Podcasts about value based care

We're discussing Relationships and Community: the Fabric of Rural Health! Faisel and Dan are joined by Dr. Sonya Bruton: CEO and President of CCI Health Services, Clinical Psychologist, and Author.Our conversation revolves around the inherent link between physical and behavioral health, the necessity of physicians staying engaged with their passion for care, and the hesitancy of patients around AI in healthcare.

Dr. Brad Diephuis, COO & President of Thyme Care, joins Kellogg MBA student Joy Basinger to unpack how wraparound, value-based oncology care is transforming the cancer experience—especially for high-risk, MA populations. They explore how Thyme Care is going beyond the doctor's office to deliver proactive, tech-enabled symptom monitoring and reduce avoidable ER visits and hospitalizations.From standardizing care team workflows through the Thyme Box platform to deepening integration with partners like Oak Street Health, this episode dives into the value of structured, longitudinal support in oncology. Timestamps:00:00 Introduction to Thyme Care and Dr. Brad Diephuis04:57 The Thyme Care Model: Supporting Cancer Patients12:41 Technology Integration in Care Delivery20:15 Thyme Care's Business Model and Revenue Generation22:57 Measuring Outcomes and Quality of Care27:42 Focus on Medicare Advantage Population30:35 Partnerships and Collaborations in Value-Based Care (e.g., Oak Street)34:48 Future Growth and Service Expansion LinkedIn: Dr. Brad Diephuis, COO & President of Thyme Care⁠Joy Basinger, Kellogg MBA ('25)⁠ 

NOTES00:01:08 – 00:04:30 Why continuous learning fuels credible leadership00:04:30 – 00:08:00 Emotional intelligence as the “second bottom line” in care00:08:00 – 00:11:30 The payer paradox: collaboration vs. competition00:11:30 – 00:14:45 Staying mission-driven when policies keep shifting00:14:45 – 00:18:40 Adaptability, AI, and the future of primary care00:18:40 – 00:22:10 Data as a conversation, not a conclusion00:22:10 – 00:27:30 Mentoring, apprenticeship, and building leadership pipelines00:27:30 – 00:33:00 Managing vs. leading: the rowboat and the horizon00:33:00 – 00:34:11 The leadership qualities that will matter most in the next decadeKey TakeawaysEmpathy and analytics aren't opposites—they're partners in better outcomes.True collaboration starts when incentives align around patient health, not billable units.Wearables and AI expand what we can measure; curiosity and compassion determine what we do with the data.Mentoring isn't a nice-to-have; it's the supply chain of future leadership.The next decade of value-based care will belong to leaders who balance curiosity, courage, and care. www.YourHealth.Org

"It was pretty apparent to me that something was going on with him," says Kristi Levine, describing the realization that, based on her experience as a Montessori teacher, her infant son, Trey, was missing developmental milestones. Unfortunately, Kristi's hunch turned out to be correct and Trey was later diagnosed with a rare genetic mutation called CACNA1A which is impacting his motor skills, balance, coordination and speech. Kristi and her husband, Eric, join host Michael Carrese on this installment in our Year of the Zebraseries to help us understand the disorder and its implications for Trey and their family, which includes Trey's older sister Stella.  “There's a lot of guilt involved in being a parent of a child who has a disability because you never feel like you're doing enough,” shares Eric, even though they both work full time and have becoming experts at juggling work, caregiving, advocating, and volunteering with the CACNA1A Foundation. In this candid interview, Eric and Kristi discuss the challenges of parenting a child with complex medical needs, the importance of community support, the ongoing search for treatment options, and share some advice for clinicians caring for patients and families living with rare disorders. “We just want medical professionals to respect and understand what we're dealing with on a day-to-day basis and to see our kids holistically, and not just try to fix the problem medically. Understand that for us, the biggest thing that we want for our kids is just their quality of life.”Mentioned in this episode:CACNA1A Foundation If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast

Send us a textIn this episode we sit down with Alon Joffe, CEO of Israeli AI startup Eleos, for a fascinating deep dive into how behavioral health documentation is being revolutionized. What makes this conversation compelling is learning why Israel has become such a health tech powerhouse - with $1.2 billion in funding in 2024 alone and digital medical records dating back to the 1970s.Alon breaks down how his AI technology reduces clinical documentation time by over 70% for mental health workers dealing with 60-90 minute therapy sessions. The company now serves 20,000 clinicians across 34 states, focusing on the most underserved populations in behavioral health. They explore the stark differences between acute care and behavioral health tech needs, why companies like Epic struggle to cross that divide, and how AI agents are about to transform EMR integration. Plus, Alon shares the dramatic shift from pre-ChatGPT skepticism to today's reality where a quarter of US physicians are already using ambient AI tools.Timestamps:00:00:08 - Introduction and Welcome00:01:02 - Israeli Health Tech Ecosystem and Innovation Culture00:03:51 - Government Healthcare Systems and Innovation Frameworks00:06:09 - Value-Based Care vs Fee-for-Service Risk Models00:09:14 - Introduction to Eleos: Mission and Market Focus00:11:42 - Technology Differentiation and Competitive Landscape00:15:19 - Behavioral Health vs Acute Care System Differences00:16:01 - AI Agents and Job Automation in Healthcare00:18:03 - EMR Integration and the Future of Healthcare Interfaces00:20:12 - Epic's Market Evolution and Platform Strategy00:25:04 - Fundraising Experience and Series C Journey00:27:17 - Technology Evolution: Pre vs Post-ChatGPT Era00:33:53 - Future Plans and Expansion Strategy00:34:57 - Closing Remarks and Final Thoughts

Key Topics Discussed:The philosophy of care behind RPM How RPM empowers patients and improves outcomes Common barriers for providers and patients—and how to overcome them The emotional and human impact of being “seen” through RPM Why RPM is essential for proactive care and value-based models How RPM strengthens patient-provider partnershipsWho Should Listen:Providers looking to elevate their standard of care Patients managing chronic conditionsCaregivers advocating for loved onesHealthcare leaders navigating the shift to proactive careTune in to hear why Jennifer believes every Your Health patient should be on RPM—and why the time to act is now. www.YourHealth.Org

This week on Faisel and Friends, we are discussing Innovations in Primary Care: Independent & Rural Practices. Dan moderates a panel discussion with Dr. Jim Lancaster, Sonya J. Bruton, Psy.D, Tim Gronniger, and Carrie Cochran-McClain, DrPH.Our conversation explores providing important care for small communities, solving the workforce shortage in rural practices, and addressing the financial barriers that independent practices face.This conversation was recorded live at Primary Care for America's annual event PrimaryCare25.

