Value Based Care Advisory (VBCA) Podcast – Détails, épisodes et analyse

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Value Based Care Advisory (VBCA) Podcast

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Fréquence : 1 épisode/98j. Total Éps: 18

The VBCA Podcast is a solution-focused platform dedicated to advancing the transformation of healthcare through value-based care (VBC) models. Our mission is to break down complex healthcare topics into accessible, actionable insights for leaders, entrepreneurs, engaged consumers, and anyone passionate about meaningful change in healthcare. By challenging the healthcare industrial complex, we provide tools, strategies, and expert perspectives that empower our listeners to navigate and accelerate the shift toward better outcomes, lower costs, and improved patient experiences. Each episode delivers thought-provoking discussions and practical advice from industry experts, spotlighting innovative approaches to healthcare reform and highlighting voices that are often overlooked in traditional dialogues. Whether you're a healthcare executive, provider, payer, policy influencer, entrepreneur, or informed patient, we aim to inspire new ideas and support you in driving transformation in the healthcare space. Powered by Carenodes.

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https://flboardofmedicine.gov/latest-news/board-revises-floridas-telemedicine-practice-rule/
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https://healthcare-wiki.com/2021/06/22/florida-market-telehealth-rule/
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https://www.morganstanley.com/
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Managed Care Contracting for Health Tech Startups

Saison 2 · Épisode 12

mercredi 9 avril 2025 • Durée 13:57

How Health Tech Startups Can Win at Managed Care Contracting: Insider Strategies for Scalable Payer Partnerships.

This episode dives deep into the essentials of navigating managed care contracts as a health tech startup.

Whether you're a founder, operator, or policy strategist, you'll walk away with a clear understanding of how to position your company for payer partnerships, structure risk-based contracts, and avoid common pitfalls in the healthcare financing space. We explore real-world examples and discuss how to align your innovation with payer priorities, compliance standards, and long-term sustainability.

Perfect for early-stage startups, digital health innovators, and anyone looking to scale within the complex world of managed care.

Key Themes:

Understanding managed care mechanics (HMOs, PPOs, ACOs)
Value-based care vs. fee-for-service
Contracting tips for Series A and B stage startups
Risk corridors, capitation, and performance metrics
How to speak the payer language and win trust

Target Audience:

Health tech entrepreneurs, product and ops leads, VCs in digital health, provider networks, and healthcare consultants.

Takeaways:

Understanding managed care contracting is essential for health tech startups to succeed.
Health tech entrepreneurs must align their innovations with payer priorities and compliance standards.
Effective negotiation strategies are crucial for securing favorable managed care contracts.
Startups should utilize data transparency to build credibility and foster trust with payers.
Establishing a structured contracting process is vital to avoid unfavorable agreements and ensure sustainability.
Learning from real-world case studies can provide invaluable insights into successful managed care strategies.

Companies mentioned in this episode:

Innovate Health
MedTech Solutions
Health Wave
United
Humana
Aetna

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Doulas and Value-Based Maternity Care: Driving Cost Reduction and Improved Outcomes

Saison 2 · Épisode 11

lundi 17 mars 2025 • Durée 08:01

This conversation explores the historical context of childbirth, the current state of maternal mortality in the U.S., and the emerging role of doulas in modern maternity care. It highlights the paradox of high maternal mortality rates despite advanced medical technology and discusses how doulas can improve outcomes and reduce costs in the healthcare system.

Tips are provided to strategically leveraging the doula opportunity in risk-based contracting.

Takeaways:

The integration of doulas into maternity care significantly reduces unnecessary interventions and enhances outcomes.
Evidence demonstrates that doulas can lower postpartum depression rates, benefiting both mothers and healthcare systems.
Doulas are increasingly recognized as a strategic component in modern maternity care, facilitating cost savings.

