The ask
How do we simplify our buyer and our offering enough to scale — before we add anything else?
This isn't a proposal to throw work away. It's a question about sequencing: we've been adding programs, products, and client types faster than we've been building the ability to repeat any one of them. What's the smallest version of Symphonic that can grow without us in the middle of every engagement?
The answer this document argues for: Symphonic becomes the outsourced provider network growth and operations team for IPAs, MSOs, and clinically integrated networks. One package, one price sheet, one delivery calendar, no custom scoping — and nothing new added until that runs without us.
Target: 13–15 clients at $8,500 blended = $1.3M ARR, with an expansion path to $2M+ from the same accounts.
Why change anything
We built a menu, not a business.
Nine programs, three tiers, Canopy, Orion, Relay, the diagnostic, the sprint model. Each piece is defensible. Put them on one page and a prospect can't tell what we do — only what we're willing to do.
The root cause: everything is organised around what we make — websites, campaigns, portals — instead of around something a specific buyer can't stop doing.
An IPA doesn't grow by getting patients. It grows by recruiting practices, and it loses ground when practices leave or when bad provider data quietly cuts off referral flow. That work is recurring, deadline-driven, non-optional, and currently done badly by an office manager with Word and a stale PDF.
The work · 1 of 5
Twelve deliverables. That's the whole package.
Two halves doing two different jobs. Acquire is why a CEO takes the meeting. Operate is why the contract renews without a conversation — once we're running the network's communications every month, replacing us means rebuilding an operational function mid-year.
Each row below is one deliverable, what changes for the client because of it, and how often it happens.
Grow the network. Six deliverables.
“Why join” site
A practice weighing the network can see, in one place, why joining beats the alternative — real economics, plan mix, support model, comparison against the competing IPA.
Built once · refreshed quarterly
Target practice list
Recruitment stops being word-of-mouth. Named, unaffiliated and competitor-affiliated practices by specialty and geography.
Quarterly
Outbound sequences
Target practices hear from the network on a schedule instead of by accident. Email and print to owners and office managers.
Monthly
Physician proof assets
Recruiting conversations have evidence behind them — testimonials, practice profiles, referral-volume stories.
Quarterly
Inquiry pipeline
No interested practice goes unanswered. Tracked handoff, response SLA, visible status.
Continuous
Onboarding kit
New practices are productive in weeks instead of months. Welcome sequence and packet, assembled per practice from template.
Per practice signed
Run the network. Six deliverables.
Provider directory
Referring physicians can reliably find the right specialist inside the network — and nobody falls out of a plan directory because a verification request went unanswered.
Monthly
Provider bulletin
Every provider hears about plan and policy changes before they become operational problems.
Monthly
Network gap analysis
Leadership knows where the network is thin before a health plan tells them. Doubles as the next recruitment target list.
Quarterly
Website & forms
Provider-facing information is current and requests route to the right person.
Continuous
Translation
Threshold-language obligations are met on provider- and member-facing material. Spanish minimum.
Monthly
Scorecard
Everyone can see what moved — directory accuracy, pipeline, bulletin engagement, onboarding time.
Monthly
Plus one thing that sits outside the retainer: the annual provider manual and onboarding materials refresh. It's 40–60 hours and does not fit inside a monthly budget already at capacity. Priced separately at $8–12K. We produce the documents; we do not run, host, or track anything built from them.
The work · 2 of 5
Who does what.
The single biggest delivery risk isn't our capacity — it's waiting on the client. Naming the split up front, in the contract, is how we avoid the MedPOINT feedback pattern.
Symphonic
- Process the roster and resolve exceptions
- Write, design, and produce every deliverable
- Build and maintain the site and directory
- Run outbound and manage the inquiry pipeline
- Send, publish, translate, and verify delivery
- Report monthly and analyse quarterly
Client — with dates
- Roster export by the 1st business day
- Bulletin inputs by the 5th
- Review inside 48 hours
- Flag new practices as they sign
- Supply plan and policy source material
- Name one owner for the relationship
No roster by the 5th → the directory publishes unchanged with a variance note on the scorecard. No bulletin inputs → it ships with standing content and the gap is noted. No review inside 48 hours → we proceed as submitted. Automated reminders, not personal follow-up. Missed inputs shift the client's own results, visibly.