Podcast Show NotesWhy Medicare and supplemental insurance may not be the best combination — and what to consider instead.The myth that paying more for health insurance guarantees better care.Why value-based care plans like Humana are worth a closer look — especially for long-term cost and wellness.The emotional and financial weight of long-term care insurance — and who really needs it.Personal stories about estate planning, remarriage, and how inheritance issues can fracture families.Practical tips on reviewing your insurance plan yearly, using your agent wisely, and planning with clarity.How booking the Airbnb or family cruise now could shape who shows up for you later in life.  www.YourHealth.Org

We have a special guest on today's episode whose voice will be familiar to regular listeners. Last year at this time, Dr. Raven Baxter occupied the Raise the Line host chair for a special ten-part series we produced in collaboration with the Cohen Center for Recovery from Complex Chronic Illness (CoRe) at Mount Sinai in New York City, where she serves as the Director of Science Communication. The series explored the latest understandings of post-acute infection syndromes -- such as Chronic Lyme and Long COVID -- with an array of experts from the Center and other researchers and providers. In this episode, we check-in with Dr. Baxter to get an update on the work of the Cohen Center, especially with regard to its mission to educate providers. “We're building programs so that clinicians can earn credit for learning about chronic illnesses that are infection associated, and we've also developed a 200-page provider manual. I really think that we will be able to shift the narrative that currently exists,” Dr. Baxter tells host Michael Carrese. That narrative includes lingering skepticism among providers of some infection-associated illnesses, which Dr. Baxter witnessed herself as a Long COVID patient, an experience that has added meaningful perspective to her work. Dr. Baxter is also working on her own time to advance knowledge and combat misinformation through a robust social media presence as “The Science Maven” and helps other scientists and clinicians to do the same. "If we're not there to fill in that void, other people will fill it for us and the narrative may not be consistent with the truth or facts." This is a great opportunity to learn about the art and science of communications that can reach clinicians and patients alike.Mentioned in this episode:Cohen Center for Recovery from Complex Chronic IllnessThe Science Maven If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast

Both CMS and value-based healthcare systems are increasingly leveraging data and enhanced communication to transition patients out of acute care more efficiently, support successful post-acute recovery, and reduce readmissions. In this video, Phyllis Wojtusik, RN, Executive Vice President of Value-Based Care at Real Time Medical Systems (Real Time), outlines the key components of an effective care transition process – and how Real Time's data-driven solution and interventional analytics help enable smoother transitions and improved outcomes.Check out our interview with Phyllis Wojtusik from Real Time to learn more about the CMS TEAM model – and how acute and post-acute providers can better coordinate care for improved patient outcomes.Learn more about Real Time Medical Systems: https://realtimemed.com/Health IT Community: https://www.healthcareittoday.com/

In this episode of the Becker's Healthcare Podcast, Erika Spicer Mason is joined by Linda Bedwell of Powder River Surgery Center and Dana Jacoby of Vector Medical Group to discuss the evolving role of ambulatory surgery centers (ASCs) in value-based care. The conversation explores how physician alignment, data-driven strategies, and innovative care models are enabling ASCs to deliver longitudinal, patient-centered care—despite challenges like staffing shortages and low reimbursement rates. Tune in for insights on building sustainable, risk-aware strategies that move beyond fee-for-service and deliver measurable outcomes.This episode is sponsored by Vector Medical Group.

Flashback episode in honor of Hinge Health's IPO this week. In the episode, Jacob and Nikhil sit down with Daniel Perez, the Co-Founder and CEO of Hinge Health, a digital clinic for patients with joint and muscle pain. They discuss Hinge Health's strategy for selling to employers, how digital health solutions can reach and retain users, the role of software x hardware in disrupting healthcare, and more. (0:00) Intro(2:34) The Evolution of Employer Health Solutions(4:03) Challenges and Strategies in Digital Health(7:07) Focus on Musculoskeletal Care(9:51) Engaging and Retaining Patients(16:17) Marketing and Awareness Strategies(19:31) The Role of Independent Validators(22:27) Clinical Validation and R&D Excellence(23:04) Healthy Competition and Market Differentiation(23:59) Product Superiority and Customer Validation(26:05) Team Dynamics and Tough Decisions(29:49) Future of Hinge Health and Healthcare Automation(31:44) AI and Technology Integration(36:18) Hardware Innovations and Market Impact(39:19) Value-Based Care and Outcome Guarantees(41:14) Regulatory Challenges and Innovation Constraints(43:38) Closing Thoughts and Entrepreneurial Advice Out-Of-Pocket: https://www.outofpocket.health/

We're discussing Addressing the Chronic Disease Crisis: The Foundation of Making America Healthy! Faisel moderates a panel discussion with Dr. Wayne Jonas, Dr. Kate Goodrich, Dr. Joseph B. Brodine, and Peter Shin, PhD.Our conversation revolves around incentivizing primary care as a viable career for physicians, optimizing processes to unburden patients, and collaborating on multidisciplinary teams for whole-person care.This conversation was recorded live at Primary Care for America's annual event PrimaryCare25. 

CMS Changes and the Future of Value-Based CareJennifer Houlihan and Jennifer Gasperini of Advocate Health discuss the impact of new CMS and CMMI leadership, current challenges in value-based care, and the future of ACOs, ECQMs, and Medicare Advantage. A timely conversation for anyone navigating the evolving policy landscape.Welcome to the Move to Value Podcast, powered by CHESS Health Solutions.In this episode, we're joined by Jennifer Houlihan, Vice President, and Jennifer Gasparini, Director of Policy, from Advocate Health's Population Health Team. Together, we unpack the implications of the recent administration change, explore what new leadership at CMS could mean for value-based care, and hear their perspectives on the legislative priorities they hope to see take shape.Thomas Royal Jennifer Houlihan, Jennifer Gasparini, welcome to the move to Value podcast.Jennifer GasperiniThanks for having us.Jennifer Houlihan Happy to be here.Thomas Royal So you both just attended the NAACOS conference?Can you tell us what are some of the hot topics that folks were talking about?Jennifer GasperiniI can get us started.I think it's always great to see colleagues at the NAACOs conference and was also great to see Kim Brandt, who is the deputy administrator and COO at CMS, come and share some of Doctor Oz's priorities. For CMS and I think a lot of those priorities align really well with value based care. So they they really spoke a lot about tackling fraud and abuse. And as you know, ACOs are really the early identifiers of fraud.And so really was pleased to see them talking about that and also using technology and better data really for beneficiaries and providers to advance care. And I think ACOs obviously are very focused on that goal as well.Jennifer, do you have anything else to add there?Jennifer Houlihan Yeah. There, in addition, there were some really good sessions on the new team model, the transferring Episode Accountability model as well as guide and a lot of thoughtful conversation around how to integrate these models into the ACO and a clearer path for outcomes there. So I think there was a great discussion and got to give kudos to Jennifer. She was part of a really well attended and fantastic panel on how ACOs are adapting ECQMs and MIPCQMs and some of the kind of demands and multiple issues that are impacting ACOs on how to do all payer adjustments leveraging some of these requirements. So a lot of really timely topics and I think then the kind of final was Specialty Care integration, I think continued to be a recurring topic that we need to think more deeply about that and and how those get nested within cost, so hopefully we'll see more about that in the future.Thomas Royal So there is new leadership in place at HHS, CMS and CMMI.What does NAACOS think this might signal for the future of value-based care?Jennifer HoulihanSure, I I can. I can jump in on that one first, so I think you know, looking at Abe Sutton, you know, as as Jennifer mentioned, Kim Brandt was there from CMS. But we've also seen with Abe Sutton's appointment, who's been a strong supporter of value-based care. I think the mood was mostly positive, that there has been sort of a lot of statements, whether it's in some of the confirmation hearings, or direct statements that value-based care and the need to achieve savings is is one of the priorities. I think there's gonna be some different thinking about more aggressive requirements for more savings and as as as we've seen already, some of the model review that's already taking place. The ability to kind of end models early if they're not achieving the outcomes and the savings. So I think the mood in...

Dhrooti Vyas, Co-founder at a value-based care startup and expert in healthcare incubations at Primary VC, joins the podcast to share her perspective on what makes a healthcare startup truly impactful. She discusses foundational best practices for early-stage companies and emphasizes the importance of delivering real value to communities, specifically through her work with Crosswalk. Dhrooti also reflects on her personal experiences with the emergency department and how they revealed major issues in primary care—sparking efforts to connect EMS systems more directly with health insurance providers to close care gaps.

