Ask MGMA: How to Right-Size Staffing for Value-Based Care vs. Fee-for-Service
Download MP3Well, hi, everyone. Welcome to the Ask MGMA podcast. I'm Daniel Williams, and I'm joined today, as always, by cohost Christy Good, a senior industry adviser here at MGMA. Christy, always good to see you.
Cristy Good:Thanks, Daniel. I love doing these with you.
Daniel Williams:Alright. So we were just chatting about colleges and hockey here, everybody. So offline, Christy and her son have a lot of decisions to make. He's when does he graduate from high school? Coming up here in the next
Cristy Good:May 15.
Daniel Williams:Good gracious. Okay. So by the time y'all listen to this, her son will be graduated because I think this is coming out post. So with all that said, we wanna thank y'all again. We love doing this ask MGMA podcast, this one in particular, because this is really where Christie gets a chance to share the questions that are coming in to ask MGMA and to provide tools, answers, insights to that.
Daniel Williams:So let's look at our topic for today. We are looking at a member had sent in a question about staffing benchmarks in primary care, specifically how staffing ratios differ in value based care versus traditional fee for service models. So we're gonna get right into that. Christie, let's start as we always do with the basics here. How do value based care and fee for service models, how do they fundamentally differ when it comes to staffing?
Cristy Good:Yeah, this was a great question. It was actually asked by a big organization in Queens, and we do have staffing benchmarks through MGMA Data Dive. Unfortunately, we don't separate it out as value based care versus fee for service. So it was a great question to dig into to say, how do they differ? And honestly, at the core, that service really focuses on volume.
Cristy Good:Volume. The more visits, more procedures, so staffing is really optimized for throughput. With value based care, they prioritize outcomes, prevention and cost efficiency. So that really shifts the staffing toward a broader care team that includes roles like care coordinators, health coaches, and social workers, all aimed at managing chronic care conditions and social determinants of health. So trying to figure out how do I staff using our MGMA benchmarks, knowing that it's going to be set up a little bit different if my focus is on value based care versus fee for service is important.
Daniel Williams:Okay. So let's talk about the care teams themselves. What are the key differences in composition between the two models, if there are differences?
Cristy Good:Yeah, the fee for service usually tend to be physician centric. So physician, nurse, medical assistant, many are used to that kind of model. Value based care model really expands on that an interdisciplinary model. So you might see a care team with a physician, nurse practitioner, behavioral health specialist, care coordinator, and even a data analyst. The goal is really to support the patients holistically and reduce the downstream costs by preventing issues before they escalate.
Cristy Good:So before that patient then all of a sudden is so sick that they have to go to the emergency room.
Daniel Williams:Okay. That is really cool. Thank you for that clarification there. So let's look at that staffing ratio itself. What kind of ratios are we seeing under each model?
Cristy Good:Yeah. And we'll have some charts to go with it. But in the fee for service, the ratio might be something like one physician per 1,800 to 2,000 patients, where the value based care shifts by distributing responsibility. So you may see a lower physician to patient ratio, but a higher number of support staff per provider. So for example, you may have one care coordinator per two fifty high risk patients.
Cristy Good:That redistribution is critical for success in that value based care model.
Daniel Williams:Okay. I know we've been talking value based care for years and years now, but one aspect of it that at least has alluded me to this point is where does technology fit in here? What role is it playing in either of those models there?
Cristy Good:Yeah. I think we know that EHR is important in any situation, but in value based care, that technology is really a force multiplier. Staff really need to be fluent in electronic health records, but also the telehealth tools, the remote patient monitoring, and then predictive analytics. So you're not just staffing for clinical delivery, but for data informed decision making. I think that's really the key difference from fee for service where tech is often limited to billing and scheduling.
Daniel Williams:Okay. In the introduction, we both talked about benchmarking and what role it plays. So the old saying, I know that Owen Dahl and Dave Ganz and other experts in benchmarking always said, if you can't measure it, you can't manage it. So if we bring in those benchmarking tools to track for a practice to see if the staffing model is effective, what are the main benchmarking aspects we want to look at here?
Cristy Good:Definitely. There are some key core areas. The one being clinical outcomes, things like readmission rate or chronic disease control. Of course, there's patient experience, and that's looking at satisfaction, your net promoter scores and access. So how quickly you can get your patients in to be seen.
Cristy Good:Their next available is commonly used. Another one is cost utilization, so the number of ED visit rates and your per month per member, which is called a PMP cost. Those are important to look at under the cost utilization benchmarks. Of course care coordination, that's a little bit harder one to track, but what you're looking at there is follow-up success after discharge. And it's also looking at do you have readmission rates?
Cristy Good:Again, that's in your clinical outcomes, but it's also in your care coordination. Just follow-up after discharge and making sure they're not going in and that they're being taken care of. And then preventative care. So what are your screening? Your vaccination rates are important to look at.
