Medical practices navigating the shift to value-based care (VBC) face specific challenges in how they staff their teams. The structure of care delivery changes when outcomes, prevention, and cost-efficiency become the drivers rather than volume-based reimbursement. For MGMA members, aligning staffing models with VBC principles is essential to delivering effective, sustainable care.
Cristy Good, MPH, MBA, CPC, CMPE, a senior industry advisor at MGMA, addresses these challenges on the Ask MGMA podcast. She notes that while MGMA's DataDive provides staffing benchmarks, "we don’t separate the data by value-based versus fee-for-service models. That makes it important for practices to understand how the philosophies differ and apply the benchmarks with context."
Understanding the Shift in Staffing Models
Fee-for-service (FFS) environments are typically optimized for throughput. Staff roles focus on increasing visit and procedure counts, with core teams composed of physicians, nurses, and medical assistants.
In contrast, VBC relies on interdisciplinary teams with roles such as care coordinators, behavioral health specialists, health coaches, social workers, and data analysts. These teams are designed to proactively manage chronic conditions and social determinants of health, aiming to reduce hospitalizations and improve patient outcomes.
"In value-based care, you're not just staffing for clinical delivery," Good says. "You're staffing for data-informed decision making."
The Role of Technology in VBC Staffing
Technology plays a different role in VBC as well. Practices must invest in staff who are trained not only in electronic health records (EHRs), but also in remote monitoring, telehealth and predictive analytics. These tools are critical for identifying at-risk patients and enabling proactive outreach.
Adjusting Staffing Ratios for Better Outcomes
One of the biggest differences between FFS and VBC is the structure of staffing ratios. In traditional settings, it might be common to see one physician for every 1,800 to 2,000 patients. Under VBC, the physician-to-patient ratio typically decreases, offset by increased support staff. For example, a care coordinator might manage 250 high-risk patients.
Key Metrics to Measure Staffing Effectiveness
To ensure that these teams function effectively, practices must track the right metrics. Good identified key performance indicators that go beyond visit counts:
- Readmission and hospitalization rates
- Chronic disease control metrics (such as HbA1c for diabetes)
- Emergency department utilization
- Per-member-per-month (PMPM) cost
- Patient satisfaction and Net Promoter Scores
- Staff turnover and burnout rates
- Equity in access and outcomes across demographics
"If you can't measure it, you can't manage it," Good says, referencing a common refrain among MGMA experts. Tracking these metrics allows practices to evaluate whether their staffing model supports their population health goals.
Assess Patient Needs First
A strategic first step for practices moving to VBC is to assess their patient population. What chronic conditions are most prevalent? What are the social needs?
"You want to ensure that every team member contributes directly to outcomes," Good emphasizes. For example, in a population with a high prevalence of diabetes, hiring care coordinators skilled in diabetes management may be more effective than adding another physician.
Evolving Roles in VBC Teams
Some roles are expanding rapidly in VBC settings. Health coaches, population health managers, and behavioral health professionals are being added to support self-care, mental health, and care transitions. These roles reduce physician burden and support comprehensive care.
Create a Culture That Supports VBC Staffing
Burnout is a concern in any model, but VBC offers new tools to address it. With better distribution of responsibilities, such as delegating follow-ups to care coordinators, teams function more efficiently. Training in soft skills—empathy and communication—also improves engagement and reduces staff attrition.
Busting the Myths About VBC Staffing
Common assumptions can prevent practices from embracing effective staffing models. Here’s what’s true—and what’s not:
- Myth: VBC means hiring twice as many people.
Fact: It’s not about more people—it’s about different roles. - Myth: VBC is more expensive to staff.
Fact: Initial costs may be higher, but long-term savings through better outcomes often offset those investments. - Myth: One staffing model fits all VBC practices.
Fact: Staffing must be tailored to patient needs and contract goals.
Use Benchmarking and Resources to Guide Strategy
There is no one-size-fits-all model. Good stresses, "It depends entirely on your patient population and your contract goals." Practices should tailor their staffing structures accordingly.
MGMA members can begin with the organization’s staffing benchmarks as a baseline. For those seeking further guidance, studies from JAMA, Luo & Pittman, and Gwynne provide insights on how VBC-aligned clinics organize care teams.
Staffing for VBC is not about adding headcount. It’s about aligning people, roles, and skills with population needs. Practices that adopt this approach are better positioned to meet quality metrics, reduce costs, and deliver high-value care.
Resources
- JAMA Clinical Staffing and Quality of Care in US Health Centers
- Luo & Pittman (2021)
Optimal Staffing in Community Health Centers
Models relationship between staffing ratios and care quality outcomes across VBC-aligned CHCs.
Health Services Research - Proctor (2024)
Staffing Models in Primary Care Clinics
Mixed-method study showing how staffing ratios influence revenue and patient satisfaction in VBC clinics.
ProQuest - Gwynne (2023)
Integrated Chronic Care & VBC Transformation
Defines role alignment and caseload capacity planning for chronic care VBC clinics.
Springer Link
