Analyzing Healthcare

Roy Bejarano and Jason Schifman: SCALE Community and SCALE Healthcare
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What’s next in healthcare? Analyzing Healthcare delivers expert insights, real-world case studies, and bold ideas shaping the future of U.S. & global health systems. Hosted by Roy Bejarano and Jason Schifman of SCALE Healthcare & SCALE Community, each episode explores medical innovation, healthcare leadership, value-based care, provider operations, health policy, artificial intelligence, & emerging health trends. Whether you're a provider, investor, operator, or simply healthcare curious—this podcast helps you stay informed, inspired, & ahead of the curve. More info at www.scale-community.com

  1. FEB 18

    How Hospital Clínic Barcelona Is Driving Europe’s Healthcare Innovation Engine - Jorge Fernandez

    Jorge Juan Fernandez discusses public healthcare innovation, hospital spinouts, CAR-T therapies, and why collaboration is shaping modern care delivery. In this episode of Analyzing Healthcare, he joins Jason Schifman to share how Hospital Clínic Barcelona became one of Europe’s most dynamic innovation engines.Fernandez explains how a public healthcare system can launch venture-backed startups, develop CAR-T therapies, and embed innovation across 9,000 employees. The discussion covers commercialization, operational ROI, cultural transformation, primary care integration, and hospital alliances that expand access and reduce inefficiencies. He emphasizes that innovation must improve operations—and that no single hospital can deliver world-class care alone. What You’ll Learn • ✅ How a public hospital created 30+ spinout companies across biotech, medtech, and digital health• ✅ The three-part innovation model: In-Out, In-In, and Out-In• ✅ Why operational improvement—not hype—is the test for adopting new technology• ✅ How frontline clinicians and nurses drive meaningful innovation• ✅ Why public systems can compete with pharma through structured tech transfer• ✅ How CAR-T therapies moved from research to national deployment• ✅ Why strategic partnerships are essential for modern healthcare delivery Key Timestamps • (00:43) Introduction to Hospital Clínic Barcelona and its global positioning• (09:43) Defining innovation in a public hospital system• (10:06) 30+ spinouts: competing with pharma and building companies• (15:35) Building a culture of innovation across 9,000 employees• (20:10) Internal innovation awards and frontline problem-solving• (26:56) Operational ROI: why great startups still fail in hospitals• (33:00) Strategic partnerships with primary care and rural hospitals• (36:40) “One hospital is not enough” — collaboration as strategy Key Takeaways • 💎 Public healthcare systems can innovate at scale with structured pathways• 💎 Commercial success begins with research strength and tech transfer discipline• 💎 Innovation must materially improve operations to earn adoption• 💎 Frontline pain points—not executive mandates—drive sustainable change• 💎 Strategic alliances expand access without duplicating infrastructure• 💎 Collaboration across care settings is a competitive advantage Guest Jorge Juan Fernandez GarciaChief Innovation Officer at Hospital Clínic Barcelona Guest Bio Jorge Juan Fernandez Garcia is Chief Innovation Officer at Hospital Clínic Barcelona, leading innovation strategy across four institutions within Campus Clínic Barcelona, including research foundations and global health initiatives. Under his leadership, the organization has launched more than 30 spinout companies across biotech, medtech, and digital health. Hospital Clínic is a top-ranked public tertiary hospital and a European leader in CAR-T therapy development, competing directly with pharmaceutical manufacturers in advanced therapies and translational research. Subscribe Subscribe to Analyzing Healthcare for candid conversations with healthcare leaders, clinicians, and system builders exploring healthcare strategy, AI in healthcare, digital health, and the future of care delivery. Visit Scale Community- www.scale-commmunity.com to access exclusive healthcare insights, member-only recordings, and leadership perspectives from across the global healthcare ecosystem. Keywords public healthcare innovation, Hospital Clínic Barcelona, Jorge Fernandez, healthcare innovation, CAR-T therapy, biotech startups, hospital spinouts, digital health, healthcare commercialization, healthcare strategy, public-private partnerships, healthcare cost efficiency, hospital alliances, primary care integration, Thought Leaders in Healthcare, Healthcare Industry Insights, Healthcare Innovations, Healthcare Strategy, Latest Trends in Healthcare, Healthcare Thought Leadership, Scale Healthcare, Roy Bejarano, Scale Community, Jason Schifman

