Forthcoming
Reclaiming the Continuum of Care
A Physician-Owned Capital Platform for Aligning Care Delivery, Risk, and Financial Infrastructure
Thomas J. Chambers, MD · John D. Miles, MD, MBA · Marty Nichols
Soon to be released on The Journal of Orthopaedic Experience & Innovation
The paper
Abstract
Modern healthcare is characterized by a fundamental structural misalignment: physicians deliver care, yet do not control the financial infrastructure that determines its cost, access, or sustainability. In Mid-Missouri alone, independent physicians collect roughly 29% less from Medicare and close to half the commercial rates that the local university hospital receives for identical orthopedic procedures. This paper introduces the Physicians Nexus, a physician-owned capital platform designed to align care delivery, insurance risk, and financial infrastructure under unified physician governance. By internalizing the economic value of care delivery and redeploying it through a coordinated financial structure, the model shifts physicians from participants in fragmented systems to owners of an integrated platform.
The paper
Key findings
- Independent Mid-Missouri physicians collect ~29% less from Medicare and about half the commercial rates of the local university hospital for identical orthopedic procedures
- The CY 2026 CMS fee schedule drops total hip reimbursement from $1,043 to $975.20
- A single C-Arm loan requires ~29 total hip replacements a year (or ~217 primary care visits) just to service its interest
- On a 100-life book, the Cooperative Captive recovers ~$110,000 per year in stop-loss premium; retained and compounded, $66.9M modeled over ten years (see methodological note)
- Five operating entities are live in Missouri today: 1,300+ providers, 78 employer groups, 15,000+ covered lives, 8 partner facilities
The paper
How to cite
Chambers TJ, Miles JD, Nichols M. Reclaiming the Continuum of Care: A Physician-Owned Capital Platform for Aligning Care Delivery, Risk, and Financial Infrastructure. Forthcoming in The Journal of Orthopaedic Experience & Innovation. [CONFIRM volume, issue, and DOI once published.]