The methodology.
What happens behind the doors of the Alliance. How we evaluate applicants, vet partners, govern decisions, and decide what makes membership worth the price. Written down because a curated network only works if the curation is legible.
How we evaluate membership applicants.
Every application is read personally by the Membership team. We do not use automated triage, scoring algorithms, or third-party qualification services. The decisions are made by humans because the relationships are with humans.
What the team looks for, in order:
- Ownership structure. PPA is built for owner-led practices. We confirm the practice is owned by practicing physicians (or, in some cases, a physician-controlled holding structure) and not by private equity, hospital systems, or non-physician investors.
- Model commitment. The practice operates a concierge, direct primary care, or hybrid membership-based model — or has a credible plan and runway to launch one. We are not the right home for traditional insurance-only practices, regardless of size or revenue.
- Operational competence. We look for practices that run well. That doesn't mean perfect — most members join because they want to improve something — but it does mean the practice has functioning fundamentals: payroll, malpractice, EHR, accounting, basic team structure.
- Cultural fit. The alliance operates on direct conversation between physicians who run their own practices. Applicants who are not comfortable in that mode — those who want a vendor relationship instead of a peer one — usually realize PPA is not the right fit during the introductory call.
- Geographic and panel-stage diversity. Not a strict criterion, but the team is mindful of network composition. A network that is 90% Florida concierge practices isn't as useful to members as one with breadth.
The introductory call is where most of the qualification actually happens. Applications give us the shape; the call gives us the substance. We say no on the call more often than we say no on paper.
How we vet partners.
The partner roster is the part of PPA that gets the most scrutiny inside the alliance. Members trust the roster because we treat it as a small, slow-changing list — not a directory we get paid to fill.
Every partner enters through the same three-step process, documented in detail on the Partners page:
- A current member must recommend the partner from direct working experience. No cold inbound. No introductions from intermediaries. The recommending member's name travels with the recommendation through the entire process.
- The Partnership Committee vets the partner's track record, financial stability, the value they would actually deliver to members, and the strategic fit against the existing roster. We say no more often than we say yes — usually because the value isn't differentiated from what members already have access to.
- An invitation is extended directly to the partner. Tier, structure, and integration cadence are set during a working conversation with the partner — not a checkout flow.
The roster is reviewed annually. Partners who don't deliver — measured against the value they were brought in to provide, not against a generic engagement metric — are not renewed.
How decisions get made.
PPA is governed by a nine-member Board of Directors — eight practicing physicians and one practicing operations leader, every one of them running a physician-led membership-based practice they own. The Board's roster is public.
Decisions split into three categories:
- Operational decisions (the cadence of programming, vendor management, day-to-day team direction) are made by the PPA staff, with the Board kept informed.
- Strategic decisions (annual roadmap, tier structure, partner roster, major partnerships, advocacy positions) are made by the Board with member input on substantive issues.
- Member-impacting decisions (pricing changes, code of conduct, governance changes) require both Board approval and an open comment period to the full membership before they take effect.
The Board meets quarterly in person and monthly by video. Minutes are not public, but the resulting decisions are communicated to members in the Afternoon Report cadence and at the Annual Meeting.
Member input flows through three channels: the App's discussion forums, direct outreach to the Board, and the annual member survey conducted before each Annual Meeting. The roadmap presented at the Annual Meeting is, in practice, a synthesis of those three inputs.
What members agree to.
PPA membership is not a passive subscription. Members agree to a small set of standards that make the network work for everyone.
- Honesty in peer conversations. Members share real numbers, real challenges, and real failures in the App's forums and during ops calls. The network is only useful if the data is honest.
- Good-faith responsiveness on referrals. When a member sends a patient to another member's market, the receiving practice responds quickly and treats the patient with the standard of care they would expect for their own.
- Confidentiality. What is shared inside the network — financial data, operational details, vendor experience, governance discussions — stays inside the network unless the originating member explicitly says otherwise.
- No corporate or PE financial interest. If a member's ownership changes during the membership term, they let PPA know within 30 days. Ownership changes can be a reason for non-renewal, depending on the structure.
The full member agreement is provided at the time of acceptance. We keep the standards short on purpose — long codes of conduct are unread and unenforced. Four standards, plainly stated, are easier to actually hold.
Why members stay.
Annual member renewal at PPA is 98%. That number is unusual in the association space, and it is the metric the Board pays the most attention to.
From member exit interviews — yes, we conduct them — the reasons members stay break into four buckets, in roughly equal weight:
- The peer network is the durable product. Members tell us the relationships with other owners are what they would replace the membership for if they had to. Exclusive Member Offers are valuable; the network is irreplaceable.
- The negotiated rates pay for themselves. Average member savings on supplies, malpractice, and operational services run 12-18% in the first quarter. For most practices that exceeds the annual dues. Renewal is a math problem with one answer.
- The intelligence cadence reduces solo decision burden. Members report that the Afternoon Report and Ops Briefings remove regulatory, clinical, and operational decisions from the long list of things they have to research themselves.
- The Annual Meeting and Leaders Retreat are the room. Members say they would attend even if no other benefit existed. The room is what gets them back the next year.
The mechanics, written down.
If you're considering membership, you should know how this works before you commit. That's the point of writing it down.