    41 min

  2. FEB 11

    Physician Burnout, Private Equity, and AI: What Comes Next for U.S. Healthcare? with Kevin Pho, Founder at KevinMD

    Physician burnout, AI in healthcare, and private equity—Kevin Pho and Roy Bejarano explore the future of U.S. medicine and its challenges. In this episode of Analyzing Healthcare, host Roy Bejarano sits down with Kevin Pho, MD, founder of KevinMD, to examine what’s driving physician burnout—and what might actually help fix U.S. healthcare. Drawing on two decades as a practicing physician and leading voice in healthcare media, Kevin unpacks the loss of autonomy, growing corporatization, reimbursement pressure, and productivity metrics pushing clinicians toward burnout. He explains why burnout is a slow-burn crisis, how online platforms have replaced the physician lounge, and why isolation is worsening across specialties. The conversation also explores AI’s role in healthcare, separating tools that reduce cognitive load from those that introduce new clinical and ethical risks, alongside a candid discussion on private equity, regulation, and patient outcomes. What You’ll Learn Why physician burnout is worsening—even as healthcare spending rises. How loss of autonomy and corporatization are reshaping medical practice. Why productivity metrics and reimbursement pressures fuel moral injury. How KevinMD became a modern “physician lounge” for shared experience. Where AI genuinely helps clinicians—and where it creates new risks. Why ambient AI scribes may reduce burnout but raise privacy questions. How Silicon Valley’s pace clashes with patient safety realities. The unresolved debate around private equity and patient outcomes. Why training more physicians alone won’t fix access or burnout. What healthcare leaders must prioritize over the next decade. Key Timestamps (00:00) Kevin Pho’s journey from primary care physician to KevinMD(04:25) Burnout, moral injury, and why physicians feel isolated(07:45) Loss of autonomy and the corporatization of medicine(10:10) Are physicians burning out faster—or just steadily worse?(13:40) Metrics vs. medicine: where the system breaks(17:15) Private equity in healthcare—risk, reality, and regulation(24:35) AI in healthcare: real tools vs. dangerous hype(26:40) Why AI won’t replace doctors—but may replace those who ignore it(29:20) “Move fast and break things” vs patient safety(33:30) Residency caps, physician shortages, and structural bottlenecks Key Takeaways Burnout is a systemic failure, not an individual weakness. Loss of physician autonomy is a primary driver of moral injury. Metrics without clinical context worsen care and clinician wellbeing. AI can reduce cognitive load—but also introduce serious safety risks. Healthcare cannot adopt Silicon Valley’s speed without consequences. Private equity’s impact on care is nuanced—not binary. Training more doctors won’t solve access without structural reform. Resource Links Guest: Kevin Pho, MD – Founder, KevinMDHost: Roy Bejarano – CEO & Co-Founder, SCALE HealthcarePodcast: Analyzing HealthcareSCALE Community: https://www.scale-community.com Guest Bio Dr. Kevin Pho is a board-certified internal medicine physician and the founder of KevinMD, the leading physician-led media platform amplifying frontline clinical voices. Since launching KevinMD in 2004, he has built a global community where clinicians share real-world experiences on burnout, autonomy, health policy, and emerging technologies like AI. Dr. Pho brings a practicing physician’s perspective to national healthcare debates and continues to care for patients in New Hampshire. SEO Keywords Physician burnout, Kevin Pho, KevinMD, AI in healthcare, healthcare innovation, private equity in healthcare, physician autonomy, healthcare policy, healthcare AI, medical burnout, Healthcare Podcast, Healthcare Trends and Innovations, Healthcare Strategies, Leading Healthcare Stakeholders, Thought Leaders in Healthcare, Healthcare Industry Insights, Healthcare Innovations, Healthcare Strategy, Latest Trends in Healthcare, Healthcare Thought Leadership, Roy Bejarano, Jason Schifman

    38 min

  3. FEB 4

    Is AI the First Technology Doctors Actually Trust? Robert Wachter, Author & Chair of Medicine, UCSF

