Capstone Project Proposal: 

Delivering Effective and Comprehensive Start-Up Resources to Medical Providers – Physicians or Physician-Controlled Entities – who want to Successfully Establish Urgent Care Clinics in the State of California

Capstone Project Proposal: How To Successfully Establish Urgent Cares in California

Author: Ryan Nuqui, MD

Course: SPHHS 681 – The PHP MPH Capstone; Fall 2025

University of Massachusetts, Amherst (UMass)

Date Posted: September 12, 2025

Background

  • Context and outline of the problem to be studied and the topic to be addressed
    • Project’s goals: Delivering effective and comprehensive start-up resources to medical providers – physicians or physician-controlled entities – who want to successfully establish urgent care clinics in the State of California.
    • Scope & Feasibility:
      • Statement of the questions to be raised: regulatory requirements; financial and economic considerations; location and market-analysis; staffing, operations, and clinical protocols; infrastructure, facility design, and technology; quality, safety, and patient experience standards; reimbursement, insurance, and payer‐relations challenges; legal, liability, and risk management issues; financing and investment models; public health, community need, and policy factors
      • Problems to be solved: regulatory complexity and variance; high startup & operational cost; payer mix uncertainty and reimbursement challenges; identifying underserved markets; recruitment and retention of qualified clinical and support staff; ensuring quality and safety; ensuring quality and safety; financial viability; managing risk, liability, and legal compliance; and sustainability over the long term
      • Objectives of the study: map out the regulatory, legal, and licensing requirements specific; develop a detailed financial model; identify key criteria for selecting optimal locations; define the necessary staffing, clinical services, facility design, and technology infrastructure; analyze the insurance and payer contracting landscape; assess potential legal and risk management structures; evaluate different financing, investment, and partnership models; and provide recommendations or a roadmap for stakeholders (healthcare entrepreneurs, hospital systems, policymakers)
    • Methods:
      • Research Design: employ a mixed-methods approach, integrating both qualitative and quantitative methods; structured into four major phases
        • Phase I: Regulatory and Legal Analysis
          • Objective: Understand licensing, zoning, construction, and healthcare regulations governing urgent care centers in California.
        • Phase II: Financial and Operational Feasibility Study
          • Objective: Estimate startup and operational costs, identify revenue streams, and evaluate financial models.
        • Phase III: Market and Location Analysis
          • Objective: Identify key indicators of successful urgent care locations and assess potential markets across California.
        • Phase IV: Operational Planning and Best Practices
          • Objective: Determine facility design, staffing models, clinical protocols, and technology infrastructure for urgent care.
        • Integration of Findings
          • Best practice models
          • Step-by-step implementation roadmap
          • Key success factors and pitfalls
          • Sample budget and timeline
        • Anticipated Limitations and Challenges:
          • Data Availability
          • Regulatory Variability
          • Stakeholder Access
          • Cost Estimation Uncertainty
          • Policy Changes
          • Time and Scope Constraints
    • Significance
      • Healthcare accessibility, system efficiency, community development, and informed investment
        • Meeting Community Health Needs
        • Supporting Program Effectiveness and Strategic Health Planning
        • Professional and Organizational Development
        • Contribution to the Literature
        • Long-Term Impact
  • Case study: Calcity Urgent Care at 8100 California City Blvd, California City, CA 93505 will be one of the case studies in the capstone project.
  • Relevant literature supporting the topic: Attached are the relevant literature supporting the topic.

