Value Based Care Advisory (VBCA) Podcast

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The VBCA Podcast is a solution-focused platform dedicated to advancing the transformation of healthcare through value-based care (VBC) models. Our mission is to break down complex healthcare topics into accessible, actionable insights for leaders, entrepreneurs, engaged consumers, and anyone passionate about meaningful change in healthcare. By challenging the healthcare industrial complex, we provide tools, strategies, and expert perspectives that empower our listeners to navigate and accelerate the shift toward better outcomes, lower costs, and improved patient experiences. Each episode delivers thought-provoking discussions and practical advice from industry experts, spotlighting innovative approaches to healthcare reform and highlighting voices that are often overlooked in traditional dialogues. Whether you're a healthcare executive, provider, payer, policy influencer, entrepreneur, or informed patient, we aim to inspire new ideas and support you in driving transformation in the healthcare space. Powered by Carenodes.

  1. Medicare Negotiates Like an Owner. Commercial Doesn’t.

    28 FEB

    Medicare Negotiates Like an Owner. Commercial Doesn’t.

    In this episode of the VBCA Podcast, Alex Yarijanian sits down with Dr. Kumar Dharmarajan — co-founder and Chief Medical Officer of World Class Health and former Chief Scientific and Medical Officer at Clover Health — to unpack one of the most important structural differences in U.S. healthcare: incentive alignment. Why are employers often paying two to four times Medicare rates for identical procedures performed in the same hospital by the same physician? The answer isn’t clinical complexity. It’s incentive design. Dr. Kumar breaks down how Medicare Advantage plans negotiate as owners of financial risk — and why that matters. In contrast, much of the commercial self-insured market relies on administrators who negotiate without full downside exposure, creating a structural pricing gap. The conversation also explores: What Medicare Advantage plans are actually looking for when contracting with digital health and AI solutionsWhy engagement — not automation — is the real leverage pointThe economics of supplemental benefits and underutilized Star opportunitiesHome-based and remote care as risk containment strategiesThe future vision of standardized specialty care marketplaces This is a structural conversation about incentives, risk ownership, and where execution truly matters in value-based care. Key TakeawaysIncentive alignment drives pricing discipline. Medicare Advantage plans negotiate differently because they own the full medical loss ratio.Commercial self-insured markets often lack that same alignment, contributing to higher negotiated rates.AI in Medicare Advantage is less about backend efficiency and more about member activation and physician-level quality improvement.Underutilized supplemental benefits represent unrealized revenue and quality movement.Home-based and remote care models are fundamentally about managing high-acuity risk, not convenience. Timestamps00:00 – Introduction 01:39 – What Medicare Advantage plans actually want from AI vendors 03:27 – Why engagement infrastructure is the real leverage point 04:28 – Virtual care, socioeconomic complexity, and risk ownership 06:18 – High-acuity members and access-driven cost escalation 07:11 – Supplemental benefits and engagement economics 08:36 – Stars, utilization, and revenue implications 09:55 – Employers paying 2–4x Medicare rates 10:27 – Why commercial pricing diverges 12:17 – Incentive structure and negotiation power 12:47 – Vision for standardized specialty care marketplaces About the GuestDr. Kumar Dharmarajan is a practicing cardiologist and geriatrician and the co-founder and Chief Medical Officer of World Class Health. He previously served as Chief Scientific and Medical Officer at Clover Health and was on faculty at Yale School of Medicine, where his research helped shape national post-acute care quality measures. He has published in the New England Journal of Medicine, JAMA, and Health Affairs. Companies mentioned in this episode: World Class HealthClover Health

    13 min
  2. Billions for Rural Health: What CMS Is Funding in 2026

    31 JAN

    Billions for Rural Health: What CMS Is Funding in 2026

    CMS is moving tens of billions of dollars into every state to stabilize rural healthcare heading into 2026—not through across-the-board rate increases, but through targeted investments in workforce, technology, care coordination, and alternative payment models. In this episode, Alex Yarijanian breaks down what the Rural Health Transformation Program / Rural Health Fund (RHTF) actually is, what state strategies reveal about the future of rural access, and why this matters far beyond rural hospitals—impacting payer strategy, provider contracting, network adequacy, and healthcare economics. You’ll hear key highlights from state plans including California, Texas, Florida, New York, and Illinois, plus the cross-state themes showing up everywhere: hub-and-spoke models, shared services, EMS reform, telehealth hubs, and AI-driven admin reduction (including automated fax processing). What You’ll LearnWhat the Rural Health Transformation Program actually isWhy this funding wave is different (state plans are concrete and approved)What state strategies reveal about access risk + reimbursement limitsHow payers should interpret this as a network adequacy / access signalWhy providers should see this as both opportunity + accountability shift State Highlights CoveredCalifornia Hub-and-spoke maternal + specialty access modelsExample of rate + infrastructure working together (Health Plan of San Mateo specialty rate increases) Texas Technology as a force multiplierAI-enabled specialty access, telehealth coordination, clinically integrated networksTech becomes a parallel lever to reimbursement in high-dispute markets Florida Remote patient monitoring (RPM) + community paramedicineUtilization management upstream in MA-heavy environments New York Patient-centered medical homes + workforce pipelinesCare coordination over unit cost expansion in concentrated payer markets Illinois Integrated primary + behavioral health infrastructureEMS treat-not-transport modelsAlternative models as a response to inflation vs lagging rates Key Cross-State ThemesHub-and-spoke models are returning at scaleShared services (centralized EHR, billing, analytics) to reduce admin burdenAI as infrastructure (clinical decision support + operational efficiency)Specific AI use cases being funded:Automated fax processingAI scribesAI-enabled care coordination Key TakeawayRural health stabilization strategy is not uniform across states — but the goal is consistent: protect access where reimbursement alone hasn’t been enough. Mentioned in this episode: Health plan of San MateoCaliforniaTexasFloridaNew YorkIllinoisOklahomaWashingtonUtahVermont

