Podcasts about care coordination

There's a number attached to every patient's chart that quietly shapes the resources they receive, the care they're offered, and whether their health conditions are fully seen — and most providers don't fully understand it. In this episode, Jamie sits down with Ericka Bauman, Director of Quality Assurance at Your Health, to break down the Risk Adjustment Factor — better known as the RAF score. Ericka has spent years traveling across Georgia and South Carolina, walking into provider offices, sitting with care teams, and doing the work of turning confusing data into meaningful patient outcomes. What you'll hear in this episode: What the RAF score actually is — explained the way Erica explains it to every team she visits, from providers to front desk staff Why most RAF scores are too low — and how underdocumenting a patient's conditions leaves them exposed to missed care, hospitalizations, and unmet needs The biggest misconception providers have about RAF (hint: it's not another box to check) How RAF and quality measurement are really asking the same question from two different angles — and why treating them separately is a mistake What changes for patients when care teams show up prepared, proactive, and looking at the whole person — not just the reason for today's visit The numbers will follow when you take care of the patient. This episode will show you how. www.YourHealth.Org

Most nursing homes think they're measuring success by how many patients move through their building. What they're not measuring is how many of those same patients end up right back in the hospital — and who pays the price when they do. In this episode of The Disrupted Podcast, Scott Middleton — Owner of Your Health and Chief Disruption Officer — pulls back the curtain on the facility partnership model Your Health is rolling out across the Southeast. It's a model that doesn't just serve patients in skilled nursing facilities; it pays those facilities for the care coordination work their staff is already doing, while creating the kind of presence that actually moves the needle on outcomes. Scott and Jamie cover the mechanics, the competitive landscape, and the cultural shift required to make it all work: Why Your Health is contracting with nursing homes to pay up to $20,000 a month for care coordination — and what that's worth annually to a facility with 200 Medicare patients The difference between "popping in" and genuine presence — and why only one of them drives real cost savings and keeps patients from bouncing back to the hospital Why physicians working in isolation are the biggest liability in a team-based care model, and how a September 1st bonus restructure is designed to change that culture How 80% of what used to require an in-person visit can now happen via telehealth — and the one thing technology will never replace: the relationship that makes a patient actually follow through Scott's 10-year urgency: why Your Health is already three steps ahead of the competition — and why that lead only matters if the model scales fast enough If you work in a nursing facility, lead a care team, run a healthcare organization, or believe the system needs a fundamentally better architecture — this is what building it actually looks like. Press play. www.YourHealth.Org

What if the biggest threat to your healthcare organization isn't competition or reimbursement rates — it's the moment one of your team members decided that the policy was more important than the person in front of them? In this episode, Jamie sits down with Matt Staub, CEO of Your Health, to explore the timeless "Give 'Em the Pickle" philosophy — born in a burger joint, but almost perfectly designed for healthcare. Matt and Jamie unpack the four pillars of the pickle framework — service, attitude, consistency, and teamwork — and trace each one directly into the reality of patient care, care team dynamics, and organizational culture. Video LinkGive Em The Pickle Youtube Video   What you'll hear in this episode: Why charging a loyal customer 75 cents for extra pickles is the same mistake healthcare makes every day — and how the Ritz Carlton's $2,500 employee empowerment policy points to a better way How attitude isn't just a soft skill — it's the infrastructure of every patient interaction, including the ones where you're already having a bad day Why mistakes in healthcare aren't failures — they're invitations, and the patients who complained and felt heard often become your fiercest advocates What real consistency looks like in care delivery: not doing the same thing robotically, but doing ordinary things extraordinarily well, every single time How teamwork in healthcare means every person in the organization — from the CEO to the community health worker — has a role in whether the patient feels seen and served This episode will challenge you to look at service not as a department or a satisfaction score, but as the very soul of what your organization stands for. Give 'em the pickle.

Most nursing home administrators don't realize they're sitting on one of the most underutilized revenue streams in all of Medicare — and until someone shows up and tells them what it's worth, they never will. In this episode, Scott Middleton — founder and Chief Disruption Officer of Your Health — calls in from the road as he travels across rural Georgia on a multi-day facility tour, fresh off completing a major merger with TCPA. What follows is an unfiltered, on-the-ground breakdown of two transformational opportunities Scott is actively building: chronic care management (CCM) reimbursement and ACO cost savings — and the very specific reasons most of the industry is getting both wrong. In this episode, you'll hear: Why Medicare already pays $65/hour for care management performed by nurses, community health workers, and social workers — and how Your Health is now contracting with nursing home facilities to perform it, paying them up to $100 per patient per month The "Fuse" platform — a communication and documentation tool that routes care management notes directly into billing-ready buckets, syncing with point-of-care software so the minutes get captured and billed automatically How ACO risk scores work, why Your Health's scores have grown 30% under their current plan, and what failing to see hospice patients could cost the organization — up to $22 million in a single year The $4,800 per patient per year problem: how one physician in their network was quietly rated one of the worst under the ACO model simply because his patients were going home without any follow-up Scott's announcement that SSAs and TCPs are being restructured to report directly to peer group administrators — and why the confusion about their roles has cost the company If you lead a nursing home, an assisted living facility, a physician group, or any organization inside the long-term care ecosystem, this episode will change how you look at what you're already doing — and what you're leaving behind. www.YourHealth.Org

What does it look like the day a healthcare merger closes — not in a press release, but in real life? Scott Middleton was still signing DocuSign documents from his car when Jamie Preston hit record, and what followed is one of the most honest conversations yet about what it takes to grow a healthcare organization without losing the soul of why you started. Scott Middleton, Owner of Your Health and Chief Disruption Officer, joins the show to break down the just-completed acquisition of TCPA and Providence Care — and what it means to suddenly be responsible for 32 nursing home buildings, 900 new patients, and the enormous operational lift of pulling it all together under one roof. In this episode, Scott and Jamie cover: Why Your Health is immediately deploying two nurses and two community health workers per building — and how the revenue model makes them essentially self-funding from day one The continuous care hospice strategy: how night nurses on call can simultaneously generate $67/hour in Medicare reimbursement and ensure no patient dies alone The critical failure Scott discovered — hospice patients who haven't been seen by a provider since January, and the financial and human cost of letting that slide Why strategic planning lives in the field, not the boardroom — and what happens when leaders stop getting out from behind their desks The 30-day integration sprint: switching all providers to Athena, connecting hospice nurses to nurse practitioners, and getting risk scores captured before it's too late This is what disruption actually sounds like — not a keynote, not a case study, but a leader in motion, making decisions in real time, building something the healthcare system has never seen. If you're in healthcare, business, or just believe the way things have always been done is not good enough — this one's for you. www.YourHealth.Org