In this episode of the Becker's Healthcare Podcast, Erika Spicer Mason speaks with Brian Workinger and Lauree Handlon of The Craneware Group about how AI and data-driven insights are helping providers navigate increasingly complex payer contracting and reimbursement environments. The conversation covers predictive modeling, payer transparency, and preparing for shifts in Medicare Advantage participation, all within the broader context of value-based care. Tune in to hear how hospitals can leverage advanced analytics to drive smarter financial strategies and improve long-term sustainability.This episode is sponsored by Craneware.

Natalie Davis, CEO of United States of Care, joins us to talk about the challenges of discussing value-based care with patients and policymakers. Through extensive research with over 30,000 individuals, Davis shares that the term "value-based care" often evokes negative connotations of low-quality care. When presented with the benefits of value-based care without using the term itself, people were most interested in spending more time with their doctors and receiving personalized, quality care. Join us to learn more about effectively communicating with patients and policymakers about value-based care. Connect with us at acoshow@aledade.com or visit the Aledade Newsroom

Show Notes: Ami Parekh discusses the business model and services of Included Health, a company that provides personalized healthcare. Included Health partners with self-insured employers and health plans to improve the way working Americans and their families receive healthcare.  Included Health Services  About a third of Fortune, 100 companies, and 10 million Americans have access to Included Health's services. The company focuses on providing access answers and advocacy as people engage in the healthcare system. The company has nearly 3000 people, including 1000 clinicians across the country, including primary care doctors, specialists, nurse practitioners, and therapists. Additionally, hundreds of care advocates help patients understand the ins and outs of the healthcare system. Many patients come to Included Health because they can't get access to primary care and behavioral health, which can take one to two months across most of the country. The company aims to address this supply problem. Navigating the Healthcare System Ami talks about the role of Included Health in helping patients navigate the healthcare system, focusing on personalized and best-for-the-patient approach. She explains how it can help patients navigate their insurance and coverage options. She also covers the use of data and data science to match patients with the highest quality healthcare professionals for specific requirements, such as orthopedic surgeons or specialists. Ami emphasizes that Included Health are not plans or payers, but providers who work with a wide field of providers, and their job is to help patients achieve the best outcomes within the current healthcare system. Accessing Quality Data in Healthcare The conversation turns to the concept of quality data in healthcare, how it is crucial to consider the quality of care and the likelihood of repeat surgeries, and the issue of inappropriate prescribing behavior, such as the use of opiates and benzodiazepines, which can be addictive. Ami explains how Included Health accesses and uses data, and how collected sanctioned data can help determine if a provider is safe for family members to see. Ami emphasizes that data is never perfect, and in the worst case scenario, patients can consult with clinicians to find the right doctor. The data can help inform conversations about who to see, and Included Health offers support in finding publicly available data sources and the right practitioner. She highlights the need for better data and collaboration between healthcare providers and patients to improve patient outcomes and overall healthcare quality. Improving Healthcare Pricing and Cost Employers typically pay for Included Health as a layer on top of their health plan, as they want their employees to be healthy, productive, and engaged members of their workforce. They also want healthcare costs to remain low so that they can pay their employees a living wage and invest in other benefits. Healthcare is often the number two cost after supplies in America, and employers want their employees to be healthy, productive, and engaged. Included Health offers a way to give healthy days back to employees by reducing the number of days they are unable to be healthy due to mental or physical health reasons. This results in increased productivity, better work performance, and overall cost savings. There are two dimensions to using included health services: first-time care and saving time. First, employees get the right care the first time, which can lead to cost savings. Second, health plans are incentivized to offer support to their patient population, as they are paying for it. Third, Included Health helps find providers quickly, saving employees time and freeing them up to focus on the healing process and family. Furthermore, Included Health provides access to primary care doctors, which is crucial for long-term cost savings and better health. How Included Health Works Included Health has about 1500 clinicians available for virtual appointments, including behavioral health providers. The app allows users to schedule appointments within a week, ensuring choice and quick access to healthcare services. Technology has brought about broader trends in the industry, such as value-based care and making things easier to access. The cost of healthcare is increasing by seven to 10% year over year, making it unsustainable for the American population. Employers, who are often the purchasers of healthcare, are seeking better solutions to control healthcare costs. They are trying to do this through products and services, creating new networks, and focusing on wellness. The trend is driven by employers and the government, as well as insurance companies. Included Health fits into this trend by reducing total care costs and prioritizing the member experience. By being a one-stop shop for patients and members, employers can experiment with different services without disrupting the member experience. This allows them to work with the growing trend of cost-cutting and value-based care in the healthcare industry. Included Health's Clients and Pricing Structure  The pricing structure for the company is custom, client-by-client, and depends on the population being served. The company does not have a per-head pricing structure, but rather on a population level. Performance guarantees are part of the pricing model, which includes up-operation and delivery of savings.The company has started participating in shared savings models with CalPERS, which allows California employees and their dependents access to their services. Payers see the company as a provider for their members, and they believe that these models are helping them achieve better outcomes for patients. Included Health mostly focuses on larger enterprise and jumbo clients, with 33 of the Fortune 100 companies being clients. Smaller clients also receive good results from the company. The Role of AI in Healthcare Ami discusses the use of Telehealth in healthcare. She mentions her parents as an example of how they could do more virtually than they are today. Ami also discusses the role of AI in healthcare, stating that, by providing tools that can help healthcare workers it is a beneficial tool.  AI has been used in healthcare for therapy, diagnosis, and diagnosis, with 20% of conversations being healthcare-related. She is excited about the potential of AI in healthcare. Member-facing AI can answer basic health insurance questions and provide guidance on insurance deductibles and costs. Included Health ensures all of their AI services are supported by humans, whether on the clinical side or on the care team side, to ensure a human is available to the customer when needed.  Ami believes that AI will be a tool that supports the human workforce in healthcare, making their jobs easier and allowing them to do more for the members. Over the next year or two, AI will play a significant role in healthcare, with AI helping navigate systems, schedule calls, and provide better access to care for patients. Timestamps: 01:22 Included Health's Services and Impact 03:22: Navigating the Healthcare System  07:20: Challenges and Solutions in Healthcare Data  14:29: Employer and Health Plan Perspectives  21:33: Value-Based Care and Pricing Structure  27:21: Health Plan and TPA Relationships  32:41: Role of AI in Healthcare  Link:  https://includedhealth.com/   Unleashed is produced by Umbrex, which has a mission of connecting independent management consultants with one another, creating opportunities for members to meet, build relationships, and share lessons learned. Learn more at www.umbrex.com.

In today's episode of Value-Based Care Insights, host Daniel J. Marino sits down with Dr. Amit Jain, MD, MBA, Associate Professor of Orthopedic Surgery and Neurosurgery, Chief of Minimally Invasive Spine Surgery at Johns Hopkins, and Director of Value-Based Care for Johns Hopkins Health System. Together, they unpack how organizations can reduce costs while improving performance outcomes such as length of stay and readmission rates—ultimately advancing their value-based care strategy. Explore expert insights on aligning surgical services with cost-effective, high-quality care delivery.

