The Disrupted Podcast

James Preston, Scott Middleton
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  • Entrepreneurship
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Entrepreneur and Chief Disruption Officer Scott Middleton share's his experiences of how he uses disruption to innovate and keep an organization moving forward and growing. Scott shares these weekly stories on The Disrupted Podcast with Scott Middleton.

  1. 2d ago

    A Value-Based Merger

    What if the patient you discharged three years ago is still costing you money today? In this episode of The Disrupted Podcast, Scott Middleton pulls back the curtain on the mechanics of value-based care most providers never see — and the merger bringing it all into focus. With the July 15th closing date approaching, Scott walks through what the merger of Your Health with TCPA and Providence Care actually means on the ground: new contracts, new provider numbers, a reimbursement model built on RAF scores and revenue rather than guesswork, and a technology stack — from the Clini app to QR-coded patient wristbands — designed to capture what was previously left on the table. In this episode: Why patient attribution under value-based contracts follows you for years — and what hospice discharges are really costing the organization How the new bonus structure ties pay to billing, RAF scores, and quality measures (and why you can never be paid to put someone on hospice) The difference between care management, facilitated visits, and what providers have been under-billing all along How skilled nursing facilities became the highest-leverage opportunity in the entire model Why advanced care plans aren't just clinical — they're a 30% income increase hiding in plain sight If you've ever wondered why the "why" behind a process matters more than the process itself, this episode is the answer. Press play. www.YourHealth.Org

    46 min

  2. Jun 22

    We NOT Them

    What if the fastest way to grow your healthcare organization is to slow down? In this episode of The Disrupted Podcast, Scott Middleton returns from Scotland straight into the thick of a merger — and what he's learning is reshaping how he thinks about change itself. Scott takes us inside the integration of TCPA and Providence Care into Your Health, where two very different models are colliding. One organization built 640 billing codes last year; the other built 40. One puts a single nurse practitioner in a building with no support; the other surrounds providers with nurses and community health workers. The opportunity is enormous — but so is the risk of moving too fast and scaring everyone away. What if the fastest way to grow your healthcare organization is to slow down? In this episode of The Disrupted Podcast, Scott Middleton returns from Scotland straight into the thick of a merger — and what he's learning is reshaping how he thinks about change itself. Scott takes us inside the integration of TCPA and Providence Care into Your Health, where two very different models are colliding. One organization built 640 billing codes last year; the other built 40. One puts a single nurse practitioner in a building with no support; the other surrounds providers with nurses and community health workers. The opportunity is enormous — but so is the risk of moving too fast and scaring everyone away. In this conversation, Jamie and Scott explore: Why a nurse practitioner alone is a "single source of failure" — and how staffing changes everything How to enter a building without threatening the provider they already love Why billing isn't bureaucracy — it's how Medicare knows you made a difference The art of giving people what they think they need now, and the rest over time Advanced care planning, DNRs, and why the right message sometimes needs a different voice This is a masterclass in change management disguised as a healthcare conversation. Listen now — and rethink what "disruption" really requires. Why a nurse practitioner alone is a "single source of failure" — and how staffing changes everything How to enter a building without threatening the provider they already love Why billing isn't bureaucracy — it's how Medicare knows you made a difference The art of giving people what they think they need now, and the rest over time Advanced care planning, DNRs, and why the right message sometimes needs a different voice This is a masterclass in change management disguised as a healthcare conversation. Listen now — and rethink what "disruption" really requires. www.YourHealth.Org

    41 min

  3. Jun 8

    If You Didn't Document It, Medicare Thinks It Never Happened

    It was 3 o'clock in the morning when Scott Middleton finally signed the papers. The merger was official. And within days, he was already on the road — visiting facilities, riding along with providers, and spotting the same gap everywhere he went: brilliant clinicians doing real work that was completely invisible to the system. In this episode of The Disrupted Podcast, Jamie sits down with Scott Middleton, calling in from Boston, to unpack what he's discovering on the ground in the newly merged Your Health organization — and why tracking your time isn't about paperwork. It's about protection, proof, and getting paid for every minute of care you're already delivering. What you'll hear in this episode: The Dr. Jeeve story: a high-producing doc who managed a nursing home crisis by phone, saved a patient from an unnecessary ER visit — and never billed for it, leaving Medicare with no record of his intervention Why not documenting a visit before a hospitalization doesn't just cost you revenue — it makes you look like a bad provider, even when you did everything right How insurance companies like United Healthcare boldly take 15% off the top of every healthcare dollar — and why that math means providers can't afford to give their time away for free The TCPA pattern Scott keeps seeing: 15,000–18,000 visits a month, almost entirely in nursing homes, with zero follow-up once patients go home The new post-discharge standard: every patient leaving a nursing home gets a telehealth visit within 48 hours, then weekly follow-up for four weeks — no one gets left in the gap This episode is a masterclass in understanding that documentation isn't bureaucracy — it's how you tell your story, protect your reputation, and keep the care you've already given from disappearing. www.YourHealth.Org