Entrepreneurship Beyond Unicorns: Passion, Failure, and Fixing Mental Health with David Crane   Ken Okonek interviews veteran entrepreneur David Crane about myths of entrepreneurship, emphasizing that most founders are middle-class people working 80–100 hours and should pursue passion over money. Crane shares his healthcare-focused career, advice on finding passion by intersecting what you love with what you're good at, and the importance of research, coachability, and building advisory teams to improve odds in a space where most startups fail. He describes learning through failure, managing founder anxiety by stepping out of the weeds, and the challenges of rapid growth. Crane explains his healthcare ventures focused on communication and care coordination, and his pivot into mental health after his sons' struggles during COVID, including ListenRing for on-demand urgent mental health therapy and a peer-support platform for parents. Both discuss stigma, employer underuse of mental health resources, and giving back through volunteering.   00:00 Welcome and Guest Intro 00:45 Entrepreneurship Beyond Unicorns 02:31 Myths and Realities of Startups 03:42 Chase Passion Not Money 04:54 Finding Your Passion Sweet Spot 09:38 Turning Ideas Into Action 11:30 Overcoming Paralysis by Analysis 15:48 Failure as a Business Requirement 18:05 Advisory Boards for Growth 19:07 Healthcare Roots and First Venture 22:21 Care Coordination and Communication 23:18 Mental Health Pivot and New Platforms 27:41 Peer Led Advice 29:37 Liz Finds Support 31:15 Stigma And Pay 34:04 Workplace Stigma 36:07 EAP Not Used 37:59 Founder Anxiety 41:48 Panic Coping Skills 43:19 Owner To CEO 46:58 Managing Growth 50:02 Purpose And Giving 52:06 Wrap And Subscribe

What if the most powerful growth strategy in hospice and primary care had nothing to do with your clinical protocols, your technology stack, or your marketing budget — and everything to do with who shows up, and how often? In this episode of The Disrupted Podcast, Scott Middleton — founder and Chief Disruption Officer of Your Health — unpacks the real-world lessons shaping how your Health is staffing, growing, and rebuilding trust as it integrates the newly merged TCPA and Providence Care organizations. Scott spent the week in the field — Monroe, Georgia; Beaufort, South Carolina; Atlanta and beyond — sitting in care team meetings, talking to nurses, watching exercise classes, and rethinking everything from staffing ratios to personality matching. What he found is both a warning and a blueprint. In this episode: Why minor service failures — a nurse who didn't show up once — can cost you an entire facility relationship, and what it actually takes to earn it back The strategic case for pulling a nurse off a shared caseload and planting her full-time in a single building — even when the numbers don't fully justify it yet The story of a nurse so embedded in one facility that an administrator told Your Health: "I will cut you if you move her" How DISC personality profiles should determine which staff member walks into which building — and why getting it wrong creates friction that kills referrals Why the best talent you'll ever hire is already living in the community you serve — and why your recruiters will never find them on Indeed The centralize-then-decentralize model Your Health deploys every time it launches something new — and why it's the only way to scale without losing quality If you lead a care team, run a hospice program, manage a building, or are trying to grow in any direction in healthcare right now — this episode is your field guide. www.YourHealth.Org

In this episode, Dr Sara Ann Scott and Dr Syeda Saba Kareem discuss toxicities and the safe management of bispecific antibodies used in the treatment of RRMM to improve outcomes for patients, including: The incidence of cytokine release syndrome (CRS), along with the grading system, treatment strategies, and the role of tocilizumab Neurologic toxicities like the clinical manifestation of ICANS and the ICE scoring system used to help assign grading and appropriate treatment with dexamethasone, levetiracetam, and/or high-dose methylprednisolone Infection susceptibilities associated with BCMA-targeted bispecific antibodies and how this varies for GPRC5D-directed targets throughout therapy How to set up and maintain a REMS program Get access to all of our new podcasts by subscribing to the Decera Clinical Education Podcast on Apple Podcasts, YouTube Music, or Spotify. Presenters: Syeda Saba Kareem, PharmD, BCOP Clinical Pharmacy Supervisor Malignant Hematology Moffitt Cancer Center Tampa, Florida Sara A. Scott, PharmD, BCOP Clinical Pharmacy Specialist,  Multiple Myeloma Emory Winship Cancer Institute Atlanta, Georgia Link to full program: https://bit.ly/3RUyrMx Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

What happens to a family when "wellness" stops meaning saunas and cold plunges and starts meaning keeping the lights on? In this episode, host Erin Gallardo, PT, DPT, NCS, talks with Russell Meyerowitz, founder of the Parkinson's Wellness Fund, about how the needs of families living with Parkinson's have shifted from health-and-wellness support toward urgent emergency relief — and what that means for the clinicians who serve them. Russell shares why his organization issues no-judgment relief grants for everything from walkers and ramps to groceries and utility bills, why they're now fielding two to three applications every 24 hours, and how those years on the front lines led to the launch of Raya Health, a subscription-based care-coordination platform that keeps a family's medications, appointments, documents, and clinical notes in one shared place. He and Erin dig into the continuity-of-care gaps neuro clinicians see every day, why care coordination is crucial, and the forthcoming "Ask Raya" feature for surfacing medication and exercise trends over time. It's a warm, candid conversation about being proactive instead of reactive — and about having a stranger in your corner when Parkinson's makes life feel like survival. Links mentioned:  Parkinson's Wellness Fund — parkinsonswellnessfund.org Raya Health — raya-health.com Instagram: Parkinson's Wellness Fund and Raya Health HQ Use this promo code for 100% free access to Raya Health! RAYALOVESNEURO

What if the reason your boss wants you in the office has nothing to do with your productivity — and everything to do with their ego? Scott Middleton admits it: he walked around his 30,000-square-foot corporate office on a Friday afternoon, found nobody, and got irritated. Then he caught himself. The data said his team was productive. The irritation was his ego talking. That moment of self-awareness opens a much bigger conversation about what happens when leaders — in business and in healthcare — stop reading the evidence and start acting on assumption. In this episode of The Disrupted Podcast, Scott and Jamie dig into: Why most CEOs pushing return-to-office mandates are solving for ego, not outcomes — and the New York Times data that proves it How Your Health is shifting from counting patients to measuring risk scores — and why that changes everything about how care teams are built The "legs grow back on January 1st" problem: how the Medicare system loses patient diagnoses every year and why hospice patients often appear healthier right before they die Why misinterpreting hospice rules is putting patients on the wrong track — and costing providers in ways they don't see coming The role of chaplains in advanced care planning, and why getting that right could reduce hospitalizations and change end-of-life outcomes South Carolina's jump from 49th to 26th in healthcare quality rankings — and what it means for the rest of the country Scott closes with a mission statement that's hard to argue with: at 67, he could have retired. He didn't. If this conversation lights something up in you, share it with someone who needs to hear it. www.YourHealth.Org

The American healthcare system is built around a simple idea: get sick, get treated. But what if the problem isn't how we treat illness — it's that we've never seriously tried to prevent it? In this first installment of a two-part conversation, Jamie sits down with Brody Wall, Division President of Operations at Your Health, to trace the arc from a broken, reactive healthcare system to one where data tells you what's coming before the patient even knows something is wrong. Brody's path to healthcare wasn't through a textbook — it was through a father who was a Methodist minister and a mother who spent her career caring for underprivileged children. The mission was always there. The data just became the most honest way to fulfill it. In Part 1, Jamie and Brody cover: Why fee-for-service healthcare financially rewards volume of sick visits — not health — and how that one incentive structure explains why 17-20% of America's GDP goes to healthcare costs with outcomes that still lag behind other developed nations What Your Health was flying blind on before it committed to building a real data infrastructure — and what gut-feeling decisions look like when data finally proves them wrong How social determinants of health (Z codes) and behavioral health conditions (F codes) reveal which patients are actually at the highest risk of hospitalization The finding that changed everything: patients with four or more behavioral health conditions were ten times more likely to have multiple ER visits — and the clinical response that followed This isn't just a conversation about numbers. It's about what happens when an organization decides that preventing the crisis matters more than reacting to it. Part 2 drops next week. www.YourHealth.Org