On this episode of “Raise the Line” we welcome Dr. Sheldon Fields, a trailblazer in the nursing field and the president of the National Black Nurses Association. In a candid conversation, Dr. Fields shares his inspiring journey from the bedside to becoming a prominent figure in nursing, HIV/AIDS prevention and academia and also shares the challenges he faced as a Black man in a predominantly white and female field. "I fell in love with a profession that has not always loved me back," he tells host Kelsey Lafayette. Dr. Fields brings over thirty years of experience as an educator, researcher, clinician, administrator, consultant, health policy specialist, and entrepreneur to his current role at NBNA, and as the inaugural associate dean for equity and inclusion at the College of Nursing at Penn State University, where he also serves as a research professor. Listeners will find Dr. Fields' insights on navigating a career in healthcare particularly valuable, as he stresses the importance of resilience, continuing education, and mentorship. It's a compelling listen for anyone interested in the intersection of health, policy, and social justice.Mentioned in this episode:National Black Nurses Association If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast

Nurses aren't just at the bedside—they're in boardrooms, legislatures, and labs. In this episode, Ajay Mody and Asher Perzigian sit down with Dr. Allison Norful of Columbia University and Summer Davis of the Ohio Association of Advanced Practice Nurses to unpack how nurses are reshaping healthcare. From navigating towards full practice authority to driving policy and tackling mental health, this conversation reveals the untapped power of nursing leadership in a rapidly evolving system. Part of The Heart of Healthcare series—where the future of medicine gets personal.

No one is better equipped to support patients than providers. But do health systems have the power required to improve the healthcare system?  In this episode of Healthcare Insider, Premier Inc. President and CEO Mike Alkire explains why a provider-led model—not one led by payers or legacy tech vendors—is the only viable path forward. He outlines how hospitals can take back control and lead transformation by focusing on high-value partnerships, smarter use of data and AI-driven solutions. Listen to learn how health systems can: Shift power from payers to providers through strategic partnerships Leverage data and AI to reduce costs and improve outcomes Incentivize innovation to build a more sustainable system

Ep 127 - Dr. Jain- Improving Perioperative Services to Enhance Value-Based Care Exploring one of the most significant drivers of total cost of care: surgical and perioperative services. With surgical services accounting for up to 70% of a hospital's revenue, inefficiencies in the OR can have a profound impact on both financial and clinical outcomes. On this episode Dan sits down with Dr. Amit Jain, Associate Professor of Orthopedic Surgery and Neurosurgery and Chief of Minimally Invasive Spine Surgery at Johns Hopkins. Dr. Jain also serves as Director of Value-Based Care for Johns Hopkins Health System. Together, they unpack how organizations can reduce costs while improving performance outcomes such as length of stay and readmission rates—ultimately advancing their value-based care strategy. Tune in for expert insights on aligning surgical services with cost-effective, high-quality care delivery. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Jeff Byers welcomes Farzad Mostashari, founder & CEO of Aledade and the former National Coordinator for Health IT, to the pod to break down insights in the latest MedPAC report, quality measurement reform, and areas of opportunity for value-based care.Health Affairs is hosting an Insider exclusive event on May 29 focusing on the FDA's first 100 days under the second Trump administration featuring moderator Rachel Sachs alongside panelists Richard Hughes IV and Arti Rai.Related Links:Crossing the Chasm: How to Expand Adoption of Value-Based Care (The New England Journal of Medicine)2025 MedPAC Report Subscribe to UnitedHealthcare's Community & State newsletter.

This episode of the Astonishing Healthcare podcast with Dr. Sunil Budhrani (Chief Innovation & Medical Officer) highlights the transformative potential of Judi Health™, the first Unified Claims Processing™ platform offering a combined medical and pharmacy benefit experience (with vision and dental soon to follow)! Why is unifying claim administration necessary to reach a value-based world? Well, everyone has been talking about VBC for years, and it's proved to be an elusive target. On Episode 7, Dr. Budhrani explained why pharmacy must be included in the equation along with providers, patients, and payers, and today we go a level deeper, explaining why "everything" - all the patient's data - must be in one system to be able to achieve better health outcomes at a lower cost. On AH054 - Judi Health™: Going Beyond Pharmacy and into Medical Claims, with AJ Loiacono and Dr. Sunil Budhrani, we revealed what we're doing and why.Today, Sunil discusses our experience thus far - 5 months into our unified claims experience - and the importance of flexibility in plan design to achieve a plan's goals. He also explains how Judi Health helps to empower providers and the provider-patient relationship via a "transparent architecture." What should the experience be like for patients? How about the plan sponsor/HR team side of the equation? Tune in to find out and hear why Judi Health represents an "opportunity to see - and achieve - what many people in healthcare say cannot exist" (hint: it's a win for all stakeholders). Related Content:Judi Health™ Earns Best Healthcare InsurTech Solution in the 9th Annual MedTech Breakthrough Awards ProgramCapital Rx Unveils Healthcare's First Unified Pharmacy and Medical Claims Processing PlatformAH058 - Building Judi®, the Healthcare Infrastructure of the Future, with Liya LomsadzeReplay - Build a Lasting Pharmacy Benefit Strategy with Never Move Again™Setting a New Standard for the Future of Pharmacy Benefit AdministrationFor more information about Capital Rx and this episode, please visit Capital Rx Insights.

This week on Faisel and Friends, we are discussing Connecting Back to Care: Reimagining Maternal Health. Faisel and Dan are talking with Dr. Esa Davis: Associate Vice President for Community Health at University of Maryland School of MedicineOur conversation explores navigating challenging medical situations, creating an environment where patient voices matter, and looking towards a psychologically safe future in healthcare.Dr. Esa Davis is a Vice Chair of the US Preventive Services Task Force (USPSTF) and the materials expressed in this podcast reflect her individual views only and do not represent the views or recommendations of the USPSTF.  The overall presentation should not be attributed to the USPSTF.

Elligint Health provides a toolset outside of the electronic medical record to help organizations perform value-based care arrangements. In this episode, Chris Caramanico, CEO of Elligint Health, discusses how his organization is helping drive change in healthcare delivery. He shares insights into how their solution creates proactive workflows to affect patient outcomes, emphasizing the importance of data-driven decision-making and patient activation. Chris also shares that their platform provides analytics, care management tools, and communication solutions to improve patient outcomes and drive efficiency. Finally, he touches on emerging trends in healthcare technology, particularly the role of AI and interoperability, and how Elligint Health is addressing these needs. Tune in and learn how Elligint Health is transforming healthcare with its integrated approach to value-based care, analytics, and patient activation! Resources: Connect with and follow Chris Caramanico on LinkedIn. Learn more about Elligint Health on their LinkedIn and website.

Join hosts Asher Perzigian and Ajay Mody as they welcome Carolyn Jones, a renowned filmmaker and advocate for healthcare workers, to discuss the vital, yet often unrecognized, contributions of nurses. In this episode, Carolyn shares powerful stories from her film "American Delivery," highlighting the impact of the wholistic care nurses offer their patients. Carolyn, a brilliant storyteller, offers a unique perspective on the daily challenges and triumphs of these healthcare heroes, showcasing their technical expertise and unwavering compassion. Kicking off our Nurses Month mini series, The Heart of Healthcare, this episode is a timely reminder of the expertise and compassion that nurses bring to our communities each day. Tune in to explore the incredible work of these dedicated professionals and their crucial role in shaping the future of healthcare.

