Value-Based Care Insights

This year, 2024, presented significant challenges for clinically integrated networks (CINs) delivering value-based care, with the disruption from Medicare Advantage reaching widespread levels. As we look toward 2025, it is crucial for CINs to reflect and gear up for success in the coming year by focusing on risk-based contracting, engaging specialists, and investing in care management. In this epi...

Success in the operating room is critical to the financial health of many healthcare organizations, with perioperative services contributing up to 75% of primary revenue streams. Effective perioperative care relies on skilled nurses who balance patient care while collaborating with other teams. In this episode of Value-Based Care Insights, Dan Marino sits down with Cindy Mahal, Chief Administrativ...

A coherent and consistent approach to evaluating and optimizing surgical patients not only minimizes avoidable harm and complications but also impacts inefficiencies such as case cancellation, delayed case starts and turnover. Furthermore, avoidable complications are increasingly costly through post-acute care utilization, readmissions and never events. Facilities, surgeons, anesthesiologists, pat...

Care management is crucial for adding value to value-based care, but gaining stakeholder buy-in on its significance can be challenging. While the return on investment for care management strategies is undeniable, the delayed realization of these returns can be daunting for financial leaders. In this episode of Value-Based Care Insights, Dan Marino sits down with Lisa Stockdale, the Director of Val...

Certain specialties, such as primary care, are generally better positioned to shift to value-based care. Specialists, particularly cardiologists, encounter challenges when transitioning from fee-for-service to fee-for-value. To succeed in this shift, they must rethink their approach to patient care. In this episode of Value-Based Care Insights, Dan Marino sits down with Dr. Sameer Sheth, a board-c...

Developing a strategic plan is crucial for the success of thriving healthcare organizations, but creating and adhering to the plan can be challenging. In this episode of Value-Based Care Insights, Dan Marino sits with Annette Kenney, a former healthcare Chief Strategy Officer and strategic planning consultant. Annette unlocks how healthcare organizations can develop a strategic planning process th...

Academic medicine providers are increasingly depending on their clinical practices to fund their education and research divisions. How do academic medical providers balance financial performance with clinician and community needs amidst competing missions that challenge their business models? In this episode of Value-Based Care Insights, Daniel Marino sits down with Dr. Joseph Bosco, Professor and...

The challenges posed by Medicare Advantage adoption have led numerous healthcare providers to exit the space altogether, despite the fact that 34 million Medicare patients are enrolled in Medicare Advantage plans. In this episode of Value-Based Care Insights, we sit down with Cliff Frank, a national expert on payer contracting, to delve into the complexities and hurdles healthcare providers face w...

After the Federal Trade Commission (FTC) announced a ban on non-compete clauses in April 2024, the healthcare sector experienced a major shift in physician employment contract negotiations. In this episode of Value-Based Care Insights, Hal Katz, a partner at Husch Blackwell specializing in healthcare life sciences, explores the consequences of this decision along with the resulting policy adjustme...

As healthcare providers grapple with the shortage of anesthesia providers and increasing financial constraints, leaders are redefining their relationships with anesthesia providers. In this episode of Value-Based Care Insights, Daniel Marino is joined by Tim Hanners and Dr. Dave Lebec where they address these challenges and explore best practice approaches in working with employed and independent...

With private equity's growing influence in healthcare systems, the significance of aligning healthcare providers has never been greater. In this episode of Value-Based Care Insights, we delve into the complexities of private equity interests and their profound impact on healthcare providers. Join Ericka Adler, a seasoned attorney and manager at Roetzel & Andress, as she explores the curren...

As Medicare Advantage enrollment rises and traditional Medicare enrollment declines, collaboration between payers and providers becomes essential. However, these relationships have historically been fraught with challenges and various administrative complexities. In this episode of Value-Based Care Insights, we explore the critical need for effective payer-provider partnerships. SueEllen Carroll,...

