Value-Based Care Insights

As financial pressures intensify across healthcare, payers are rethinking traditional strategies and accelerating their transition to value-based care. In this episode of Value-Based Care Insights, host Daniel Marino speaks with Joe Mangrum, Partner at ECG Management Consultants, about how payers are adapting to rising medical costs, tightening Medicare Advantage margins, and increasing regulatory demands. Together, they unpack how payer strategies are shifting from broad network expansion to more selective, high-performing partnerships, with a growing emphasis on disciplined, data-driven decision-making. The discussion highlights the critical role of payer-provider collaboration in managing total cost of care, along with the increasing importance of data sharing, risk stratification, and more mature value-based arrangements. The episode offers practical insights into aligning incentives, strengthening partnerships, and building sustainable care models for the future.

As the CMS Transforming Episode Accountability Model (TEAM) launched on January 1, 2026, healthcare organizations are now facing the realities of implementation and the pressure to perform. In this episode of Value Based Care Insights, host Daniel Marino speaks with healthcare strategist Heather Flynn Kearney about what organizations are experiencing during the early stages of this mandatory model. They discuss TEAM’s goals, why CMS targeted specific high-cost procedures, and how hospitals are managing operational, financial, and clinical challenges. From data limitations and coding accuracy to care coordination and post-acute partnerships, the conversation highlights the core capabilities needed for success. Whether you're directly involved in TEAM or preparing for future value-based models, this episode offers practical strategies to improve coordination, reduce variation, and drive better outcomes in episode-based care.

As Medicare Advantage enrollment continues to rise, health systems and provider organizations are recognizing that these contracts demand more than traditional care delivery. In this episode of Value-Based Care Insights, host Daniel Marino is joined by value-based care expert Dr. Doug Ardoin to examine what drives performance in Medicare Advantage. Together, they discuss why provider organizations often struggle after entering these arrangements and outline the core capabilities required to perform effectively, from accurate risk capture and attribution to utilization and care management. This conversation offers healthcare leaders practical insights on aligning clinical operations with contract expectations to improve financial and clinical outcomes in value-based models.

In this special episode of Value-Based Care Insights, host Daniel Marino announces an exciting new chapter: Lumina Health Partners has joined ECG Management Consultants. Dan is joined by Terri Welter, Partner and Leader of ECG’s Payer Strategy and Contracting Division. Together, they explore the evolving dynamics between payers and providers, the growing role of advanced analytics and transparency data in negotiations, and how reimbursement models are shifting in response to mounting market pressures. The conversation dives into key trends in value-based care, physician compensation alignment, clinically integrated networks, and the strategic use of data to drive sustainable performance. As healthcare organizations face increasing financial and operational strain, this episode highlights how deeper expertise, stronger analytics, and more collaborative payer-provider strategies can lead to smarter negotiations and stronger outcomes.

Emergency departments are under more pressure than ever as they are facing overcrowding, extended wait times, workforce strain, and rising patient demand fueled in part by primary care shortages. In this episode of Value-Based Care Insights, host Daniel Marino examines how these mounting challenges are reshaping the hospital’s front door and what they mean for patient care, operational performance, and long-term sustainability. Daniel is joined by Dr. Richard Wolfe, Chief of Emergency Medicine at Beth Israel Deaconess Medical Center and a nationally recognized leader in emergency medicine operations. Together, they explore why emergency departments have become a critical pressure point for hospitals, how overcrowding affects quality, safety, and clinician burnout, and what forward-thinking health systems can do to better support their emergency medicine teams while continuing to serve their communities effectively.

As healthcare organizations move from AI curiosity to real-world implementation, many leaders are asking the same question: where do we actually begin? As the industry heads into 2026, providers are under pressure to move beyond experimentation and apply artificial intelligence in ways that deliver meaningful, workflow-driven impact without adding technology overload. In this episode of Value-Based Care Insights, host Daniel Marino is joined by Don Woodlock, President of InterSystems, to explore how healthcare organizations can take a more strategic and disciplined approach to AI adoption. Drawing on InterSystems’ deep expertise in interoperability, data platforms, and AI-enabled solutions, the conversation focuses on where AI can truly enhance clinical workflows, reduce administrative burden, improve revenue cycle performance, and support better decision-making. From ambient clinical documentation to smarter data connectivity and actionable AI insights, this discussion cuts through the hype to highlight how healthcare leaders can build an AI foundation that drives real value for clinicians, patients, and health systems, all while advancing the goals of value-based care.

