VBCA Podcast
The Value Based Care Advisory (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.
Latest Episode
The Ghost Network Behind Pediatric Home Nursing: When Authorized Hours Go Unfilled
Kids authorized for private-duty nursing often can't get home from the hospital because the pediatric home health network that looks adequate on paper — hundreds of agencies — shrinks to a handful (roughly 8 of 200 in NJ) that actually take high-acuity pediatric cases, turning "authorized hours" into a false promise.
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Aug. 4, 2026
The Ghost Network Behind Pediatric Home Nursing: When Authorized Hours Go Unfilled
Episode Summary A pediatric patient in a New Jersey hospital is medically ready for discharge — equipment arranged, family ready, nursing hours authorized by the health plan. The only missing piece: an actual nurse. This episode uses that scenario to examine the structural gap between authorized private duty nursing (PDN) hours and filled hours in Medicaid managed care, why standard provider directories overstate real pediatric home health capacity, and what CMS's 2024 Medicaid managed care ac
Aug. 4, 2026
Your Billing Problem Started in the Contract
Most revenue cycle teams are chasing the wrong fire. Persistent underpayment, denials that don't respond to appeals, patterns nobody can explain — these are often contract problems wearing a billing problem's disguise. In this episode, Alex breaks down the structural gap between contracting and RCM that costs providers real money every day, and delivers three things you can take to your next denial review right now. WHAT YOU'LL HEAR • The real story behind a multi-specialty group underpa
Aug. 4, 2026
How to Decide to Contract with a Payer: Should You be Joining "the Network"?
You've built the operation — clinicians credentialed, tech stack running, compliance buttoned up. Then a regional Medicaid managed care plan wants to talk about contracting. Your first instinct: great, let's do it. Then someone pulls up the 40-page contract with a 43-code prior authorization matrix and a data-sharing provision you're not sure sits cleanly with your other obligations. The fee schedule is fine. Not great — fine. And now the question isn't can we do this. It's should we, and on w
Aug. 4, 2026
LEAD Model: The ACO Test Most Organizations Will Fail — Before They Apply
CMS has posted the LEAD (Long-Term Enhanced ACO Design) model application materials. Preliminary scoring is due April 27, 2026. Full applications are due May 17, 2026. LEAD replaces ACO REACH in 2027 and runs as a 10-year demonstration with enhanced payments and care coordination flexibility. Most ACO applications fail before they're submitted — not because organizations are ineligible, but because they were never really built for risk. This episode breaks down the six scoring domains, in orde
Aug. 4, 2026
The Definitive Playbook for Choosing Behavioral Health Markets
Rate sheets don't tell the whole story. In this episode, Alex Yarijanian breaks down the 8-indicator playbook he uses to evaluate any tele-behavioral health market before committing capital — and names the specific states he'd enter today and why. Most operators default to the biggest states: California, Texas, Florida, New York. But population size alone is one of the weakest predictors of a winning market. The real levers live in parity law enforcement, workforce economics, MCO concentrati
Aug. 4, 2026
Medicare Negotiates Like an Owner. Commercial Doesn’t.
In this episode of the VBCA Podcast, Alex Yarijanian sits down with Dr. Kumar Dharmarajan — co-founder and Chief Medical Officer of World Class Health and former Chief Scientific and Medical Officer at Clover Health — to unpack one of the most important structural differences in U.S. healthcare: incentive alignment. Why are employers often paying two to four times Medicare rates for identical procedures performed in the same hospital by the same physician? The answer isn’t clinical complexit
Aug. 4, 2026
The Rural Health Transformation Fund: What States Are Funding in 2026
CMS is moving tens of billions of dollars into every state to stabilize rural healthcare heading into 2026—not through across-the-board rate increases, but through targeted investments in workforce, technology, care coordination, and alternative payment models. In this episode, Alex Yarijanian breaks down what the Rural Health Transformation Program / Rural Health Fund (RHTF) actually is, what state strategies reveal about the future of rural access, and why this matters far beyond rural hospi
Aug. 4, 2026
Medicare Advantage 2026: How Payers Are Choosing Partners
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 contractin
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Recent Blog Posts
May 31, 2026
Beyond the Fee Schedule: Why Payer Contracts Are More Than Just Rate Negotiations
Welcome back to the blog for the VBC Podcast! In our latest episode, titled Deciding to Contract with a Payor: Joining "the Network", we delved into a crucial decision point for any healthcare provider: whether to contract with a payer. Often, when …
Dec. 26, 2024
MultiPlan Lawsuit: Allegations of a Healthcare Price-Fixing Cartel
The case 1:24-cv-10959 filed in the United States District Court for the Northern District of Illinois involves the American Medical Association (AMA) and the Illinois State Medical Society (ISMS) as plaintiffs, suing MultiPlan, Inc. for alleged ant…
About the Host
Alex Yarijanian
Welcome to the Value-Based Care Advisory Podcast (VBCA Podcast), where host Alex Yarijanian takes you behind the scenes of healthcare's most pressing challenges and transformative breakthroughs. A recognized thought leader with over 15 years of experience, Alex has revolutionized payer-provider relations, shaped the future of value-based care, and led digital health innovations that have impacted millions of lives nationwide.
As the CEO and founder of Carenodes, Alex is a trailblazer in creating healthcare systems that are not only innovative but also equitable and impactful. From negotiating groundbreaking contracts that saved Medicaid plans $58 million to expanding access to maternal and youth mental health care across 43 states, his work embodies the belief that healthcare is a right, not a privilege.
Alex's career is a blend of bold strategy and heartfelt advocacy. He's the driving force behind operational overhauls in behavioral health, an architect of cutting-edge digital health solutions, and a trusted advisor to national healthcare boards. Fluent in English, Persian, and Armenian, Alex brings a global lens to healthcare innovation, connecting the dots between policy, technology, and the human experience.
Tune in as Alex combines sharp insights, captivating storytelling, and industry expertise to spotlight the innovators and disruptors redefining healthcare. Whether you're a policymaker, a clinician, or simply a curious mind, the VBCA Podcast promises to inspire, inform, and ignite your passion for building a healthier future.