Presented by: Scott LaVigne, Health Director, Franklin County Health Department
Hosted by: Patagonia Health
Moderator: Monique Dever
Good afternoon, everybody, and welcome to today’s webinar, From Volume to Outcomes: Measuring Success in a Value-Based Environment.
My name is Monique Dever, and I’ll be your moderator for today’s presentation. More importantly, our presenter is Scott LaVigne, Health Director for the Franklin County Health Department.
Scott has served for nine years as the County Director of Community Services in upstate New York. Prior to coming to Franklin County, North Carolina, he was CEO of a county-operated outpatient mental health and substance abuse clinic. Each year, he developed a data-informed county plan in the areas of mental health, substance abuse, and developmental disability services.
Mr. LaVigne also held leadership positions in the New York State Conference of Local Mental Hygiene Directors and served as Chair of that organization before accepting his current role. He has over 29 years of behavioral health experience, including administrative and clinical management of outpatient substance abuse and mental health clinics, as well as a successful private practice.
Before relocating to North Carolina, he worked extensively in New York State with state and local officials to develop and implement oversight mechanisms for Medicaid-managed behavioral healthcare.
Mr. LaVigne holds:
- A Bachelor of Arts in Psychology from Hope College
- A Master of Social Work from Boston College
- A Master of Business Administration from St. John Fisher College
He has been the Health Director in Franklin County, North Carolina since November 2016.
Scott:
Thank you very much. Thanks for having me.
Embracing Data and Change
True confession: my name is Scott, and I am a recovering data nerd. I love big data and cannot lie. I believe in embracing the inner data nerd within.
I once attended a conference on pivot tables, and one of my peers said, “Pivot tables changed my life.” I couldn’t help myself—I said, “Amen.”
We don’t suffer from a lack of data. What we suffer from is a lack of ability to translate that data into actionable information. That’s what today’s discussion is really about—understanding how to make data meaningful in a value-based environment.
Transitioning to Value-Based Care
Across the country, healthcare systems are transitioning from a service-based model to an outcome-based model. North Carolina, like most states, is moving in that direction through the 1115 Medicaid waiver.
The goal is clear: CMS will pay managed care organizations (MCOs) and provider-led entities a per member, per month rate to deliver quality patient outcomes.
So the question becomes: how does your agency prepare for this inevitable shift?
Some management teams are forward-thinking, scanning the horizon, and leading their organizations into this new landscape. Others resist change, hoping it won’t happen. But it will happen. And in fact, it’s already happening in other sectors.
Existing Value-Based Practices
Several movements already focus on value-based and outcome-driven care, including:
- The Triple Aim Initiative (improving patient outcomes, satisfaction, and per capita cost)
- Behavioral health integration into primary care
- Focus on social determinants of health
- Motivational interviewing and behavioral support for chronic conditions
- Trauma-informed care approaches
- Provider report cards and transparency metrics
Value-based care, or value-based purchasing, is essentially a way of showing how effective your programs are at improving people’s lives.
Defining Value
So what is value? How do we measure it?
A useful definition came from Josh Rubin, formerly with the New York City Department of Health. He framed value in a simple equation:
Value = (Satisfaction + Outcomes) × Volume ÷ Cost
This formula captures the main components of value. Let’s unpack them.
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Satisfaction
Many of us already measure satisfaction—patient surveys, staff surveys, community feedback.
But high satisfaction doesn’t necessarily equal high value. For instance, early in my work with Franklin County’s home health agency, satisfaction scores were excellent, but our outcomes told a different story. Patients were satisfied because we didn’t challenge them to change behavior—but that wasn’t helping them.
To deliver true value, satisfaction must exist across patients, providers, and payers. Strive for “good enough satisfaction”—balanced across all stakeholders.
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Volume
Volume is familiar territory. We measure:
- Units of service
- Number of procedures
- Unique patients seen
You need sufficient volume to sustain operations, but volume alone doesn’t create value. A clinic could see few patients with great results, but unsustainable costs would negate overall value. The key is balance.
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Cost
Every service has a real cost. Understanding your true cost structure is critical.
Cost is the denominator in the value equation, but cutting costs alone doesn’t create value. Not everyone can operate like Walmart.