    9 min
  3. Medicare Advantage 2026: How Payers Are Choosing Partners

    30/12/2025

    Medicare Advantage 2026: How Payers Are Choosing Partners

    While most providers are waiting on CMS, payers are already narrowing networks and rewriting delegation terms. Payers are quietly narrowing networks and rewriting delegation expectations. This playbook explains how to do business with MA business for 2026. If you’re waiting, you’re already reacting—not positioning. 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. You’ll hear how payer priorities have shifted from enrollment growth to margin durability, why network narrowing is accelerating quietly, how delegation has become a stress test, and what “value-based care” really means in Medicare Advantage today. 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. Who should listen: Provider executives, payer leaders, value-based care operators, and health tech founders navigating Medicare Advantage.

    8 min
  4. Digital Health at a Crossroads: The Fallout from a $100M Adderall Fraud Scheme

    26/11/2025

    Digital Health at a Crossroads: The Fallout from a $100M Adderall Fraud Scheme

    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, but what this case means for the entire digital health ecosystem, especially behavioral health and companies prescribing controlled substances. When a company like Done collapses — and its founders now face up to 20 years in federal prison — it doesn’t just take itself down. It drags trust, access, and payer willingness down with it. Alex outlines how this case will reshape: Payer contracting and credentialingPrescribing oversight and compliance expectationsTrust in telehealth platformsThe future of value-based behavioral healthWhy incentives — good or bad — always scale And most importantly, he explains why value-based care is the antidote to the shortcuts and misaligned incentives that fueled this scandal. If you’re building, funding, regulating, or partnering with telehealth organizations, this is a must-listen. Takeaways: The case of the telehealth startup highlights the critical importance of clinical oversight in health services. Payers are likely to impose stricter regulations on telehealth providers following recent fraudulent activities. Building a sustainable healthcare model requires prioritizing patient interests over profit maximization strategies. The future of digital health will hinge on trust, necessitating alignment between clinical and business models.

    9 min
  5. 2026 Medicare Fee Schedule: 5 Big Opportunities for Providers & Startups

    03/10/2025

    2026 Medicare Fee Schedule: 5 Big Opportunities for Providers & Startups

    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 monitoringNew behavioral health add-ons to primary careIncentives that reward value-based careExpanded reimbursement for digital therapeutics & telehealthA major shift from inpatient to outpatient procedures Whether you’re running a clinic or building the next health tech solution, this playbook will help you turn policy into profit and thrive in the future of care.

    8 min
  6. How to Win in Medicare Advantage: 2026 Payment, Telehealth & Stars Update

    01/09/2025

    How to Win in Medicare Advantage: 2026 Payment, Telehealth & Stars Update

    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 assessment requirements, and the transition to a new risk adjustment model. Learn how these changes will impact care delivery, compliance, and strategy, and discover what it takes to thrive in this evolving landscape. Tune in and prepare for the Medicare Advantage showdown of 2026! 00:00 Welcome to the Value-Based Care Advisory Podcast 00:15 2026 Medicare Advantage Showdown Overview 01:24 Key Policy Updates for 2026 03:11 Telehealth and Virtual Care Innovations 04:39 Enrollment and Form Updates 06:12 Risk Adjustment and Star Ratings 08:52 Strategic Focus Areas for 2026 14:44 Final Thoughts and Conclusion Takeaways: The 2026 Medicare Advantage payments are set to increase by approximately 5%, contributing an excess of $25 billion to the plans. Significant changes have been initiated regarding supplemental benefits, particularly affecting non-medical services like transportation and meals. Telehealth services for behavioral health will become a permanent fixture, with no geographic restrictions imposed from 2026 onward. New billing codes will be introduced for digital therapeutics and remote monitoring, enhancing the infrastructure for virtual care delivery. The upcoming risk adjustment model will utilize the full 2024 CMS HCC risk model, significantly impacting financial strategies for Medicare Advantage organizations. Plans must prioritize compliance and operational integrity to navigate the complexities of changing regulations and maintain their competitive edge.