Companies mentioned in this episode:

Blue Shield Blue Cross

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Florida Market Telehealth Rule & Controlled Substances

Saison 1 · Épisode 2

mercredi 23 juin 2021 • Durée 01:17

During the 2019 legislative session, Florida passed Chapter 2019-137, Laws of Florida, which establishes standards of practice for telehealth services, including patient evaluations, record-keeping, and controlled substances prescribing. The law also authorizes out-of-state health care practitioners to perform telehealth services for patients in Florida. Signed by the Governor on June 25, 2019, this law became effective on July 1, 2019.

Out-of-state health care practitioners must be registered with the Florida Department of Health to perform telehealth services for patients in Florida.

Health care providers must be licensed within their scope of practice by the appropriate licensing body to practice telehealth in Florida.

Providers must also use two-way, interactive communication tools, such as live video, instead of email or audio-only communication. If you use Medicaid, your telehealth provider must be registered with the Florida Medicaid program to receive reimbursement for telehealth services. Florida doesn’t require private insurers to cover telehealth, so check with your insurance company to determine if you’re eligible for the service. Some of these regulations may be altered during the COVID-19 pandemic.

In Florida, telehealth providers are permitted to prescribe medications if the medications aren’t listed as controlled substances.

Telemedicine Rule, Rule 64B8-9.0141, F.A.C.Controlled substances shall not be prescribed through the use of telemedicine except for the treatment of psychiatric disorders. This provision does not preclude physicians from ordering controlled substances through the use of telemedicine for patients hospitalized in a facility licensed pursuant to Chapter 395, F.S.

How to Talk to Health Plans for Mental Health Coverage.

Saison 1 · Épisode 1

samedi 5 juin 2021 • Durée 01:23

California Governor Gavin Newsom on September 25 signed Senate Bill 855, Health coverage: mental health or substance use disorders, into law. The law increases health and disability insurers' coverage obligations for mental health and addiction diagnosis, prevention, and treatment in the state.

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Uncovering the Hidden Influencers of Our Health System

Saison 2 · Épisode 10

mardi 28 janvier 2025 • Durée 27:45

The podcast delves into the complexities and challenges of the American healthcare system, arguing that it often prioritizes profit over patient care. Through the lens of investigative journalism from More Perfect Union, the hosts explore how companies like CVS Caremark and pharmaceutical giants manipulate the system to maximize their profits, often at the expense of those they are supposed to serve. They highlight the troubling trend of Medicare Advantage plans cherry-picking healthier patients to boost their bottom line, leaving those with greater needs reliant on traditional Medicare. The discussion also uncovers the hidden influence of consulting firms like McKinsey, which contribute to a system that seems rigged against everyday citizens. Ultimately, the episode emphasizes the importance of staying informed and advocating for healthcare reform to ensure that the interests of patients are prioritized over corporate greed.

The podcast delves into the intricacies and issues surrounding the American healthcare system, raising critical questions about its efficacy and accessibility. The hosts, with the help of investigative journalism from More Perfect Union, examine whether the healthcare landscape is fundamentally designed to benefit corporations rather than patients. They highlight the confusion and frustration many face when navigating healthcare options, particularly Medicare Advantage plans, which are heavily marketed as cost-effective choices but may prioritize profit over patient care. Through examples like CVS Caremark and the impact of the Biden administration's actions against fraud, the discussion reveals how healthcare companies often prioritize their bottom line, leading to detrimental effects on both employees and consumers. With a focus on the systemic issues, the episode emphasizes the need for transparency and accountability in a system that often feels rigged against the average person.

The narrative also explores the alarming consequences of corporate control in healthcare, illustrated by the shortage of critical medical supplies, such as IV bags, following Hurricane Helene. The podcast underscores the dangers of having a single company dominate a vital resource, highlighting how such monopolistic practices can endanger lives. Furthermore, the hosts discuss the role of pharmacy benefit managers (PBMs) in escalating drug prices, portraying them as hidden players in a convoluted system that drives up costs for consumers. The episode challenges listeners to consider the broader implications of these practices, urging them to recognize the interconnectedness of corporate greed and public health.

