Ask MGMA: How to Right-Size Staffing for Value-Based Care vs. Fee-for-Service

In this episode of Ask MGMA, host Daniel Williams is joined by Cristy Good to break down staffing strategies in primary care—comparing what works in value-based care versus fee-for-service models. They dive into how staffing ratios shift between these models, how technology and care teams play a role, and why benchmarking matters. Cristy also shares practical tips for preventing burnout and walks through actionable steps for practices moving toward value-based care. Stick around for a rapid-fire round of myth-busting to separate fact from fiction in staffing trends.

00:51 – Introduction and Welcome
02:04 – Staffing Benchmarks: Value-Based Care vs. Fee-for-Service
05:20 – Role of Technology in Care Delivery
05:50 – Benchmarking and Measuring Staffing Effectiveness
07:44 – Preventing Burnout Through Smarter Staffing
08:44 – Steps for Transitioning to Value-Based Care
11:19 – Rapid-Fire Myth Busting: What Practices Get Wrong
12:12 – Final Thoughts and Where to Start

Additional Resources:

• MGMA Playbooks
• MGMA Events
• MGMA Consulting
• MGMA DataDive
• MGMA Stat
• MGMA Podcasts

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Episode Transcript

Daniel Williams (00:55):
Well, hi, everyone. Welcome to the Ask
MGMA podcast. I'm DanielWilliams, and I'm joined today,
as always, by cohost ChristyGood, a senior industry adviser
here at MGMA. Christy, alwaysgood to see you.

Cristy Good (01:11):
Thanks, Daniel. I love doing these with you.

Daniel Williams (01:14):
Alright. So we were just chatting about
colleges and hockey here,everybody. So offline, Christy
and her son have a lot ofdecisions to make. He's when
does he graduate from highschool? Coming up here in the
next

Cristy Good (01:27):
May 15.

Daniel Williams (01:28):
Good gracious. Okay. So by the time y'all
listen to this, her son will begraduated because I think this
is coming out post. So with allthat said, we wanna thank y'all
again. We love doing this askMGMA podcast, this one in
particular, because this isreally where Christie gets a
chance to share the questionsthat are coming in to ask MGMA

(01:52):
and to provide tools, answers,insights to that.
So let's look at our topic fortoday. We are looking at a
member had sent in a questionabout staffing benchmarks in
primary care, specifically howstaffing ratios differ in value
based care versus traditionalfee for service models. So we're

(02:16):
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 theyfundamentally differ when it
comes to staffing?

Cristy Good (02:28):
Yeah, this was a great question. It was actually
asked by a big organization inQueens, and we do have staffing
benchmarks through MGMA DataDive. Unfortunately, we don't
separate it out as value basedcare versus fee for service. So
it was a great question to diginto to say, how do they differ?

(02:49):
And honestly, at the core, thatservice really focuses on
volume.
Volume. The more visits, moreprocedures, so staffing is
really optimized for throughput.With value based care, they
prioritize outcomes, preventionand cost efficiency. So that
really shifts the staffingtoward a broader care team that
includes roles like carecoordinators, health coaches,

(03:12):
and social workers, all aimed atmanaging chronic care conditions
and social determinants ofhealth. So trying to figure out
how do I staff using our MGMAbenchmarks, knowing that it's
going to be set up a little bitdifferent if my focus is on
value based care versus fee forservice is important.

Daniel Williams (03:30):
Okay. So let's talk about the care teams
themselves. What are the keydifferences in composition
between the two models, if thereare differences?

Cristy Good (03:38):
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 aninterdisciplinary model. So you
might see a care team with aphysician, nurse practitioner,

(03:59):
behavioral health specialist,care coordinator, and even a
data analyst. The goal is reallyto support the patients
holistically and reduce thedownstream costs by preventing
issues before they escalate.
So before that patient then allof a sudden is so sick that they
have to go to the emergencyroom.