    Bob Wachter on AI in healthcare, EMRs, digital health, clinician burnout, and why generative AI may succeed where healthcare technology failed. In this episode of Analyzing Healthcare, Jason Schifman speaks with Bob Wachter, Chair of Medicine at UCSF and author of A Giant Leap, on why AI may finally transform healthcare. Wachter explains how EMRs increased administrative burden without delivering productivity gains, and why generative AI marks a shift by making clinical data and decision-making computable. The conversation covers real-world AI adoption—scribes, chart summarization, and decision support—while examining ROI, clinical risk, and human oversight. Wachter emphasizes that AI won’t fix healthcare’s incentives, but it can meaningfully improve clinician experience and care delivery. What You’ll Learn Why EMRs digitized healthcare without transforming it What makes generative AI fundamentally different from prior health IT waves Where AI delivers real value today—and where it still falls short Why clinician experience may be AI’s strongest early ROI How AI could reshape diagnosis, testing, and treatment decisions The risks of human–AI collaboration in clinical care Why AI can improve healthcare without replacing doctors Key Timestamps (00:00) Introduction to Bob Wachter and AI in healthcare (04:13) Why EMRs failed to transform healthcare delivery (09:37) General-purpose technology and healthcare digitization (15:42) Why AI adoption is happening “suddenly,” not gradually (19:38) What makes generative AI different from past tools (34:03) AI scribes: adoption, experience, and ROI reality (38:15) Clinical decision support as AI’s true “home run” (44:16) Unintended consequences and the human-in-the-loop risk Key Takeaways 💎 Digitization alone does not equal transformation 💎 Generative AI enables healthcare data to become computable 💎 Clinician experience is a critical early driver of AI adoption 💎 Real cost savings depend on changing clinical decisions, not documentation 💎 AI can improve healthcare without fixing broken incentives 💎 Human oversight introduces new risks alongside new benefits Guest Bob Wachter, MDChair, Department of Medicine, UCSFAuthor, A Giant Leap: How AI Is Transforming Healthcare and What It Means for Our Future Guest Bio Bob Wachter, MD, is Professor and Chair of the Department of Medicine at the University of California, San Francisco, and a nationally recognized leader in healthcare quality, safety, and innovation. He coined the term “hospitalist,” the fastest-growing medical specialty in U.S. history, and has authored six books and hundreds of articles on health technology and policy. His 2015 book The Digital Doctor was a New York Times bestseller, and his latest, A Giant Leap, explores AI’s impact on care. Subscribe Subscribe to Analyzing Healthcare for candid conversations with healthcare leaders, clinicians, and system builders exploring healthcare strategy, AI in healthcare, digital health, and the future of care delivery. Visit Scale Community- www.scale-commmunity.com to access exclusive healthcare insights, member-only recordings, and leadership perspectives from across the global healthcare ecosystem. Keywords AI in healthcare, Bob Wachter, healthcare innovation, electronic health records, EMR adoption, digital health, clinical decision support, physician, healthcare productivity, healthcare costs, healthcare technology, affordable healthcare, healthcare solutions, healthcare access, Healthcare Podcast, Healthcare Trends and Innovations, Healthcare Strategies, Leading Healthcare Stakeholders, Thought Leaders in Healthcare, Healthcare Industry Insights, Healthcare Innovations, Healthcare Strategy, Latest Trends in Healthcare, Healthcare Thought Leadership, Scale Healthcare, Roy Bejarano, Scale Community, Jason Schifman

    46 min

  4. JAN 28

    Inside the Mind of a Global Biotech Investor: What Actually Gets Funded- Dr. George Syrmalis, CEO, Bioscience Equity Partners