The work · 3 of 5
First 60 days: build the machine once.
Onboarding is where the templates get built and the roster gets clean. It runs at 30–40 hours a month — roughly double steady state — which is what the $12,500 setup fee covers.
Weeks 1–2
Audit & intake
- Directory accuracy audit
- Collateral inventory
- Compliance calendar mapped to their dates
- Kickoff, owner named
Weeks 3–4
Roster & data
- Roster ingestion and cleanup
- Structure into Sanity
- n8n pipeline connected
- Baseline accuracy recorded
Weeks 5–6
Build
- Canopy site build or migration
- Directory live
- Forms and routing
- “Why join” page
Weeks 7–8
Templates & launch
- Bulletin, kit, scorecard templates
- First bulletin ships
- Calendar locked
- Handoff to steady state
Some networks keep their roster across three systems and credentialing won't hand it over. That's a real onboarding failure mode — find it before we sign, not in week three.
The work · 4 of 5
Then the same month, every month.
Fixed calendar for every client. Dates are contractual, not aspirational.
| Day | Activity | Hrs |
|---|---|---|
| 1 | Roster export due. n8n ingests, normalises, diffs against last month, generates exception report. | 0.5 |
| 2–4 | Exception resolution — duplicate NPIs, missing taxonomy, terminated providers still listed, address and panel changes. Sample check against NPPES. Publish. | 3.5 |
| 5 | Bulletin content cutoff — intake call plus submission form closes. | 0.5 |
| 6–9 | Bulletin drafted against fixed sections, produced from template. | 4 |
| 10–11 | Client review window — 48 hours, default-proceed. | — |
| 12 | Translation QA and publish. | 1 |
| 15 | Bulletin ships. Deliverability check. | 1 |
| 15–22 | Recruitment cycle — outbound sequence, inquiry follow-up, content refresh, pipeline update. | 4 |
| Ongoing | Onboarding kits triggered per new practice signed. | 2 |
| 25 | Scorecard delivered plus 30-min check-in. | 2 |
| Steady state per client, per month | 18.5 | |
Quarterly work — gap analysis, target list refresh, accuracy report, review call — adds roughly 2.5 hours a month amortised, for about 21 hours total.
Manual roster reconciliation is 12 hours. Automated, with a human handling only exceptions, it's 4. Across 15 clients that's 120 hours a month — the difference between this working and not. The roster pipeline must exist before client three.
The work · 5 of 5
What we don't do.
This list is not a limitation to apologise for. It's the reason we can price the way we do and staff the way we plan to.
Patient-facing campaigns · custom development beyond the template · print production (pass through at cost plus 20%) · video · event collateral · anything that tracks, stores, or evidences compliance activity.
The hard line — read this twice
If the deliverable is a document, we take it. If the deliverable is a database someone gets audited against, we refuse it.
We may produce training documents as a one-off annual deliverable. We do not build or run training systems, attestation trackers, or compliance evidence repositories. Each makes us a system of record with permanent support obligations — the exact trap we're unwinding at MPM with the custom Strapi build. We never certify compliance and never sit in an audit. Same boundary we set for Canopy.
We do not replace provider relations staff — that's relationship work we don't do, and the claim gets discovered around month four. What we say instead: “We augment your provider relations organisation by running the communications, recruitment infrastructure, and operational execution they don't have time to build.”
The business
Get off their G&A line.
Directory maintenance and bulletins land in G&A. That makes our buyer an ops director spending cost-centre budget — the first budget squeezed. The same work, attached to how the IPA earns, lands in front of a COO or CFO instead.
An IPA makes money on PMPM for attributed lives under risk, shared savings, quality bonuses, risk-adjusted revenue, and fees to member practices. Three reframes. The first two need zero scope change.
Every figure below is an illustrative model structure, not a benchmark. Populate with MedPOINT actuals first. Presenting invented numbers to a buyer who knows their own is how we lose credibility in one meeting.
1 · Directory accuracy as leakage control
Under risk, every referral leaving the network is money the IPA eats. When a PCP's office can't quickly find an in-network specialist, they refer out.
| Input | Illustrative |
|---|---|
| Attributed lives under risk | 40,000 |
| Specialist referrals per member per year | 0.8 |
| Out-of-network leakage rate | 15% |
| Cost differential per leaked episode | $400 |
| IPA risk share | 50% |
| IPA's annual exposure | $960K |
A two-point reduction recovers roughly $128K/year against a $102K/year retainer. Ask on the call: “What's your out-of-network referral rate, and do you know what it costs you?” Many won't know — that question alone qualifies the account.