Credentialing rarely makes headlines, but it plays a critical role in determining how quickly patients can access care, how providers join health plan networks, and how healthcare organizations maintain quality at scale. In this episode of Quality Matters, host Tsveta Polhemus examines why credentialing has become one of the most important foundations for modern healthcare delivery—especially as virtual care continues expanding across states and specialties. Joining the conversation are Sharon Meers, President and Co-Founder of Midi Health, and Greg Smith, Director of Operations at Evernorth Health Services. Together, they explore how credentialing impacts providers, payers, and patients alike, and why standardized, trusted processes are essential for improving access while maintaining confidence in care. Sharon shares Midi Health's remarkable growth from approximately 20 clinicians to nearly 800 providers serving patients nationwide. As the organization rapidly expanded across all 50 states, credentialing and payer enrollment became one of its greatest operational challenges. She explains how achieving NCQA Credentialing Accreditation enabled delegated credentialing with major national payers, reducing enrollment timelines from months to just days and allowing patients to access care sooner. Greg offers the payer perspective, discussing how credentialing supports network adequacy, strengthens audit readiness, and creates greater consistency across provider networks. He explains why recognized standards help reduce administrative friction while giving health plans greater confidence in the organizations they partner with. The episode concludes with a Patient Voice segment featuring Carroll Schreibman, who shares her experience navigating perimenopause symptoms after years of searching for answers. She reflects on how quickly accessing virtual care through Midi Health transformed her health, work, and quality of life—and why listening to patients remains central to delivering meaningful care. As healthcare delivery continues evolving, one message becomes clear: credentialing isn't simply a compliance exercise. It's the infrastructure that enables trusted, timely, and equitable access to quality care. Highlights Credentialing Enables Access Credentialing determines how quickly providers can begin seeing patients, making it one of the most important drivers of timely access to care. Scaling Virtual Care Responsibly Midi Health shares how standardized credentialing supported rapid national expansion while maintaining consistency and quality. Trusted Standards Build Confidence NCQA Credentialing Accreditation creates a common framework that strengthens relationships between providers, payers, and patients. The Payer Perspective Credentialing helps health plans improve network adequacy, streamline oversight, and reduce administrative burden while supporting quality care. A Patient's Experience Carroll Schreibman shares how timely virtual access to menopause care helped restore her quality of life after years of unanswered questions.     Key Quote "Credentialing isn't just a compliance requirement—it's the infrastructure that makes timely, trusted, high-quality care possible." — Sharon Meers     Time Stamps - Waiting on Final File (00:00) Why Credentialing Matters More Than Ever (01:52) Meet Sharon Meers & Greg Smith (05:43) A Patient's Journey to Virtual Care (09:25) Credentialing 101: Why It Matters (12:12) How Delegated Credentialing Improves Access (14:36) Scaling Midi Health from 20 to 800 Clinicians (18:00) Balancing Speed, Quality, and Trust (24:44) Measuring Patient Access and Outcomes (28:47) The Future of Credentialing and Virtual Care (33:25) Patient Voice: Carroll Schreibman's Story (42:47) Key Takeaways and Closing Thoughts     Links & Resources NCQA Credentialing Accreditation Learn more about Midi Health Learn more about Evernorth Health Services Connect with Sharon Meers Connect with Greg Smith Connect with Carroll Schreibman Connect with Tsveta Polhemus Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

As healthcare organizations seek to reduce avoidable readmissions and improve patient outcomes, many are exploring how AI can help bridge gaps in post-discharge care. Patty Hayward joins Michael to discuss the evolving role of AI-driven care coordination, where automation can create value, and why the human element remains critical to successful patient engagement.

What if the patient you discharged three years ago is still costing you money today? In this episode of The Disrupted Podcast, Scott Middleton pulls back the curtain on the mechanics of value-based care most providers never see — and the merger bringing it all into focus. With the July 15th closing date approaching, Scott walks through what the merger of Your Health with TCPA and Providence Care actually means on the ground: new contracts, new provider numbers, a reimbursement model built on RAF scores and revenue rather than guesswork, and a technology stack — from the Clini app to QR-coded patient wristbands — designed to capture what was previously left on the table. In this episode: Why patient attribution under value-based contracts follows you for years — and what hospice discharges are really costing the organization How the new bonus structure ties pay to billing, RAF scores, and quality measures (and why you can never be paid to put someone on hospice) The difference between care management, facilitated visits, and what providers have been under-billing all along How skilled nursing facilities became the highest-leverage opportunity in the entire model Why advanced care plans aren't just clinical — they're a 30% income increase hiding in plain sight If you've ever wondered why the "why" behind a process matters more than the process itself, this episode is the answer. Press play. www.YourHealth.Org

What if the patient never noticed the merger at all? For Matt Staub, that's not a failure — it's the goal. In this episode, Your Health CEO Matt Staub sits down with Jamie to talk through the company's merger with TCPA and Providence Care — a move that brings together similar footprints in primary care, palliative, hospice, skilled nursing, and assisted living across South Carolina and Georgia. As a 23-year healthcare veteran going through his first merger, Matt is candid about the tedious due-diligence "earnest money" phase, the EMR transitions ahead, and why he refuses to let "what could go wrong" crowd out "what could go right." You'll hear: Why "mass moves mass" — and what scale actually buys patients in care management and data analytics How Your Health breaks 50,000 patients into groups, teams, and "hubs" so no one falls through the cracks The "change is hard" philosophy and the discipline of productive (not just effective) communication How the spirit of agape — godly love — still threads through a company that's evolved far past its original name What success looks like in six months: patient retention, mission and margin If you lead through change — or live through it — this one will reframe how you think about getting bigger without losing what made you matter.

What if the most important care in the entire healthcare system is also the most underfunded? While hospitals and inpatient reimbursements rise with inflation, the physician fee schedule has quietly declined roughly 33% in real terms over 25 years — and this year it's facing another cut. In this episode, Jamie Preston sits down with Your Health CEO Matt Staub, just back from Capitol Hill, where he spent a record-setting 95-degree day meeting with seven legislative offices to advocate for physicians, providers, and the patients they serve across rural South Carolina, Georgia, and beyond. What follows is part field report, part reflection on why preventive primary care saves money and lives — and why we plan meticulously for weddings, retirement, and vacations, but treat our own health with a "call us if something happens" approach. In this conversation: Why a 2.5–5% physician fee cut hits frontline rural practices hardest The bipartisan doctors' caucus and the real appetite for reform Why winning can come from a loss — the Kobe Bryant mindset on process over outcome How a Disney ride (Spaceship Earth) reframes humanity's whole story around communication The case for proactive, team-based primary care over reactive sick visits Press play for a conversation about advocacy, communication, and a simple, powerful idea: the change you need to make starts with you.

This episode recorded live at the Becker's Spring 2026 Payer Issues Roundtable features Liz Signorella, Senior Director of Payor Contracting, Clover Health. She discusses reducing administrative burdens for providers, leveraging AI and real-time data to support proactive care, and improving patient outcomes through stronger care coordination and earlier intervention.In collaboration with Hippocratic AI.