Artificial intelligence (AI) is rapidly reshaping healthcare, yet many provider organizations still struggle to move from interest to practical application particularly when it comes to value-based care contracts. While AI promises efficiency and insight, turning it into measurable performance and financial advantage remains a challenge. In this episode of Value-Based Care Insights, host Daniel Marino explores how AI can be used to address one of healthcare’s most complex challenges: evaluating and managing value-based contracts. Drawing on real-world experience, Daniel explores how AI can be used to build performance models that connect contract design with operational outcomes across clinically integrated networks, ACOs, and other value-based arrangements.Joined by Eddie Diaz, a data scientist with more than 15 years of experience in value-based care analytics, the discussion highlights how AI can bring clarity to attribution, risk, quality, and financial performance to help CFOs, CMOs, and managed care leaders better understand contract opportunities, risks, and results. Together, they explore how AI can move beyond hype to deliver real, actionable value in value-based care contracts.

As healthcare leaders look ahead to 2026, the pace of change shows no signs of slowing. From the rapid acceleration of artificial intelligence and evolving site-of-service regulations to new federal policy signals and leadership shifts in Washington, the strategic pressures facing providers, including hospitals and medical groups, are intensifying. In this episode of Value-Based Care Insights, host Daniel Marino sits down with Chris Collins, President and CEO of ECG Management Consultants, to reflect on the defining forces of 2025 and explore what healthcare leaders must be prepared for in 2026. Drawing on more than 25 years of advising health systems, academic medical centers, and physician enterprises nationwide, Chris offers perspective on emerging trends, strategic risks, and the leadership priorities that will matter most in the year ahead. Together, they unpack how provider organizations can navigate regulatory uncertainty, harness innovation responsibly, and position themselves for long-term success in an increasingly complex healthcare landscape.

Orthopedic care is evolving rapidly, driven by shifts in site-of-service, advances in surgical techniques, and growing patient expectations for advanced technology, improved outcomes, and convenience. As procedures, such as joint replacements, move from inpatient settings to same-day outpatient care, orthopedic groups are rethinking how they deliver high-quality, cost-effective care while remaining competitive in this changing market. In this episode of Value-Based Care Insights, host Daniel Marino continues the clinical service line series with a deep dive into the orthopedic service line. He is joined by Lori Pagan, CEO of Ortho Northeast, a physician-led orthopedic and spine practice in Indiana known for its entrepreneurial approach and strategic partnerships. Together, they explore how orthopedic groups are adapting to industry trends and building stronger physician–hospital partnerships. They highlight strategies for positioning orthopedic groups for long-term growth while enhancing patient outcomes and experience.

As the year comes to a close, we thought you would enjoy a throwback to one of our most popular episodes of 2025. In this episode of Value-Based Care Insights, host Daniel Marino explores the evolving role of artificial intelligence (AI) in population health. As AI continues to dominate industry conversations and drive vendor offerings, healthcare leaders are faced with questions: What is real, what is hype, and where does the value lie? Dr. David Nash, Founding Dean Emeritus of Jefferson College of Population Health and a nationally recognized thought leader in value-based care and population health, join the conversation. Additionally, Rick Howard, a seasoned Chief Data Officer and AI Strategist contributes to the conversation with his deep expertise in driving data-driven innovation across healthcare organizations. Together, they break down common misconceptions, highlight the most promising AI applications in care delivery, and offer practical insights into how health systems, providers, and payers can responsibly integrate AI to drive meaningful outcomes and return on investment (ROI).

