From Volume to Value: Urgent Care’s Next Big Challenge

Introduction

Healthcare is evolving at an unprecedented pace. Urgent care centers are no exception, as value-based care (VBC) reimbursement models redefine how providers deliver services and how they are compensated. For urgent care operators, understanding this shift is critical—not just for compliance, but for long-term sustainability, growth, and patient satisfaction.

What Is Value-Based Care?

Value-based care rewards providers for quality over quantity—aligning financial incentives with patient outcomes, efficiency, and satisfaction. Instead of simply billing for services rendered, urgent care centers are now encouraged to deliver coordinated, outcome-driven care.

Why It Matters for Urgent Care

Historically rooted in fee-for-service, urgent care must now evolve. Payers are demanding measurable outcomes, cost control, and patient experience—all core to VBC models.

Key Operational Impacts:

• Enhanced Documentation & EMR  Capabilities: Systems like UrgentIQ with AI-coding and real-time eligibility tools streamline reporting and compliance.
• Seamless Care Coordination: Urgent care centers must bridge to primary care and specialty providers via referrals, discharge summaries, and follow-ups.
• Revenue Model Transformation: Performance-based metrics like reduced complications or higher satisfaction — will drive reimbursement.
• Patient Engagement & Satisfaction: Digital tools, portals, and proactive communication enhance outcomes and payer metrics.

Payers Embracing Value-Based Reimbursement

Value based care is already shaping urgent care service delivery. Below is a small snapshot of those payers or healthcare systems who are leading the charge to prepare for this shift.

• Federal Programs (Medicare & Medicaid)
      CMS has ambitious goals — to enroll all Medicare and most Medicaid beneficiaries in value-based programs by 2030. Programs like MSSP (Accountable Care Organizations), bundled payments, and other VBC models already support this shift
• Private Insurers & Integrated Plans
  
   
  • Carelon Health (formerly CareMore), part of Elevance Health, targets high-risk Medicare/Medicaid patients with proactive, coordinated care — delivering outcomes like 42% fewer hospital admissions and 67% fewer diabetic amputations compared to fee-for-service benchmarks
   
  • Atrius Health, as an early adopter in Massachusetts, signed on to Blue Cross Blue Shield’s Alternative Quality Contract (AQC) and participated in CMS’s Pioneer ACO model — consistently achieving high quality and cost metrics
 
• Health System-Insurer Hybrid Models
  
   
  • Kaiser Permanente exemplifies value-based care: integrated insurance and delivery systems focus on prevention and data-driven interventions. Its new initiative, Risant Health, aims to scale this model by bringing in community health systems like Geisinger
 
• Retail & Payer Partnerships
  
   
  • CVS Health acquired Oak Street Health — clinics focused on value-based primary care for Medicare Advantage patients—to deepen its value model and align with payer incentives
   
  • Walgreens partnered with Pearl Health and invested in VillageMD and Summit Health to create value-aligned primary/urgent care services
   
  • Walmart is expanding in-store care centers in collaboration with UnitedHealth Group to deliver value-based care to Medicare Advantage members

Why It Matters for Urgent Care

Aligning with these forward-looking payers means better contracting opportunities, access to training and analytics, and enhanced reimbursement tied to outcomes.

How Urgent Care Centers Can Prepare for Transitioning to Value-Based Care

Transitioning from fee-for-service to VBC requires a strategic roadmap:

1. Upgrade EMR & Analytics Infrastructure
       Adopt systems that support outcome tracking, coding accuracy, and interoperability — boosting readiness for VBC metrics.
2. Forge Payer Alliances
       Engage with Medicare Advantage programs, ACOs, and private insurers increasingly leaning into value models.
3. Train Your Team
       Empower clinicians and staff with education on documentation, risk stratification, and patient engagement.
4. Develop Strong Referral Networks
       Build relationships with primary care and specialists to support continuity and manage patient outcomes.
5. Prioritize Patient Engagement
       Utilize communication tools, reminders, portals, and education to drive satisfaction metrics and preventive care.
6. Pilot & Scale
       Start with targeted VBC initiatives—perhaps with a specific payer or service line—then refine and expand based on performance data.

Strategic Opportunities for Urgent Care Leaders

• Integrate EMR Tools that support value metrics, payer compliance, and workflow efficiency.
• Invest in Data Analytics that highlight gaps and performance drivers tied to VBC.
• Innovate Provider Training around VBC documentation and clinical workflows.
• Explore Risk-Based Contracting with proactive, aligned payers and health systems.

Conclusion

Value-based reimbursement isn't hypothetical — it’s here. By aligning with progressive payers, upgrading systems, and orienting care delivery to outcomes, urgent care centers can thrive in a rapidly evolving reimbursement landscape. Resistance risks revenue loss; adaptation offers leadership and growth.

To learn more about how the right EMR can help you be prepared for these changes, contact us at sales@urgentiq.com

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