This episode of Quality Matters examines the growing role of digital wellness and chronic condition management programs and the challenge of measuring what truly matters. Host Rachel Harrington is joined by Peter Robertson of the Purchasing Business Group on Health and California Quality Collaborative and Kevin Masci of Omada Health to discuss how digital health solutions can help address rising healthcare costs, workforce shortages and fragmented care experiences. Peter and Kevin explain why meaningful engagement goes far beyond app downloads and login counts. Instead, successful programs focus on sustained participation, patient-centered goal setting, integration with primary care and measurable improvements in health outcomes. The conversation explores how employers, health plans and providers are evaluating digital solutions through clinical outcomes, patient-reported outcomes, utilization measures and value-based contracting arrangements. The guests also discuss one of the most important challenges facing digital health: trust. Privacy, transparency, data security and clear communication about how patient data is collected and used all play critical roles in long-term adoption. The episode concludes with a Patient Voice segment featuring Brandee Hicks, who shares her firsthand experiences using digital health tools, highlighting both the convenience they offer and the ongoing challenges around interoperability, digital literacy and maintaining support after programs end.     Highlights Beyond Logins and Clicks Meaningful engagement isn't about how often patients open an app. It's about helping people achieve their health goals through sustained participation and measurable outcomes. Measuring What Matters Guests discuss the growing use of clinical outcomes, patient-reported outcomes, utilization data and value-based contracting to assess digital health program performance. Trust Is Essential Digital health solutions must address concerns around privacy, transparency, data security and how patient information is stored and shared. The Patient Perspective Brandee Hicks shares how digital tools can improve organization, access and self-management while also revealing gaps in continuity, support and interoperability. Looking Ahead The future of digital health depends on better integration with primary care, more personalized engagement strategies and stronger measurement frameworks that prioritize patient outcomes.     Key Quote: "If we're really serious about improving health outcomes, we have to move beyond measuring clicks and logins. The real question is whether people are achieving meaningful progress toward their health goals—and whether these programs are creating lasting value for patients, providers and purchasers alike." — Kevin Masci     Time Stamps: (02:20) Meet Peter Robertson (03:45) Meet Kevin Masci (05:53) Why Digital Solutions Matter (10:01) Care Coordination, Not Care Fragmentation (11:52) Defining Meaningful Patient Engagement (15:07) Why Consistent Measurement Matters (18:32) Measuring Outcomes in Value-Based Contracts (21:12) Data Stratification, Risk Adjustment and Performance Guarantees (27:22) Privacy, Trust and Transparency in Digital Health (30:44) The Future of Digital Wellness and Chronic Care Management (35:08) Patient Voice: Brandee Hicks (40:25) Patient Challenges, Access and Continuity of Care (45:23) Key Takeaways and Closing Thoughts     Dive Deeper: Connect with Peter Robertson Connect with Kevin Masci Connect with Brandee Hicks Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

What if your healthcare team already knew what happened during your hospital stay — before you even explained it? What if someone on your care team noticed you were struggling on a Saturday and simply showed up? In this episode, Jamie sits down with Christopher Laffey, Nurse Practitioner at Your Health, to break down what a truly connected, proactive model of care actually looks like when it's working. Christopher practices in North Charleston, SC, where his team — nurses, therapists, social workers, community health workers, and more — functions less like a traditional office practice and more like a living, breathing safety net woven around each patient's real life. What you'll hear in this episode: Why most patients are failing not because nobody cares, but because the system itself is fragmented — and what doing it differently actually looks like on a Tuesday morning The real difference between "patient-centered" as a marketing phrase and patient-centered as a daily practice (hint: it involves seeing the medication bottles on the kitchen table) A powerful real-life story of a bedbound patient whose caregiver suddenly disappeared — and how the team mobilized over a weekend, on their own time, to prevent a hospitalization The single mindset shift every clinician needs to make the transition from visit-based thinking to longitudinal care Why "value-based care" doesn't mean discounted care — it means the organization is accountable for your outcomes, not just your appointments If you've ever left a doctor's appointment feeling more confused than when you walked in, this episode will show you what healthcare can feel like when it's actually designed around you. www.YourHealth.Org

In this episode, Shailu Verma, CEO and Co-Founder, Mila Health, discusses how AI agents are transforming care coordination, patient follow-up, and healthcare accessibility through personalized, multilingual support. He also shares insights on building scalable AI solutions, improving patient engagement, and reducing healthcare costs while maintaining high-quality care.

Heads up — this is Part 2 of Jamie's conversation with Jaclyn Taylor If you haven't heard Part 1 yet, go back and start there. It sets up everything we unpack today. Most healthcare teams are working hard. They're just not working together. And the patient is the one absorbing the cost. In this second half of the conversation, Jamie and Jaclyn move from the why into the how. What does it actually look like when a provider stops responding to today's schedule and starts managing an entire patient panel? How do you turn a community health worker, a pharmacist, a PT, and a social worker into one coordinated team instead of four parallel ones? And what's the difference between data that produces reports and data that produces decisions? You'll hear: Why "frequent touches" only work when they're connected — and how fragmented touches still land patients back in the hospital The quarterback model — what it actually means for a provider to own a patient's trajectory, not just their visit The shift from seeing patients to managing a population — and why most providers were never taught how Why we don't have a resource problem in healthcare — we have an orchestration opportunity How to use technology and data without drowning in either What "showing up" really means inside a system that isn't perfect yet This is the episode for anyone trying to lead change from inside a system that's still catching up. Press play. www.YourHealth.Org

What if every "non-compliant" patient was actually a signal that the system isn't working for them? In this episode, Jamie sits down with Jaclyn Taylor, Clinical Strategy Director at Your Health and a nurse practitioner who started her career as a home-based provider in 2020 — thrown straight into the fire of COVID, isolated patients, and a healthcare world rewriting itself in real time. What she saw inside patients' homes — medications scattered on tables, food insecurity, missing transportation — changed how she thinks about every chart she's ever read. You'll hear: Why a nurse-first pathway gives nurse practitioners a fundamentally different lens than a medical school pathway — and why patients feel it What working across home care, telehealth, trauma, and wellness teaches you about treating the whole human, not just the diagnosis Why trauma surgery turned Jacqueline into a believer in proactive, longitudinal care — and what gets missed when we only meet patients after something has already gone wrong The two words she uses to describe what's most broken in traditional healthcare: fragmentation and misalignment How empathy stops being a poster and starts being operational — built into the design of care itself If you've ever felt invisible inside the healthcare system, or if you're the one trying to fix it, this conversation reframes the whole game. Press play. www.YourHealth.Org

- Role of Caregivers in Care Coordination for People Living with Cancer & Co-Morbidities - What Research Tells Us About Caregivers, Including Long Distance Caregivers - Coordinating Follow-Up Appointments - Discussion of Adherence – Taking Pills on Schedule - Planning Ahead with Your Pharmacist: Lead Time in Refilling Prescriptions & Planning for Weekends, Travel & Holidays - Accessing Resources for the Costs of Care, Including Homecare - Finding the Practical Help You Need: Co-Pay Foundations, Federal, State & Local Programs - Learning How to Appeal Insurance, Medicare & Provider Denials - Tips on Choosing Community & Medical Resources to Improve Your Quality of Life - Strategies to Communicate More Effectively with the Health Care Team - Time Saving Self Care/Self Advocacy Tips for Caregivers - Questions for Our Panel of Experts

- Role of Caregivers in Care Coordination for People Living with Cancer & Co-Morbidities - What Research Tells Us About Caregivers, Including Long Distance Caregivers - Coordinating Follow-Up Appointments - Discussion of Adherence – Taking Pills on Schedule - Planning Ahead with Your Pharmacist: Lead Time in Refilling Prescriptions & Planning for Weekends, Travel & Holidays - Accessing Resources for the Costs of Care, Including Homecare - Finding the Practical Help You Need: Co-Pay Foundations, Federal, State & Local Programs - Learning How to Appeal Insurance, Medicare & Provider Denials - Tips on Choosing Community & Medical Resources to Improve Your Quality of Life - Strategies to Communicate More Effectively with the Health Care Team - Time Saving Self Care/Self Advocacy Tips for Caregivers - Questions for Our Panel of Experts

