Value Based Care Episodes

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.

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.

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.

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.

CMS is sending tens of billions of dollars to every state in 2026 to stabilize rural healthcare through targeted investments in workforce, technology, care coordination, and alternative payment models (not broad rate increases). In this VBCA episode, Alex explains what the Rural Health Transformation Fund (RHTF) is, how states are using it, and why it matters for payer strategy, provider contracting, network adequacy, and rural access risk going forward.

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.

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:



Shorter, billable windows for remote monitoring


New behavioral health add-ons to primary care


Incentives that reward value-based care


Expanded reimbursement for digital therapeutics & telehealth


A major shift from inpatient to outpatient procedures




Whethe...

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...

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 m...

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...

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.

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

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 multi...

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 ...