Business Episodes

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.

Got a contract. The fee schedule is fine. Not great — fine. And now the question isn't can we do this. It's should we, and on what terms?

CMS has posted the LEAD (Long-Term Enhanced ACO Design) model application materials. Most ACO applications fail before they're submitted — not because organizations are ineligible, but because they were never really built for risk.

Before you deploy capital into a tele-behavioral health market — run this checklist.

Rate sheets alone will mislead you. I've seen operators get into markets with strong Medicaid rates, only to get squeezed by high clinical labor costs, concentrated MCO power, or zero licensure compact coverage.

Why are employers paying up to four times Medicare rates for identical procedures? Dr. Kumar Dharmarajan joins Alex Yarijanian to break down incentive alignment, Medicare Advantage contracting, AI-driven engagement, and the structural pricing gap between MA and commercial markets.

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.

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.

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, ...

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 assess...

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...

The health insurance industry is confronting a convergence of rising healthcare costs, increased patient demand, and heightened legislative scrutiny as we approach 2025. Medicare Advantage plans, once highly profitable, are now under significant pressure due to these factors. Major insurers like Humana and UnitedHealth are experiencing challenges that may redefine managed care. However, this period of disruption presents 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.

Key Takeaways:

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

Medicare Advantage plans are experiencing financial strain from surging patient demand and utilization rates.

Healthcare providers should analyze their patient populations to identify high-cost areas and develop …

In this episode of the VBCA Podcast, host Alex Yarijanian delves into the challenges faced by healthcare startups in the value-based care (VBC) sector, emphasizing the critical importance of robust patient acquisition strategies. The discussion highlights how many startups, despite ambitious goals to enhance patient outcomes and reduce costs, struggle to meet volume requirements and maintain contracts due to inadequate patient engagement approaches.

In this episode of the VBCA Podcast, host Alex Yarijanian and guest Dr. Chris Esguerra delve into the complexities of mental health parity, emphasizing the necessity for behavioral health services to receive the same level of care and coverage as physical health services. They discuss the challenges providers face when navigating insurance plans and the barriers to accessing equitable care for patients.