We turn visit-level revenue and labor data into a single, actionable score.
About VVI
The Visit Value Index™ (VVI)- A framework for today's leaders and tomorrow's AI Agents.
As healthcare systems adopt AI-driven operational agents, most attempt to train them on fragmented financial indicators and blunt, lagging metrics.
The Visit Value Index™ (VVI) provides what those agents, and leaders, lack: A structured, interpretable framework that translates financial inputs into operational meaning.
- A single standardized efficiency score
- Clear revenue and labor sub-factors
- A 16-scenario diagnostic matrix
- Action pathways that can be automated
What the VVI Does
The VVI converts noisy financial statements into a single, interpretable score using three universal inputs:
- Visits
- Net Operating Revenue
- Total Labor Cost
With one number, VVI shows where value is created or leaking, and which lever to pull next. When two optional budget inputs are added, results adjust to your organization’s targets.
The outcome: a clear diagnostic view of performance, featuring tiered scoring, sub-factor analysis, and an expanded prescriptive matrix.
Simple. Actionable. Insightful.
Why It Works
VVI reframes traditional metrics, such as salary and wages as a percent of revenue, into a per-visit efficiency model built on the two levers you directly control:
- Net Revenue per Visit (NRPV): Your earning strength
- Labor Cost per Visit (LCV): Your largest expense
Together, these form an interpretable score revealing the balance between revenue, labor, and operational reliability.
The Four-Tier Scoring Model
Excellent: Strong revenue/labor balance. Maintain and monitor.
Stable: Operationally sound. Target small gains in weaker factors.
At Risk: Efficiency decline affecting margins. Investigate Revenue/Labor drivers.
Critical: Unsustainable performance. Immediate corrective action required.
This scoring model gives leaders a fast, reliable way to benchmark, compare, and prioritize support across clinics.
Diagnosis → Prescriptive Actions
Beneath the overall score are two deeper diagnostic layers:
- Revenue Factor (RF): How effectively each visit generates revenue
- Labor Factor (LF): How efficiently each visit is staffed
These layers pinpoint whether issues stem from front-end revenue leakage or back-end staffing inefficiency.
RF and LF combine to create 16 diagnostic scenarios, each paired with targeted prescriptive actions tailored to the pattern your scores reveal.
Why It Matters for AI
In short, VVI is the operational language, the framework, AI agents can understand, learn from, and act on. It bridges financial insight, human behavior, and algorithmic intelligence, ensuring tomorrow’s decision-support tools are trained with sharper instruments.
I’ve always hoped the tools I’ve built have helped those I’ve had the privilege to lead, and now, I hope this one helps you.
-Michael Bramhall, Founder, Bramhall Consulting, LLC
predict. perform. prosper.
A special shoutout to the team at Tribytics for bringing the VVI calculator online. You truly provide clarity amidst complexity and precision in performance! Visit this innovative and talented team at: https://www.tribytics.com/
About the founder:
Michael Bramhall is a healthcare operations leader and consultant with more than 30 years of frontline and executive experience. Beginning his career as a medical assistant, Michael spent the next three decades rising through leadership roles across multi-state urgent care and occupational health networks. For the past 15 years, he has served in senior and executive positions overseeing hundreds of clinics, thousands of caregivers, and complex operational and financial performance portfolios.
Because he has worked at every level of healthcare, from rooming patients to steering multi-market operations, Michael brings a rare blend of analytical discipline and deep operational empathy. He understands the pressure operators face: unclear financial signals, rising labor costs, shifting volumes, staffing volatility, burnout, and the overwhelming flow of dashboards and reports that often lack actionable clarity.
This lived experience is what led him to develop operator-first tools such as the Visit Value Index™ (VVI), the VVI Performance Driver Assessment (VPDA), and the Predictive Coverage Model (PCM). These frameworks help leaders cut through financial noise, prevent staffing drift, stabilize operations, and build repeatable systems of performance that work across clinics, regions, and entire markets.
Michael’s work focuses on restoring clarity, structure, and predictability to clinical environments, so teams can perform at their best without being overwhelmed by operational chaos. Through Bramhall Consulting, he partners with organizations nationwide to build reliable, efficient, and financially strong clinics capable of thriving in today’s healthcare environment and tomorrow’s AI-enabled landscape.
predict. perform. prosper.
Our Products & Services:
VVI App Full Access
- Real-time operational visibility into VVI, RF, LF, NRPV, and LCV — allowing leaders to detect performance drift early and intervene before margin erosion occurs.
- AI-powered coaching (AI Coach) that interprets results, explains root causes, drafts talking points, and guides leaders on what to do next — instantly and consistently.
- Standardized performance framework that aligns operators, clinic managers, and finance teams around a single clear way of measuring and discussing performance.
- Scenario-driven insight packs that turn raw data into prescriptive guidance with root causes, action plans, risks, and expected impact.
- Executive-ready narratives that help leaders communicate results, set expectations, and run highly effective morning huddles and staff updates.
- What-if simulation tools allowing users to model revenue or labor improvements and immediately see their impact on VVI, RF, and LF.
- Leadership development at scale, using AI-driven explanations and structured insights to elevate manager capability without requiring additional oversight or training.
- Consistent accountability rhythm, enabling daily, weekly and/or monthly email performance checks with clear benchmarks, movement signals, and action steps.
- ROI: VVI is designed to pay for itself through better, earlier decisions. Adopting just one prescriptive action, such as tightening a staffing template, correcting a recurring registration issue, or improving documentation consistency, will more than cover the monthly cost. Even modest improvements typically return several multiples of the annual licensing cost.
Enterprise & Platform Licensing
VVI is designed to be both highly standardized and configurable, so your organization can preserve methodological consistency while tailoring VVI to fit your operational reality.
Enterprise customers may configure:
1) Standard Targets + Benchmarks
- Service-line specific targets (Urgent Care, Occ Health, Primary Care, Specialty, etc.)
- Region-or market-specific wage environments and labor norms
- Normalized benchmarks tied to internal “what good looks like”
- Threshold ranges and tolerance bands aligned to your existing scorecard practices
2) Prescriptive Action Logic (Algorithmic Playbooks)
VVI’s built-in diagnostic guidance can be customized to reflect your organization’s approved operational playbooks and change-management approach.
This includes:
- Action pathways tied to RF/LF patterns (what to do first, second, and third)
- Role-specific prescriptions (clinic manager vs. regional director vs. finance partner)
- Guardrails to prevent “harmful efficiency moves” (e.g., staffing cuts that compromise throughput or quality)
- Escalation rules (when to trigger deeper review, support deployment, or finance involvement)
The result is not just a score, it becomes a standardized decision engine, aligned to your internal operating model.
3) VVI AI Coach / Agent Configuration
For organizations building AI-driven decision support, VVI can serve as the interpretation framework and coaching logic behind an AI performance coach.
The AI Coach can be configured to match your organization’s standards, culture, and workflows, including:
- Your preferred language, tone, and leadership expectations
- Embedded policies (approved staffing models, productivity rules, throughput standards)
- Role-based coaching (frontline, regional ops, finance, executives)
- Integration into daily/weekly management routines (huddles, scorecard reviews, KPI alerts)
- “Next best action” recommendations driven by VVI diagnostics, not generic analytics
This creates a scalable, explainable AI layer that doesn’t just find patterns, it follows your organization’s governed playbooks and standardization practices.
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