2025 Opportunities in Healthcare: Navigating the Perfect Storm

Saison 2 · Épisode 9

vendredi 3 janvier 2025 • Durée 13:37

What Every Provider and Innovator Must Know Going into 2025:

The health insurance industry is facing a perfect storm characterized by rising healthcare costs, increased patient demand, and intense scrutiny from lawmakers. As we move into 2025, the challenges confronting Medicare Advantage plans, once considered the crown jewel of insurer profitability, are becoming increasingly apparent.

Industry giants like Humana and UnitedHealth are grappling with significant pressures that could redefine managed care. However, amidst this turmoil, there are opportunities for healthcare providers and entrepreneurs to innovate and adapt. By focusing on high-cost patient areas and exploring innovative contracts, stakeholders can position themselves to thrive in this evolving landscape.

This episode delves into the tumultuous state of the health insurance industry as it faces unprecedented challenges heading into 2025. Rising healthcare costs, increased patient demand, and government scrutiny are converging to create a 'perfect storm' for insurers, particularly in the Medicare Advantage sector. This segment highlights how traditional revenue models are being tested as utilization rates rebound post-COVID, with many patients returning for procedures they deferred during the pandemic.

Insurers are grappling with higher medical loss ratios (MLR), which are squeezing their profit margins and forcing a reevaluation of their operational strategies. Industry giants like Humana and UnitedHealth Group are highlighted as they navigate this challenging landscape, revealing how their dependence on Medicare Advantage has made them particularly vulnerable amidst shifting policies and scrutiny from lawmakers.

The discussion emphasizes the urgent need for healthcare providers and entrepreneurs to identify innovative solutions that can not only alleviate cost pressures but also enhance patient care, suggesting that these turbulent times may present new opportunities for growth and transformation within the industry.

Takeaways:

The health insurance industry is facing significant challenges due to rising costs and increased scrutiny.

EXPOSED: The MultiPlan Healthcare Cartel Costing Providers and Patients Billions

Saison 2 · Épisode 8

mardi 3 décembre 2024 • Durée 10:15

Welcome to this eye-opening episode of the VBCA Podcast, where we tackle one of the most pressing yet underreported issues in healthcare: hidden fees, surprise bills, and the alleged cartel controlling out-of-network reimbursements.

In this episode, host Alex Yarijanian breaks down the allegations against MultiPlan, a third-party repricing company accused of working with major insurers like UnitedHealthcare, Cigna, and Aetna to suppress out-of-network payments. We explore:

How MultiPlan's practices impact patients, providers, and employers.
The AMA’s antitrust lawsuit accusing MultiPlan of operating a cartel.
Real stories, like that of Kelsey Toney, a behavioral therapist forced to turn away patients due to unsustainable payment rates.
The staggering $19 billion providers lose annually to these practices.

If you’ve ever wondered why your healthcare bills are so high or why your provider suddenly stopped taking your insurance, this is the episode for you.

Key Topics Discussed:

What are in-network vs. out-of-network providers?
How does MultiPlan determine reimbursement rates?
The human cost of suppressed reimbursements for providers and patients.
Legal implications of the AMA and ISMS lawsuit against MultiPlan.
The broader impact on value-based care and healthcare transparency.

Takeaways:

Hidden fees in healthcare create a sense of unpredictability and financial anxiety for patients.
MultiPlan's involvement in processing out-of-network claims often leads to underpayment for healthcare providers.
Out-of-network providers typically charge fees that reflect their true cost of delivering services.
Patients frequently find themselves responsible for covering the difference in reimbursement rates from insurers.
Real-life patient stories underscore the profound human impact of rising healthcare costs and surprise bills.

