Contracting Episodes
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. Most ACO applications fail before they're submitted — not because organizations are ineligible, but because they were never really built for risk.
Medicare Advantage Negotiates Like an Owner. Commercial Doesn’t.
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.
Managed Care Contracting for Health Tech Startups
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. Whet...
EXPOSED: The MultiPlan Healthcare Cartel Costing Providers and Patients Billions
In this episode of the VBCA Podcast, host Alex Yarijanian delves into the complex issue of hidden healthcare fees, surprise billing, and the alleged antitrust activities surrounding out-of-network reimbursements. The discussion centers on MultiPlan, a third-party repricing company accused of collaborating with major insurers—such as UnitedHealthcare, Cigna, and Aetna—to suppress out-of-network payments, adversely affecting patients, providers, and employers.
Paying for Biopsychosocial Care
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 qualit...