Cardiovascular service lines are in the midst of a major transformation, reshaping how physicians and health systems deliver care. Sites of service are shifting, patients present with greater complexity, and prevention is taking on a more prominent role across the continuum of care. In this episode of Value-Based Care Insights, host Daniel Marino is joined by longtime colleague and nationally recognized leader Dr. Nihar Desai, Associate Professor of Medicine and Vice Chief of Cardiovascular Medicine at Yale School of Medicine. Dr. Desai brings a unique perspective at the intersection of research, operations, and value-based transformation, as he and Daniel take a deep dive into the evolving cardiovascular service line. They discuss what these changes mean for clinical outcomes, financial performance, and the patient experience.

Strengthening service line performance requires a strong foundation in primary care, which remains central to delivering effective value-based care. Yet, the landscape of primary care delivery is marked by significant challenges including workforce shortages, provider burnout, administrative burdens, and increasing barriers to patient access. In this episode of Value-Based Care Insights, host Daniel J. Marino kicks off a new series exploring specialty service lines by starting with the primary care service line. He is joined by Dr. Sarita Soares, Program Director for the Yale Primary Care Internal Medicine Residency Program, and Dr. Brad Richards, Executive Director of the Yale Primary Care Internal Medicine Residency Program and Associate Professor of Medicine at the Yale School of Medicine. Together, they discuss the shifting dynamics of primary care, the growing integration of behavioral health, the role of technology in improving access, and what healthcare leaders can do to better support providers and patients in this changing environment.

In this episode of Value-Based Care Insights, host Daniel J. Marino reflects on his experience at the Lead from Identity Summit, a transformative leadership conference hosted by Dr. Doug McKinley in Silverton, Colorado. Unlike traditional leadership events focused on strategies and communication tactics, this summit challenged participants to explore how their personal identity shapes their leadership style and response to challenges. Daniel, a summit participant, is joined by two fellow attendees—Michelle Williams, Senior Nursing Executive and Chief Nursing Officer, and Lucy Zielinski, Managing Partner at Lumina Health Partners and a member of the summit’s planning team—to discuss key takeaways from the event. Together, they discuss how leading from identity fosters authenticity, resilience, and meaningful connections across healthcare teams—and how self-awareness and purpose-driven leadership can transform the way we lead and serve others. Want to learn more about leading from identity? Check out Dr. McKinley's podcast episode Leading from Identity with Jamie Winship

Across the U.S., hospitals and surgical centers are facing a growing provider shortage—particularly among anesthesiologists. At the same time, demand for surgical and procedural services continues to rise, especially in ambulatory surgery centers (ASCs). This imbalance has forced many healthcare organizations to rethink their anesthesia coverage models. In this episode of Value-Based Care Insights, host Daniel J. Marino sits down with Dr. Thomas Pallaria, Assistant Professor and Director of the Nurse Anesthesiology Program at Rutgers School of Nursing, to discuss the evolving role of Certified Registered Nurse Anesthetists (CRNAs). Together, they explore the growing reliance on CRNAs to meet demand, the benefits and challenges of integrating them into care models, and the implications for hospitals, anesthesiologists, and patient outcomes.

As CMS continues to expand value-based care programs, one stands out for its focus on supporting some of our most vulnerable patients—and their caregivers. The GUIDE model (Guiding an Improved Dementia Experience) is designed to improve care for individuals with dementia and Alzheimer’s, while providing essential resources and support for the family members and caregivers who support them. In this episode of Value-Based Care Insights, host Daniel J. Marino is joined by Seth Hyman, Co-Founder and Partner at JVS Health. Together, they explore the goals of the GUIDE model, why CMS is prioritizing dementia care, and how health systems can prepare to implement and benefit from this transformative initiative.

The newly signed One Big Beautiful Bill Act is reshaping the healthcare landscape, with ripple effects for providers, payers, and patients. From Medicaid coverage shifts and rural hospital funding challenges to stricter ACA rules, expanded value-based care, and mandatory risk models, the implications are broad and far-reaching. In this episode of Value-Based Care Insights, host Daniel J. Marino speaks with Ben Sparks, President of Bryan Health Connect, a clinically integrated network, to examine four critical areas leaders must prepare for: projected Medicaid losses, financial pressures on hospitals, new insurance access rules, and the wider fiscal and political fallout across states. Drawing on Bryan Health Connect’s experience, Ben shares practical takeaways to help leaders adapt to the new law.