    Healthcare innovation doesn’t fail because of a lack of science—it fails when governance, execution, and incentives break down. In this episode of Analyzing Healthcare, host Roy Bejarano, CEO & Co-Founder of SCALE Healthcare, sits down with George Syrmalis, Founder & CEO of Bioscience Equity Partners, to unpack how early-stage biotech, medtech, and digital health investments are really evaluated—and why most countries fail to attract global capital. Drawing on decades of experience as a physician, biotech founder, and global investor, George explains why governance, intellectual property, execution quality, and regulatory clarity matter more than geography. The conversation explores early-stage biotech funding, global clinical trial strategy, FDA vs international regulators, Big Pharma’s looming patent cliff, radiopharmaceuticals, AI in drug discovery, and why “innovation without impact” doesn’t get funded. From why the U.S. remains the most attractive biotech market to how Saudi Arabia is rapidly emerging as a future life sciences hub, this episode delivers a rare, operator-level view into how capital actually flows across global healthcare innovation. What You’ll Learn ✅ How global biotech investors assess early-stage risk and return✅ Why governance and IP matter more than geography✅ How FDA clarity often outweighs lower clinical trial costs abroad✅ Why many countries struggle to attract life sciences capital✅ The real bottlenecks in clinical trials and contract manufacturing✅ How Big Pharma’s patent cliff will reshape M&A and deal flow✅ Where radiopharmaceuticals, medtech, and AI are creating real value✅ Why most “AI in healthcare” pitches don’t survive diligence Key Timestamps • (00:00) George Syrmalis’ background and investment philosophy• (05:10) Governance, IP, and biotech deal breakers• (10:20) Why the U.S. dominates global biotech investing• (12:15) Where to run clinical trials—and where not to• (18:20) FDA clarity vs lower-cost regulators• (22:35) Big Pharma’s patent cliff and M&A surge• (25:30) Where capital is moving in biotech and medtech• (29:40) Real AI vs hype in healthcare• (32:00) Tariffs, pricing risk, and capital strategy Key Takeaways • 💎 Early-stage biotech success depends on execution, governance, and IP• 💎 FDA transparency often outweighs lower global trial costs• 💎 Clinical trial quality matters more than geography• 💎 Manufacturing failures can derail approvals and destroy value• 💎 Big Pharma’s patent cliff will drive aggressive M&A• 💎 Radiopharmaceuticals and medtech are entering a second growth wave• 💎 Most healthcare AI pitches fail real diligence Resource Links Guest: George Syrmalis – Founder & CEO, Bioscience Equity PartnersHost: Roy Bejarano – Analyzing HealthcareCommunity: www.scale-community.comPodcast Hub: Analyzing Healthcare by SCALE Community Guest Bio Dr. George Syrmalis is a physician-scientist, entrepreneur, and global healthcare investor best known as Founder & CEO of Bioscience Equity Partners, a specialist investment bank and fund manager focused on early-stage biotech, med-tech, and digital health ventures. He has decades of experience bridging scientific innovation and capital markets, helping groundbreaking life sciences technologies advance from discovery through financing and public markets. His leadership emphasizes rigorous science, governance, and strategic execution to accelerate meaningful healthcare innovations worldwide. SEO Keywords Biotech, healthcare investment, clinical trials, AI in healthcare, Dr. George Syrmalis, investment strategies, global healthcare, pharmaceutical industry, innovation in medicine, biotech trends, Healthcare Podcast, Healthcare Trends and Innovations, Healthcare Strategies, Leading Healthcare Stakeholders, Thought Leaders in Healthcare, Healthcare Industry Insights, Healthcare Innovations, Healthcare Strategy, Latest Trends in Healthcare, Roy Bejarano, Scale Community, Jason Schifman

    34 min

  5. JAN 21

    Why Transcarent Unified Medical, Pharmacy, and Point Solutions Into One AI-Powered Experience with Glen Tullman, CEO at Transcarent

    Healthcare innovation continues to accelerate, yet access, affordability, and patient experience remain persistent challenges across the U.S. healthcare system. Despite advances in digital health and healthcare technology, many solutions fail to address the root issues driving cost, complexity, and fragmented care delivery. In this episode of Analyzing Healthcare, host Jason Schifman sits down with Glen Tullman, CEO of Transcarent, to examine why healthcare systems struggle to deliver affordable healthcare and consistent access—and what healthcare strategies can actually move the industry forward. Glen shares how Transcarent is rethinking digital health by prioritizing patient experience, decision support, and AI in healthcare to simplify access to care for employees and their families. The conversation explores how healthcare solutions must align incentives, technology, and experience to improve outcomes. Glen also reflects on broader healthcare trends and innovations, explaining why leading healthcare stakeholders must focus less on volume-driven care and more on scalable, consumer-centered healthcare innovations that improve access, quality, and cost simultaneously. What You’ll Learn ✅ Why healthcare innovation has not translated into better patient experience✅ How AI in healthcare can improve access and guide better care decisions✅ What digital health platforms must get right to drive adoption and impact✅ Why affordable healthcare depends on fixing incentives, not adding complexity✅ How healthcare technology can simplify navigation across fragmented systems✅ What leading healthcare stakeholders should prioritize in today’s market Subscribe Subscribe to Analyzing Healthcare for in-depth conversations with thought leaders in healthcare covering healthcare strategy, healthcare technology, and the latest trends in healthcare. Visit Scale Community to access exclusive healthcare industry insights, member-only recordings, and leadership perspectives from across the healthcare ecosystem. Timestamps • (00:00) Why healthcare innovation hasn’t fixed access or affordability• (03:05) Glen Tullman’s perspective on healthcare trends and innovation cycles• (07:10) Why patient experience remains the biggest failure point• (10:20) Volume-driven incentives and unnecessary care• (14:50) Digital health lessons from EMRs and healthcare technology• (18:35) AI in healthcare and simplifying decision-making• (22:10) Creating a single front door to healthcare access• (26:15) Employers, digital health, and healthcare strategy alignment• (31:45) Affordable healthcare through better system design• (36:10) What the future of healthcare innovation requires Key Takeaways • 💎 Healthcare innovation must focus on experience to drive adoption• 💎 AI in healthcare is most powerful when applied to navigation and decisions• 💎 Digital health solutions must reduce complexity, not add layers• 💎 Affordable healthcare requires fewer unnecessary interventions• 💎 Healthcare strategy succeeds when incentives align with outcomes Guest Glen Tullman, CEO, TranscarentHost: Jason Schifman, President & Co-Founder, SCALE Healthcare Organization: https://www.scale-community.comPodcast Hub: Analyzing Healthcare by SCALE Community Guest Bio Glen Tullman is CEO of Transcarent, where he is working to simplify healthcare by giving employees of self-insured employers a single, consumer-directed front door to high-quality, affordable care. Previously, Glenn founded Livongo, leading its historic IPO and $18.5B merger with Teladoc, and earlier served as CEO of Allscripts. Across his career, he has focused on aligning incentives, improving experience, and reducing unnecessary cost in healthcare. Keywords Healthcare innovation, Glen Tullman, Transcarent, digital health, patient experience, AI in healthcare, healthcare technology, affordable healthcare, healthcare solutions, healthcare access, Healthcare Podcast