We're honored to continue our global tour of medical education today with Professor Katarzyna Taran, MD, PhD, a pioneering interdisciplinary researcher of tumor cell biology, an award winning educator noted for her focus on student engagement, and -- in a first for a Raise the Line guest -- a shooting sports certified coach and referee. As Professor Taran explains to host Michael Carrese, these seemingly disparate professional activities require the same underlying attributes: patience, the ability to overcome barriers, openness and adaptation. She believes those last qualities are especially important for today's medical students to acquire given the accelerated pace of change in healthcare. “They need to be equipped with the ability for critical thinking, to analyze and synthesize, and to search for unconventional solutions.” Professor Taran tries to impart these skills, in addition to the medical and scientific knowledge students must know, through a high level of engagement. “Teaching is relational, so try to be familiar with students' concerns. Talk to them, listen to them and you will become someone they trust.” In this wide-ranging and engaging conversation, Professor Taran also discusses her work as the head of the Laboratory of Isotopic Fractionation in Pathological Processes in Chair of Oncology, the use of neurodidactics in teaching, and the connection between the science of pathology and the future of humans in space. Mentioned in this episode:Medical University of Lodz If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast

As major healthcare payers, employers can drive value-based care, health equity, and innovative models to improve outcomes and cut costs. In this episode, Dan Mendelson, CEO of Morgan Health, discusses how employers, as significant healthcare payers, can play a pivotal role in demanding and implementing quality care models. He dives into the impact of primary care innovations, tackling health equity. Dan talks about the critical need for actionable data in transforming healthcare delivery. Dan also mentions how Morgan Health helps close the gaps by putting primary healthcare services close to their employees.  Tune in and uncover how employers can revolutionize healthcare delivery through value-based care, health equity initiatives, and innovative small business solutions!  Resources: Connect with and follow Dan Mendelson on LinkedIn. Follow Morgan Health on LinkedIn and visit their website.

Brian Drozdowicz, Senior VP and General Manager for Acute and Payer at PointClickCare, provides a platform using predictive analytics and AI for data sharing and collaboration across healthcare stakeholders. Interoperability has been an ongoing challenge due to the lack of standards and clear governance to support data sharing. The shift to value-based care drives the need for more access to patient data to improve patient outcomes, facilitate care transitions, and reduce readmissions and costs.   Brian explains, "PointClickCare has been a player in the market for quite some time. We're best known for the market-leading senior care EHR that we've had in market for 20-plus years. I run a business unit that sits by the side of that. We refer to that as the acute and payer business. And ultimately, this additional business and value proposition to the market operates the largest care collaboration network, sharing healthcare data across all the different stakeholders, hospitals, health plans, ambulatory clinics, community providers, and connecting is our core business. So we're ultimately in the business of sharing data and doing that safely, securely in a trusted way." "There are a lot of ways of driving adoption and sharing data at scale. I'd call out a couple of key areas in which we've seen a lot of progress in recent years. First is having well-established technology standards that safely and securely transmit that data. Number Two is having to share that data. So, otherwise, it's a bunch of data flowing back and forth just for the sake of data. And that doesn't solve anything with value-based care. Putting a set of guardrails in place requires providers and payers to work together with this data." #PointClickCare #HealthcareData #Interoperability #MedAI #DataSilos #ValueBasedCare #VBC  pointclickcare.com Download the transcript here

Brian Drozdowicz, Senior VP and General Manager for Acute and Payer at PointClickCare, provides a platform using predictive analytics and AI for data sharing and collaboration across healthcare stakeholders. Interoperability has been an ongoing challenge due to the lack of standards and clear governance to support data sharing. The shift to value-based care drives the need for more access to patient data to improve patient outcomes, facilitate care transitions, and reduce readmissions and costs.   Brian explains, "PointClickCare has been a player in the market for quite some time. We're best known for the market-leading senior care EHR that we've had in market for 20-plus years. I run a business unit that sits by the side of that. We refer to that as the acute and payer business. And ultimately, this additional business and value proposition to the market operates the largest care collaboration network, sharing healthcare data across all the different stakeholders, hospitals, health plans, ambulatory clinics, community providers, and connecting is our core business. So we're ultimately in the business of sharing data and doing that safely, securely in a trusted way." "There are a lot of ways of driving adoption and sharing data at scale. I'd call out a couple of key areas in which we've seen a lot of progress in recent years. First is having well-established technology standards that safely and securely transmit that data. Number Two is having to share that data. So, otherwise, it's a bunch of data flowing back and forth just for the sake of data. And that doesn't solve anything with value-based care. Putting a set of guardrails in place requires providers and payers to work together with this data." #PointClickCare #HealthcareData #Interoperability #MedAI #DataSilos #ValueBasedCare #VBC  pointclickcare.com Listen to the podcast here

This episode of Relentless Health Value features Dr. Kenny Cole from Ochsner Health System. The discussion emphasizes the critical role of trusted relationships and excellent primary care teams in keeping patients out of the emergency room, thus reducing healthcare costs. Stacey Richter revisits this conversation to highlight the importance of care teams building trust with patients and the concept of primary care as an investment in health and wellness. The episode outlines four key points for delivering great primary care, including accountability for outcomes, belief in clinical goals, standardized care flows, and building patient trust. Dr. Cole also discusses the real-world challenges and strategies for achieving clinical and financial success in primary care. The episode serves as a guide for plan sponsors, clinicians, and healthcare executives looking to improve primary care delivery and align it with financial viability. The discussion is further enriched with insights on digitizing care pathways and the importance of measuring and sharing best practices to achieve high standards of care.I Stacey revisits, in a take two, this episode with Dr. Kenny Cole because she's listening to it this time with a new focus. That focus is the theme that keeps coming up over and over and over again on Relentless Health Value these past few months. === LINKS ===

We're discussing From Pain to Purpose: Transforming Trauma into Healing! Faisel and Dan are joined by Dr. Jeff Brenner: CEO at The Jewish Board.Our conversation revolves around the unexpected findings regarding coordinated care, the reality of medicalizing social issues, and the importance of timely empathy in mental and behavioral health.

Visionary healthcare leaders from The Permanente Medical Group, UC Davis Health, UNC Health, Summit Medical Group and Navina joined Eric Glazer to explore how artificial intelligence transforms clinical workflows and enables better value-based care. Discover how AI-driven chart prep, ambient scribe technology, and risk models streamline provider workflows, improve patient outcomes, and reduce clinician burnout. From overcoming implementation roadblocks to building cross-functional frameworks that promote trust and equity, this episode is packed with strategic insights and real-world success stories you can apply at your organization. Panelists Include: Brian Hoberman, MD, EVP & CIO, The Permanente Medical Group Reshma Gupta, MD, Chief of Population Health and Accountable Care, UC Davis Health Ram Rimel, Manager of Data Science Engineering, UNC Health Eric Penniman, D.O. Executive Medical Director, Summit Medical Group Dana McCalley, VP of Value-Based Care, Navina https://www.brightspotsinhealthcare.com/events/the-new-physician-playbook-ai-workflows-value-based-care-in-action/#url This episode is sponsored by Navina Navina is the clinician-first AI copilot for value-based care. Recently named Best in KLAS for clinician digital workflows, Navina turns fragmented patient data into actionable clinical insights right at the point of care. Natively integrated into the clinical workflow, their AI copilot helps improve risk adjustment, quality metrics, and population health – while significantly easing the administrative burden. Navina has earned the trust of more than 10,000 clinicians and care team members across 1,300 clinics, from some of the leading value-based care organizations in the country like Privia Health, Agilon Health, and Millennium Physician Group. About Bright Spots in Healthcare Bright Spots in Healthcare is produced by Bright Spots Ventures Bright Spots Ventures brings healthcare leaders together to share working solutions or "bright spots" to common challenges. We build valuable and meaningful relationships through our Bright Spots in Healthcare podcast, webinar series, leadership councils, customized peer events, and sales and go-to-market consulting. We believe that finding a bright spot and cloning it is the most effective strategy to improve healthcare in our lifetime. Visit our website at www.brightspotsinhealthcare.com