Startup Pitfalls and Healthcare Horror Stories: Introduction to Value-Based Care

Saison 2 · Épisode 7

mercredi 13 novembre 2024 • Durée 21:40

This episode explores the rising tide of healthcare startups pursuing value-based care (VBC) with ambitious visions to improve patient outcomes and lower costs. However, without a robust patient acquisition strategy, many founders find themselves struggling to meet volume requirements, maintain contracts, and deliver quality care. Through candid dialogue and practical insights, host Alex Yarijanian addresses these pain points and offers actionable advice for navigating the competitive healthcare market.

Segment Highlights

Startup Realities in Value-Based Care

Analogy to Streaming Service Overload: Alex compares the influx of VBC startups to the crowded streaming industry, highlighting how many of these startups lack a practical strategy, assuming that contracts with big payers alone will drive patient volume.
Importance of Patient Acquisition: Building meaningful connections and community engagement is critical for driving patient volume—something often overlooked by startup founders. Alex discusses tactics like forming referral networks and partnering with local organizations to build a sustainable patient base.

Key Strategies for Healthcare Startups

Understanding Payer Volume Thresholds: Alex underscores the need for startups to grasp the minimum patient volumes required by payers to maintain contracts.
Patient Engagement & Marketing: Effective marketing and visibility are as essential as clinical quality. Engaging patients through tailored messaging and demonstrating value within local communities can solidify a startup's presence and relevance in the healthcare landscape.

New Segment: 'Tough Calls in Healthcare'

This episode introduces a new segment, where Alex addresses real-world negotiation dilemmas faced by healthcare professionals. In this installment, he discusses:
Negotiating Reimbursement Rates: Tips on understanding local market rates and using data to strengthen negotiation positions with payers.

Understanding the Mental Health Parity Act: A Guide for Providers (From Payer Executives)

Saison 1 · Épisode 6

vendredi 1 novembre 2024 • Durée 53:38

This podcast episode dives deep into the complexities of mental health parity and the implications of the Mental Health Parity Act. The conversation emphasizes the necessity for behavioral health services to be treated with the same level of care and coverage as physical health services, addressing the ongoing disparities in treatment and reimbursement practices.

Alex Yarijanian and Dr. Chris Esguerra discuss the challenges providers face when navigating insurance plans and the barriers to accessing equitable care for patients.

Dr. Esguerra is board certified in both Psychiatry and Health Care and Quality Management and is a Fellow of the American Psychiatric Association and the American Board of Quality Assurance and Utilization Review Physicians.

Dr. Esguerra’s extensive payer-side executive experience includes:

Senior Medical Director, Blue Shield of California
Senior Medical Director, Magellan Health
Deputy Chief Medical Officer, Health Plan Of San Mateo

They highlight the critical role employers play in advocating for better mental health coverage and how they can leverage their purchasing power to ensure compliance with parity laws. Ultimately, the episode aims to empower providers with the knowledge and tools necessary to advocate effectively for their patients and promote a more integrated and equitable healthcare system.

A significant focus of the episode is on the role of providers in identifying and addressing parity violations. The speakers guide listeners through the necessary steps for raising concerns regarding unequal treatment, emphasizing the importance of gathering evidence and understanding insurance policies.

This segment is particularly valuable for behavioral health providers who may face obstacles in securing appropriate coverage for their patients. The discussion also touches upon the regulatory landscape, explaining how self-insured plans differ from traditional insurance plans and the implications this has for parity enforcement.

Additionally, the episode discusses the importance of employers in advocating for better mental health coverage, encouraging providers to leverage their relationships with these entities to push for systemic changes that prioritize mental health equity.

Changing Demographics & Value-Based Care

Saison 1 · Épisode 5

dimanche 12 février 2023 • Durée 00:57

This episode is also available as a blog post: https://healthcare-wiki.com/2022/03/12/changing-demographics-value-based-care/

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Value Based Care Advisory (VBCA) Podcast – Détails, épisodes et analyse

Détails du podcast

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