patients and family safe, including virtual visits, vaccination programs, and triaging for in person visits.
Physician culture begins at selection of high performing, well-respected practices in their communities to join Privia, and continues with on boarding and implementation, continuous education on VBC, physician led PODS and participation at both the market and national executive and clinical leadership levels.
Growth Strategy
Privia operates in 13 states and the District of Columbia, not including the company’s planned exit from Delaware, covering 160 target MPSAs (including 54 out of the largest 100 MPSAs). The company has over 4,300 implemented provider partners in the company’s existing markets. There are approximately 1,000,000 total physicians and providers in the United States. The company’s existing provider relationships and market share provides the company with significant opportunity to grow in both the company’s existing and new geographies.
The company’s growth strategy is centered on capturing whitespace opportunity in existing markets and entering new markets nationally over the next decade and consists of the following elements.
Organic Growth in Existing Practices
Patient panel and volume growth through enhanced patient experience and value-based clinical model, which increases retention and drives new patient referrals;
New provider growth through strategic expansion, succession planning, and use of advanced practice practitioners;
Expansion of practice services such as more convenient virtual care and in-office ancillaries; and
Revenue optimization through enhanced payer contracting strategies and strong revenue cycle performance which drives efficiency and higher revenue realization.
Moving Markets to VBC
Focus on same store growth of patients attributed to value-based contracts in each existing geographic market (e.g. the company has over 224,000 patients aging into Medicare over the next five years);
Increase the company’s revenue opportunity on a per patient basis by continuing to improve performance and continuing to take increasing levels of risk in existing value-based programs across commercial, MSSP, Medicare Advantage, Medicaid and other existing and emerging direct payer and employer contracting programs; and
Develop new products and programs in partnership with aligned payers that are built with and around the Privia network of physicians and providers.
White Space Opportunities in Existing Markets
The company intends to add primary care and specialist practices in existing markets to enhance growth. The company’s data-driven approach allows the company to efficiently identify primary care and specialist provider groups that would benefit from the company’s platform;
Expand Privia Women’s Health and Privia Pediatrics platforms;
Develop value-oriented ancillary services for the company’s Medical Groups. This includes leveraging existing platforms of providers and patients to provide ancillary services (e.g., clinical laboratory, imaging and pharmacy) within the company’s Medical Groups;
Expand relationships with self-insured employers, businesses, schools, universities, and third-party administrators seeking population health and virtual care solutions. This includes leveraging the company’s 24/7 Virtual Clinic, the company’s care coordination and high-risk chronic care management programs, and the company’s technology-enabled platform to deliver highly tailored, scalable solutions;
Continue to pursue direct contracting opportunities, including direct primary care and onsite / near-site clinics fully integrated with the company’s local Privia networks; and
Expand the company’s clinical research program by designing and executing on clinical trials across multiple therapeutic areas. Privia participates in clinical trials of heart failure, COPD, diabetes, and COVID vaccine and treatment trials.
New Market Development
Privia’s in-market operating structure and ability to serve providers wherever they are on their transition to VBC is designed to benefit each of the approximately one million U.S. providers;
The company’s solution is applicable across all 50 states;
The company’s data-driven market selection process identifies attractive expansion opportunities and informs the company’s approach to opening new geographies;
The company evaluate the broader market landscape for attractive opportunities on a continuous basis and proactively develop relationships before committing to enter a market;
Due to the company’s active and ongoing new market reviews and evaluations, when the company enters a new market, the company is able to move quickly and efficiently to capture and maximize the opportunity; and
The company has a longstanding track record of successful, profitable expansion that the company will leverage to execute on the company’s robust pipeline of new market opportunities.
Acquisitions and Investments in Full Service Care Models
The company’s growth playbook also factors in the opportunity to acquire minority or majority ownership of provider groups or clinically integrated networks in existing and new markets and the company may also open de-novo, wholly or partially owned, sites of care in existing and new markets.
Sales, Marketing and Business Development
The company intends to continue growing its national platform by expanding geographically into new markets and increasing density within the company’s existing markets. The company’s business development, sales and marketing initiatives focus on the following avenues to drive growth:
Anchor health systems and medical groups—The company establishes customized anchor partnerships with leading medical groups and health systems in new markets developed from long-term relationships led by the company’s business development team. The company uses a data driven approach to qualify, segment, and evaluate new market opportunities. The company collaborates with leading medical groups and health systems looking to capitalize on the opportunity to create next generation physician led medical groups and transition their local markets to VBC.
