How VVI Works
How VVI Works
The Visit Value Index™ (VVI) simplifies complexity into clarity. By utilizing three key inputs—Visits, Net Operating Revenue, and Total Labor Cost—the VVI assesses efficiency based on industry-standard financial metrics. When you add two additional inputs, it customizes results to align with your organization’s budget targets. This results in a clear, diagnostic view of healthcare performance, featuring tiered scoring, sub-factor analysis, and an expanded prescriptive matrix. Simple. Actionable. Insightful. A Smarter Way to See Performance.
Developed by Bramhall Consulting, LLC, the VVI transforms financial data into actionable operational insight. It reframes traditional metrics—like salary and wages as a percent of revenue—into a per-visit efficiency model that highlights the two most controllable levers of performance:
- Net Revenue per Visit (NRPV): Your earning strength
- Labor Cost per Visit (LCV): Your largest expense
Together, these create a single, interpretable score that exposes the balance between revenue, labor, and operational efficiency.
Analysis: More than just a metric, the VVI is a management discipline. It empowers leaders to diagnose issues, act with confidence, and measure improvement—connecting finance and operations through a shared language. The Four-Tier Scoring Model - VVI Score Ranges:
- Excellent - Strong Balance of Revenue and Labor - Maintain and Monitor
- Stable - Operationally Sound - Target Small Gains in Weak Factors
- At Risk - Efficiency decline impacting margins - Investigate RF/LF drivers and act
- Critical - Unsustainable, efficiency and margin compromised - Immediate corrective action needed
This model provides leaders with a fast, reliable way to benchmark, compare, and prioritize support across clinics.
Diagnosis/Prescription: Beneath the overall score are two diagnostic layers:
- Revenue Factor (RF) – Identifies how effectively each visit generates revenue
- Labor Factor (LF) – Measures how efficiently each visit is staffed.
These layers explain why performance appears as it does—pinpointing whether issues stem from front-end revenue leakage or back-end staffing inefficiency. The VVI score, alongside its RF and LF sub-scores, generates 16 diagnostic scenarios, each linked to a corresponding prescriptive action tailored to the specific performance pattern revealed by your scores.
The Visit Value Index™ bridges financial insight and operational execution—guiding leaders from VVI assessment to diagnosis (RF/LF factors) to prescription (targeted action). In a world where AI finance tools deliver data but not always interpretation, VVI delivers clarity.
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.
Origin of VVI
The Origin of the Visit Value Index™ (VVI)
Throughout my career I’ve sought better ways to understand performance, going beyond just the numbers on a financial statement to uncover what they really mean—insights into efficiency, effort, and balance.
Over the last 20 years, I’ve developed numerous staffing models, predictive tools, scorecards, and action plans. Each initiative enhanced my ability to identify where a clinic was overstaffed, underutilized, or not reaching its full potential. However, irrespective of the complexity of the system, one consistent truth emerged: the best way to grasp performance was by analyzing revenues and expenses per visit.
In 2023, I decided to advance that principle further by designing a unique model that not only measures financial results but also evaluates healthcare performance through efficiency per visit. I began creating formulas, testing sub-formulas, and weighting them to accurately reflect the drivers of performance in the field. As the logic matured, I turned to AI finance tools to validate and refine my approach.
By the time I completed the foundational work, I had dedicated over 90 hours collaborating with ChatGPT and pressure-testing with GROK. What began as a straightforward concept—a better way to interpret per-visit economics—transformed into a comprehensive framework.
This collaboration between human expertise and AI intelligence culminated in the Visit Value Index™ (VVI), a model that integrates Net Revenue per Visit (NRPV) and Staffing Wages & Benefits (SWB) per Visit into a single, actionable measure of operational performance.
The VVI assessment quickly evolved into a diagnostic system featuring Revenue and Labor Factors, visual scoring, and prescriptive insights, effectively bridging the longstanding gap between finance and operations.
The VVI is more than just a formula; it represents years of inquiry into performance, people, and the narratives our financial metrics convey.
Thank you for reading.
— 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 Bramhall Consulting, LLC
About Michael Bramhall
Michael Bramhall is a seasoned healthcare operations leader with over 30 years of experience across multi-state urgent care and occupational health networks. Known for transforming underperforming systems into high-performing networks, he has overseen more than 100 clinics and led rapid expansions in complex, multi-market environments. As
Michael Bramhall is a seasoned healthcare operations leader with over 30 years of experience across multi-state urgent care and occupational health networks. Known for transforming underperforming systems into high-performing networks, he has overseen more than 100 clinics and led rapid expansions in complex, multi-market environments. As the founder of Bramhall Consulting, Michael now partners with healthcare organizations to enhance profitability, access, and sustainability through precision-built operational models like the Visit Value Index (VVI) assessment and the upcoming Predictive Coverage Model (PCM), set to launch in Q1 2026. His innovative approach integrates data analytics and AI finance tools to track financial metrics, alongside frontline empathy and leadership discipline, enabling operators to predict, perform, and prosper in healthcare performance.
Mission
To bring clarity, precision, and predictability to healthcare operations, Bramhall Consulting leverages AI finance tools to enhance financial metrics and improve healthcare performance. By utilizing intelligent analytics, operational discipline, and data-driven leadership, organizations can transition from reactive management to proactive performance, including effective VVI assessment.
Vision
Vision
To redefine how healthcare leaders perceive and manage healthcare performance, Bramhall Consulting leverages AI finance tools. By combining real-world operational expertise with artificial intelligence, we transform disconnected data into actionable direction — creating systems that measure financial metrics and anticipate performance through VVI assessment.
Values
Vision
At Bramhall Consulting, we simplify complexity, turning data into understanding and insights into action. Our approach to utilizing AI finance tools ensures that precision is at the forefront; we believe accuracy creates confidence, and confidence drives better decisions. We prioritize accountability by measuring what matters and owning t
At Bramhall Consulting, we simplify complexity, turning data into understanding and insights into action. Our approach to utilizing AI finance tools ensures that precision is at the forefront; we believe accuracy creates confidence, and confidence drives better decisions. We prioritize accountability by measuring what matters and owning the outcomes our insights influence, particularly in the realm of financial metrics.
Our commitment to innovation lies in fusing human experience with AI intelligence to enhance healthcare performance. With integrity, we present the truth in numbers — transparent, grounded, and always aligned with client success, including insights from our VVI assessment.