In this episode of Value-Based Care Insights, host Daniel Marino is joined by Christina Kuta, a healthcare attorney specializing in regulatory and transactional healthcare law. Together, they explore the growing shift toward concierge medicine and address common misperceptions surrounding full and hybrid concierge models. They discuss key legal and contractual considerations—ranging from commercial insurance implications to the Medicare opt-out process and membership agreements—that providers must understand before transitioning to concierge practices. Tune in to gain insights into how physicians can successfully navigate regulatory requirements, protect patients, and build sustainable concierge practices.

In this episode of Value-Based Care Insights, host Daniel Marino explores the potential impact of new federal legislation, including One Big Beautiful Bill Act of 2025, which is set to reshape healthcare delivery and payment models. He is joined by Natalie Davis, a nationally recognized health policy leader who has spent nearly two decades shaping and implementing initiatives to improve access to affordable, high-quality care for all. In 2018, Natalie co-founded United States of Care, an organization dedicated to advancing health equity and ensuring care is accessible regardless of health status, social needs, or income. She also played a key role in launching Town Hall Ventures and The Medicaid Transformation Project. Together, they examine the implications of the legislation for hospitals across the country, highlighting both the opportunities to advance value-based care and the challenges of adapting to new funding and operational requirements. Tune in to gain insights into how hospitals can proactively prepare for change, navigate evolving financial pressures, and sustain access and quality of care particularly in resource-limited settings. Strategies are explored to help organizations achieve success while maintaining strong community impact.

In this episode of Value-Based Care Insights, host Daniel Marino tackles one of healthcare’s most persistent challenges: physician burnout. Joining him are two experts who bring both clinical and research perspectives to the conversation. First, Dr. Stephen Hippler, a retired Chief Clinical Officer at OSF HealthCare, oversaw more than 1,500 physicians and advanced practice providers and has led initiatives to support provider well-being and a thriving work culture. Second, Dr. Laurence Weinzimmer, an endowed research professor at Bradley University, is a nationally recognized healthcare researcher and advisor to Fortune 100 companies.  Together, they share insights from their latest study on “physician fortitude” examining the deeper, human roots of burnout, the organizational and cultural factors at play, and the strategies needed to drive meaningful change. Listeners will gain an understanding of why burnout persists, and what leaders can do to better support clinicians, build resilience, and improve workforce well-being over the long term. 

In this episode of Value-Based Care Insights, host Daniel Marino explores the evolving role of operating room (OR) nurse leaders within the perioperative service line. As perioperative services become an increasingly important strategic and financial focus for hospitals and health systems, the demand is growing for leaders who can combine clinical expertise with business and operational acumen. Joining the conversation is Cheryl Barratt, a seasoned healthcare consultant with over 30 years of experience in surgical services operations, system integration, and performance improvement. Cheryl discusses how perioperative nurse leaders, while strong clinically, frequently lack the training needed to manage the broader responsibilities of these roles. She shares practical insights into how organizations can support their development with leadership, financial, and strategic competencies that enable them to lead more effectively and drive long-term performance.

In this episode of Value-Based Care Insights, host Daniel Marino continues the conversation on CMS’s mandatory TEAM Model (Transforming Episode Accountability Model) — a five-year episode-based pricing initiative impacting 741 hospitals across the country. Joining the discussion is Dr. Christian Pean, a board-certified orthopedic trauma and reconstruction surgeon at Duke University School of Medicine, executive director of AI and Innovation for Duke Orthopedic Surgery, and co-founder/CEO of Revel AI Health. Together, they unpack the clinical and operational impacts of TEAM, with a focus on five key surgical procedures. Dr. Pean highlights how emerging technologies — including conversational AI platforms — are enhancing episode management and streamlining outreach, triage, and documentation to help providers improve care coordination and succeed under TEAM. 

