When Dr. Candace Fugate, pediatrician and Chief Medical Officer of Trusted Doctors, opened her recent talk, she posed a question every medical leader should be asking:

“Are you meeting your quality goals as efficiently as possible?”

It’s a simple question with profound implications—because in today’s healthcare environment, efficiency isn’t just about productivity. It’s about aligning your workflows, your reimbursement models and your mission so that quality care and financial performance move in tandem.

The money you’re leaving on the table

Dr. Fugate didn’t hesitate to connect quality metrics to financial outcomes.

“If you’re not doing SDOH screening,” she said, “you’re leaving money on the table. The executive at CareFirst? He’s out buying cars with the money you’re not getting paid.”

Her message was clear: workflows that ignore opportunities for value-based reimbursement aren’t just inefficient—they’re costly. To evaluate those workflows effectively, Dr. Fugate uses four guiding rules.

Rule #1: Volume pays

“Volume is the most impactful driver of your bottom line,” Dr. Fugate explained. “If I can help each of our four locations see just one more patient per day, that’s $200,000 more per year.”

Every workflow should make it easier—not harder—to serve more patients. Value-based care, when implemented strategically, can actually increase volume.

“ADHD recalls, well visits, vaccine reminders—they all drive patient volume,” she said. “And that volume drives revenue.”

The principle holds true for every specialty: proactive patient engagement, recall programs and preventive outreach boost both outcomes and revenue.

Rule #2: Does it serve the mission?

Every organization has a mission, and for Dr. Fugate, that mission is simple: take care of people.

“Vaccines do that. Vaccines are good. Measles? Bad. No debate,” she said with a smile.

Whether you care for children, manage chronic disease, or perform complex procedures, the guiding question remains the same: Does this workflow help us fulfill our mission of delivering better care?

If not, it’s time to redesign it.

Rule #3: Protect the “golden time”

The “golden time,” Dr. Fugate emphasized, is the face-to-face interaction between provider and patient—the only place where real change happens.

“It’s not in the waiting room, no matter how nice your fish tank is,” she quipped.

When used well, technology enhances that time instead of eroding it. Digital questionnaires completed before a visit, for example, can equip providers with vital context before they walk into the exam room.

“I ask my providers how they feel about screeners,” she said. “They tell me, ‘It lets me know what I’m walking into.’ That matters. If you know before entering the room that a patient screens positive for depression, you can act on it. If you find out afterward? It’s too late.”

Rule #4: Don’t fall for the sunk cost fallacy

Dr. Fugate cautioned against clinging to outdated systems simply because you’ve already invested in them.

“Just because you paid for something doesn’t mean you should keep using it,” she said. “It’s like watching a terrible movie all the way through just because you spent $10 on the ticket.”

She illustrated the point with a vivid metaphor: two cavemen dragging a cart of coal. Someone offers them a wheel, but they refuse. “We already paid for this cart.”

“The cost is gone. The contract is signed,” she said. “So ask yourself: What change could increase your revenue without dramatically increasing your costs? That’s the mindset we need moving forward.”

The takeaway

Dr. Fugate’s message applies across all specialties: lasting success in value-based care requires both clinical insight and operational courage.

To thrive, practices should continually ask:

• Does this workflow help us serve more patients?
• Does it align with our mission of better care?
• Does it protect provider-patient interaction?
• And are we brave enough to move on from what no longer works?

Efficiency isn’t about doing more—it’s about doing what matters, better.

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