We like to think of Osmosis from Elsevier as a global community of millions of learners, connected by a desire to serve humanity and an inclination to use a diverse mix of educational resources to help them become excellent healthcare practitioners. On today's episode of Raise the Line, we're going to learn how Osmosis has created an opportunity for hundreds of those students from sixty countries to actually solidify those connections through the Osmosis Health Leadership Initiative (OHLI). Our guide to this effort is Osmosis Community Specialist Alfred Collins, who brings a keen interest in developing tech solutions to power the future of human communication to his work with OHLI.“Technology collapses barriers to communication and to understanding the nuances behind culture, behind global perspectives,” he tells host Lindsey Smith. One example he cites is how OHLI members learn about variations in the way different cultures approach collaboration, an important insight to gain as they head into team-based healthcare environments. OHLI members convene regularly over video sessions to hear from leaders in healthcare and learn about hosting successful on-campus events, among other enriching content.  They also have an opportunity to provide feedback on improving the Osmosis learning platform, and this year they're participating in a “hackathon” aimed at improving the future of healthcare. Tune in to find out more about what the OHLI program offers, how to apply, and how Alfred thinks virtual reality and AI technologies will impact the future of community building. Mentioned in this episode:Osmosis Health Leadership Initiative If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast

In this special edition of Quality Matters, we explore what three powerful conversations have taught us about one of health care's most pressing and perplexing questions: What do we know about the economics of care in America, and how can we make substantial, sustainable improvements? We look back at previous episodes of Quality Matters to reflect. We begin with health economist Sanjula Jain, who challenges conventional thinking around value-based care and urges a shift toward a more intuitive concept: “value for money.” With real-world examples (think hotels and Costco), she explains why the US health economy needs stability, and what it would take to rebuild trust and deliver real value to patients.Next, Brittany Cunningham, of Vanderbilt University Medical Center, shares how My Health Bundles help employers rein in costs while improving patient experience and provider satisfaction. Her team's approach flips the traditional payment model on its head—designing care first and payment second.And obstetrician Tiffany Inglis, of Elevance Health, takes us inside a groundbreaking program that pairs OB/GYNs with dedicated practice consultants. The result? Dramatic improvement in maternal health outcomes that could affect a staggering 12% of the nation's births.Each voice in this episode offers fresh, actionable insight. Together, they offer a roadmap toward a more sustainable—and humane—health care economy. Key Quote:“ Value for money is the ultimate consumer of the service is going to determine that value based off what they are paying. Value-based payment, it's different because value-based payment is ultimately a reimbursement scheme that doesn't change the total cost of care. Value-based payment is really a policy scheme focused on the provider level, which doesn't even affect the patient or consumer. It's one pool of dollars that is being reallocated. Providers are just reallocating those dollars and actually reducing the total cost of care. Who is benefiting doesn't actually translate down to the patient or the consumer.”Sanjula JainTime Stamps: (00:25) The Macroeconomics of Health Care(8:40) Value-Based Care in Action With Health Bundles14:30) The Economics of Prenatal Care

In this episode of Mavericks in Healthcare, hosts Ajay Mody and Asher Perzigian sit down with trailblazing leader Beth Dolan, Dean of the College of Health at Lehigh University. Beth isn't just rethinking healthcare education—she's turning it on its head. From championing interdisciplinary learning to weaving data science into the fabric of public health, Beth shares how Lehigh is preparing students to tackle today's most urgent health challenges. Discover how the College's bold initiatives—like its cutting-edge Population Health program and hands-on community-based research—are shaping a new kind of health professional. Plus, Beth opens up about the critical role of mental health in academia and what it really means to build a truly supportive student experience. If you're curious about the future of healthcare, education, and innovation, this conversation is a must-listen. Beth Dolan is on a mission—and she's inviting the next generation to lead the way.

Send us a textObesity is a pressing and complex challenge. GLP-1 meds are a game changer, but on their own, they may just bankrupt insurers without doing a whole lot to improve health. Can we build a better system for weight management that's clinically sound cost effective and scalable?In this episode of the HealthBiz Podcast, we're joined by Elina Onitskansky, Founder & CEO of Ilant Health. Elina explains why the current approach to obesity care is broken and how Ilant Health is making treatment more accessible by making it affordable, available, and accepted through value-based care.

This week on Faisel and Friends, we are discussing Expanding the Frontier: The Future of Primary Care. Faisel and Dan are talking with Tim Gronniger: Chief Executive Officer at Hopscotch Primary Care.Our conversation revolves around primary care in rural communities, the next generation of primary care practices, and pushing the boundaries of what primary care can be.

Jacob and Nikhil sit down with Dr. Rushika Fernandopulle. Rushika is the former CEO and Co-Founder of Iora Health, a primary care provider centered around value-based care and Medicare that One Medical acquired for $2.1 billion. They discuss why we're still in the second inning of value-based care, intersections of tech and healthcare, what it takes for VBC to succeed, and more. [0:00] Intro[0:29] Early Days of Value-Based Care[2:34] Challenges in Commercial Value-Based Care[5:20] Adapting Care Models for Different Populations[13:08] Medicaid and Long-Term Care Issues[16:30] Big Tech's Foray into Healthcare[20:37] Amazon's Healthcare Strategy[21:09] Challenges in Serving Low-Income Seniors[21:43] Innovative Solutions for Patient Transportation[22:16] The Economics of Healthcare Visits[23:22] Building a Custom EHR System[27:34] The Role of AI in Modern Healthcare[33:17] Future of Primary Care and Policy Implications Out-Of-Pocket: https://www.outofpocket.health/

This podcast is brought to you by Outcomes Rocket, your exclusive healthcare marketing agency. Learn how to accelerate your growth by going to outcomesrocket.com Operationalizing value-based care is the core purpose of modern population health management, moving beyond simple definitions.  In this episode, Michael Hoxter, Chief Technology Officer at Lightbeam Health Solutions, shares key insights from HIMSS 2025, highlighting the growing role of AI and his company's 12-year journey from a small table to a major industry presence. He explains how Lightbeam leverages data warehousing, analytics, AI-driven patient segmentation, care management, and outreach to support value-based care, particularly in Medicare programs, where they have achieved significant savings. Michael distinguishes population health from chronic care management, emphasizing its broader responsibility for patient outcomes beyond clinical settings. He also discusses Lightbeam's shift from a product-only company to offering advisory and care management services shaped by client needs and industry feedback. Tune in and learn how data-driven insights transform patient care and the critical role of listening to clients in building a successful health tech company! Resources:  Connect with and follow Michael Hoxter on LinkedIn. Learn more about Lightbeam Health Solutions on their LinkedIn, Instagram, and website. Fast Track Your Business Growth: Outcomes Rocket is a full-service marketing agency focused on helping healthcare organizations like yours maximize your impact and accelerate growth. Learn more at outcomesrocket.com

Today, we're excited to get to know Dr. Ali Khan, Chief Medical Officer of Aetna Medicare, overseeing healthcare services for over 4 million members. His career spans across some of the most impactful value-based care organizations, including Oak Street Health, CareMore, and Iora Health. He is also an adjunct lecturer at Northwestern University's Kellogg School of Management and serves on the clinical faculty of the Yale School of Medicine. Additionally, Dr. Khan is a director on the American Board of Internal Medicine. Also a trusted advisor on Pear's Health Industry Council.Before Aetna, Dr. Khan played a key role in Oak Street Health's rapid expansion, scaling it from 21 to 200+ clinics, culminating in its acquisition by CVS Health. Prior to that, he was instrumental in CareMore Health's growth and innovation in care delivery for vulnerable populations.He holds an MD-MPP from Virginia Commonwealth University and Harvard Kennedy School, completed his residency at Yale, and has taught at institutions like Northwestern Kellogg and Yale School of Medicine.As a leader in value-based care, he has firsthand experience in building, scaling, and optimizing healthcare startups—making his insights invaluable for founders, investors, and industry leaders navigating the complex world of healthcare innovation.

