- General Dentistry
- 2 Dentists
- 4 Hygienists
- 2,960 Active Patients
- $3.45M Production
The financial analysis for Eden Prairie, MN Clinics was focused on one major part of the patient base. The clinic’s largest payer segment, representing about one-third of all patients, was sitting in a lower reimbursement tier. Moving that segment to a higher tier offered a meaningful increase in reimbursement without requiring the clinic to leave the carrier entirely.
At first glance, changing anything tied to the largest payer segment sounds risky. But once the patient-level effect was examined, the real risk looked much smaller.
What made the opportunity especially attractive was the expected patient impact:
- About 85% of the affected patients were expected to have no out-of-pocket change
- About 10% were expected to have some out-of-pocket responsibility
- About 5% were expected to have little or no usable benefit
That breakdown changed the conversation.
Most of the affected patients were not expected to feel a meaningful financial difference. That meant the clinic was not likely to see broad disruption across the entire impacted group.
Because the group had two locations, the revenue benefit needed to be viewed across both together. When that was done, the result was very favorable.
If attrition was 0%, the clinic gained about $197,000 in annual revenue
Even if attrition reached about 15% of the affected patients, the clinic still gained about $70,000 in annual revenue
The revenue remained positive until attrition approached roughly one-fifth of the impacted group
That is the key takeaway. The move did not depend on perfect retention. The clinic could lose a meaningful number of affected patients and still come out ahead financially.
The situation became even stronger when growth was factored in.
This was not a static clinic. It was growing quickly and churning slowly. The change also had a 90-day notice period before taking effect. That mattered because it gave the business time to continue adding new patients before the transition was ever fully felt in the schedule.
In practical terms, that meant the clinic was not simply asking, “What if some patients leave?” It was also asking, “How many new patients are likely to come in before the effective date arrives?”
That moving target made the downside even smaller.
A clinic with weak growth and high churn has to be much more careful with a payer change. This clinic was in a different position. Because new patients were already coming in and churn was relatively controlled, even a moderate amount of attrition from the affected segment could likely be offset before the change ever became operationally painful.
That is why this was such a clear recommendation.
The clinic was not being advised to move fully out of network yet. That was not the right move at this stage. But it also was not a clinic that needed to stay frozen in place. This tier change gave the group a way to improve reimbursement, increase financial stability, and continue progressing toward its long-term fee-for-service goal without forcing too much change all at once.
This recommendation allowed the clinic to:
- Improve reimbursement in its largest payer segment
- Strengthen financial stability across both locations
- Reduce the risk of future strategic changes
- Keep moving toward a fee-for-service future
- Make progress now without forcing a full transition before the business was ready
Not every clinic should make the same move. Some clinics can move fully out of network immediately. Some need a phased transition. Some need to spend a year or two strengthening finances, patient communication, and growth channels before taking the next step. The right recommendation depends on the clinic’s specific circumstances.
For this group, the right answer was a targeted intermediate step.
The win was not just higher reimbursement. The win was choosing the right move for this clinic at this time. Instead of forcing the final destination too early, the group took a smart step that improved the business immediately and made the long-term goal more achievable.
That is what individualized strategy is supposed to do.
A clinic does not always need to choose between doing nothing and doing everything. Sometimes the best move is a focused step that improves stability now, lowers future risk, and moves the business closer to its ultimate goal.
That was the success in this case.