In this episode of Value-Based Care Insights, host Daniel Marino explores the evolving role of artificial intelligence (AI) in population health. As AI continues to dominate industry conversations and drive vendor offerings, healthcare leaders are faced with questions: What is real, what is hype, and where does the value lie? Dr. David Nash, Founding Dean Emeritus of Jefferson College of Population Health and a nationally recognized thought leader in value-based care and population health, join the conversation. Additionally, Rick Howard, a seasoned Chief Data Officer and AI Strategist contributes to the conversation with his deep expertise in driving data-driven innovation across healthcare organizations. Together, they break down common misconceptions, highlight the most promising AI applications in care delivery, and offer practical insights into how health systems, providers, and payers can responsibly integrate AI to drive meaningful outcomes and return on investment (ROI).

In this episode of Value-Based Care Insights, host Daniel Marino explores the newly introduced the CMS Transforming Episode Accountability Model (TEAM)—a mandatory five-year, episode-based pricing model, informed by earlier initiatives from the CMS Innovation Center. Designed to cover high-volume, high-cost surgical procedures, TEAM represents a significant shift in how hospitals and providers approach bundled payments. Join Daniel and special guest Lucy Zielinski, an expert in value-based programs and HCC coding , as they unpack what the TEAM model entails and what participating hospitals must do to prepare for the January 1, 2026 implementation. Gain insights how this model influences financial performance, drives care coordination redesign, and introduces new incentives and penalties. Whether you are a healthcare leader, provider, or payer, don’t miss this overview of one of CMS’s initiatives shaping the future of value-based care.

As hospitals and health systems continue to evolve in value-based care, optimizing the post-acute recovery process has become a top priority. In this episode of Value-Based Care Insights, Diane Shifley, Assistant Vice President of Population Health and Post-Acute Services at a major Chicago health system joins us to discuss how robust transitions-in-care programs can drive better patient outcomes. She shares insights on the critical role of early patient evaluation—whether at hospital admission or pre-surgery—in shaping effective transitions. We explore how transitional care models that include post-acute facilities and home care can reduce readmission rates, improve patient satisfaction, and control post-acute costs. This episode offers actionable strategies to strengthen your transitions-in-care to support patients through successful recovery.

In this episode of Value-Based Care Insights, host Daniel Marino explores one of the most pressing issues in healthcare today—workforce engagement and retention. Since the COVID-19 pandemic, healthcare organizations have faced unprecedented levels of burnout, turnover, and staffing shortages. Daniel is joined by Tanya Allee, Vice President of Patient Experience at Campbell County Health, a rural health system that is making meaningful strides in workforce development. Tanya shares practical strategies and initiatives to boost staff satisfaction, improve retention, and create a healthy culture of support and engagement. Tune in for valuable insights on how health systems can navigate workforce challenges and create a healthy organizational culture resulting in better patient care.

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.

Artificial intelligence (AI) is making headlines everywhere—but how much of it is real, and how much is just hype? In this episode, host Daniel Marino is joined by Rick Howard, Chief Information and Data Officer at Brand Engagement Network, to unpack the growing role of AI in healthcare. Together, they separate fact from fiction, explore the opportunities and challenges AI presents, and discuss how healthcare organizations can responsibly integrate AI to improve operations and patient care. Whether you're excited, confused, or cautious about AI, this conversation offers clarity and insight for navigating the rapidly evolving digital landscape.

In this special episode of Value-Based Care Insights, host Daniel Marino is joined by Fred Goldstein, President of Accountable Health and podcast host of PopHealth Week, to unpack key takeaways from HIMSS25. They share their experience at this year’s conference, focusing on artificial intelligence (AI), digital technology, and future trends. Already, AI is transforming care delivery and decision-making, while digital technology is revolutionizing patient engagement and operational efficiency. Join us for an insightful conversation on the evolving healthcare technology landscape and the trends shaping the future of care delivery, driving a more connected and efficient healthcare ecosystem.

In this special episode of Value-Based Care Insights, host Daniel Marino brings you exclusive interviews recorded live at HIMSS25, where healthcare innovation took center stage. The first interview features Stephen Overman, CEO & Founder of Standpoint Solutions, who shares their groundbreaking technology aimed at improving communication within perioperative services. Next, Dr. Alan Young, Client Executive at Point B Solutions, dives into the transformative role of artificial intelligence in patient care. The future of AI-driven healthcare is explored, including the rise of intelligent agents and their potential to influence clinical decision-making. Tune in for an insightful discussion on the future of healthcare, technology, and how innovation is reshaping patient care.