Daniel Williams (04:15):
Okay. That is really cool. Thank you for that
clarification there. So let'slook at that staffing ratio
itself. What kind of ratios arewe seeing under each model?

Cristy Good (04:27):
Yeah. And we'll have some charts to go with it.
But in the fee for service, theratio might be something like
one physician per 1,800 to 2,000patients, where the value based
care shifts by distributingresponsibility. So you may see a
lower physician to patientratio, but a higher number of
support staff per provider. Sofor example, you may have one

(04:50):
care coordinator per two fiftyhigh risk patients.
That redistribution is criticalfor success in that value based
care model.

Daniel Williams (04:59):
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 thispoint is where does technology
fit in here? What role is itplaying in either of those
models there?

Cristy Good (05:16):
Yeah. I think we know that EHR is important in
any situation, but in valuebased care, that technology is
really a force multiplier. Staffreally need to be fluent in
electronic health records, butalso the telehealth tools, the
remote patient monitoring, andthen predictive analytics. So
you're not just staffing forclinical delivery, but for data

(05:40):
informed decision making. Ithink that's really the key
difference from fee for servicewhere tech is often limited to
billing and scheduling.

Daniel Williams (05:49):
Okay. In the introduction, we both talked
about benchmarking and what roleit plays. So the old saying, I
know that Owen Dahl and DaveGanz and other experts in
benchmarking always said, if youcan't measure it, you can't
manage it. So if we bring inthose benchmarking tools to

(06:10):
track for a practice to see ifthe staffing model is effective,
what are the main benchmarkingaspects we want to look at here?

Cristy Good (06:18):
Definitely. There are some key core areas. The one
being clinical outcomes, thingslike 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 canget your patients in to be seen.

(06:38):
Their next available is commonlyused. Another one is cost
utilization, so the number of EDvisit rates and your per month
per member, which is called aPMP cost. Those are important to
look at under the costutilization benchmarks. Of
course care coordination, that'sa little bit harder one to

(06:59):
track, but what you're lookingat there is follow-up success
after discharge. And it's alsolooking at do you have
readmission rates?
Again, that's in your clinicaloutcomes, but it's also in your
care coordination. Justfollow-up after discharge and
making sure they're not going inand that they're being taken
care of. And then preventativecare. So what are your
screening? Your vaccinationrates are important to look at.

(07:24):
Of course, staff engagement,which includes burnout and
turnover. Often we talk aboutyear turnover is important to
look at specifically just tosee. And then equity and access.
So are you closing care gapsacross populations? If your
staffing supports improvementacross those, then you're on the

(07:44):
right track.

Daniel Williams (07:45):
Okay. Now you mentioned that word burnout. So
let's talk about that. How doesstaffing strategy influence
burnout and how to combat it?

Cristy Good (07:55):
I think a lot of people I know we've heard over
the years burnout, burnout, orwe talk about having that
balance at work and between yourwork and your life so that
you're not burning out. In valuebased care, we also encourage
cross training and role clarityso tasks are appropriately
distributed. If a carecoordinator is handling follow

(08:16):
ups instead of the physician,the whole team functions better
and you can help burnout beless. So really engaging your
whole team across the group tohelp each other so that no one
feels that burden. And theninvesting in soft skills like
empathy and communication alsohelps staff feel more connected

(08:38):
to the mission and hopefullyreduces some of that feeling of
burnout or disconnect.

Daniel Williams (08:43):
Okay. One of the things you always do is
really break down your answersfor Ask MGMA into steps. So when
we are looking at a practice, ifthey're making that jump from
fee for service to value basedcare, what is step one? What is
a good step to take to reallyget things rolling?

Cristy Good (09:02):
Yeah, that's a great question. So I would say
start by assessing your patientpopulation. Look at the risk
factors, the chronic conditionsand the social needs, and then
align your staffing with thoseneeds. For instance, if you have
a high diabetic population,you'll want care managers
skilled in that area. So youwant to ensure that every team
member contributes directly tothe outcome.