    33 min

  4. Jun 1

    The Merger

    What does it actually cost when a doctor writes a verbal order over the phone instead of seeing the patient? Scott Middleton has the receipts — and the answer is going to make you rethink everything about how American healthcare spends its money. In this episode of The Disrupted Podcast, Scott announces a landmark three-way merger bringing Your Health together with Transitional Care Professionals of America (TCPA) out of Georgia and Providence Care, a hospice organization in South Carolina. The combined organization will serve approximately 55,000 active patients — not patients on a list, but people being seen regularly — and Scott lays out exactly how he's going to run it. What you'll hear in this episode: Why Scott's family owning 80% of the merged company changes everything about how decisions get made — and who they get made for The difference between fee-for-service and value-based care, and why the ACO model means every unnecessary hospitalization literally comes out of Your Health's pocket How Your Health's risk-adjustment-based visit model (16 visits per year per risk point) was independently validated by a new government study — and why it works The three things Scott is asking every new employee to do in the first weeks: align with a nurse practitioner, track every minute of care management, and recruit like their livelihood depends on it — because it does Why Scott's new management philosophy is six words: "Keep them out of the hospital and see your damn patients" This isn't a corporate announcement. It's a playbook for how healthcare can actually work when operators run the company, providers see their patients, and every minute of care gets counted. www.YourHealth.Org

    35 min

  5. May 9

    The Administrator Role Part 2

    Most organizations will tell you their people are their greatest asset — then build compensation systems that prove they don't believe it. In Part 2 of this conversation, Scott Middleton — owner of Your Health, founder, and Chief Disruption Officer — gets honest with Jamie Preston about what it actually takes to build, pay, and keep the team an administrator is going to lead.  In this episode: Why "can I have a raise?" is the wrong conversation — and what apprenticeship-based compensation solves How a nurse practitioner can quietly hit $200K by working the bonus structure the right way The math behind every hire: why every team member costs roughly $10,000 a month — and how to pay for yourself The 5,000-patient hospice gap no one wants to talk about — and what it's costing families Why every hospice patient gets a custom plan, not a copy-pasted template The DISC profile Scott looks for in administrators — and why it's not what you'd guess The honest state of hiring: 30 care groups, growing, and actively recruiting If you lead people, hire people, or are thinking about stepping into healthcare leadership — this is the episode where the economics get real. www.YourHealth.Org

    21 min

  6. May 2

    The Administrator Role Part 1

    Most healthcare organizations wait until they're drowning to add administrative support. Your Health is doing the opposite — and it's changing the math on what a primary care practice can actually deliver. In Part 1 of this two-part conversation, Scott Middleton — owner of Your Health, founder, and Chief Disruption Officer — sits down with Jamie Preston to unpack why a dedicated administrator is now sitting beside the executive director of clinical services at every care group. With hospice added to the model, a single care group can now be responsible for more than 80 staff members across four care teams — bigger than most medical organizations in the country. Asking a nurse to run that alone was breaking people and burying clinical judgment under scheduling concerns. In this episode: Why the care group exploded overnight — and what hospice changed about staffing ratios What the administrator does on Monday morning before the clinical team even looks at the dashboard The Bridget story: how a "we're not allowed to do one-on-ones" response nearly cost a dementia patient her home Why "what could we have done today" is the wrong question — and what to ask instead How fee-for-service quietly incentivizes the wrong decisions at the hospital level The team structure every administrator now sits inside: nurse, HR, marketing, engagement If you've ever wondered what's actually supposed to stand between a great clinician and burnout, this is it. www.YourHealth.Org

    29 min

  7. Apr 25

    The Nurse Case Manager

    What if the people case-managing your care had a financial reason to keep you sicker? That's the uncomfortable question Scott Middleton puts on the table in this episode — recorded live from the American Case Managers Conference in Orlando, where Scott went to learn, and ended up being told Your Health didn't "fit" because they weren't a hospital. Jamie and Scott unpack what the nurse case manager role actually looks like at Your Health — and why moving case management out of hospitals and into patients' homes isn't just better care, it's better economics. Scott shares the research proving the model works: 50% reduction in Medicare spend when patients are seen at the right frequency by the right people. In this episode: Why hospitalists may be "the demise of the American healthcare system" The difference between nurse practitioners (diagnose and treat) and nurse case managers (assess and guide) — and why blurring them costs patients The 16.05-visits-per-risk-point model David Clemens' research validated How coding departments are quietly diagnosing patients with diseases they don't have Why Medicare's 6-year insolvency window may be the disruption we need Head-to-toe assessments, delegation rights, and the real job of an RN in the home If you've ever suspected the system is working exactly as designed — just not for the patient — press play. www.YourHealth.Org

    26 min

  8. Apr 18

    The Care Group Model

    What if the reason healthcare teams burn out isn't the workload — it's the org chart? On this episode of The Disrupted Podcast, Jamie and Scott, break down the evolution of The Care Group Model — and why the instinct to build a "separate hospice team" is exactly the wrong move. Scott walks through what a true care team looks like when nurse practitioners, nurses, community health workers, social workers, chaplains, and triage nurses are orchestrated around the patient — not siloed around a diagnosis. Inside the episode: Why adding hospice to existing care groups beats building a parallel hospice division The new non-clinical "administrator" role Your Health is rolling out — and why every nurse needs one at their side Using DISC assessments to build teams that actually function (and why nurses aren't the same personality type) How mutual accountability and group-based bonuses fix the "don't bill too much CCM" problem Why matching a chaplain to a patient's faith tradition matters more than checking the box The $110 million Medicare savings story the industry still doesn't understand If you lead a clinical team, run an operation, or care about what healthcare could look like when it's built around people instead of paperwork — press play. www.YourHealth.Org

    41 min
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About

Entrepreneur and Chief Disruption Officer Scott Middleton share's his experiences of how he uses disruption to innovate and keep an organization moving forward and growing. Scott shares these weekly stories on The Disrupted Podcast with Scott Middleton.

Information

  • Creator
    James Preston, Scott Middleton
  • Years Active
    2021 - 2026
  • Episodes
    139
  • Rating
    Clean
  • Copyright
    © James Preston
  • Show Website
    The Disrupted Podcast

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