National healthcare organizations like the Healthcare Financial Management Association (HFMA), American Hospital Association (AHA), and Medical Group Management Association (MGMA) offer valuable industry-wide insights and legislative guidance. However, state associations provide a more tailored, in-depth understanding of the specific challenges healthcare providers face in their local markets. In this episode of Value-Based Care Insights, host Daniel Marino sits down with fellow Illinois MGMA board members, Meghan Heiy and Jenny Kovich, and explores the growing importance of state healthcare associations in effectively navigating today’s rapidly evolving healthcare landscape.

The healthcare industry is grappling with a growing shortage of providers in every specialty, with primary care being hit the hardest. In this episode, host Daniel Marino is joined by primary care physician, Dr. Leila Obeid, to discuss how physician shortages and rising patient demands are forcing many primary care physicians to seek better work-life balance through alternative practice models. One solution? Concierge medicine. Tune in as we discuss how this model helps physicians regain control, improve patient care, and create a sustainable future in healthcare.

In 2025, the continued growth of Medicare Advantage underscores the increasing importance of specialists in value-based care, as healthcare models shift toward more integrated, patient-centered approaches. In this episode of Value-Based Care Insights, host Dan Marino sits down with Lynn Carroll, COO and Head of Strategy at HSblox, to explore how specialists can successfully engage in value-based care models. Tune in to explore current value-based programs that incorporate specialty providers, key challenges encountered, and the critical infrastructure required for success in this evolving healthcare landscape.

The Physician Fee Schedule (PFS) Final Rule for Calendar Year (CY) 2025 introduces several key updates to Medicare payment policies, aiming to enhance care delivery and reduce administrative burdens. In this episode, Daniel Marino is joined by Managing Partner, Lucy Zielinski, as well as Sarah Hartley, to explore the implications of the PFS Final on physicians and other billing professionals. Together, they discuss the key changes and opportunities for physician services furnished in a variety of settings including physician offices, hospitals, ambulatory surgery centers (ASCs), and others. Tune in to stay informed and gain valuable perspectives on navigating these critical regulatory updates.

Healthcare providers will continue to move toward value-based care, fostering a more equitable healthcare system that enhances accessibility, quality, affordability, and innovation. In this episode of Value-Based Care Insights, I sit down with Lumina’s Managing Partner, Lucy Zielinski, to explore the healthcare trends of 2025, the effects of new regulatory changes, and the pressures these developments place on providers. Tune in to learn about the top five trends that health systems should include in their strategic planning. 

Based on your feedback, our listeners, we've selected the top three episodes for 2024. We dive into the key challenges and opportunities defining healthcare trends this past year through three captivating Value-Based Care Insights episodes. In Episode 102, Sarah Hartley discusses the unique demands of managing Medicare Advantage contracts, offering creative strategies to align providers and patients. Episode 98 features Dr. Riya Pulicharam and Kevin Zhao exploring how integrating clinical data and fostering cultural change within care management transforms patient outcomes. In Episode 106, Tim Hanners and Dr. Dave Lebec tackle the anesthesia provider shortage and delve into tactics to boost financial performance, optimize staffing models, and improve payer reimbursement.

Accountable Care Organizations (ACOs) have made great strides in enhancing patient care and reducing costs, saving $3.1 billion in 2023. The recently released report based on ACO performance in 2023 (PY2023) provides valuable insights into where ACOs are excelling. In this episode of Value-Based Care Insights, Dan Marino sits down with Sarah Kachur PharmD, MBA, BCACP, Executive Director of Strategy and Solutions at Johns Hopkins Population Health Analytics, to discuss the key findings of the report and what they reveal about the future of ACOs. Gain insights into the priorities of the most successful ACOs (in PY 2023) and their predictions for changes and challenges in 2025 and beyond. LinkedIn https://www.linkedin.com/in/sarahgracekachur/ [email protected] Hopkins ACGs: https://www.hopkinsacg.org/ Illustra Health from Johns Hopkins: https://illustra.health/