    16 min

  7. 31/07/2025

    Behind the Scenes of Power: Emotional Labor in Negotiation

    In this episode of the VBCA podcast, host Alex Yarijanian delves into the often overlooked yet crucial aspect of leadership: emotional labor. Discover how managing emotions plays a pivotal role in negotiations and leadership effectiveness. Alex shares personal experiences and insights on how emotional labor can be both a powerful tool and a silent tax on leaders, especially for those challenging dominant norms. Tune in to learn how to harness emotional intelligence to build trust and lead with empathy and strength. Takeaways: In the realm of healthcare leadership, emotional labor serves as an essential yet often unacknowledged component that significantly influences negotiation outcomes. Effective leadership necessitates an acute awareness of emotional dynamics, as managing feelings is integral to fostering productive dialogue among stakeholders. The notion of emotional labor encompasses not just personal emotional management, but also the responsibility to create a supportive environment for others. A leader's capacity to engage in emotional labor can lead to profound transformations, underscoring the importance of empathy and understanding in professional interactions.

    6 min
  8. Meditate Like a CEO: Real ROI from Mindful Leadership

    12/06/2025

    Meditate Like a CEO: Real ROI from Mindful Leadership

    This podcast episode delves into the intricate relationship between mindfulness meditation and its profound implications for healthcare leadership. We explore how mindfulness practices not only enhance emotional well-being but also significantly improve the quality and effectiveness of leadership within healthcare settings. Through a rigorous examination of scientific evidence, we elucidate the neurological benefits of mindfulness, demonstrating its capacity to modulate stress and foster cognitive flexibility, thereby enabling leaders to navigate the complexities of their roles with greater composure and efficacy. Furthermore, we provide practical mindfulness training techniques that can be seamlessly integrated into the daily routines of healthcare professionals, offering a pathway to both personal and organizational transformation. Ultimately, this discourse underscores the necessity of cultivating a mindful approach in healthcare leadership to enhance overall performance and well-being. Mindfulness meditation and its application within the healthcare sector represent a profound intersection of neurological research, emotional intelligence, and leadership efficacy. The discussion begins with a thorough exploration of mindfulness, defined as a state of present-oriented consciousness, which fosters a non-judgmental awareness of one's moment-to-moment experiences. This foundational understanding serves as a springboard to investigate the transformative potential of mindfulness practices for healthcare leaders, who are often beleaguered by high levels of stress and burnout. The episode highlights compelling evidence demonstrating that mindfulness can mitigate stress, enhance cognitive flexibility, and improve emotional regulation—qualities that are indispensable for effective leadership in the ever-evolving landscape of healthcare. By integrating mindfulness into their daily routines, healthcare leaders can cultivate a more resilient mindset, ultimately translating into better organizational outcomes and improved patient care. Through the lens of empirical studies, the podcast delves into how mindfulness training yields significant neurological benefits, such as increased white matter density and enhanced executive function. One landmark study cited illustrates that patients undergoing mindfulness-based interventions reported a greater awareness of their symptoms and a reduced identification with negative cognitive patterns—a finding that underscores the therapeutic potential of mindfulness in both clinical and leadership contexts. In practical terms, the episode outlines actionable strategies for implementing mindfulness practices within healthcare organizations, emphasizing that even modest initiatives can catalyze meaningful improvements in workplace culture and employee wellbeing. As the conversation unfolds, listeners are encouraged to reflect on their own practices and consider how mindfulness could serve as a catalyst for personal and organizational growth. Takeaways: Mindfulness training serves as a pivotal mechanism for enhancing the performance of healthcare leaders by fostering emotional resilience and cognitive flexibility. The practice of mindfulness has been scientifically corroborated to mitigate stress levels significantly, enabling leaders to navigate high-pressure environments more effectively. Utilizing mindfulness techniques within healthcare organizations can yield substantial improvements in employee productivity, as evidenced by a notable increase in productive hours per week. Healthcare leaders must cultivate a non-judgmental awareness of their experiences to effectively integrate their internal and external realities, thereby enhancing overall leadership efficacy. Implementing mindfulness practices in healthcare settings has demonstrated substantial positive outcomes, such as reduced burnout among healthcare professionals and improved organizational performance. The neurological benefits of mindfulness training, including increased gray matter density, underscore its importance in developing a sharp, focused mind essential for effective healthcare leadership. Companies mentioned in this episode: Aetna Boston Medical Center

    19 min
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About

The VBCA Podcast is a solution-focused platform dedicated to advancing the transformation of healthcare through value-based care (VBC) models. Our mission is to break down complex healthcare topics into accessible, actionable insights for leaders, entrepreneurs, engaged consumers, and anyone passionate about meaningful change in healthcare. By challenging the healthcare industrial complex, we provide tools, strategies, and expert perspectives that empower our listeners to navigate and accelerate the shift toward better outcomes, lower costs, and improved patient experiences. Each episode delivers thought-provoking discussions and practical advice from industry experts, spotlighting innovative approaches to healthcare reform and highlighting voices that are often overlooked in traditional dialogues. Whether you're a healthcare executive, provider, payer, policy influencer, entrepreneur, or informed patient, we aim to inspire new ideas and support you in driving transformation in the healthcare space. Powered by Carenodes.

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