Restructuring for Scale at Hill Country Medical Partners

Hill Country Medical Partners is a specialty medical practice with four locations across the Austin and San Marcos corridor, serving approximately 32,000 active patients. Founded by Dr. Allison Grant in 2010, the practice had grown through a combination of organic expansion and one prior acquisition — but the operational infrastructure had not kept pace.

Each clinic operated with significant autonomy. Scheduling, billing, and patient intake processes varied by location. The central administrative team was small and reactive, spending most of its time firefighting rather than building systems. Dr. Grant was still the escalation point for decisions that should have been handled by site managers or department leads.

With a second acquisition on the horizon and a fifth location under LOI, the leadership team recognized that integrating another practice into the current operating model would create unacceptable risk — both clinically and financially. Regulatory compliance, provider credentialing, and billing consistency were already strained across four sites.

The practice needed an organizational structure that could support multi-location growth, standardized clinical and administrative operations, and a leadership layer that could execute without constant CEO involvement. They also needed a repeatable integration playbook for future acquisitions.

Solvane started with a comprehensive organizational assessment across all four locations. We interviewed the CEO, clinical directors, practice managers, and front-office leads to understand how decisions were made, how work flowed between sites, and where inconsistencies created risk or inefficiency.

The assessment confirmed that each clinic had evolved its own operating procedures — scheduling protocols, billing workflows, patient intake processes, and vendor relationships varied meaningfully site to site. The central office team of eight was overwhelmed trying to support four locations without standardized systems or clear escalation paths.

We facilitated a two-day leadership workshop to align the executive team on a target operating model. The group agreed on a "center-led, site-executed" structure: clinical standards, finance, HR, compliance, and technology would be centralized, while each site retained autonomy over patient experience and local community relationships within defined parameters.

Over twelve weeks, we redesigned the management structure. We created a Director of Clinical Operations role to own standards across sites, elevated two site managers to regional leads, and clarified reporting lines so the CEO was no longer the default escalation point for operational issues. We documented decision rights for clinical, operational, and financial matters using a RACI framework tailored to healthcare compliance requirements.

In parallel, we mapped and standardized the five highest-impact workflows: patient scheduling, intake and registration, insurance verification, billing and collections, and new provider onboarding. Each workflow was documented, assigned an owner, and integrated into the practice management system with consistent templates across locations.

Finally, we built an integration playbook for the planned acquisition — a step-by-step 90-day plan covering due diligence checkpoints, staff communication, systems migration, and cultural onboarding that Hill Country could execute when the right opportunity arose.

• Operational consistency — Standardized workflows across all four locations within 14 weeks, reducing site-to-site process variation by an estimated 80%
• Central office capacity — Administrative ticket volume to the CEO dropped by 65% after decision rights were clarified
• Days in A/R — Improved from 48 to 36 days through standardized billing workflows
• Staff clarity — Employee engagement survey scores on role clarity improved 28% year-over-year
• Acquisition readiness — Integration playbook completed and approved by board, used successfully for a fifth location acquired six months later
• Provider onboarding — New provider ramp time reduced from 12 weeks to 7 weeks with documented onboarding process

The CEO described the engagement as "the first time we built the practice like a business, not a collection of clinics." The acquisition integration — completed using Solvane's playbook — came in under budget and ahead of the 90-day timeline.