MSA Concentration
🛡️ Public data only — no PHI permitted on this instance.
MSA Provider Market Concentration
HHI · CR3 · CR5 · regime classification · whitespace scoring · stress scenarios · top operators — 1,705 corpus deals
MSAs Analyzed
20
Fragmented
4
Moderately Concentrated
13
Highly Concentrated
3
Avg HHI
1,680
Avg CR3
34.7%
Whitespace MSAs
6
Corpus Deals
1,705
MSA-Level Concentration Analysis
| MSA | Specialty | Providers | HHI | CR3 | CR5 | Structure | Top Operator |
|---|---|---|---|---|---|---|---|
| Houston-The Woodlands-Sugar Land, TX | Gastroenterology | 428 | 1,850 | 42.0% | 58.0% | moderately concentrated | GI Alliance (PE) |
| Dallas-Fort Worth-Arlington, TX | Gastroenterology | 385 | 1,520 | 38.0% | 52.0% | moderately concentrated | US Digestive Partners |
| New York-Newark-Jersey City, NY | Dermatology | 1,250 | 420 | 12.0% | 18.0% | fragmented | Schweiger Dermatology |
| Los Angeles-Long Beach-Anaheim, CA | Dermatology | 985 | 485 | 14.0% | 22.0% | fragmented | ADCS / SkinWorks |
| Phoenix-Mesa-Chandler, AZ | Cardiology | 325 | 2,450 | 48.0% | 62.0% | moderately concentrated | Banner / HonorHealth |
| Miami-Fort Lauderdale-Pompano Beach, FL | Home Health | 2,850 | 380 | 15.0% | 22.0% | fragmented | BrightStar / multiple |
| Atlanta-Sandy Springs-Alpharetta, GA | Urgent Care | 385 | 1,850 | 28.0% | 42.0% | moderately concentrated | Piedmont / WellStar |
| Chicago-Naperville-Elgin, IL | Orthopedics | 285 | 1,650 | 32.0% | 48.0% | moderately concentrated | Illinois Bone & Joint (PE) |
| Philadelphia-Camden-Wilmington, PA | Anesthesiology | 228 | 2,850 | 52.0% | 68.0% | highly concentrated | USAP / NAPA |
| Boston-Cambridge-Newton, MA | Ophthalmology | 185 | 1,420 | 35.0% | 48.0% | moderately concentrated | Eye Health Network (PE) |
| San Francisco-Oakland-Berkeley, CA | Fertility / IVF | 42 | 4,250 | 72.0% | 88.0% | highly concentrated | Kindbody / RMA |
| Seattle-Tacoma-Bellevue, WA | Urgent Care | 165 | 1,250 | 28.0% | 42.0% | moderately concentrated | Swedish / Providence |
| Denver-Aurora-Lakewood, CO | ASC / Orthopedics | 128 | 1,850 | 38.0% | 52.0% | moderately concentrated | Panorama Ortho (KKR) |
| Nashville-Davidson, TN | Behavioral Health | 165 | 1,420 | 32.0% | 48.0% | moderately concentrated | Acadia Healthcare |
| Austin-Round Rock-Georgetown, TX | Anesthesiology | 85 | 3,250 | 58.0% | 72.0% | highly concentrated | USAP |
| Tampa-St. Petersburg-Clearwater, FL | Home Health | 1,850 | 480 | 18.0% | 28.0% | fragmented | LHC Group / Amedisys |
| Orlando-Kissimmee-Sanford, FL | Urgent Care | 285 | 1,620 | 32.0% | 48.0% | moderately concentrated | AdventHealth / Orlando Health |
| Minneapolis-St. Paul-Bloomington, MN | Primary Care | 485 | 1,250 | 28.0% | 42.0% | moderately concentrated | Optum / HealthPartners |
| Detroit-Warren-Dearborn, MI | Cardiology | 225 | 2,250 | 48.0% | 62.0% | moderately concentrated | Henry Ford / Beaumont |
| San Diego-Chula Vista-Carlsbad, CA | Behavioral Health | 225 | 1,120 | 24.0% | 38.0% | moderately concentrated | Scripps / Sharp |
Market Regime Classification & Expected Returns
| Regime | Description | HHI Range | CR3 Range | Typical MOIC | Typical Hold (yr) | MSAs in Sample |
|---|---|---|---|---|---|---|
| Fragmented | Many small practices; no dominant operator | <1500 HHI | <25% CR3 | 2.85x | 4.8 | 8 |
| Moderately Concentrated | 3-5 leading operators; active roll-up | 1500-2500 HHI | 25-50% CR3 | 2.62x | 4.5 | 18 |
| Highly Concentrated | Dominant operator; antitrust scrutiny | >2500 HHI | >50% CR3 | 2.25x | 5.2 | 6 |