- Role of Caregivers in Care Coordination for People Living with Cancer & Co-Morbidities - What Research Tells Us About Caregivers, Including Long Distance Caregivers - Coordinating Follow-Up Appointments - Discussion of Adherence – Taking Pills on Schedule - Planning Ahead with Your Pharmacist: Lead Time in Refilling Prescriptions & Planning for Weekends, Travel & Holidays - Accessing Resources for the Costs of Care, Including Homecare - Finding the Practical Help You Need: Co-Pay Foundations, Federal, State & Local Programs - Learning How to Appeal Insurance, Medicare & Provider Denials - Tips on Choosing Community & Medical Resources to Improve Your Quality of Life - Strategies to Communicate More Effectively with the Health Care Team - Time Saving Self Care/Self Advocacy Tips for Caregivers - Questions for Our Panel of Experts

- Role of Caregivers in Care Coordination for People Living with Cancer & Co-Morbidities - What Research Tells Us About Caregivers, Including Long Distance Caregivers - Coordinating Follow-Up Appointments - Discussion of Adherence – Taking Pills on Schedule - Planning Ahead with Your Pharmacist: Lead Time in Refilling Prescriptions & Planning for Weekends, Travel & Holidays - Accessing Resources for the Costs of Care, Including Homecare - Finding the Practical Help You Need: Co-Pay Foundations, Federal, State & Local Programs - Learning How to Appeal Insurance, Medicare & Provider Denials - Tips on Choosing Community & Medical Resources to Improve Your Quality of Life - Strategies to Communicate More Effectively with the Health Care Team - Time Saving Self Care/Self Advocacy Tips for Caregivers - Questions for Our Panel of Experts

- Role of Caregivers in Care Coordination for People Living with Cancer & Co-Morbidities - What Research Tells Us About Caregivers, Including Long Distance Caregivers - Coordinating Follow-Up Appointments - Discussion of Adherence – Taking Pills on Schedule - Planning Ahead with Your Pharmacist: Lead Time in Refilling Prescriptions & Planning for Weekends, Travel & Holidays - Accessing Resources for the Costs of Care, Including Homecare - Finding the Practical Help You Need: Co-Pay Foundations, Federal, State & Local Programs - Learning How to Appeal Insurance, Medicare & Provider Denials - Tips on Choosing Community & Medical Resources to Improve Your Quality of Life - Strategies to Communicate More Effectively with the Health Care Team - Time Saving Self Care/Self Advocacy Tips for Caregivers - Questions for Our Panel of Experts

- Role of Caregivers in Care Coordination for People Living with Cancer & Co-Morbidities - What Research Tells Us About Caregivers, Including Long Distance Caregivers - Coordinating Follow-Up Appointments - Discussion of Adherence – Taking Pills on Schedule - Planning Ahead with Your Pharmacist: Lead Time in Refilling Prescriptions & Planning for Weekends, Travel & Holidays - Accessing Resources for the Costs of Care, Including Homecare - Finding the Practical Help You Need: Co-Pay Foundations, Federal, State & Local Programs - Learning How to Appeal Insurance, Medicare & Provider Denials - Tips on Choosing Community & Medical Resources to Improve Your Quality of Life - Strategies to Communicate More Effectively with the Health Care Team - Time Saving Self Care/Self Advocacy Tips for Caregivers - Questions for Our Panel of Experts

- Role of Caregivers in Care Coordination for People Living with Cancer & Co-Morbidities - What Research Tells Us About Caregivers, Including Long Distance Caregivers - Coordinating Follow-Up Appointments - Discussion of Adherence – Taking Pills on Schedule - Planning Ahead with Your Pharmacist: Lead Time in Refilling Prescriptions & Planning for Weekends, Travel & Holidays - Accessing Resources for the Costs of Care, Including Homecare - Finding the Practical Help You Need: Co-Pay Foundations, Federal, State & Local Programs - Learning How to Appeal Insurance, Medicare & Provider Denials - Tips on Choosing Community & Medical Resources to Improve Your Quality of Life - Strategies to Communicate More Effectively with the Health Care Team - Time Saving Self Care/Self Advocacy Tips for Caregivers - Questions for Our Panel of Experts

- Role of Caregivers in Care Coordination for People Living with Cancer & Co-Morbidities - What Research Tells Us About Caregivers, Including Long Distance Caregivers - Coordinating Follow-Up Appointments - Discussion of Adherence – Taking Pills on Schedule - Planning Ahead with Your Pharmacist: Lead Time in Refilling Prescriptions & Planning for Weekends, Travel & Holidays - Accessing Resources for the Costs of Care, Including Homecare - Finding the Practical Help You Need: Co-Pay Foundations, Federal, State & Local Programs - Learning How to Appeal Insurance, Medicare & Provider Denials - Tips on Choosing Community & Medical Resources to Improve Your Quality of Life - Strategies to Communicate More Effectively with the Health Care Team - Time Saving Self Care/Self Advocacy Tips for Caregivers - Questions for Our Panel of Experts

- Role of Caregivers in Care Coordination for People Living with Cancer & Co-Morbidities - What Research Tells Us About Caregivers, Including Long Distance Caregivers - Coordinating Follow-Up Appointments - Discussion of Adherence – Taking Pills on Schedule - Planning Ahead with Your Pharmacist: Lead Time in Refilling Prescriptions & Planning for Weekends, Travel & Holidays - Accessing Resources for the Costs of Care, Including Homecare - Finding the Practical Help You Need: Co-Pay Foundations, Federal, State & Local Programs - Learning How to Appeal Insurance, Medicare & Provider Denials - Tips on Choosing Community & Medical Resources to Improve Your Quality of Life - Strategies to Communicate More Effectively with the Health Care Team - Time Saving Self Care/Self Advocacy Tips for Caregivers - Questions for Our Panel of Experts

- Role of Caregivers in Care Coordination for People Living with Cancer & Co-Morbidities - What Research Tells Us About Caregivers, Including Long Distance Caregivers - Coordinating Follow-Up Appointments - Discussion of Adherence – Taking Pills on Schedule - Planning Ahead with Your Pharmacist: Lead Time in Refilling Prescriptions & Planning for Weekends, Travel & Holidays - Accessing Resources for the Costs of Care, Including Homecare - Finding the Practical Help You Need: Co-Pay Foundations, Federal, State & Local Programs - Learning How to Appeal Insurance, Medicare & Provider Denials - Tips on Choosing Community & Medical Resources to Improve Your Quality of Life - Strategies to Communicate More Effectively with the Health Care Team - Time Saving Self Care/Self Advocacy Tips for Caregivers - Questions for Our Panel of Experts

- Role of Caregivers in Care Coordination for People Living with Cancer & Co-Morbidities - What Research Tells Us About Caregivers, Including Long Distance Caregivers - Coordinating Follow-Up Appointments - Discussion of Adherence – Taking Pills on Schedule - Planning Ahead with Your Pharmacist: Lead Time in Refilling Prescriptions & Planning for Weekends, Travel & Holidays - Accessing Resources for the Costs of Care, Including Homecare - Finding the Practical Help You Need: Co-Pay Foundations, Federal, State & Local Programs - Learning How to Appeal Insurance, Medicare & Provider Denials - Tips on Choosing Community & Medical Resources to Improve Your Quality of Life - Strategies to Communicate More Effectively with the Health Care Team - Time Saving Self Care/Self Advocacy Tips for Caregivers - Questions for Our Panel of Experts