About Chris Caramanico:Chris Caramanico is a growth-oriented CEO, investor, and consultant with a proven track record of driving profitable growth in healthcare technology. With over 20 years of experience, Chris excels in both startups and large corporations, leading successful transformations and delivering results in complex environments. He is adept at anticipating market trends, developing innovative strategies, and building high-performance teams. Chris is a customer-focused strategist with expertise in value-based care and a passion for improving healthcare delivery through intelligence and intervention. Currently, he serves as CEO of Elligint Health, leveraging his expertise to reshape the healthcare landscape.Things You'll Learn:Elligint Health provides a toolset outside of the electronic medical record to help organizations perform value-based care arrangements.Their solution combines data analytics, care management, and communication tools to proactively identify and address patient needs.The platform aggregates data from various sources to create prospective work lists, enabling targeted interventions and improved patient outcomes.Elligint Health emphasizes patient activation, encouraging patients to take a proactive role in their care to improve health outcomes and address labor shortages.The organization is focused on interoperability and is prepared to meet CMS's rulings regarding prior authorization and data exchange.Resources:Connect with and follow Chris Caramanico on LinkedIn.Learn more about Elligint Health on their LinkedIn and website.

So, the show today, it's sort of an encore but not really an encore because I recorded this whole new introduction that you are currently listening to. And I also did a few inserts that we popped into the show itself. Inserts from the future, you might say. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. But why did I pull this episode from 2021, you might be wondering, as an immediate follow-on to the show from last week (EP469) about possible Medicaid cuts? Well, for one thing, the show last week about Medicaid cuts was about how the cuts might impact plan sponsors. And it left me feeling a little bit like part of the story was going unsaid. So much of what happens in healthcare, we see numbers on a spreadsheet but can easily lose track of human beings. I was reading something the other day. It reminded me of the people behind these numbers. I don't know if this happened in rural America, but it easily could have. Here's the link. Someone could not get a needed surgery. This surgery had all of the medical necessity boxes checked, except the hospital would not perform the needed surgery without cash up front in prepayment. This patient, he did not have enough money to cover the prepayment. So, somebody in the hospital finance department gave him a solution: Just wait until the situation becomes life-threatening, and then I guess you can go to the ER with your newly life-threatening condition, and they will have to perform the surgery without the money up front. And here we have the theme of people not being able to afford or not being able to access primary care or, in this case, I guess something more than that—a surgery—and they wind up in the emergency room. As John Lee, MD, put it, the healthcare system in this country is like a balloon. And the way we are currently squeezing it, everybody is getting squeezed into the emergency room—which is the very most expensive place to obtain care, of course, especially when that care is non-emergent. In rural America, this is particularly true. Now, by no means am I suggesting any kind of magic bullet to this Medicaid situation. As we all know, health and healthcare are not the same thing as health insurance; and we all know enough about the issues with Medicaid. That is not what the show is about. The episode that follows with Nikki King, who is my guest today, offers some great advice when there's just such a scarcity of clinicians available; and she does a great job of it. So, I am going to spend my time with you in this intro talking about rural hospitals in rural areas—the place where many patients wind up when they cannot get primary care in their community, just exacerbating all of the issues we have with Medicaid and affording Medicaid. But yeah, even if there is adequate or even great primary care, you still kind of need a hospital. The thing is, if an economic situation emerges where, say, for example—and this is the case in a lot of rural places—let's just say a factory or two or a mine or whatever closes down. It might mean the local hospital also closes down if that local hospital was dependent on commercial lives and cost shifting to those commercial lives. Like, this is not higher math or anything. It's easy to see how a doom loop immediately gets triggered. Recall that one big reason—and Cynthia Fisher (EP457) talked about this in an episode from a few months ago—one reason why employers in rural areas are choosing to move facilities somewhere else or overseas is that hospital costs are too high in the USA in these rural areas. So, they are closing their factory down because the hospital is charging too much. The lower the volume of commercial lives, the higher the hospital winds up raising their prices for the other employers in the area. Now, there's a point that comes up a lot in 2025 in conversations about rural hospital financials or just hospital financials in general, I guess. I had a conversation with Brad Brockbank about this a while back, and I've been mulling over it ever since. There are many who strongly suggest the reason why rural and other hospitals are in trouble is squarely because they don't have enough patients with commercial insurance in their payer mix. As Nathan Kaufman wrote on LinkedIn the other day, he wrote, “The ‘tipping point' is the percent of commercial gross revenues. When most hospitals hit 25%, if they don't have commercial rates in the high 300% [over Medicare] range, things begin to unravel.” And look, I'm not gonna argue any of the points here. How would I know? For any given hospital, it could be a financial imperative to try to get 300% over Medicare out of the local employers. I don't doubt it. The question I would ask, if someone knows that hospital finances are currently dependent on cost shifting, especially in a rural area with unstable industry, what are the choices that are made by hospital boards or leadership? Is this current dependency used as a justification to level up the cost shifting to local employers just as volume diminishes keep charging more, which is ultimately going to cause even more employers to leave the area? Which seems to be kind of a default. It's like the safety valve is, charge the local employers more. The point I'm making here is not all that profound, actually. It's just to point out that safety valve, taking advantage of it, comes with downstream impact that actually worsens a situation. So, what do we do now? And similar to the Medicaid, what I just said about Medicaid, I'm not showing up with any silver bullet here. And running a hospital is ridiculously hard. So, I do not wanna minimize that. And I certainly do not wanna minimize Medicare advantage paying less than Medicare going on and the mental health crisis and the just crippling issues that a lot of rural hospitals face. Here's a link to a really interesting report by the Center for Healthcare Quality & Payment Reform (CHQPR) about the ways hospitals can restructure and rethink how they deliver services, but I will take a moment to point out some case studies of success for what happens when people crossed off go get more money from the local employers off the list. Then there's also FQHCs (Federally Qualified Health Centers) doing some amazing things even in rural areas. Listen to the episode a while back with Doug Eby, MD, MPH, CPE (EP312) about the Nuka System of Care in Alaska, serving areas so rural, you need to take a prop plane to get to them. Their patients, their members have some of the best outcomes in the entire country. Their secret: yeah … great primary care teams that include behavioral health, the doctor, the nurse, a whole crew. And look at us. We've come full circle. Primary care (good primary care, I mean) is an investment. Everything else is a cost. Lastly, let me just offer a very large update: Today, you cannot just say rural hospital anymore and automatically mean a hospital in dire financial straits struggling to, like, make the rent. Large consolidated hospital systems have bought up so many rural hospitals for all kinds of reasons that may (or maybe not) have less to do with mission and more to do with all the things I discussed with Brennan Bilberry (EP395) in the episode entitled “Consolidated Hospital Systems and Cunning Anticompetitive Contracts.” Here is the original episode with Nikki King. Nikki, let me just mention, has gotten a new job since she was on the pod. She is now the CEO of Alliance Health Centers in Indiana. Also mentioned in this episode are Alliance Health Centers; John Lee, MD; Cynthia Fisher; Patient Rights Advocate; Brad Brockbank; Nathan Kaufman; Doug Eby, MD, MPH, CPE; Nuka System of Care; and Brennan Bilberry.   You can learn more at Alliance Health Centers and by following Nikki on LinkedIn.   Nikki King, MHSA, DHA, is the chief executive officer for Alliance Health Centers, Inc. Her work serves both urban and rural populations and is focused on substance abuse, communities underserved in healthcare, affordable housing, and economic development. Before working in the healthcare industry, she worked for the Center of Business and Economic Research studying models of sustainability in rural communities. Growing up as a first-generation college student in Appalachia, she brings lived experience of rural communities and approaches her work in healthcare as pivotal in breaking the cycle of poverty. Nikki completed her DHA at the Medical University of South Carolina and her MHSA from Xavier University.   08:14 How dire is the rural hospital situation right now? 08:33 How could freestanding ERs be a potential solution for rural hospitals? 09:56 Advice from CHQPR: Rural hospitals should not be forced to eliminate inpatient care. 11:22 Why is broadband a roadblock to telehealth as a solution for rural health access? 14:52 What are other potential rural health access solutions? 15:37 The “hot potato” of nurse practitioners in the healthcare world. 16:34 “The number of residencies for physicians each year is not increasing, but the population … is increasing.” 20:28 EP312 with Douglas Eby, MD, MPH, CPE, of the Nuka System of Care. 22:00 What's the issue with maternity care in rural America? 24:09 “As healthcare becomes more and more specialized, [the] ability to treat high-risk cases is better, but access gets worse.” 27:57 How is mental health care affected in rural communities? 28:29 “Rural communities are trying very hard to hang on to what they have.” 29:52 “When you look at the one market plan that's available in a rural community, you probably can't afford it.” 31:37 What's the single biggest challenge to moving to a model that incentivizes keeping people healthy? 32:32 “The easiest low-hanging fruit … is having national Medicaid and have that put under the same hood as Medicare.”   You can learn more at Alliance Health Centers and by following Nikki on LinkedIn.   Nikki King, MHSA, DHA, discusses #ruralhospitals and #ruralprimarycare. #healthcare #podcast #changemanagement #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! James Gelfand (Part 2), James Gelfand (Part 1), Matt McQuide, Stacey Richter (EP467), Vivian Ho, Chris Crawford (EP465), Al Lewis, Betsy Seals, Wendell Potter (Encore! EP384), Dr Scott Conard, Stacey Richter (INBW42)