2 · Recruitment priced in lives, not logos
| Input | Illustrative |
|---|---|
| Attributed lives per recruited PCP practice | 1,200 |
| Net margin retained by IPA (PMPM) | $10 |
| Annual value of one recruited practice | $144K |
| Annual retainer | $102K |
One primary care practice covers the retainer with room to spare. This also fixes our attribution problem: we report the owned event — qualified inquiries through our tracked pipeline — and let the client attach lives and dollars to it. Same pattern we used for Concern Health's broker form.
3 · White-label practice marketing — expansion, not launch
The IPA offers patient marketing to member practices as a paid member benefit, marks it up, and we deliver behind their brand. At $750 to the practice and $500 to us, the IPA keeps $250 per practice per month. At a conservative 20–30% attach across a 50-practice network, that's roughly $120K/year incremental to us and new margin for them.
Three effects at once: the IPA earns money from our service, membership gets stickier, and recruitment gains a differentiator no competing IPA offers. It's also the cleanest re-entry for everything we've built for medical groups.
Sequencing: mention it in the pitch as something we're exploring; build it after five clients are stable. It's a second product with its own delivery load.
The business
Price on scope, not on headcount comparison.
| Network size | Monthly |
|---|---|
| Under 300 providers | $6,500 |
| 300–1,000 | $8,500 |
| 1,000–2,500 | $11,500 |
| 2,500+ / enterprise | Custom |
| Setup (60-day onboarding) | $12,500 |
| Annual manual + onboarding materials | $8–12K |
Provider count is the visible tier. A complexity qualifier at scoping — specialty count, plan contracts, locations — can move a client up one tier. 300 providers across 12 specialties, 3 plans and 40 locations is not the same work as 300 in one specialty.
Higher tiers must contain more real delivery — dedicated recruitment execution, higher outbound volume, monthly rather than quarterly analysis. Otherwise value perception breaks around month four.
Margin, modelled honestly
| Mid-tier client | Monthly |
|---|---|
| Revenue | $8,500 |
| Delivery hours | 21 |
| Direct delivery cost | ~$1,260 |
| Gross margin on delivery | ~85% |
| Less sales, client success, QA, rework, software, collections, bad debt | — |
| Realistic contribution margin | 55–65% |
Contract terms: 12-month minimum, 90-day out after year one. At $12,500 setup cost with negative month-one margin, a client leaving at month six is a loss.
The business
Starting price matters less than the ladder.
If an $8.5K client reliably becomes $15K by year three, net revenue retention matters more than any tier adjustment — and it's worth more to enterprise value than a million in new top line.
Year one
$8.5K/mo
- Core network operations
- Acquire + Operate
- Annual manual (separate)
Year two
$11–12K/mo
- Relay practice portal
- White-label practice marketing
- Expanded recruitment execution
Year three
$15K+/mo
- Orion provider journeys
- Campaign-level recruitment
- Advanced network analytics
Every rung is a product we already own or have specified. None requires custom work.
The business
A finite, nameable market — and a reason to be in the inbox.
Roughly 1,000–1,500 IPAs nationally, of which perhaps 500–800 are large enough to afford us and small enough to lack an internal team. California is densest, then New York and Texas. Add clinically integrated networks, specialty MSO roll-ups, and ACOs — same delivery engine, no package change — and the qualified universe roughly doubles.
We need fifteen. We can build a literal list of every prospect in the country. Ideal condition for a single-package play, impossible for “healthcare marketing.”
The signature play: Network Visibility Score
Run their public directory against NPPES and their own site. Score it. Send it cold.
Network Visibility Score — sample output
A score beats a raw error list — everyone wants their number. But the benchmark has to be real. Before claiming “top networks average 91,” we score 40 public directories ourselves and publish the methodology. Invented benchmarks in healthcare get caught, and the credibility loss is permanent.