Cristy Good:Of course, staff engagement, which includes burnout and turnover. Often we talk about year turnover is important to look at specifically just to see. And then equity and access. So are you closing care gaps across populations? If your staffing supports improvement across those, then you're on the right track.
Daniel Williams:Okay. Now you mentioned that word burnout. So let's talk about that. How does staffing strategy influence burnout and how to combat it?
Cristy Good:I think a lot of people I know we've heard over the years burnout, burnout, or we talk about having that balance at work and between your work and your life so that you're not burning out. In value based care, we also encourage cross training and role clarity so tasks are appropriately distributed. If a care coordinator is handling follow ups instead of the physician, the whole team functions better and you can help burnout be less. So really engaging your whole team across the group to help each other so that no one feels that burden. And then investing in soft skills like empathy and communication also helps staff feel more connected to the mission and hopefully reduces some of that feeling of burnout or disconnect.
Daniel Williams:Okay. One of the things you always do is really break down your answers for Ask MGMA into steps. So when we are looking at a practice, if they're making that jump from fee for service to value based care, what is step one? What is a good step to take to really get things rolling?
Cristy Good:Yeah, that's a great question. So I would say start by assessing your patient population. Look at the risk factors, the chronic conditions and the social needs, and then align your staffing with those needs. For instance, if you have a high diabetic population, you'll want care managers skilled in that area. So you want to ensure that every team member contributes directly to the outcome.
Daniel Williams:Okay. Something that you brought up earlier that I just find fascinating. I've been hearing about value based care forever and done interviews with it, but you really broke down the makeup of staffing, what that looks like. So with that in mind, are there any particular roles expanding quickly in these value based care environments?
Cristy Good:I do know that many practices have started adding like care coordination care coordinators. Others have added health coaches, population health managers. And then we know there's been a big kind of uptick in behavioral health professionals to help manage transition and support self care and reduce preventable hospitalization. All those kind of help with the overall well-being of your patients, which also in the long run, hopefully help reduce stress in your practice by just expanding the support.
Daniel Williams:Okay. Now I just thought of something. I had asked you earlier about different aspects of benchmarking. But when we look at it even deeper, where would you point people from a data perspective to help guide staffing strategy?
Cristy Good:I know. I mentioned earlier the MGMA data dive, and we do have the staffing benchmarks. It's a great place to start. And like I said, we right now don't have fully distinguished between fee for service and value based care. And honestly, a lot of practices are a mix.
Cristy Good:But we do have resources that will link to this from JAMA that did a study on health center staffing. And then there was a research paper that was by Lou and Pittman, excellent insights on how value based care aligned clinics, structure teams, and we'll link those in the show notes.
Daniel Williams:Okay. Before we sign off then, we're always trying to mix up ask MGMA a little bit, so let's do a rapid fire myth busting round. Are you ready?
Cristy Good:Yep. Let's go.
Daniel Williams:Alright. True or false, value based care means hiring twice as many people.
Cristy Good:It's not about more people. It's about different people with different roles.
Daniel Williams:Okay. True or false? It's more expensive to staff for value based care.
Cristy Good:Initially, maybe. I've heard both. But long term savings throughout better outcomes and fewer readmissions usually outweigh the upfront investment.
Daniel Williams:True or false? There's one perfect staffing model that works for every value based care practice.
Cristy Good:Absolutely false. It depends entirely on your patient population and your contract goals.
Daniel Williams:Alright. Can you give us a real world example then?
Cristy Good:Sure. One, FQHC in the Southwest hired two full time care coordinators to work in their diabetic population, and then within a year, they saw a fifteen percent reduction in ER visits and a measurable increase in HbA1c control. That freed up the physician time and improved patient satisfaction, and that's the power of having targeted staffing to really look at those patient populations.
Daniel Williams:Okay. Final question then. How can practices foster a culture that supports value based care aligned staffing?
Cristy Good:It comes down to collaboration accountability. You want to have a created shared mission where every staff member sees how their role contributes to patient outcomes. You want to encourage communication, set clear expectation, and then celebrate those team based wins. Value based care success is a team sport and everyone needs to know their position and their field. And we know we've been talking about value based care for many years, and I don't think it's going away.
Cristy Good:I think we just need to figure out how to make it work for everyone.
Daniel Williams:Alright. Christie, thank you so much as always, and thank you for being a good sport and doing the rapid fire true or false aspect of this interview. We'll see if we'll ever bring it back, but, you were a good sport on that. Thank you.
Cristy Good:Thank you.
Daniel Williams:Alright, everyone. If you are looking to optimize your staffing model or better align with value based care goals, be sure to check out a lot of the additional resources that we are going to put into the episode note show notes. We'll also directly link to some of those other surveys and reports that Christy mentioned. So until then, thank you all so much for being MGMA podcast listeners.