While many OTs work in a fee for service model, the reality is that we are undergoing a seismic shift towards value based care. In fact it's estimated that 238.8 million Americans receive healthcare in a value-based care model. These already large numbers are expected to grow significantly in the coming years.OTs has tremendous potential in value-based care models. But, the reality is we are missing the boat.  That's because becoming involved in a value based care model involves a contracting process that can feel complicated. There has been MUCH written to support doctors and other medical providers in the value-based care process, and they are outpacing us.  But, in today's episode we break this information down for OTs. Our favorite value-base care expert, Dana Stauss, PT, DPT  is going to walk private practice owner Carlin Reaume through: identify value-based care opportunities locally, crafting a proposal, and ultimately drafting a contract. Let's be honest. This feels dense. But, this is exactly what we need to be learning, and we are here to set you up for success!You can find more details on this course here:https://otpotential.com/ceu-podcast-courses/value-based-care-contracts Support the show Support the show

David Game remembers the days when the use of digital technology in education publishing amounted to putting a dictionary on a compact disc. Now, as the senior vice president of Product Management, Global Medical Education at Elsevier, he oversees a suite of learning materials that use artificial intelligence, virtual reality and 3-D modeling. “We've expanded into immersive technology with Apple Vision Pro that enables you to be inside the human body, to see and explore the human heart from the inside out and it is absolutely stunning,” says Game, whose long career in publishing includes experience in North America, the United Kingdom, Europe, China and India. As Game has witnessed first-hand, advancements in ed tech, including distance learning, have provided students with an array of options and modalities to choose from that accommodate different learning styles and life circumstances, and that puts a premium on being able to meet students where they are. “We want to make sure that students find learning from our materials engaging, efficient, and aligned with how they live their lives and do their work.” Join host Lindsey Smith for this fascinating episode of Raise the Line to learn how Elsevier is leveraging the innovations offered by Osmosis, Complete Anatomy and ClinicalKey Student to enrich the learning of medical students on their journey to becoming excellent clinicians.Mentioned in this Episode:Complete AnatomyClinicalKey StudentOsmosis If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast

Today's interview features Dr. Stephanie Huhn, founder of RoMo DPC as she shares her inspiring journey from traditional and "value based" primary care to Direct Primary Care (DPC) in rural Missouri. Dr. Huhn discusses her medical background, decision to pursue a DPC model, and how the transition has allowed her to offer personalized, patient-centered care without the constraints of traditional insurance. Throughout the conversation, she highlights the challenges and joys of working in a health professional shortage area and her dedication to improving healthcare access for her community. With her unique experiences in the Navy and academic settings, Dr. Huhn emphasizes the importance of following one's passions in medicine. She also shares successful community outreach strategies to educate patients about DPC, express her passion for patient care, and the rewarding aspects of the profession. For those interested in how rural healthcare can thrive under the DPC model, this episode offers valuable insights and practical advice. Join Dr. Huhn as she redefines healthcare delivery, ensuring patients experience the relief of having a physician in the family.FREE MARKET MEDICAL ASSOCIATION (FMMA) 4/9-11/25: Use code MYDPCSTORY for $800 off your FMMA Annual Conference registration! FREE Alternative to Up TO Date: OPEN EVIDENCESupport the showBe A My DPC Story PATREON MEMBER! SPONSOR THE PODMy DPC Story VOICEMAIL! DPC SWAG!FACEBOOK * INSTAGRAM * LinkedIn * TWITTER * TIKTOK * YouTube

Send us a textJoin Dr. Paulie as he explores value-based care in education with Leila Farshchian MA, BCBA, leader of ABA Toolbox—an award-winning platform advancing science-driven, learner-centered interventions for individuals with autism and disabilities. The conversation explores how integrating behavior analytic principles with compassion and creativity can significantly enhance outcomes for students with special needs. Listen in as Layla shares her inspiring journey into behavior analysis, the critical role of values in education, and practical strategies to empower educators, students, and families alike.Key Takeaways:How CABAS merges science & teaching for individualized success The role of tech-driven solutions in special education & ABA Toolbox The power of collaboration in transforming therapy & learningThis engaging conversation is packed with practical insights for providers dedicated to collaboration, brining the learner to the center for enhanced treatment outcomes in education.To learn more about Leila and her mission, please visit us at: www.abatoolbox.comLeila Farshchian, MA, BCBA. https://www.linkedin.com/in/leila-farshchian-33974335 Contact: Leila@abatoolbox.com