Care management is critical, especially for individuals with chronic conditions like dementia, because it ensures coordinated, comprehensive, and individualized care. Currently, more than 6.7 million Americans are living with dementia and Alzheimer’s disease, and this number is projected to continue rising. While the impact of the disease on individuals is widely recognized, the personal and financial burden it places on caregivers is less often highlighted. Today, on Values-Based Care Insights, Dan Marino sits down with JVS Health’s CEO Vanessa Guzman and Co-founder Seth Hyman to discuss the GUIDE Model, a Centers for Medicare & Medicaid Services (CMS) supplement for caregivers of patients with dementia and Alzheimer’s disease. Gain insights into the valuable services within the GUIDE model that can support and benefit individuals living with dementia and their unpaid caregivers.

This year, 2024, presented significant challenges for clinically integrated networks (CINs) delivering value-based care, with the disruption from Medicare Advantage reaching widespread levels. As we look toward 2025, it is crucial for CINs to reflect and gear up for success in the coming year by focusing on risk-based contracting, engaging specialists, and investing in care management. In this episode of Value-Based Care Insights, Dan Marino sits down with Dr. Will Faber, to tackle several challenges, including the lack of structure among commercial payers to effectively handle value-based contracts and obstacles in negotiating such contracts with specialty providers. Gain insights into strategies and data utilization that will position your provider organization for success in 2025.

Success in the operating room is critical to the financial health of many healthcare organizations, with perioperative services contributing up to 75% of primary revenue streams. Effective perioperative care relies on skilled nurses who balance patient care while collaborating with other teams. In this episode of Value-Based Care Insights, Dan Marino sits down with Cindy Mahal, Chief Administrative Officer of Providence Saint Joseph Medical Center, to explore the challenges nurses face in achieving alignment and how to overcome them. We’ll uncover insights into key strategies administrators can implement to empower nurses, giving them a voice and enabling them to not only align but also lead.

A coherent and consistent approach to evaluating and optimizing surgical patients not only minimizes avoidable harm and complications but also impacts inefficiencies such as case cancellation, delayed case starts and turnover. Furthermore, avoidable complications are increasingly costly through post-acute care utilization, readmissions and never events. Facilities, surgeons, anesthesiologists, patients and families share an interest in doing better from the very beginning of the surgical journey. On today’s episode of Value-Based Care Insights, Daniel Marino explores how to identify and capture opportunities to streamline care and is joined by Alex Hannenberg, former President of the American Society of Anesthesiologists and Adjunct Clinical Professor of Anesthesiology at Tufts School of Medicine, and Art Boudreaux, Professor of Anesthesiology and Perioperative Medicine at the University of Alabama, Birmingham. Gain insights into the importance of aligning and standardizing perioperative processes, and how leveraging data can help reduce inefficiencies, reduce costs, and improve patient outcomes.

Care management is crucial for adding value to value-based care, but gaining stakeholder buy-in on its significance can be challenging. While the return on investment for care management strategies is undeniable, the delayed realization of these returns can be daunting for financial leaders. In this episode of Value-Based Care Insights, Dan Marino sits down with Lisa Stockdale, the Director of Value-Based Care at Silver Cross Health Systems, to look at challenges, as well as the benefits, in implementing successful care management programs. Gain insights into the importance of leadership buy-in, technology, and reinvestment in effective and cost-saving care management programs.

Certain specialties, such as primary care, are generally better positioned to shift to value-based care. Specialists, particularly cardiologists, encounter challenges when transitioning from fee-for-service to fee-for-value. To succeed in this shift, they must rethink their approach to patient care. In this episode of Value-Based Care Insights, Dan Marino sits down with Dr. Sameer Sheth, a board-certified cardiologist who helps specialists transition to value-based care by focusing on a patient-centric approach to medicine. Gain insight into the healthcare provider ecosystem and how data and tools, patient engagement, and communication support the shift from volume-based to value-based care.

