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Closing Value-Based Care Gaps To Capture $11M in Unrealized Revenue

Over a three-year period, a large academic healthcare system faced concerns from rising costs of care, missed quality targets and unrealized revenue. The organization was seeking to move into more advanced risk-based value contracts and wanted to ensure it could remain successful. At the same time, an increase in staffing levels without commensurate financial returns raised concerns about whether resources, workflows and care delivery were optimally aligned to capture the full financial opportunity in these contracts. The hospital’s leadership engaged FTI Consulting to assess their Population Health programs to identify revenue opportunities, evaluate their model’s ability to support more advanced risk-based contracts, assess their care management staffing model and better understand the potential disconnect between resource investment and financial performance.

Our Impact

FTI Consulting’s provider performance standardization strategy demonstrated a clear pathway to capture up to $11 million in unrealized value-based care revenue by maximizing value-based contracts.
Leadership was able to pinpoint where revenue leakage, quality shortfalls and rising cost-of-care trends were limiting financial performance.
We defined a scalable approach to improve gap closure and increase patient satisfaction by enhancing network provider engagement, standardizing quality workflows and enabling more personalized care delivery.

Our Role

FTI Consulting performed actuarial and financial analysis of multiyear value-based contract results, quality performance, cost trends and revenue opportunities.
The team identified improvement levers and developed an implementation roadmap by evaluating care management models, staffing productivity, workflows and accountability structures.
Our experts analyzed the root causes of contract underperformance and uncovered quality measure performance shortfalls and revenue leakage due to lack of coordinated care management and cost-of-care increases.
We developed an actionable implementation roadmap to improve care management execution, provider engagement and value-based contract portfolio performance without adding staff by recommending a streamlined operating model with redesigned roles and workflows.