- Role of Caregivers in Care Coordination for People Living with Cancer & Co-Morbidities - What Research Tells Us About Caregivers, Including Long Distance Caregivers - Coordinating Follow-Up Appointments - Discussion of Adherence – Taking Pills on Schedule - Planning Ahead with Your Pharmacist: Lead Time in Refilling Prescriptions & Planning for Weekends, Travel & Holidays - Accessing Resources for the Costs of Care, Including Homecare - Finding the Practical Help You Need: Co-Pay Foundations, Federal, State & Local Programs - Learning How to Appeal Insurance, Medicare & Provider Denials - Tips on Choosing Community & Medical Resources to Improve Your Quality of Life - Strategies to Communicate More Effectively with the Health Care Team - Time Saving Self Care/Self Advocacy Tips for Caregivers - Questions for Our Panel of Experts

- Role of Caregivers in Care Coordination for People Living with Cancer & Co-Morbidities - What Research Tells Us About Caregivers, Including Long Distance Caregivers - Coordinating Follow-Up Appointments - Discussion of Adherence – Taking Pills on Schedule - Planning Ahead with Your Pharmacist: Lead Time in Refilling Prescriptions & Planning for Weekends, Travel & Holidays - Accessing Resources for the Costs of Care, Including Homecare - Finding the Practical Help You Need: Co-Pay Foundations, Federal, State & Local Programs - Learning How to Appeal Insurance, Medicare & Provider Denials - Tips on Choosing Community & Medical Resources to Improve Your Quality of Life - Strategies to Communicate More Effectively with the Health Care Team - Time Saving Self Care/Self Advocacy Tips for Caregivers - Questions for Our Panel of Experts

- Role of Caregivers in Care Coordination for People Living with Cancer & Co-Morbidities - What Research Tells Us About Caregivers, Including Long Distance Caregivers - Coordinating Follow-Up Appointments - Discussion of Adherence – Taking Pills on Schedule - Planning Ahead with Your Pharmacist: Lead Time in Refilling Prescriptions & Planning for Weekends, Travel & Holidays - Accessing Resources for the Costs of Care, Including Homecare - Finding the Practical Help You Need: Co-Pay Foundations, Federal, State & Local Programs - Learning How to Appeal Insurance, Medicare & Provider Denials - Tips on Choosing Community & Medical Resources to Improve Your Quality of Life - Strategies to Communicate More Effectively with the Health Care Team - Time Saving Self Care/Self Advocacy Tips for Caregivers - Questions for Our Panel of Experts

- Role of Caregivers in Care Coordination for People Living with Cancer & Co-Morbidities - What Research Tells Us About Caregivers, Including Long Distance Caregivers - Coordinating Follow-Up Appointments - Discussion of Adherence – Taking Pills on Schedule - Planning Ahead with Your Pharmacist: Lead Time in Refilling Prescriptions & Planning for Weekends, Travel & Holidays - Accessing Resources for the Costs of Care, Including Homecare - Finding the Practical Help You Need: Co-Pay Foundations, Federal, State & Local Programs - Learning How to Appeal Insurance, Medicare & Provider Denials - Tips on Choosing Community & Medical Resources to Improve Your Quality of Life - Strategies to Communicate More Effectively with the Health Care Team - Time Saving Self Care/Self Advocacy Tips for Caregivers - Questions for Our Panel of Experts

- Role of Caregivers in Care Coordination for People Living with Cancer & Co-Morbidities - What Research Tells Us About Caregivers, Including Long Distance Caregivers - Coordinating Follow-Up Appointments - Discussion of Adherence – Taking Pills on Schedule - Planning Ahead with Your Pharmacist: Lead Time in Refilling Prescriptions & Planning for Weekends, Travel & Holidays - Accessing Resources for the Costs of Care, Including Homecare - Finding the Practical Help You Need: Co-Pay Foundations, Federal, State & Local Programs - Learning How to Appeal Insurance, Medicare & Provider Denials - Tips on Choosing Community & Medical Resources to Improve Your Quality of Life - Strategies to Communicate More Effectively with the Health Care Team - Time Saving Self Care/Self Advocacy Tips for Caregivers - Questions for Our Panel of Experts

- Role of Caregivers in Care Coordination for People Living with Cancer & Co-Morbidities - What Research Tells Us About Caregivers, Including Long Distance Caregivers - Coordinating Follow-Up Appointments - Discussion of Adherence – Taking Pills on Schedule - Planning Ahead with Your Pharmacist: Lead Time in Refilling Prescriptions & Planning for Weekends, Travel & Holidays - Accessing Resources for the Costs of Care, Including Homecare - Finding the Practical Help You Need: Co-Pay Foundations, Federal, State & Local Programs - Learning How to Appeal Insurance, Medicare & Provider Denials - Tips on Choosing Community & Medical Resources to Improve Your Quality of Life - Strategies to Communicate More Effectively with the Health Care Team - Time Saving Self Care/Self Advocacy Tips for Caregivers - Questions for Our Panel of Experts

- Role of Caregivers in Care Coordination for People Living with Cancer & Co-Morbidities - What Research Tells Us About Caregivers, Including Long Distance Caregivers - Coordinating Follow-Up Appointments - Discussion of Adherence – Taking Pills on Schedule - Planning Ahead with Your Pharmacist: Lead Time in Refilling Prescriptions & Planning for Weekends, Travel & Holidays - Accessing Resources for the Costs of Care, Including Homecare - Finding the Practical Help You Need: Co-Pay Foundations, Federal, State & Local Programs - Learning How to Appeal Insurance, Medicare & Provider Denials - Tips on Choosing Community & Medical Resources to Improve Your Quality of Life - Strategies to Communicate More Effectively with the Health Care Team - Time Saving Self Care/Self Advocacy Tips for Caregivers - Questions for Our Panel of Experts

- Role of Caregivers in Care Coordination for People Living with Cancer & Co-Morbidities - What Research Tells Us About Caregivers, Including Long Distance Caregivers - Coordinating Follow-Up Appointments - Discussion of Adherence – Taking Pills on Schedule - Planning Ahead with Your Pharmacist: Lead Time in Refilling Prescriptions & Planning for Weekends, Travel & Holidays - Accessing Resources for the Costs of Care, Including Homecare - Finding the Practical Help You Need: Co-Pay Foundations, Federal, State & Local Programs - Learning How to Appeal Insurance, Medicare & Provider Denials - Tips on Choosing Community & Medical Resources to Improve Your Quality of Life - Strategies to Communicate More Effectively with the Health Care Team - Time Saving Self Care/Self Advocacy Tips for Caregivers - Questions for Our Panel of Experts

- Role of Caregivers in Care Coordination for People Living with Cancer & Co-Morbidities - What Research Tells Us About Caregivers, Including Long Distance Caregivers - Coordinating Follow-Up Appointments - Discussion of Adherence – Taking Pills on Schedule - Planning Ahead with Your Pharmacist: Lead Time in Refilling Prescriptions & Planning for Weekends, Travel & Holidays - Accessing Resources for the Costs of Care, Including Homecare - Finding the Practical Help You Need: Co-Pay Foundations, Federal, State & Local Programs - Learning How to Appeal Insurance, Medicare & Provider Denials - Tips on Choosing Community & Medical Resources to Improve Your Quality of Life - Strategies to Communicate More Effectively with the Health Care Team - Time Saving Self Care/Self Advocacy Tips for Caregivers - Questions for Our Panel of Experts