Developing a strategic plan is crucial for the success of thriving healthcare organizations, but creating and adhering to the plan can be challenging. In this episode of Value-Based Care Insights, Dan Marino sits with Annette Kenney, a former healthcare Chief Strategy Officer and strategic planning consultant. Annette unlocks how healthcare organizations can develop a strategic planning process that includes input from all stakeholders, including the communities they serve. Uncover insights into how to transform a strategic plan into an actionable workplan that prioritizes activities and drives real success.

Academic medicine providers are increasingly depending on their clinical practices to fund their education and research divisions. How do academic medical providers balance financial performance with clinician and community needs amidst competing missions that challenge their business models? In this episode of Value-Based Care Insights, Daniel Marino sits down with Dr. Joseph Bosco, Professor and Vice Chair of NYU Langone’s Health Orthopedics, and Jeff Peters, a national expert in growth and service line strategies, to explore how academic medicine is addressing conflicting missions across their enterprise. Gain insight into growth models in academic medicine that prioritize clinician and geographic accessibility to keep patients in-network, while maintaining a strong focus on research, education, and quality care.

The challenges posed by Medicare Advantage adoption have led numerous healthcare providers to exit the space altogether, despite the fact that 34 million Medicare patients are enrolled in Medicare Advantage plans. In this episode of Value-Based Care Insights, we sit down with Cliff Frank, a national expert on payer contracting, to delve into the complexities and hurdles healthcare providers face with Medicare Advantage plans, and explore how their responses impact both staff and patients. Gain insight into how geography and legislation influence the short- and long-term implementation of Medicare Advantage, and discover strategies for healthcare providers to safeguard patients from confusing plans and hidden costs.

After the Federal Trade Commission (FTC) announced a ban on non-compete clauses in April 2024, the healthcare sector experienced a major shift in physician employment contract negotiations. In this episode of Value-Based Care Insights, Hal Katz, a partner at Husch Blackwell specializing in healthcare life sciences, explores the consequences of this decision along with the resulting policy adjustments and legal appeals. Gain insights into the FTC ruling on physician employment agreements, the required alignment between single-specialty groups health systems, and more.  

As healthcare providers grapple with the shortage of anesthesia providers and increasing financial constraints, leaders are redefining their relationships with anesthesia providers. In this episode of Value-Based Care Insights, Daniel Marino is joined by Tim Hanners and Dr. Dave Lebec where they address these challenges and explore best practice approaches in working with employed and independent anesthesia groups. The discussion explores ways to improve financial performance by enhancing anesthesia outcomes, optimizing staffing models, and managing reimbursement from payers.

With private equity's growing influence in healthcare systems, the significance of aligning healthcare providers has never been greater. In this episode of Value-Based Care Insights, we delve into the complexities of private equity interests and their profound impact on healthcare providers. Join Ericka Adler, a seasoned attorney and manager at Roetzel & Andress, as she explores the current trends in private equity and their implications on physicians and healthcare systems. Gain insights into physician employment models, the regulatory landscape, and effective strategies for healthcare transactions.

As Medicare Advantage enrollment rises and traditional Medicare enrollment declines, collaboration between payers and providers becomes essential. However, these relationships have historically been fraught with challenges and various administrative complexities. In this episode of Value-Based Care Insights, we explore the critical need for effective payer-provider partnerships. SueEllen Carroll, Managing Director at AArete, and Darren Ghanayem, a seasoned expert in healthcare and IT. SueEllen and Darren Ghanayem join us to share their insights on building trust between payers and providers and strategies for improving governance. Gain insights into fostering contract collaboration, improving patient care, and reducing the administrative burden often associated with Medicare Advantage contracts.

As healthcare providers engage in payer contract negotiations, understanding their contractual reimbursement rates compared to their market has never been more crucial. In this episode of Value-Based Care Insights, we sit down with Damon Morse, an expert in rate analyses to discuss the challenges healthcare providers face with payer contract negotiations, and the strategies required to level discussions. Gain insights into how thorough analysis and strategic positioning can ensure fair reimbursement for provider organizations and support organizational growth.