Sales process
| Stage | What happens |
|---|---|
| Score | Cold outreach with their actual directory findings |
| Score call | 30 min, walk the findings, no pitch |
| Diagnostic — $2,500 | Credited against onboarding if they sign within 60 days |
| Proposal | Template. Fixed scope, tier by roster size plus complexity qualifier. |
| Onboarding | 60 days, setup fee, 12-month term |
Two motions, run as a deliberate experiment
| Motion | Target | Goal |
|---|---|---|
| Mid-market | 12–15 clients @ $7–9K | Diversified revenue, repeatability |
| Enterprise / MSO | 6–8 clients @ $12–15K | Fewer accounts, deeper expansion |
The business
Qualified practice opportunities generated.
One company metric. It's the leading indicator we control, it doesn't depend on client-supplied data, and every part of the business — outreach copy, “why join” pages, onboarding speed, directory accuracy — should improve it.
Clients still receive a full scorecard: net practice growth, directory accuracy, bulletin engagement, onboarding cycle time. Company North Star and client reporting are different objects. We report many things. We optimise one.
Decide
Nothing gets thrown away. It gets reorganised.
| Asset | New role |
|---|---|
| Canopy | Stops being a product we sell. Becomes delivery infrastructure for every engagement — settling the “default for all clients?” question by necessity. |
| Orion | Phase 1 becomes provider comms, not patient. No PHI, no EHR integration, no HIPAA exposure, no Keragon dependency. Ships in weeks. |
| Relay | Year-two expansion — gated portal for member practices. Concern Health remains first deployment. |
| Nine programs | Collapse into one package plus a change-order menu. The thinking survives; the merchandising doesn't. |
| $2,500 Diagnostic | Same front door, now credited rather than sold. |
Aggregated cross-client provider data as a benchmarking product sounds like a moat and mostly isn't. Rosters are client property under our MSA; five networks in two states is not a dataset; NPPES is public and Definitive and Quest already sell this at scale. Our real moat is embedment — after eighteen months we hold their roster pipeline, bulletin cadence, onboarding flow, and site. Note network intelligence as a possible year-four product; don't build the company story on it.
Decide
Four things that could break this.
1 · Discipline, not delivery
At ~21 hours per client the deliverable set must be genuinely identical. One custom client breaks the model. Agencies die from “just one more thing,” and this is historically our weakest muscle.
2 · Growth has an attribution problem
The client is the only witness to a signed practice. Define and agree the owned event before Jack sells it, not after.
3 · The roster automation is a single point of failure
Not built by client three, delivery hours double and the economics stop working.
4 · Onboarding data risk
Some rosters live across three systems and credentialing won't share them. Qualify for it during the diagnostic.
And we are narrowing on purpose. We will say no to work we could have done. That's the point, and it will feel bad the first three times.
Decide
What needs an owner and a date.
| # | Decision | Owner | By |
|---|---|---|---|
| 1 | Commit to one package and one buyer, or keep the menu | All three | This week |
| 2 | Mid-market vs. enterprise motion — run as formal experiment | Jack + Alex | 3 prospects |
| 3 | Final tiers, complexity qualifier, setup fee | Jack | 2 weeks |
| 4 | Confirm the exclusion list — anything a dealbreaker? | Nick | 2 weeks |
| 5 | Canopy mandatory for all clients | All three | 30 days |
| 6 | Orion Phase 1 redirected to provider comms | Alex | 30 days |
| 7 | Owned-event definition for growth reporting | Alex + Jack | Before first sale |
| 8 | White-label — roadmap now, build after client five? | All three | 45 days |
| 9 | Reprice MedPOINT into this model | Jack | Next renewal |
Decide
What happens if the answer is yes.
| Step | Owner | Timing |
|---|---|---|
| Partner discussion — decision #1 only | All three | This week |
| Pull real economics from MedPOINT (leakage, lives, PMPM, attrition) | Alex | Next check-in |
| Build named IPA / MSO / CIN prospect list | Jack | 2 weeks |
| Score 40 public directories to establish a real benchmark | Alex | 30 days |
| Template spec — bulletin, onboarding kit, scorecard, “why join” | Nick | 30 days |
| Roster ingestion pipeline in n8n | Alex | 45 days |
| Test both price points against 3 live conversations | Jack | 45 days |
| Test white-label appetite with MedPOINT | Jack | 45 days |
| Reprice MedPOINT as proof case | Alex + Jack | Next renewal |