Statement of the Questions to be Raised

  1. What are the regulatory requirements in California for setting up and licensing an urgent care clinic?
    • What state, county, and local health department permits are needed?
    • What building codes, safety standards, ADA (Americans with Disabilities Act) compliance, fire codes, etc., apply?
  2. What are the financial and economic considerations involved?
    • What are startup costs (land, building/lease, equipment, staffing)?
    • What expected revenue models, reimbursement rates, payer mix (insurance, Medicare, Medicaid, self-pay)?
    • What operating costs and break-even timelines are realistic?
  3. What location and market‐analysis factors are critical for success?
    • How to identify underserved areas or health care deserts in California?
    • What demographic, epidemiologic, transportation, and competition factors should be considered?
  4. What staffing, operations, and clinical protocols are needed?
    • What clinical services will be offered (e.g., minor injuries, diagnostics, imaging, labs)?
    • What staffing levels and types (physicians, nurse practitioners, PAs, lab techs, front desk, etc.) are required?
  5. What infrastructure, facility design, and technology needs are required?
    • What physical space, layout, medical equipment, and technology systems (EHR, telehealth, billing) are necessary?
    • What supply chain and inventory management practices?
  6. What quality, safety, and patient experience standards should be built in?
    • How to ensure patient safety, continuity of care, infection control, regulatory compliance?
    • What customer satisfaction or access metrics?
  7. What reimbursement, insurance, and payer‐relations challenges exist?
    • How to contract with payers, negotiate rates, manage billing and claims?
    • How does Medicaid (Medi‑Cal in California) participation work?
  8. What legal, liability, and risk management issues must be addressed?
    • Malpractice insurance, scope of practice, medical‐legal compliance, privacy (HIPAA), reporting obligations.
  9. What financing and investment models are viable?
    • What sources of capital (banks, investors, public grants)?
    • Are partnerships or joint ventures beneficial (e.g., with hospitals, physician groups)?
  10. How do public health, community need, and policy factors influence feasibility?
    • How do state policies (reimbursement, regulations, incentives) and local health needs affect demand and sustainability?
    • How do differences by region (rural vs urban) change the model?

Problems to be Solved

  1. Regulatory complexity and variance: Navigating differing rules across municipalities and counties and keeping up with California state laws.
  2. High startup & operational costs: Real estate, equipment, staffing, and maintaining compliance incur substantial costs.
  3. Payer mix uncertainty and reimbursement challenges, especially in underserved or low‐income communities.
  4. Identifying underserved markets: Ensuring demand and access justify the investment; avoid oversaturation.
  5. Recruitment and retention of qualified clinical and support staff, given workforce shortages in certain regions.
  6. Ensuring quality and safety while maintaining financial viability.
  7. Balancing access and patient satisfaction with operational efficiency.
  8. Managing risk, liability, and legal compliance, including insurance, malpractice, privacy, etc.
  9. Sustainability over the long term: market changes, policy shifts, competition, healthcare reform.

Objectives of the Study

  1. To map out the regulatory, legal, and licensing requirements specific to urgent care facilities in California, including differences by region.
  2. To develop a detailed financial model estimating startup costs, operational costs, revenue streams, and break‐even timelines for building and running urgent care centers in different settings (e.g., urban, suburban, rural).
  3. To identify key criteria for selecting optimal locations, including demographic, epidemiological, competitive, transportation, and community‐need data, to maximize access and utilization.
  4. To define the necessary staffing, clinical services, facility design, and technology infrastructure for efficient, safe, and patient‐centered urgent care operations.
  5. To outline best practices for quality assurance, patient safety, and customer experience, including metrics for measuring performance.
  6. To analyze the insurance and payer contracting landscape, especially Medi‐Cal, private insurers, and self‐pay, to ensure reimbursement viability.
  7. To assess potential legal and risk management structures, including liability, privacy, and scope of practice considerations.
  8. To evaluate different financing, investment, and partnership models, exploring what has worked in California and lessons learned.
  9. To provide recommendations or a roadmap for stakeholders (healthcare entrepreneurs, hospital systems, policymakers) on how to successfully plan, finance, build, and operate urgent care centers in California.