    42 min

  6. JAN 14

    What Does the Evidence Actually Say About U.S. Healthcare? Dr. Aaron E. Carroll, CEO at AcademyHealth

    Healthcare costs keep rising because trade-offs are unavoidable. Dr. Aaron Carroll explains pricing, policy, insurance limits, and global healthcare systems. In this episode of Analyzing Healthcare, host Roy Bejarano, CEO & Co-Founder of SCALE Healthcare, sits down with Dr. Aaron E. Carroll, President & CEO of AcademyHealth, to unpack why U.S. healthcare remains the most expensive system in the world—and why no reform comes without painful trade-offs. Drawing on decades of health services research and policy leadership, Dr. Carroll explains why rising premiums, shrinking coverage, and public frustration are driven less by insurance design and more by pricing, delivery models, and political reluctance to confront trade-offs. The conversation explores healthcare costs, insurance, public health investment, innovation incentives, global healthcare systems, and lessons from countries like Switzerland, Singapore, Canada, and the UK. What You’ll Learn ✅ Why healthcare costs in the U.S. remain structurally high✅ How trade-offs shape healthcare policy decisions✅ Why insurance is not the core driver of healthcare inflation✅ The role of public health and prevention in long-term outcomes✅ What global healthcare systems get right—and wrong✅ Why innovation thrives in U.S. healthcare despite inefficiencies✅ How political avoidance worsens healthcare challenges Timestamps • (00:00) Introduction: Academy Health and healthcare policy• (02:54) Why healthcare costs keep rising• (09:03) “Everything is to blame” in U.S. healthcare spending• (18:41) The real difference between U.S. and global healthcare systems• (29:38) Why single-payer won’t fix healthcare costs• (31:40) Innovation, incentives, and trade-offs• (39:45) Public vs private responsibility in healthcare delivery• (44:44) Why insurance debates miss the real problem Key Takeaways • 💎 Healthcare trade-offs are unavoidable—there are no cost-free solutions• 💎 High healthcare costs are driven by pricing and delivery, not insurance alone• 💎 Public health and prevention improve outcomes, even if they don’t always cut costs• 💎 Global healthcare systems balance public and private roles more explicitly• 💎 Innovation in healthcare is fueled by incentives—but comes with complexity Resource Links Guest: Dr. Aaron E. Carroll – President & CEO, AcademyHealthHost: Roy Bejarano – Analyzing HealthcareCommunity: www.scale-community.comPodcast Hub: Analyzing Healthcare by SCALE Community Guest Bio Dr. Aaron E. Carroll is President & CEO of AcademyHealth and a nationally recognized physician, health policy researcher, and thought leader in healthcare economics. A former academic leader at Indiana University, he has spent decades advancing evidence-based healthcare policy, health services research, and public health reform. Dr. Carroll is widely known for translating complex healthcare systems, insurance dynamics, and global health trade-offs into clear, data-driven insights that inform policymakers, executives, and healthcare leaders. SEO Keywords Academy Health, healthcare costs, healthcare innovation, healthcare policy, insurance, public health, healthcare systems, trade-offs, healthcare challenges, global health, AI in Healthcare, Managed Care, Healthcare Podcast, Healthcare Trends and Innovations, Healthcare Strategies, Leading Healthcare Stakeholders, Thought Leaders in Healthcare, Healthcare Industry Insights, Healthcare Innovations, Healthcare Strategy, Latest Trends in Healthcare, Healthcare Thought Leadership, Scale Healthcare, Roy Bejarano, Scale Community, Jason Schifman

