Explore every episode of the podcast Value Based Care Advisory (VBCA) Podcast
| Title | Pub. Date | Duration | |
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| Managed Care Contracting for Health Tech Startups | 09 Apr 2025 | 00:13:57 | |
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:
Target Audience: Health tech entrepreneurs, product and ops leads, VCs in digital health, provider networks, and healthcare consultants. Takeaways:
Companies mentioned in this episode:
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| Doulas and Value-Based Maternity Care: Driving Cost Reduction and Improved Outcomes | 17 Mar 2025 | 00:08:01 | |
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:
Companies mentioned in this episode:
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| Florida Market Telehealth Rule & Controlled Substances | 23 Jun 2021 | 00:01:17 | |
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. 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. However, there is one important exception to this rule: If you need a controlled substance to manage a mental health condition, your telehealth provider is allowed to prescribe it. Before prescribing medication, your telehealth provider must conduct an evaluation and explain the risks and benefits of the medication to you. Filling out a questionnaire before your telehealth appointment isn’t enough to satisfy the evaluation requirement, so you should expect the provider to ask multiple questions about your symptoms and health history. This episode is also available as a blog post: https://healthcare-wiki.com/2021/06/22/florida-market-telehealth-rule/ A Carenodes Production. | |||
| How to Talk to Health Plans for Mental Health Coverage. | 05 Jun 2021 | 00:01:23 | |
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. | |||
| Uncovering the Hidden Influencers of Our Health System | 28 Jan 2025 | 00:27:45 | |
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. Towards the conclusion, the podcast shifts towards empowerment, encouraging listeners to become advocates for change. It stresses the importance of staying informed, engaging with elected officials, and participating in local organizations dedicated to healthcare justice. The episode serves as a call to action, emphasizing that collective efforts can lead to meaningful reforms in a healthcare system that often feels overwhelming and unfair. By fostering awareness and community engagement, the hosts aim to inspire listeners to take ownership of their health care experiences and push for a system that genuinely serves the needs of all individuals, rather than just corporate interests. Takeaways:
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| 2025 Opportunities in Healthcare: Navigating the Perfect Storm | 03 Jan 2025 | 00:13:37 | |
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:
Companies mentioned in this episode: Research Links: | |||
| EXPOSED: The MultiPlan Healthcare Cartel Costing Providers and Patients Billions | 03 Dec 2024 | 00:10:15 | |
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:
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:
Takeaways:
Companies mentioned in this episode:
Research Links:
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| Startup Pitfalls and Healthcare Horror Stories: Introduction to Value-Based Care | 13 Nov 2024 | 00:21:40 | |
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 HighlightsStartup Realities in Value-Based Care
Key Strategies for Healthcare Startups
New Segment: 'Tough Calls in Healthcare'
Key Takeaways
Companies Discussed:
Listeners can expect a blend of in-depth analysis, actionable advice, and fresh perspectives on how to navigate the complexities of launching and sustaining a healthcare startup focused on value-based care. | |||
| Understanding the Mental Health Parity Act: A Guide for Providers (From Payer Executives) | 01 Nov 2024 | 00:53:38 | |
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:
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. Takeaways:
Companies mentioned in this episode:
Chris Esguerra MD MBA | |||
| Changing Demographics & Value-Based Care | 12 Feb 2023 | 00:00:57 | |
This episode is also available as a blog post: https://healthcare-wiki.com/2022/03/12/changing-demographics-value-based-care/ | |||
| Paying for Biopsychosocial Care | 08 Mar 2022 | 00:01:03 | |
The system used to pay for health care today does not encourage the integration of health care and social care, nor can it adequately adapt to the trending shift toward value-based payments for care — paying for better quality and better health outcomes. New financing approaches are needed to enable the health care sector to engage in activities that strengthen social care and community resource. This episode is also available as a blog post: https://healthcare-wiki.com/2021/07/21/paying-for-biopsychosocial-care/ | |||
| Telehealth Landscape Overview 50 States + DC | 03 Aug 2021 | 00:03:53 | |
