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Roadmaps to Value-based Profitability: A Practice Transformation Guide

Book -

Revenue Cycle

Value-Based Operations

Practice Efficiency

SKU: 1007


ISBN #978-1-56829-669-2

What does it mean to shift value-based payment models?
Maybe you aren’t sure where to start. How can you stay competitive amidst the changes in healthcare when resources are limited? While reading this book, you will dive deeply into the key challenges and opportunities of value-based care. We will explore how you can use your core values and strengths to transform your practice — driving away from maximizing volume with fee-for-service billing to reimbursement under incentive programs that are part of value-based payments. By answering critical questions such as where to start, what does the finish line look like and what happens along the way, you will gain the insight needed to deliver a better patient experience while improving health and lowering the cost of care. Learn to:
  • Support your practice’s transformation by understanding the leadership skills needed to succeed in value-based incentive programs.
  • Evaluate what already exists in your practice and what needs to change to succeed in demonstrating outcomes.
  • Determine key elements to assess when considering options for participating in programs with alternative payment models.
  • Examine how the organization of teams can deliver better patient experience and higher staff satisfaction.
  • Determine how to create a high-functioning team based on each person’s strengths.
  • Analyze the behavioral traits of team members to maximize their potential and improve retention.
Across the healthcare industry, the push is to deliver value rather than volume with value-based payment programs being the financing mechanism to drive change. This book is the perfect starting point to gather information about how to prepare for, and maximize, your participation in value-based payment models. You will learn to create the foundation to evaluate value-based payment models and understand how your practice needs to be structured to succeed in value-based care and avoid penalties or exclusion from networks. Reading this book, you will gain insights from a managed care perspective and walk away with recommendations to implement in your practice.


Jennifer Ternay

Jennifer Ternay

Jennifer Ternay is a healthcare expert that shares over two decades of knowledge to help healthcare organizations succeed despite the challenges and constant disruptions to the industry. Offering insights to solve problems with an approach that is founded in values, Jennifer offers strategic consulting to help healthcare organizations reduce healthcare costs, obtain healthier patient outcomes and improve patient experience. Blending financial and operational knowledge, she is passionate about the delivery of integrated, patient-centered care and assisting clients to meet the challenges of today’s healthcare environment.

Jennifer’s consulting career began in 2010 after working in public accounting and managed care. Prior to creating her consulting business, she was the CEO for a statewide Medicaid ASO program in Maryland with previous leadership positions as CFO.  Jennifer’s education and certifications include Bachelors in Business Administration (Accounting), Masters in Business Administration as well as licensure as a Certified Public Accountant (CPA) and NCQA recognition as a Patient-Centered Medical Home Certified Content Expert (PCMH CCE).

Chapter 1: Getting ahead of the curve
  • How we arrived at the healthcare intersection
  • The value-based care healthcare delivery model 
  • Population health and patient-centered care
  • Values and the value-based future

Chapter 2: First steps to making change meaningful and achievable
  • Who do you serve?
  • Internal readiness assessment
  • People
  • Process and infrastructure
  • External readiness assessment
  • Payers 
  • Competitors 
  • Regulatory 
  • Finalizing the readiness assessment
  • Quality measures 
  • Sources of measures 
  • Prioritizing outcomes 
  • Planning

Chapter 3: Transforming requires leadership. .
  • Why and why now
  • Laying the groundwork 
  • Planning the project
  • The communication plan
  • Characteristics
  • Modes of communication
  • Content 
  • Eliminate obstacles
  • Reinforcing the changes
  • Keeping the new culture 
  • Continuous assessment
  • Finding the practice’s competitive advantage 

Chapter 4: What do your patients have in common?
  • Population health
  • Getting to know your patient population 
  • Data basics
  • Starting with the easy stuff 
  • Demographic data 
  • Diagnosis and procedure codes
  • General health outcomes and factors  
  • Finding out what you know 

Chapter 5: Understanding the whole picture of patient health
  • Social determinants of health
  • Unhealthy behaviors impacted by social determinants of health 
  • Behavioral health 
  • Screenings 
  • Cultural competency 
  • Conclusion 

Chapter 6: Identifying the biggest opportunities to deliver value
  • Challenges are not non-starters
  • Data sources 
  • Stratification 
  • Predictive modeling 
  • How to stratify your patient population
  • Internal data 
  • External data
  • Interventions
  • Care management
  • Narrowing your focus 
Chapter 7: Structuring the practice
  • Access to care 
  • Scheduling
  • Open access models
  • Alternatives to office visits
  • Evidence-based care
  • Comprehensive assessment and medication reconciliation
  • Delivering on value-based care 

Chapter 8: Incorporating team-based care
  • The case for team-based care
  • Workforce shortage
  • Burnout 
  • Organization-level supports
  • Hiring 
  • Training 
  • Evaluate progress 
  • Performance evaluations 
  • Implementing a team-based care program 
  • Team roles and responsibilities 
  • Team meetings 
  • Patient orientation
  • Communication
  • Building trust and respect 
  • Building engagement at all levels

Chapter 9: Being a part of the community and involving the medical neighborhood 
  • Care coordination
  • Behavioral health 
  • Models of behavioral healthcare 
  • Resources outside of traditional healthcare
  • Building the practice’s situational awareness 

Chapter 10: Involving the patient
  • Patient experience
  • Patient engagement
  • In-office approach to patient involvement
  • Communication
  • Education
  • Goal setting
  • Changing your perspective
  • Out of office approach to patient involvement 
  • Patient portal
  • Other technology 
  • Patient satisfaction 
  • Developing the relationship with the patient
Chapter 11: Getting reimbursed
  • Research your options 
  • Value-based payment financing models
  • The apm framework
  • Understanding financial basics 
  • Determining costs
  • Projecting revenue 
  • Making the business case 
  • Know what motivates a payer
  • Making an appealing business case 
  • Preparing your analysis 
  • Negotiating

Chapter 12: Keeping the momentum
  • Establishing quality improvement 
  • Models for quality improvement
  • Six Sigma®
  • Lean and Lean Six Sigma 
  • The Model for improvement
    • Plan
    • Do
    • Study
    • Act 
  • Sharing results
  • Third party accreditation or recognition 
  • The joint commission 
  • Ncqa 
  • Continuous quality improvement culture

Chapter 13: In Conclusion 

About the Author


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