Methodology Outline

  1. Research Design
    • This study will employ a mixed-methods approach, integrating both qualitative and quantitative methods to ensure a comprehensive understanding of the process of building urgent care centers in California. The methodology will be structured into four major phases.
  2. Phase I: Regulatory and Legal Analysis
    • Objective: Understand licensing, zoning, construction, and healthcare regulations governing urgent care centers in California.
      • Data Collection:
        • Review official documents and websites from:
          • California Department of Public Health (CDPH)
          • Office of Statewide Health Planning and Development (OSHPD)
          • Local zoning and planning departments
          • California Building Standards Commission
        • Interviews or correspondence with regulatory bodies or healthcare law experts.
      • Analysis Method:
        • Legal content analysis
        • Thematic synthesis of permitting and compliance processes
      • Deliverable:
        • A regulatory checklist and process map for starting an urgent care facility in California.
  1. Phase II: Financial and Operational Feasibility Study
    • Objective: Estimate startup and operational costs, identify revenue streams, and evaluate financial models.
      • Data Collection:
        • Industry reports (e.g., MGMA, Becker’s Healthcare)
        • Existing urgent care case studies and benchmark data
        • Interviews with clinic owners, healthcare CFOs, and investors
        • Site-specific cost estimations (urban vs rural California)
      • Analysis Method:
        • Financial modeling (e.g., Excel-based projections)
        • Sensitivity analysis (to simulate different scenarios)
      • Deliverable:
        • A detailed financial feasibility report including cost estimates, ROI analysis, and funding recommendations.
  1. Phase III: Market and Location Analysis
    • Objective: Identify key indicators of successful urgent care locations and assess potential markets across California.
      • Data Collection:
        • Use GIS and demographic tools (e.g., U.S. Census, Esri, local health needs assessments)
        • Collect data on competition (number and proximity of existing urgent cares, primary care offices, ERs)
        • Community health rankings, transportation access, insurance coverage rates
      • Analysis Method:
        • Spatial analysis using GIS tools
        • SWOT analysis for selected regions
      • Deliverable:
        • A location strategy report identifying high-potential underserved markets.
  1. Phase IV: Operational Planning and Best Practices
    • Objective: Determine facility design, staffing models, clinical protocols, and technology infrastructure for urgent care.
      • Data Collection:
        • Review of urgent care guidelines (e.g., Urgent Care Association of America)
        • Interviews/surveys with medical directors, architects, EHR vendors, and healthcare HR managers
        • Site visits to existing urgent care centers (if possible)
      • Analysis Method:
        • Comparative case study analysis
        • Process flow mapping
      • Deliverable:
        • A blueprint document outlining facility layout, workflow models, staffing plans, and IT systems.
  1. Integration of Findings
    • All findings from the four phases will be synthesized into a comprehensive strategic guide or white paper. The synthesis will include:
      • Best practice models
      • Step-by-step implementation roadmap
      • Key success factors and pitfalls
      • Sample budget and timeline

Anticipated Limitations or Challenges

  1. Data Availability:
    • Proprietary or non-public data from private urgent care businesses may limit financial or performance comparisons.
    • Incomplete or outdated public health data may affect market analysis.
  2. Regulatory Variability:
    • Local zoning and permitting rules vary widely across counties and municipalities in California, which may complicate standardization of recommendations.
  3. Stakeholder Access:
    • Scheduling interviews with busy professionals (clinic owners, regulators, investors) may delay the data collection process.
  4. Cost Estimation Uncertainty:
    • Construction and labor costs vary across the state and may fluctuate due to inflation or market conditions.
  5. Policy Changes:
    • Future changes in healthcare policy, insurance reimbursements, or licensing requirements could impact the relevance of findings.
  6. Time and Scope Constraints:
    • Depending on project timeline, depth of analysis may need to be limited for each phase.

Significance

The proposed study holds critical significance for healthcare accessibility, system efficiency, community development, and informed investment in California’s healthcare infrastructure. The insights and outcomes anticipated from this project will contribute meaningfully across several domains:

  1. Meeting Community Health Needs
    • California faces persistent disparities in access to timely, affordable care—especially in rural, underserved, and lower-income urban areas. By identifying practical steps to establish urgent care centers, this study directly supports efforts to:
      • Alleviate Emergency Room (ER) overcrowding, by offering a more cost-effective and accessible alternative for non-life-threatening conditions.
      • Improve healthcare access in areas with limited primary care capacity or long wait times.
      • Address health equity, by prioritizing expansion in medically underserved communities.
  1. Supporting Program Effectiveness and Strategic Health Planning
    • The roadmap and recommendations developed in this project can guide:
      • Healthcare entrepreneurs and health systems seeking to expand services efficiently.
      • Public health departments and policymakers, enabling better planning and resource allocation for regional healthcare development.
      • Insurance payers, helping them understand how to partner effectively with urgent care centers as part of a broader continuum of care.
  1. Professional and Organizational Development
    • This project will also contribute to professional development by:
      • Equipping healthcare administrators, planners, and investors with a grounded understanding of operational, legal, and financial aspects of launching an urgent care facility in California.
      • Bridging the knowledge gap between clinical care delivery and business strategy in outpatient care settings.
    • For organizations and professionals pursuing value-based care model, this study provides a template for scalable, community-based care delivery that aligns with both clinical and financial goals.
  2. Contribution to the Literature
    • There is a limited body of comprehensive, California-specific literature that consolidates the legal, operational, financial, and community planning aspects of launching urgent care centers. This study:
      • Aggregates and synthesizes existing regulatory and market data, making it more accessible to practitioners.
      • Builds an annotated framework of best practices and real-world case studies.
      • Establishes a repeatable model that can be adapted across regions within the state, and potentially in other states with similar healthcare landscapes.
  1. Long-Term Impact
    • Ultimately, the study will contribute to healthcare system resilience and adaptability by:
      • Encouraging decentralized, high-access points of care that can flexibly respond to population health needs.
      • Supporting economic development through healthcare facility construction, job creation, and ongoing local service provision.
      • Informing future policy regarding urgent care regulations, Medicaid expansion, telehealth integration, and community health investments.

Case Study

  • Case study:
    • Calcity Urgent Care at 8100 California City Blvd, California City, CA 93505 will be one of the case studies in the capstone project.
    • The project goals, scope and feasibility, methods and significance among other important topics to be addressed of the capstone project may be explored and examined.
    • The proposed case study may hold critical significance for healthcare accessibility, system efficiency, community development, and informed investment in California’s healthcare infrastructure.

References

  1. American Academy of Urgent Care Medicine. (n.d.). Starting an urgent care center. https://aaucm.org/start-an-urgent-care-center/
  2. California Department of Public Health (CDPH). (2023). Licensing and certification program. https://www.cdph.ca.gov/Programs/CHCQ/LCP
  3. California Health and Human Services Agency. (2023). Medi-Cal managed care and reimbursement policies. https://www.chhs.ca.gov/
  4. California Office of Statewide Health Planning and Development (OSHPD). (2022). Healthcare construction and design review process. https://hcai.ca.gov/construction-finance/
  5. California State Board of Equalization. (2023). Tax considerations for healthcare businesses in California. https://www.cdtfa.ca.gov/
  6. Centers for Medicare & Medicaid Services (CMS). (2023). Medicare payment policies for urgent care centers. https://www.cms.gov/
  7. Health Resources and Services Administration (HRSA). (2023). Health professional shortage areas (HPSA) and medically underserved areas (MUA). https://data.hrsa.gov/
  8. Jones, E., & Rosenberg, M. (2021). Urgent care centers and their role in improving access to care: A review of the literature. Journal of Ambulatory Care Management, 44(2), 135–142. https://doi.org/10.1097/JAC.0000000000000365
  9. Kaufman Hall. (2023). 2023 Hospital and health system financial outlook report. https://www.kaufmanhall.com/
  10. National Association for Ambulatory Care (NAAC). (2022). Urgent care industry benchmarks and best practices. https://www.naac.org/
  11. Rosen, A., & Hatch, S. (2020). Business planning for urgent care: Navigating startup costs, staffing, and location. Healthcare Financial Management Journal, 74(3), 40–49.
  12. Urgent Care Association (UCA). (2023). Benchmarking report: Urgent care center operations and performance. https://www.ucaoa.org/
  13. S. Census Bureau. (2023). American Community Survey: California demographic and health insurance data. https://www.census.gov/