| Near-Monopoly | Single dominant; regulatory intervention likely | >5000 HHI | >75% CR1 | 1.85x | 6.8 | 2 |
Whitespace Markets — Rollup Priority
| MSA | State | Pop (000) | Providers | Top Share | CR3 | Whitespace Score | Priority |
|---|---|---|---|---|---|---|---|
| Raleigh-Cary, NC | NC | 1,585 | 385 | 12.0% | 22.0% | 92 | priority expansion |
| Charlotte-Concord-Gastonia, NC | NC | 2,770 | 685 | 15.0% | 25.0% | 88 | priority expansion |
| Jacksonville, FL | FL | 1,650 | 285 | 18.0% | 30.0% | 85 | priority expansion |
| Columbus, OH | OH | 2,150 | 485 | 20.0% | 32.0% | 82 | active target |
| Indianapolis-Carmel-Anderson, IN | IN | 2,100 | 325 | 22.0% | 35.0% | 78 | active target |
| Richmond, VA | VA | 1,320 | 185 | 25.0% | 38.0% | 75 | active target |
| Albuquerque, NM | NM | 925 | 125 | 28.0% | 42.0% | 72 | fill-in |
| Boise City, ID | ID | 825 | 95 | 32.0% | 48.0% | 68 | fill-in |
| Omaha-Council Bluffs, NE-IA | NE-IA | 985 | 165 | 28.0% | 42.0% | 72 | fill-in |
| Tucson, AZ | AZ | 1,050 | 148 | 32.0% | 48.0% | 68 | fill-in |
| Des Moines-West Des Moines, IA | IA | 710 | 85 | 35.0% | 52.0% | 62 | selective |
| Knoxville, TN | TN | 925 | 125 | 32.0% | 45.0% | 68 | fill-in |
Stress-Test Scenarios — FTC Action Likelihood
| Scenario | HHI Delta | CR3 Delta | Likely FTC Action | Value at Risk ($M) |
|---|---|---|---|---|
| Base case (consolidate 1 top-5 operator) | +250 | +8.0pp | unlikely challenge | $0.00 |
| Consolidate top 2 operators | +680 | +18.0pp | possible 2R | $125.00 |
| Platform + 3 practices same MSA | +420 | +12.0pp | likely review | $45.00 |
| Cross-MSA consolidation (geographic diversification) | +120 | +4.0pp | clears | $0.00 |
| Acquire market leader (all 5 markets) | +1250 | +28.0pp | likely challenge | $285.00 |
| Vertical integration (payer acquisition) | +350 | +10.0pp | FTC vertical scrutiny | $85.00 |
Active Healthcare Platform Operators
| Operator | Markets Active | Practices | Providers | Median HHI Contribution | Strategy |
|---|---|---|---|---|---|
| USAP (US Anesthesia Partners) | 28 | 385 | 4,250 | 2,850 | concentrated; FTC scrutiny |
| GI Alliance | 22 | 125 | 685 | 1,850 | active roll-up (PE) |
| ADCS / Schweiger / Forefront Derm | 42 | 425 | 1,850 | 625 | active roll-up (multi-PE) |
| DaVita Kidney Care | 48 | 2,850 | 8,500 | 2,250 | consolidated; mature |
| Fresenius Medical Care | 38 | 2,650 | 7,850 | 1,950 | consolidated; mature |
| Optum Health Services | 45 | 1,850 | 52,000 | 1,450 | vertical payer |
| Acadia Healthcare | 32 | 250 | 4,850 | 1,250 | behavioral health leader |
| LHC Group (UnitedHealth) | 42 | 1,250 | 14,500 | 485 | home health leader |
| Panorama Orthopedics (KKR) | 6 | 58 | 485 | 2,850 | regional ortho roll-up |
| US Digestive Partners | 15 | 85 | 425 | 1,620 | GI roll-up (PE) |
| Kindbody / RMA | 12 | 42 | 185 | 3,850 | fertility consolidator |
| Illinois Bone & Joint Institute | 3 | 28 | 175 | 1,650 | regional ortho |
Market Concentration Thesis: 20 MSAs profiled.
Avg HHI 1,680 places portfolio in moderately concentrated zone — sweet spot for PE rollups (CR3 <50%, typical MOIC 2.62x).
4 markets remain fragmented — platform opportunities in NY/LA dermatology and Miami/Tampa home health.
3 highly concentrated markets (Austin anesthesia, SF fertility, Philadelphia anesthesia) face FTC scrutiny and should be avoided without remediation.
Whitespace scoring surfaces Raleigh, Charlotte, and Jacksonville as highest-priority expansion targets.
Use /antitrust-screener for deal-level FTC screening.