At the 2025 ACMA National Conference, Marlene Crouse (Vice President, Care Management) and Katie Wilt (Senior Director, Population Health Care Management) of WellSpan Health shared a compelling transformation story: how one of the Pennsylvania region’s largest ACOs redesigned its Ambulatory Care Management model to meet the demands of a rapidly changing healthcare environment.
The Context: Rising Costs and the Shift to Value-Based Care
Healthcare spending in the U.S. is growing at an unsustainable rate—projected to rise by $250 million per day through 2031. At the same time, more than 47% of Medicare-eligible patients are now enrolled in Medicare Advantage as of 2025, signaling a major shift in how care is paid for and delivered; value-based care (VBC) arrangements are becoming the new norm.
On top of rising financial strain, the healthcare system faces serious performance challenges. The U.S. currently ranks 40th in life expectancy worldwide, and health outcomes remain uneven across different populations.
The system isn’t just costly—it often struggles with inefficiency and inequity. For organizations like WellSpan, it was clear that simply maintaining the status quo wasn’t enough. A new approach was needed—especially for reaching and supporting patients in ambulatory and community settings.
What is Value-Based Care
The Center for Medicare and Medicaid Services (CMS) defines value-based care as “health care that is designed to focus on the quality of care…doctors and other health care providers work together to manage a person’s overall health while considering an individual’s personal health goals.”
The Challenge: Care Management Burnout and Misalignment
WellSpan’s Ambulatory Care Management model had become too broad and unspecialized. Care managers were tasked with handling everything from clinical coordination to social needs navigation—roles that extended far beyond their original scope. As Katie Wilt put it:
“Too often care managers find themselves being the ‘end all be all.’ When that happens, we lose focus and burn out our teams.”
This approach led to inefficiencies, missed opportunities to engage the right patients at the right time, and growing team fatigue. Without a clear structure or operating model, care management efforts weren’t being targeted where they could have the most impact.
The Solution: A Three-Part Transformation to Advance Value-Based Care
WellSpan responded with a full redesign of its ambulatory care management strategy, focusing on three key dimensions: refocusing roles, upgrading technology and analytics, and strengthening operations.
1. Refocusing Care Management
The first step was clarifying what care managers should—and shouldn’t—be doing. WellSpan prioritized interventions with the highest return on impact and created pathways for lower-risk patients to access support through self-service and technology. This allowed care managers to direct their expertise toward more complex cases, without becoming overwhelmed by tasks better handled elsewhere.
2. Leveraging Analytics and Technology
Analytics played a central role in helping teams work smarter. WellSpan shifted from using claims-based risk scores to more nuanced, multidimensional models that integrated clinical data and demographic factors. They implemented LACE scores to better identify patients at risk during care transitions and embedded referral workflows directly into the EMR. ADT alerts also helped care teams stay ahead of patient needs, routing referrals automatically and prioritizing outreach based on real-time risk.
3. Enhancing the Operating Model
Operational changes ensured that strategy translated into day-to-day action. Specialized teams were created for value-based and non-value-based populations, recognizing that different reimbursement models require different approaches. New roles were introduced for pharmacy and behavioral health care managers.
Frontline care teams gained access to tools like Uber Health accounts and digital referral platforms to support non-clinical needs. Embedding care team members in primary care offices created immediate access to social services, improving coordination without slowing down clinical workflows.
The Results: Empowering Care Teams and Enhancing Patient Engagement
Key Takeaways:
- Proactive care management outreach soared from 17% to 94%.
- 5,738 hours of contact time tied to low-risk cases are now being redirected to where it matters most.
This transformation serves as a roadmap for how technology and optimized operations can facilitate the shift to value-based care. With innovations like intelligent referral routing, self-service tools, advanced risk stratification, and digital care coordination, there are countless opportunities to drive this transformation.
The focus of the model now centers on impactability—targeting areas where the system can have the most meaningful effect on patient outcomes.
As Katie Wilt emphasized, “Care Management isn’t about doing everything for the patient—it’s about giving them the keys to the car. The goal is empowerment: allowing patients and their care partners to take charge of their own journey, with the right guidance and tools to succeed.”