Existing market provider growth—The company’s in-market and national sales and marketing teams work together to add new medical groups, physician practices and individual providers in existing markets. The company accelerates its go-to-market strategy using on the ground market intelligence and a data driven approach. The company’s enterprise sales force is consisted of an in-house group of sales professionals organized by market. The company’s sales operations team supports its sales force with lead generation, while the company’s growth analytics team conducts financial and operational analysis on the company’s value proposition for prospective partners. The company’s provider recruitment team assists its existing practices in hiring new providers, from sourcing through onboarding.
Consumer sales and marketing—As the company’s medical groups grow in each market, the company looks to transition the market to value-based programs by increasing the patient panels of the company’s providers and adding attributed risk lives across various value-based programs. The company’s marketing and communications team operates the company’s brand management, enterprise web presence and care center websites, and creates other forms of patient communication and engagement materials. The company’s branding and marketing strategy to drive growth to the company’s practices have continued to result in increased engagement with new and existing patients and expanded enterprise web presence.
The company’s marketing strategy focuses on increasing the overall brand awareness of Privia Health and of the company’s Medical Group brands in each of the company’s markets. The company runs targeted advertisements through print, direct mail, Google search, and social media for provider and patient acquisition. The company also develops thought leadership content, such as whitepapers, e-brochures, and blog posts and use public relations to secure earned media placements. Additionally, the company participates in industry conferences, and collaborates with media outlets, industry associations, event venues, and local businesses to increase brand awareness. In each of the company’s markets, local independent doctors unite together to form the larger Privia Medical Group. The local practice locations maintain their legacy brand, but also adopt the overarching Privia Medical Group brand.
Intellectual Property
As of December 31, 2023, the company exclusively owned six registered trademarks in the United States, including Privia Health. In addition, the company has registered domain names for websites that the company uses in its business.
Government Regulations
The company operates a single Owned Medical Group that furnishes healthcare services through the company’s Privia Providers in the Commonwealth of Virginia, the State of Maryland, and the District of Columbia, and the company operates two Owned Medical Groups in the State of Georgia, one for adult healthcare services and one for pediatric healthcare services.
The company employs its own sales force and attempt to meet the Anti-Kickback Safe Harbor for Bona Fide Employment.
Many states have also passed anti-kickback statutes and physician self-referral prohibitions similar to the Federal Anti-Kickback Statute and the Stark Law. However, in many of the states the company operates, these state self-referral prohibitions are often drafted broadly to cover all payers (i.e., not restricted to Medicare and other federal health care programs) or certain programs within the state, such as the state Medicaid program or state workers’ compensation program.
In addition to the FCA, the various states in which the company operates have adopted their own analogs of the FCA.
The HIPAA privacy and security regulations also require covered entities to enter into written agreements with certain contractors, known as business associates, to whom the company discloses PHI.
As an employer that offers self-insured health benefits, the company is a covered entity under HIPAA. Further, in the provision of management services to the company’s Medical Groups, the company is a business associate to those practices. The company’s Medical Groups are all covered entities as well. Further, the company’s Owned and Non-Owned Medical Groups act as an affiliated covered entity under HIPAA, which, among other things allow them to operate a single set of privacy and security standards, a single notice of privacy practices, appoint a single privacy and security officer, and imposes on them joint and several liability relative to any violations of HIPAA.
The company is also subject to a provision of the federal 21st Century Cures Act that is intended to facilitate the appropriate exchange of health information.
The company’s Owned and Non-Owned Medical Groups’ operations are subject to various state hazardous waste and non-hazardous medical waste disposal laws, state law requirements for licensure of ancillary services such as lab services, pharmacy services, and operation of radiological producing equipment, federal Clinical Laboratory Improvement Amendments of 1988, Occupational Safety and Health Administration standards, including the Bloodborne Pathogens Standards, Drug Enforcement Administration standards for administering and prescribing controlled substances and distributing drug samples, reporting financial relationships with drug, biologicals and medical device companies and numerous other federal, state and local laws governing the day-to-day provision of medical services by the company’s Affiliated Provider. These regulatory requirements apply to both the company’s practices and the company’s providers.
History
Privia Health Group, Inc. was founded in 2007 as a Delaware limited liability company. The company was incorporated in 2016.