    46 min

  7. JAN 7

    How is Technology Redefining Pediatric Care? Chris Johnson, CEO of Bluebirds Kids Health

    Pediatric care in the U.S. is increasingly defined by fragmentation — especially for children with complex needs and those covered by Medicaid and CHIP. Access barriers, disconnected services, and lack of coordination often leave families navigating care on their own, with real consequences for outcomes. In this episode of Analyzing Healthcare, host Jason Schifman speaks with Chris Johnson of Bluebird Kids Health about what actually drives pediatric outcomes and why traditional, encounter-based models fall short. Chris explains why most determinants of pediatric health exist outside the clinic, how integrating physical health, behavioral health, and social care is essential to improving outcomes, and why children play a central — but often misunderstood — role in Medicaid performance. The conversation focuses on practical system design: aligning care teams, coordinating across community resources, and redefining success around impact — measured in healthier days at home, not just utilization. What You’ll Learn ✅ How digital care platforms are improving access, efficiency, and outcomes✅ Why data integration and interoperability remain foundational challenges✅ How healthcare organizations can scale innovation without disrupting care delivery✅ The role of partnerships in accelerating healthcare transformation✅ What healthcare leaders must prioritize when adopting new technology✅ How patient-centric design drives adoption and long-term impact Subscribe Subscribe to Analyzing Healthcare for in-depth conversations with leaders transforming healthcare through strategy, technology, policy, and global innovation. Visit SCALE Community to access exclusive leadership insights and full member-only recordings. Timestamps • (00:00) Why pediatric care is broken in the U.S.• (03:12) The scale and complexity of caring for high-need children• (07:45) Where fragmentation hurts families and outcomes most• (12:30) How Bluebird Kids Health integrates care beyond the clinic• (17:10) Aligning clinical teams, data, and family support• (21:55) Technology’s role in coordinating pediatric care• (26:40) Working with payers and health systems in the U.S.• (31:20) Measuring outcomes in pediatric population health• (36:05) What scalable pediatric care models must get right• (40:30) Lessons for U.S. healthcare leaders and policymakers Key Takeaways • 💎 Digital platforms are becoming central to modern care delivery• 💎 Interoperability is essential for scaling value-based models• 💎 Technology must align with clinical workflows to drive adoption• 💎 Partnerships accelerate innovation across fragmented systems• 💎 Patient-centric design is critical to long-term success Guest: Chris Johnson, Founder & CEO Bluebird Kids HealthHost: Jason Schifman, President & Co-Founder, SCALE Healthcare Organization: https://www.scale-community.comPodcast Hub: Analyzing Healthcare by SCALE Community Guest Bio Chris Johnson is a healthcare executive and innovator focused on advancing pediatric care through technology-enabled, family-centered models. As a leader at Bluebird Kids Health, Chris works at the intersection of clinical care, digital health, and care coordination to improve access and outcomes for children with complex and chronic needs. His work centers on building scalable pediatric care platforms that integrate primary care, specialty services, and social support—reducing fragmentation while supporting families beyond traditional clinical settings. Chris brings a practical, systems-level perspective on how pediatric healthcare can evolve to deliver higher-quality, more equitable care at scale. Keywords Digital healthcare, care delivery platforms, healthcare technology, interoperability, data-driven healthcare, population health, value-based care, healthcare challenges, Healthcare Podcast, Healthcare Trends and Innovations, Healthcare Strategies, Scale Healthcare, Roy Bejarano, Scale Community, Jason Schifman

    41 min

  8. 12/31/2025

    Why Medicare Pricing Still Controls U.S. Healthcare Economics featuring Medicare's Former Chief Transformation Officer, Douglas Jacobs