"We thought, from a nursing standpoint, 'What is our goal for doing this?' What we wanted was first, education of the patient. Can we successfully educate the patient to prepare them? Can we alleviate as much anxiety as possible so that they feel comfortable coming in and having this done? The second goal is to preserve kidney function throughout the treatment. To date, we've been successful with that. And the third goal is to complete treatment without infection," ONS member Chris Amoroso, BSN, RN, OCN®, registered nurse at Fox Chase Cancer Center in Philadelphia, PA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about intrarenal administration for upper urothelial tract disease. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by May 1, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Nurses caring for people with cancer require knowledge of the different routes for drug administration, including intrarenal administration via a percutaneous nephrostomy. Episode Notes  Complete this evaluation for free NCPD.  ONS Podcast™ episodes: Episode 141: Care Coordination for Urothelial Cancer Episode 133: Treatment Advancements for Advanced or Metastatic Urothelial Cancer ONS Voice articles: A Primer on Urothelial Cancer Chemo Combo May Be a Bladder Cancer Treatment Alternative During BCG Shortage Nurses Are Key to Patients Navigating Genitourinary Cancers Clinical Journal of Oncology Nursing articles: Avelumab First-Line Maintenance Therapy: Managing Patients With Advanced Urothelial Carcinoma Percutaneous Nephrostomy Infusion: Nursing Considerations for Treatment of Upper Urinary Tract Urothelial Carcinoma ONS Learning Libraries: Cancer of the Genitourinary Tract Safe Handling of Hazardous Drugs To discuss the information in this episode with other oncology nurses, visit the ONS Communities.  To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "In an office setting, it's not something we can really visualize. Patients will present with hematuria or flank pain, obstructions in the ureter, some hydronephrosis, they may be having a lot of urinary tract infections. And a routine cystoscopy in the office is not going to visualize the ureters. We can do biopsies like a ureteroscopy, a computerized tomography urogram, or a urine cytology. And those are usually the main ways of diagnosing upper tract disease—again, because it's rare." TS 2:33 "We ask patients to get into a comfortable position where they can sit or lay for an hour without too much movement. The movement of their body position can interfere with the flow of the medication going in. ... When we're ready to start, we're cleaning the ends of the nephrostomy tube and the IV tubing with a chlorhexidine solution. We're instilling this using micro drip tubing. The tubing has to be microchipped so we can accurately control the flow. The IV bag with medication is hung about 10 inches above kidney level. And the reason we do that is because we do not want to increase the intrarenal pressure. ... We want a slow infusion via gravity over about an hour. We're watching throughout the procedure to make sure that there's no leakage, no discomfort, really just watching the patient and having that communication with the patient. Are they feeling anything different? Do we notice a difference in the flow rate? Is it slowing down? And if so, why is it? Did the patient change position? If we have any [instance] where the patient says, 'I can feel something there,' or we see leakage, we stop that infusion immediately, emphasizing that it has to be gravity, never on a pump." TS 7:30 "We go over all the bacillus Calmette-Guérin (BCG) precautions because this is the drug that we're giving. As if we were doing traditional intravesical therapy such as placing a catheter up into the bladder, we're still giving patients BCG. So, we need them to follow the special precautions. We ask every patient, regardless of the drug we're giving them, to sit down to urinate, pour two cups of bleach in the toilet, let it sit for about 15 minutes, then close the lid and flush twice. Even though we're giving this for upper tract disease, it's still being excreted into the urine. So, precautions need to be followed. Sitting down to urinate to avoid splashing of the drug, putting the two cups of bleach in every time they urinate for a duration of six hours, closing the lid, and then flushing that toilet twice. The same precautions, whether it's traditional intravesical or intrarenal." TS 14:20 "The induction phase is the first six installations. So, the first time we give this drug, we're doing it once a week for six weeks. And during those six weeks, we're communicating with the patient. We'll do a follow-up phone call and ask, 'How are you feeling? Any issues?' And we do get to know our patients really well. ... If they call, we're going to send them for a urine culture and make sure there's nothing there. ... After those six weeks, we make sure the patient understands that this is not one course and done. We want to continue to do this to give them the best chance at preventing recurrence. After we've done those six, we'll wait about four to six weeks, and then we'll do a cystoscopy and ureteroscopy in the operating room to make sure we have the response we're looking for. Again, letting the patients know because sometimes they don't understand that this is going to continue—it's not six treatments and done." TS 23:08 "You can't think of this as the same as bladder cancer. This is in the upper tract. We can't approach it as if it was non-muscular invasive bladder cancer. The diagnosis is different. It's harder to diagnose. Again, we're not visualizing the ureters in a routine office cystoscopy.  ... You can't resect it out. When I was talking to our surgeon, he said, 'You can't resect the urothelial disease in the ureters like you would in a bladder tumor.' You can't go and just pick it apart. It's a little bit more complex than that. You can't go in and resect out lesions in the ureter itself." TS 36:20

George Karandinos, MD, PhD, discusses his recent study on pediatric mental health outcomes after parental firearm injury.

Most organizations put "Collaboration" on a wall. Few actually live it — and in healthcare, the cost of not living it isn't a missed deadline. It's a missed patient. In the first episode of Your Health University's brand-new Most organizations put "collaboration" on a wall. Few actually live it — and in healthcare, the cost of not living it isn't a missed deadline. It's a missed patient. In the first episode of Your Health University's brand-new Our Values Series, host Jamie Preston gathers four members of Your Health's patient experience team — Rebecca Dillard (VP of Organizational Experience), Jennifer Kessler (Division President of Product), Whitney Myers (Senior Solutions Advisor), and Carlos Hayward (Business Office Manager) — for an unfiltered conversation about what genuine collaboration looks like inside a fast-moving, mission-driven healthcare organization. No theory. No platitudes. Just the real, messy, mundane, and occasionally remarkable daily practice of people choosing to work together when it would be easier to go it alone. What you'll hear in this episode: Why real collaboration means recognizing what the person next to you brings that you simply cannot replicate — and building toward that, not around it The true story of a patient found living in an RV without his medication — and how cross-team collaboration made the difference between crisis and care Where collaboration most commonly breaks down in healthcare settings, and the small documentation and communication habits that prevent it The one question — "How can I do my job differently to make yours better?" — that builds trust across departments faster than almost anything else The daily habits these four healthcare professionals actually practice to keep collaboration alive, from weekly team check-ins to learning someone's preferred communication style before you assume Collaboration isn't a value you perform. It's a choice you make — one conversation, one phone call, one honest mistake admitted at a time. Values Series, host Jamie Preston gathers four members of Your Health's patient experience team — Rebecca Dillard (VP of Organizational Experience), Jennifer Kessler (Division President of Product), Whitney Myers (Senior Solutions Advisor), and Carlos Hayward (Business Office Manager) — for an unfiltered conversation about what genuine collaboration looks like inside a fast-moving, mission-driven healthcare organization. No theory. No platitudes. Just the real, messy, mundane, and occasionally remarkable daily practice of people choosing to work together when it would be easier to go it alone. What you'll hear in this episode: Why real collaboration means recognizing what the person next to you brings that you simply cannot replicate — and building toward that, not around it The true story of a patient found living in an RV without his medication — and how cross-team collaboration made the difference between crisis and care Where collaboration most commonly breaks down in healthcare settings, and the small documentation and communication habits that prevent it The one question — "How can I do my job differently to make yours better?" — that builds trust across departments faster than almost anything else The daily habits these four healthcare professionals actually practice to keep collaboration alive, from weekly team check-ins to learning someone's preferred communication style before you assume Collaboration isn't a value you perform. It's a choice you make — one conversation, one phone call, one honest mistake admitted at a time. www.YourHealth.Org

