Share of Wallet—A Growth Strategy to Support Value-Based Care

The MetroHealth System is a safety-net, essential health system in Cleveland, serving more than 300,000 patients annually with over two-thirds of whom are uninsured or covered by governmental programs. For over the last 15 years, MetroHealth has been aggressively pursuing the transition from fee-for-service to value-based care (VBC), with over 75% of all patients affiliated with a VBC arrangement in 2024. In the changing healthcare market, health systems are needing to refine growth strategies to strengthen their market position and remain competitive.

Traditionally, health systems have focused on market share and expansion through mergers and acquisitions. Augmenting strategic growth strategies to incorporate Share of Wallet can provide additional insights and opportunities to achieve growth objectives. While Share of Wallet is a concept that has been effectively used in other industries, it has not historically been used or monitored in healthcare. This metric can be used for gauging patient loyalty. When effectively used in concert with market share tactics, Share of Wallet can provide a more comprehensive and sustainable approach to strategic growth. Share of Wallet—the amount of money an existing customer (patient) spends at your organization compared to other healthcare organizations—focuses on the patient population for which you already have an established care relationship. Market share—the total amount of revenue within a specific market or market segment—focuses on an entire patient population, regardless if they have engaged with your organization.

In a saturated and competitive healthcare market, new patient acquisition is difficult and costly. Share of Wallet provides an opportunity to leverage existing patient-provider relationships to increase operating revenue organically while improving the integration across the continuum of care and better positioning the health system to impact the total cost of care—a critical objective to optimize performance in VBC. Since constructing a mechanism to calculate and monitor Share of Wallet metrics, MetroHealth has continued to demonstrate a strong performance in VBC across various payer segments (commercial, Medicare and Medicaid), with a contributing factor in that success being the prioritization and visibility of Share of Wallet within the organization.