How PureView Health Center and Montana Health Plus Built a Scalable Model for Rural Value-Based Care Transformation

The Challenge

Like many community health centers, PureView recognized that traditional fee-for-service models were increasingly misaligned with the needs of its patient population.

The organization understood that improving outcomes would require more than simply increasing visit volume. Success would depend on proactively identifying high-risk patients, addressing care gaps earlier, improving chronic disease management, strengthening patient engagement, and creating a sustainable care management and coordination model.

Initially, however, the organization had limited resources.

The Solution

For PureView, the transition was not simply about participating in new payment models. It required fundamentally changing how the organization identified risk, engaged patients, coordinated care, and measured performance.

“Healthcare has shifted from quantity to quality,” said Duncan. “We realized that if we wanted to improve outcomes and be successful in value-based arrangements, we needed a way to better understand our patient population and intervene earlier.”

Through MTH+, PureView gained access to network-level support that many health centers often struggle to build independently, including population health expertise, value-based contracting support, coding education, quality reporting guidance, and peer learning opportunities.

At the same time, Azara’s DRVS platform provided the population health management and analytics capabilities needed to turn those strategies into action. By integrating clinical, claims, payer, and health information exchange (HIE) data into a single longitudinal patient record, DRVS gave care teams a comprehensive view of patient risk, utilization, quality performance, and care opportunities. This unified view enabled providers to identify high-cost, high-risk patients, prioritize interventions, and measure performance across value-based contracts.

A combination of integrated data, network support, and interdisciplinary collaboration enabled PureView to shift from reactive care delivery toward a more proactive and sustainable population health model.

This combination of integrated data, network support, and interdisciplinary collaboration enabled PureView to shift from reactive care delivery toward a more proactive and sustainable population health model.

“Data is really what drives all of this work. It allows us to identify opportunities, measure progress, and support health centers in making informed decisions about where to focus their efforts.”

Breann Streck, RN, BSN, CPC, Senior Practice Transformation Coach at Montana Health Plus

The Results

Over the past several years, PureView’s investments in leadership alignment, interdisciplinary workflows, data transparency, and proactive population health management have translated into measurable improvements across patient engagement, quality performance, and value-based care readiness.

These gains created a sustainable financial foundation that allowed PureView to reinvest in staffing, expand care management capabilities, and continue advancing its value-based care strategy.

Looking Ahead

MTH+ and PureView continue to expand their value-based care capabilities, including broader deployment of care management technologies, enhanced utilization management strategies, and additional support for health centers at varying stages of value-based care maturity.

Their experience demonstrates that successful transformation does not require massive investments or large-scale organizational restructuring at the outset.

Instead, sustainable progress is built through:

• Strong leadership commitment

• Shared accountability across teams

• Transparent performance data

• Interdisciplinary workflows

• Strategic use of analytics and technology

• Continuous learning and collaboration

As healthcare continues its shift toward value-based reimbursement, rural providers face increasing pressure to improve outcomes while managing limited resources and workforce constraints. PureView and MTH+ have demonstrated that with the right combination of data, partnerships, and organizational alignment, health centers can not only adapt to this changing landscape, they can lead it.

Today, the partnership serves as a model for how community health centers can successfully transition from volume to value, creating more proactive, coordinated, and financially sustainable systems of care.

For organizations beginning their own value-based care journey, PureView’s experience demonstrates that success is less about starting with abundant resources than it is about building the right partnerships, empowering care teams, and using data to drive action. When those elements come together, meaningful transformation becomes both measurable and sustainable.