What if the healthcare system your loved one relies on doesn't even know they need help until it's too late — and what would it look like if it did? In this Q1 2026 episode, Jamie Preston sits down with Matt Staub, CEO of Your Health, for a candid and wide-ranging look at how one of the country's largest home-based care providers is navigating the evolving landscape of value-based care, population health, and the human experience at the center of it all. Matt brings his characteristic clarity and heart to a conversation that is equal parts strategy, story, and honest reckoning with what the system still gets wrong. Key topics covered: Why 11% of patients account for 67% of all healthcare spending — and why most of them don't know they're in an ACO The evolution of value-based care: from quality-over-cost to outcomes + patient experience over total costs How Your Health is becoming proactive — not reactive — about falls, readmissions, and high-needs patients The quiet crisis of patient trust: down from 71% in 2020 to just 33% today, and what the correlation means for hospitalizations Real stories: a 79-year-old patient who went from barely existing to living fully — and Matt's own mom, who hasn't fallen since leaving the hospital after her stroke If you work in healthcare, advocate for someone in the system, or simply believe that better is possible — this episode will change the way you see what care can be.

In this episode, Robin Roberts, Director of Health IT Regulatory Affairs, PointClickCare & Novella Thompson, Hospital Administrator, Population Health, UVA Health, explore how health systems are transforming care coordination from hospital to post-acute settings through interoperability, real-time data, and AI. They share practical challenges, including discharge handoffs and medication accuracy, and highlight how predictive tools and stronger partnerships are improving outcomes across the continuum of care.This episode is sponsored by PointClickCare.

America spends nearly double what the fourth-ranked country spends on healthcare per capita — and still ranks among the worst in outcomes. So what exactly are we paying for? In this episode of the Experiencing Healthcare Podcast, Jamie Preston and Your Health CEO Matt Staub examine what happens when healthcare gets treated like gasoline: something people expect to be available, can't easily compare on quality, and ultimately choose based on price or convenience. When brand and price stop mattering, the only differentiator left is how patients are made to feel — and whether they trust the person across from them enough to actually change. What you'll hear in this episode: Why Matt ranks service above outcomes and access — and the patient story that changed how he thinks about both The "Chick-fil-A problem": how your healthcare experience is now being compared to your best service experience anywhere, not just the clinic down the street What provider burnout really looks like when a clinician closes their notes at 11pm wondering if their patient listened How insurance billing creates distrust that bleeds directly into the patient-provider relationship — and what healthcare organizations can do about it Why the most caring thing a doctor can do sometimes feels like the worst customer service in the room If you've ever felt like a number in a waiting room — or if you've ever been the one trying to help someone who wouldn't listen — this conversation will stay with you. Press play.

In this Bright Spots in Healthcare episode, host Eric Glazer convenes health plan leaders who are focused on what happens beyond the clinic visit, the moments between care where behavior, adherence, and risk quietly take shape. The conversation centers on how plans are operationalizing care without proximity by extending support into daily life, redesigning benefit strategies, and moving from episodic measurement to longitudinal influence. This is a candid discussion for executives who are still building, still questioning assumptions, and still shaping what sustainable, whole-person care can become. Together, the panel explores how digitally enabled self-management, continuous insight, and targeted human support are changing how plans influence outcomes over time. Our guests include: Timothy Law, DO, MBA, Chief Medical Officer, Highmark Inc. Deborah Hammond, MD, Vice President, Medical Director, Healthfirst Jamie Zajac, Senior Director of Care Coordination, Colorado Access Omar Manejwala, MD, Chief Medical Officer, DarioHealth Together, they explore: How health plans are designing care models around daily life rather than visit cadence, closing visibility gaps that claims and labs fail to capture What actually works when continuous engagement, behavioral support, and real-time data are combined to influence adherence and sustained behavior change How home-based data capture, AI-driven personalization, and integrated human coaching are improving outcomes across cardiometabolic, behavioral health, and musculoskeletal populations How these capabilities are being embedded into care management, quality improvement, and benefit design, particularly in environments facing access barriers, workforce constraints, and geographic limitations This episode offers an honest look at the structural, operational, and cultural shifts required to manage what happens between visits, and why that interval is where outcomes are ultimately won. Panelist Bios: https://www.brightspotsinhealthcare.com/events/care-without-proximity-winning-the-moments-between-care/   Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. https://docs.google.com/document/d/1h6TzhQ4-ZlUMY09pBI4NvpqwY1FKkL9lMPOEEpftVHA/edit?tab=t.0   Key Insights Summary: Find key insights from the discussion, guest takeaways, and detailed moderator notes captured by Eric during the conversation. https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/03/Key-Takeaways_-Care-Without-Proximity-02-26-26.docx.pdf Resources:  Report: Designing Benefits for Care Without Proximity and Sustained Outcomes This companion report examines how health plans can redesign benefits to address the most overlooked driver of outcomes: what happens in the time between clinical visits. Drawing on emerging evidence and real-world implementation, the report shows how continuous guidance, low-friction engagement, and integrated human support can influence daily behavior, preserve outcomes beyond treatment, and close the gap between what is authorized and what actually happens. Inside, you'll find insights on: Reframing benefit design from static access and eligibility rules to longitudinal accountability for sustained behavior Using data from daily life, behavioral, biometric, and contextual to move beyond lagging claims and EHR signals Applying operational personalization to intervene earlier and adapt support as member needs change Integrating targeted human support with technology to manage the transition after treatment and prevent backsliding Why investing in care without proximity is becoming urgent as workforce constraints and chronic disease prevalence continue to rise To request your copy from show producer, Vekonda Luangaphay at email vluangaphay@brightspotsventures.com. Thank You to Our Episode Partner, Dario: Dario is transforming how people manage their health through consumer-friendly digital solutions designed to drive lasting behavior change. By integrating comprehensive support across well-being and chronic condition management, Dario delivers highly personalized, adaptive experiences that help members stay engaged over time—resulting in meaningful clinical outcomes and measurable financial impact for health plans. Learn more at dariohealth.com.  Schedule a Meeting with Omar Manejwala, MD, of Dario: To explore how Dario can support your organization in extending care beyond the clinic and driving sustained behavior change, reach outshow producer, Vekonda Luangaphay at email vluangaphay@brightspotsventures.com to schedule a meeting with Omar Manejwala, MD, Chief Medical Officer, Dario. About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation.   We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the "bright spots" in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com.  

What if the most expensive healthcare decisions aren't made in the boardroom — but in the exam room, when the wrong infection gets treated with the wrong antibiotic? In this episode of the Your Health University, Podcast, Jamie sits down with Madison Browning, a registered nurse in urology at Your Health, to talk about what proper urological care actually looks like, why it matters far beyond the individual patient, and how a strong, collaborative provider team is the difference between a patient thriving and a patient stuck in a revolving door of emergency room visits. What you'll hear in this episode: Why getting a UTI diagnosis right the first time has massive implications for patient health and system costs The role nurse practitioners play in specialized urology care — and why their expertise is often underestimated How the team-based model at Your Health empowers every provider to collaborate and deliver better outcomes The direct connection between outpatient urology care and reduced hospital stays, ER visits, and downstream Medicare and tax costs Madison's genuine gratitude for the team around her — and what it looks like when a healthcare culture actually works If you've ever wondered whether the healthcare system could do better — this episode is proof that it already is, one patient at a time. www.YourHealth.Org