What's really keeping practices independent, with Aaron Ledbetter of Veradigm

Seventy-nine percent of the independent practice leaders surveyed for Veradigm's 2026 State of Independent Practice report say technology is essential to staying independent. Only 64% are confident the tools they already have can deliver it. Between those two numbers sits a set of problems most practice leaders will recognize: denied claims that don't surface for one to two weeks, payer contracts multiplying faster than the staff to manage them and a revenue cycle split across internal staff and outside vendors that were never built to talk to each other.

Medical Economics Associate Editor Austin Littrell sat down with Aaron Ledbetter, solutions and growth strategist at Veradigm, to work through where the survey says independent practices are most exposed.

Ledbetter spent years in value-based care policy and payer contracting before moving to the technology side. In today’s episode he gets into why 26% of the practices surveyed reached serious acquisition negotiations before deciding to stay independent, why scale exposes larger practices to more payer complexity rather than insulating them from it, and what has to change for the electronic health record to stop being a system of record and start being a system of work. Read the full Q&A with Ledbetter.

Medical Economics and Veradigm are hosting a live virtual event on the same subject, "The State of the Independent Practice in 2026," on Wednesday, Aug. 26 at 2 p.m. Eastern. Veradigm Chief Product and Technology Officer Tehsin Syed will discuss the survey findings with an independent practice leader.

Don't miss our recent episodes on direct-to-employer drug purchasing, practice cost cutting, insurance design and patient access.

Music Credits:
Sky Drifter by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.

0:00 – 0:32 | Cold open Ledbetter previews the episode's central claim: the electronic health record is about to stop recording what happened and start doing the work.

0:32 – 1:33 | Introduction Austin Littrell introduces the episode, the guest and the Aug. 26 virtual event on the same subject.

1:33 – 2:27 | Meet Aaron Ledbetter Ledbetter describes Veradigm's clinical and revenue cycle work with independent practices, and his own path through value-based care consulting in Washington, D.C., direct work with CMS and CMMI on model design and payer contract negotiation for roughly 1,600 clinicians at a New England ACO.

2:27 – 4:16 | The confidence gap Seventy-nine percent of practice leaders call technology essential to staying independent; 64% trust the tools they have. Ledbetter attributes the gap to tools aging out mid-adoption, an arms race with payer technology and the administrative weight of a growing book of payer contracts.

4:16 – 5:52 | Why practices walk away from acquisition talks Twenty-six percent of practices surveyed reached serious acquisition negotiations before deciding to stay independent. Ledbetter says strain gets them to the table, whether administrative, operational or financial, and what pulls them back is the belief they can still solve it with better tools.

5:52 – 7:06 | Why a denial takes two weeks to surface Forty-one percent of practices don't learn about a denied claim for one to two weeks. Ledbetter calls it a symptom of a lagging operating model, with detection, root cause analysis and resolution scattered across different people and different systems, and 58% of practices running a hybrid revenue cycle.

7:06 – 8:17 | Denial drivers across the whole revenue cycle Eligibility errors, missing data and coding mismatches all trace back to information that wasn't captured, was captured incorrectly or didn't surface early enough. Ledbetter argues against fixing one stage in isolation.

8:17 – 9:08 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

9:08 – 10:56 | Scale doesn't insulate Eighty-two percent of practices reported increased financial pressure and 60% called that increase significant. Larger practices feel it as volatility driven by payer complexity, solo practices feel it as a staffing problem, and Ledbetter argues both are expressions of a shrinking margin for error.

10:56 – 12:31 | What's different about AI this time Ledbetter grants that practices are right to be skeptical and names app fatigue as a real problem, then makes the case that ambient documentation and background automation of prior authorization, reporting and denial follow-up move the electronic health record from a system of record to a system of work.

12:31 – 14:03 | The administrative barrier to value-based care Forty-nine percent of respondents named administrative requirements the top barrier to value-based care participation, ahead of clinical complexity and financial risk. Ledbetter argues technology should automate quality measure tracking across contracts and surface care gaps before the visit.

14:03 – 15:34 | Automation as a recruiting advantage Physicians ranked hardest to both recruit and retain. Independent practices can't match a guaranteed employed paycheck, but Ledbetter argues automating documentation, denials and prior authorization buys the work-life balance that decides where a physician lands.

15:34 – 17:30 | Running independence as an operating model For practices with little or no administrative staff, Ledbetter says the answer isn't hiring but choosing technology that surfaces the right signals in days instead of months. He also expects more independent practice associations banding together for leverage with vendors and payers.

17:30 – 19:02 | The inflection point Health care has spent years throwing people at manual problems and adding complexity in the process. Ledbetter's closing case is that this is the first moment technology can look at the entire system of work at once.

19:02 – [RUNTIME] | Closing thoughts and outro Littrell thanks Ledbetter, points listeners to the full Q&A and the report, and reminds the audience about the Aug. 26 virtual event.