No two states are alike in how telehealth is defined and regulated. While there are some similarities in language, perhaps indicating states may have utilized existing verbiage from other states, noticeable differences exist. These differences are to be expected, given that each state defines its Medicaid policy parameters, but it also creates a confusing environment for telehealth participants to navigate, particularly when a health system or practitioner provides health care services in multiple states. In most cases, states have moved away from duplicating Medicare’s restrictive telehealth policy, with some reimbursing a wide range of practitioners and services, with little to no restrictions. One of the most common trends with live video reimbursement was the addition of eligible services to the list of telehealth eligible services, with applied behavioral analysis being the most common service addition mentioned in Medicaid manuals. Additionally, in the wake of the COVID-19 pandemic, some states do seem to be adopting the Center for Medicare and Medicaid Services (CMS) communication technology-based services (CTBS) codes, including the virtual check-in and remote evaluation of prerecorded information, audio-only service codes and remote physiologic monitoring. All fifty states and the District of Columbia have a definition in law, regulation, or their Medicaid program for telehealth, telemedicine, or both. Additionally, because of the allowance in most states to utilize telephone as a form of telehealth during COVID-19, some states are taking steps to broaden its permanent definitions of telehealth or telemedicine by removing the explicit exclusion of telephone or including audio-only services within the definition itself. One of the states with the most significant changes to their telehealth policy was Massachusetts which passed a comprehensive telehealth law to require reimbursement for both Medicaid and private payers if the services are covered in-person and it is appropriately delivered through telehealth. The law contained some unique elements including specifying that the rate of payment for telehealth services provided via interactive audio-video technology and audio-only telephone may be greater than the rate of payment for the same services delivered by other telehealth modalities. It also provided payment parity for in-network providers of behavioral health services delivered via interactive audio-video technology or audio-only telephone only. Read: https://healthcare-wiki.com/2021/08/01/telehealth-landscape-overview-50-states-dc/ | |||
| Medicare Advantage 2026: How Payers Are Choosing Partners | 30 Dec 2025 | 00:08:13 | |
While most providers are waiting on CMS, payers are already narrowing networks and rewriting delegation terms. Payers are quietly narrowing networks and rewriting delegation expectations. This playbook explains how to do business with MA business for 2026. If you’re waiting, you’re already reacting—not positioning. In this episode, Alex Yarijanian breaks down what’s actually showing up in payer conversations right now, long before final CMS rules are published. Drawing from real contracting, network, and delegation discussions, Alex explains why waiting for regulatory clarity is already costing providers and health tech companies leverage. You’ll hear how payer priorities have shifted from enrollment growth to margin durability, why network narrowing is accelerating quietly, how delegation has become a stress test, and what “value-based care” really means in Medicare Advantage today. This episode also outlines who is most at risk heading into 2026, the three types of organizations positioned to win, and what provider and health tech leaders should do in the next 90 days to stay relevant. Who should listen: Provider executives, payer leaders, value-based care operators, and health tech founders navigating Medicare Advantage. | |||
| Digital Health at a Crossroads: The Fallout from a $100M Adderall Fraud Scheme | 26 Nov 2025 | 00:08:54 | |
A federal jury has convicted the founders of Done, one of the fastest-growing telehealth companies in the stimulant-prescribing space, for orchestrating one of the largest Adderall distribution and fraud schemes in U.S. history. More than 40 million stimulant pills, over $100 million in revenue, and a business model engineered around speed, volume, and automated prescribing — all built with no real clinical guardrails. In this episode, host Alex Yarijanian breaks down not only what happened, but what this case means for the entire digital health ecosystem, especially behavioral health and companies prescribing controlled substances. When a company like Done collapses — and its founders now face up to 20 years in federal prison — it doesn’t just take itself down. It drags trust, access, and payer willingness down with it. Alex outlines how this case will reshape:
And most importantly, he explains why value-based care is the antidote to the shortcuts and misaligned incentives that fueled this scandal. If you’re building, funding, regulating, or partnering with telehealth organizations, this is a must-listen. Takeaways:
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| Medicare 2026 Fee Schedule: 5 Big Opportunities for Providers & Startups | 03 Oct 2025 | 00:08:09 | |
Medicare’s 2026 physician fee schedule is packed with change — but change means opportunity. In this episode of the VBCA Podcast, Alex Yarijanian breaks down the five biggest updates every provider and startup should know:
Whether you’re running a clinic or building the next health tech solution, this playbook will help you turn policy into profit and thrive in the future of care. | |||
| How to Win in Medicare Advantage 2026 | 01 Sep 2025 | 00:16:16 | |
Welcome back to the Value-Based Care Advisory podcast! In this episode, host Alex Yarijanian delves into the significant updates and strategies for 2026 in the Medicare Advantage space. He covers essential news and policy changes, including a 5% increase in Medicare payment rates, the scaling back of supplemental benefits, and the permanence of telehealth for behavioral health. Alex also discusses updates to the Medicare physician fee schedule, redesigned enrollment forms, new health risk assessment requirements, and the transition to a new risk adjustment model. Learn how these changes will impact care delivery, compliance, and strategy, and discover what it takes to thrive in this evolving landscape. Tune in and prepare for the Medicare Advantage showdown of 2026! 00:00 Welcome to the Value-Based Care Advisory Podcast 00:15 2026 Medicare Advantage Showdown Overview 01:24 Key Policy Updates for 2026 03:11 Telehealth and Virtual Care Innovations 04:39 Enrollment and Form Updates 06:12 Risk Adjustment and Star Ratings 08:52 Strategic Focus Areas for 2026 14:44 Final Thoughts and Conclusion Takeaways:
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| Behind the Scenes of Power: Emotional Labor in Negotiation | 31 Jul 2025 | 00:05:57 | |
In this episode of the VBCA podcast, host Alex Yarijanian delves into the often overlooked yet crucial aspect of leadership: emotional labor. Discover how managing emotions plays a pivotal role in negotiations and leadership effectiveness. Alex shares personal experiences and insights on how emotional labor can be both a powerful tool and a silent tax on leaders, especially for those challenging dominant norms. Tune in to learn how to harness emotional intelligence to build trust and lead with empathy and strength. Takeaways:
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| Meditate Like a CEO: Real ROI from Mindful Leadership | 12 Jun 2025 | 00:18:49 | |
This podcast episode delves into the intricate relationship between mindfulness meditation and its profound implications for healthcare leadership. We explore how mindfulness practices not only enhance emotional well-being but also significantly improve the quality and effectiveness of leadership within healthcare settings. Through a rigorous examination of scientific evidence, we elucidate the neurological benefits of mindfulness, demonstrating its capacity to modulate stress and foster cognitive flexibility, thereby enabling leaders to navigate the complexities of their roles with greater composure and efficacy. Furthermore, we provide practical mindfulness training techniques that can be seamlessly integrated into the daily routines of healthcare professionals, offering a pathway to both personal and organizational transformation. Ultimately, this discourse underscores the necessity of cultivating a mindful approach in healthcare leadership to enhance overall performance and well-being. Mindfulness meditation and its application within the healthcare sector represent a profound intersection of neurological research, emotional intelligence, and leadership efficacy. The discussion begins with a thorough exploration of mindfulness, defined as a state of present-oriented consciousness, which fosters a non-judgmental awareness of one's moment-to-moment experiences. This foundational understanding serves as a springboard to investigate the transformative potential of mindfulness practices for healthcare leaders, who are often beleaguered by high levels of stress and burnout. The episode highlights compelling evidence demonstrating that mindfulness can mitigate stress, enhance cognitive flexibility, and improve emotional regulation—qualities that are indispensable for effective leadership in the ever-evolving landscape of healthcare. By integrating mindfulness into their daily routines, healthcare leaders can cultivate a more resilient mindset, ultimately translating into better organizational outcomes and improved patient care. Through the lens of empirical studies, the podcast delves into how mindfulness training yields significant neurological benefits, such as increased white matter density and enhanced executive function. One landmark study cited illustrates that patients undergoing mindfulness-based interventions reported a greater awareness of their symptoms and a reduced identification with negative cognitive patterns—a finding that underscores the therapeutic potential of mindfulness in both clinical and leadership contexts. In practical terms, the episode outlines actionable strategies for implementing mindfulness practices within healthcare organizations, emphasizing that even modest initiatives can catalyze meaningful improvements in workplace culture and employee wellbeing. As the conversation unfolds, listeners are encouraged to reflect on their own practices and consider how mindfulness could serve as a catalyst for personal and organizational growth. Takeaways:
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