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Primary care doc here.

The challenges of independence come from managing the costs of business....rent, staff, regulatory standards, compliance, compensation, etc.

The commercial payers really don't make it easy for the smaller fish and so there are various entities like ACO's, IPA"s that try to leverage a network to negotiate.

Medicare is pretty much agnostic to size in terms of episodic payments but eventually they will force the smaller practices due to need for "risk sharing"

In our practice we have integrated a lot of different digital platforms that can help patient....telehealth, remote patient monitoring, online scheduling, email. You name it. I believe that we are there with many aspects

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Agree with below. Most of the basic digital stuff is in place: Telehealth, scheduling etc. what's missing is making it flow reasonably well across care settings, surfacing insights and information to the care givers and seekers in the right way and other digital stuff we take for granted when we use apps in other industries.

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