Daniel Williams (09:24):
Okay. Something that you brought up earlier that
I just find fascinating. I'vebeen hearing about value based
care forever and done interviewswith it, but you really broke
down the makeup of staffing,what that looks like. So with
that in mind, are there anyparticular roles expanding
quickly in these value basedcare environments?

Cristy Good (09:45):
I do know that many practices have started adding
like care coordination carecoordinators. Others have added
health coaches, populationhealth managers. And then we
know there's been a big kind ofuptick in behavioral health
professionals to help managetransition and support self care
and reduce preventablehospitalization. All those kind

(10:07):
of help with the overallwell-being of your patients,
which also in the long run,hopefully help reduce stress in
your practice by just expandingthe support.

Daniel Williams (10:20):
Okay. Now I just thought of something. I had
asked you earlier aboutdifferent aspects of
benchmarking. But when we lookat it even deeper, where would
you point people from a dataperspective to help guide
staffing strategy?

Cristy Good (10:35):
I know. I mentioned earlier the MGMA data dive, and
we do have the staffingbenchmarks. It's a great place
to start. And like I said, weright now don't have fully
distinguished between fee forservice and value based care.
And honestly, a lot of practicesare a mix.
But we do have resources thatwill link to this from JAMA that
did a study on health centerstaffing. And then there was a

(10:57):
research paper that was by Louand Pittman, excellent insights
on how value based care alignedclinics, structure teams, and
we'll link those in the shownotes.

Daniel Williams (11:08):
Okay. Before we sign off then, we're always
trying to mix up ask MGMA alittle bit, so let's do a rapid
fire myth busting round. Are youready?

Cristy Good (11:20):
Yep. Let's go.

Daniel Williams (11:22):
Alright. True or false, value based care means
hiring twice as many people.

Cristy Good (11:28):
It's not about more people. It's about different
people with different roles.

Daniel Williams (11:33):
Okay. True or false? It's more expensive to
staff for value based care.

Cristy Good (11:39):
Initially, maybe. I've heard both. But long term
savings throughout betteroutcomes and fewer readmissions
usually outweigh the upfrontinvestment.

Daniel Williams (11:48):
True or false? There's one perfect staffing
model that works for every valuebased care practice.

Cristy Good (11:55):
Absolutely false. It depends entirely on your
patient population and yourcontract goals.

Daniel Williams (12:01):
Alright. Can you give us a real world example
then?

Cristy Good (12:05):
Sure. One, FQHC in the Southwest hired two full
time care coordinators to workin their diabetic population,
and then within a year, they sawa fifteen percent reduction in
ER visits and a measurableincrease in HbA1c control. That
freed up the physician time andimproved patient satisfaction,

(12:26):
and that's the power of havingtargeted staffing to really look
at those patient populations.

Daniel Williams (12:31):
Okay. Final question then. How can practices
foster a culture that supportsvalue based care aligned
staffing?

Cristy Good (12:40):
It comes down to collaboration accountability.
You want to have a createdshared mission where every staff
member sees how their rolecontributes to patient outcomes.
You want to encouragecommunication, set clear
expectation, and then celebratethose team based wins. Value
based care success is a teamsport and everyone needs to know
their position and their field.And we know we've been talking

(13:03):
about value based care for manyyears, and I don't think it's
going away.
I think we just need to figureout how to make it work for
everyone.

Daniel Williams (13:12):
Alright. Christie, thank you so much as
always, and thank you for beinga good sport and doing the rapid
fire true or false aspect ofthis interview. We'll see if
we'll ever bring it back, but,you were a good sport on that.
Thank you.

Cristy Good (13:25):
Thank you.

Daniel Williams (13:26):
Alright, everyone. If you are looking to
optimize your staffing model orbetter align with value based
care goals, be sure to check outa lot of the additional
resources that we are going toput into the episode note show
notes. We'll also directly linkto some of those other surveys
and reports that Christymentioned. So until then, thank

(13:47):
you all so much for being MGMApodcast listeners.