    Inside Medicare Pricing and Policy: Douglas Jacobs on fee schedules, primary care, ACOs, and AI. In this episode of Analyzing Healthcare, host Roy Bejarano speaks with Douglas Jacobs, former Chief Transformation Officer at Medicare, former Chief Medical Director at the Pennsylvania Department of Health, and a practicing primary care physician, to unpack how Medicare sets prices—and why those decisions shape the entire U.S. healthcare system. Drawing on his experience inside CMS and on the front lines of care, Jacobs explains why Medicare pricing is constrained by statute, excludes demand, and has historically underpaid primary care and behavioral health. The conversation covers the latest physician fee schedule, advanced primary care payments, ACO performance, quality measures that improve outcomes, the limits of AI, and lessons from Pennsylvania’s managed care model. What You’ll Learn ✅ How Medicare prices care — and why demand is excluded by law✅ Why Medicare reimbursement anchors commercial insurance pricing✅ How underpayment of primary care reshaped the physician workforce✅ What changed in the latest Medicare physician fee schedule✅ Why primary-care-led ACOs outperform large health-system ACOs✅ Why AI cannot fix healthcare without structural access reform Timestamps (00:00) Introduction: Medicare leadership and practicing medicine (01:14) Initial impressions of the new Medicare fee schedule (02:30) Specialty winners, conversion factors, and efficiency adjustments (04:20) Why Medicare pricing ignores market signals (07:03) Demand, supply, and the broken market signal (08:49) Primary care underpayment and workforce impact (11:02) How commercial payers follow Medicare pricing (13:33) Advanced primary care management payments (16:15) Why primary-care-led ACOs save more (22:35) Quality measures that reduce mortality (24:54) AI skepticism and access limitations (28:50) Pennsylvania’s managed care and cost controls Key Takeaways 💎 Medicare pricing is supply-driven and sets the reimbursement anchor for the market 💎 Underpayment of primary care has lasting workforce and access consequences 💎 Advanced primary care and primary-led ACOs deliver stronger savings and outcomes 💎 Simple, focused quality measures can materially reduce mortality 💎 AI cannot fix healthcare without addressing structural access and equity gaps Resource Links Guest: Douglas Jacobs – Former Chief Transformation Officer, MedicareHost: Roy Bejarano – Analyzing HealthcareCommunity: www.scale-community.comPodcast Hub: Analyzing Healthcare by SCALE Community Guest Bio Douglas Jacobs is a practicing primary care physician and former Chief Transformation Officer at Medicare, where he spent nearly four years helping shape national payment, quality, and value-based care policy. He previously served as Chief Medical Director at the Pennsylvania Department of Health, overseeing large-scale managed care programs and quality oversight. His work spans physician payment reform, ACO strategy, primary care transformation, and national quality measurement, bringing together frontline clinical experience with federal and state health policy leadership. SEO Keywords Medicare Fee Schedule, Medicare Pricing, Primary Care Reimbursement, Value-Based Care, ACO Performance, Healthcare Economics, CMS Policy, Quality Measures in Healthcare, AI in Healthcare, Managed Care, Healthcare Podcast, Healthcare Trends and Innovations, Healthcare Strategies, Leading Healthcare Stakeholders, Thought Leaders in Healthcare, Healthcare Industry Insights, Healthcare Innovations, Healthcare Strategy, Latest Trends in Healthcare, Healthcare Thought Leadership, Scale Healthcare, Roy Bejarano, Scale Community, Jason Schifman

    35 min
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What’s next in healthcare? Analyzing Healthcare delivers expert insights, real-world case studies, and bold ideas shaping the future of U.S. & global health systems. Hosted by Roy Bejarano and Jason Schifman of SCALE Healthcare & SCALE Community, each episode explores medical innovation, healthcare leadership, value-based care, provider operations, health policy, artificial intelligence, & emerging health trends. Whether you're a provider, investor, operator, or simply healthcare curious—this podcast helps you stay informed, inspired, & ahead of the curve. More info at www.scale-community.com

Information

  • Creator
    Roy Bejarano and Jason Schifman: SCALE Community and SCALE Healthcare
  • Years Active
    2024 - 2026
  • Episodes
    102
  • Rating
    Clean
  • Copyright
    © Roy Bejarano and Jason Schifman: SCALE Community and SCALE Healthcare
  • Show Website
    Analyzing Healthcare