If you can deliver high satisfaction, reasonable volume, and strong outcomes—even with higher costs—you’re still delivering great value.
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Outcomes
Outcomes are where we need the most improvement. Do patients actually get better? How do we know?
Most of what we collect now are process metrics (access to care, wait times, utilization). True outcome metrics measure improvement in health and function.
The HEDIS (Healthcare Effectiveness Data and Information Set) is a good example. It measures process quality across seven domains, but most metrics are still process-based rather than outcome-based.
Ultimately, process measures are not enough. We need tools that measure true patient improvement.
The Home Health Model (OASIS)
One existing model that effectively links outcomes to reimbursement is the OASIS system (Outcome and Assessment Information Set) used by CMS for home health agencies.
It’s used:
- To determine eligibility for home health care
- For care planning
- As a pre- and post-assessment tool to measure progress
CMS publishes quality reports and star ratings based on OASIS data, and since 2015, reimbursement rates have been directly tied to performance.
This model shows how outcomes and satisfaction can—and likely will—be linked to payment across healthcare sectors, including Medicaid and primary care.
Measuring Outcomes in Practice
To prepare, agencies must adopt tools that measure outcomes meaningfully.
In Franklin County, I chose the Daily Living Activities-20 (DLA-20) from MTM Services. It measures 20 functional domains, including employment, housing, and social determinants of health.
We obtained a grant to fund training and implementation. Once trained, our staff can use it permanently with no recurring costs.
Why measure outcomes now, before it’s required?
- The Hawthorne Effect: When people know they’re being measured, performance improves.
- You’ll build a data foundation before mandates begin.
- You can identify and improve weaknesses proactively.
- It strengthens negotiation with managed care payers.
- It helps align human resources and QA/QI processes.
Real-World Example
In behavioral health, I once had a therapist who worked primarily with high-needs clients diagnosed with borderline personality disorder. Her productivity was lower than average, but her clients stayed out of the hospital—reducing strain on the rest of the system.
By analyzing outcomes, I could show her work provided immense value, even if her “volume” appeared low.
This is a shift in thinking—from individual productivity to organizational value.
Steps in Your Value-Based Journey
- Evaluate your current model – What do you measure now (volume, satisfaction, cost)?
- Identify your value niche – Where are you strongest? Outcomes? Efficiency? Cost control?
- Collect outcome data – Use consistent tools across programs for apples-to-apples comparisons.
- Balance satisfaction across stakeholders – Patients, providers, and payers all matter.
- Know your real costs – Understand what it takes to deliver great value.
Remember, good value will generate good revenue. Focus on improving value, and the financial rewards will follow.
Examples from Franklin County
- Integrated Behavioral Health
- Our primary care and maternal health clinics are integrating behavioral health services.
- Many chronic conditions (obesity, diabetes, heart disease) have behavioral components.
- A therapist can help patients change behavior, even if not billable under current systems.
- In a value-based model, improved outcomes will bring reimbursement later.
- Our primary care and maternal health clinics are integrating behavioral health services.
- Grant Projects
- We secured funding for motivational interviewing and trauma-informed care training.
- Using the DLA-20 tool, we can demonstrate measurable improvement for our grant funders.
- We secured funding for motivational interviewing and trauma-informed care training.
Both examples show how outcome measurement benefits organizations today—even outside a clinical billing structure.
Audience Q&A Highlights
Q: When is it “too late” to start preparing for value-based care?
A: It varies by state, but start now. Preparing early allows you to negotiate stronger contracts later. The shift is inevitable.
Q: How will this affect public health programs?
A: Many public health programs lack strong outcome evaluation. Start integrating value-based measurement now to compare programs and demonstrate impact.
Q: What about internal resistance to change?
A: The hardest part is often with billing teams and reporting systems, since current metrics focus on units of service. We must begin redefining success based on outcomes, not just revenue or volume.
Q: Are there other tools like the DLA-20?
A: Yes, but it depends on your program type. Talk with other early adopters and organizations already using value-based approaches to identify suitable tools.
Scott:
Thank you all very much for your time today.
Monique:
Thank you, Scott, for your presentation, and thanks to everyone for joining us. We hope you found this webinar informative and valuable.
Have a great day, everyone.