As healthcare providers engage in payer contract negotiations, understanding their contractual reimbursement rates compared to their market has never been more crucial. In this episode of Value-Based Care Insights, we sit down with Damon Morse, an expert in rate analyses to discuss the challenges healthcare providers face with payer contract negotiations, and the strategies required to level discu...

Medicare Advantage has been the subject of significant attention lately among provider organizations due to its distinctive demands that influence traditional practice operations norms. In this episode of Value-Based Care Insights, we sit down with Sarah Hartley, an expert in health information management, and discuss some of the hurdles with new Medicare Advantage contracts, along with the effort...

Forty-five years after a Chicago hospital pioneered an integrated network strategy, the healthcare landscape has undergone a significant shift towards prioritizing preventative care. In this episode of Value-Based Care Insights, Jeffry Peters, an expert on medical group strategy, along with Michael Antoniades, President of the University of Chicago Medicine, explore the groundbreaking challenges a...

Within the healthcare industry, effective organizational culture requires building trust, nurturing collaboration, and positioning leaders to drive strategic and impactful change. In this episode of Value-Based Care Insights, we sit down with Dr. Eric Velazquez, Professor of Medicine at Yale, alongside Doug McKinley, a clinical psychologist and leadership coach. Together, they explore the challeng...

Behavioral health is pivotal for overall patient well-being, yet healthcare providers are just beginning to recognize the significance of lifestyle factors and social determinants in delivering this sort of whole-person patient-centric care. In this episode of Value-Based Care Insights, host Dan Marino sits down with Dr. Matthew Burg, a clinical health psychologist at Yale, to explore how social d...

Effective care management is essential for achieving favorable population health outcomes. Yet, the current structure of care management focuses on reacting to health issues and does not adequately anticipate patients' needs. As providers assume risk-based contracts, the abilities to shift to prospective care management allows care managers to more effectively meet the patient’s needs by integ...

Improving patient outcomes requires a close look at the latest innovations in healthcare. In this episode of Value-Based Care Insights, we sit down with Dr. Jason Spangler, CEO of the Innovation and Value Initiative, a non-profit organization focusing on advancing the science of determining the merit of various clinical innovations. Dr. Spangler sheds light on health technology assessments (HTAs),...

With the recent push for healthcare reform, state governments started to issue crucial legislation to redesign the Medicaid program. In this episode of Value-Based Care Insights , we explore the new terms and conditions of New York’s 1115 demonstration waivers. With Vanessa Guzman, CEO of SmartRise Health, we share insights into the $6 billion initiative focusing on health equity, workforce invest...

One of the critical bellwethers of a healthcare organization's success in strategic planning is how well the health system leaders work with their boards. In this episode of Value-Based Care Insights, we sit down with Ivan Mitchell and Ann Scott Blouin to identify 2024 healthcare trends, their impact on provider organizations, and how executive leaders can engage with their board of directors....

With post-acute care, providers face various challenges, ranging from reimbursement struggles to meeting the evolving demands of an aging population. Hal Katz, a partner with Husch Blackwell, lends his expertise to shed light on how post-acute providers can navigate these challenges and advance into value-based care. Gain insights on transforming post-acute care models, establishing integrated net...

As 2023 draws to a close, we’d like to revisit episodes that explored relevant issues we’ve seen throughout the past year. Host Daniel J. Marino revisits these profound discussions and how they impact the future trajectory of health systems, hospital and the provider community. Featuring esteemed guests in their respective fields, Dan and his guests look back on important elements affecting strate...

Amidst uncertainties surrounding financial returns and the pace of value-based care, providers and executives harbor reservations regarding the privatization of risk. This episode unravels the intricacies of transitioning from fee-for-service to value-based care, shedding light on the challenges and opportunities that accompany this transformation. In this episode of  Value-Based Care Insights,  D...

In recent years, the call for health equity has driven healthcare systems, in the communities they serve, to champion better patient care and improve their well-being. However, this aspiration brings with it a series of social and cultural challenges. Join us in the latest episode of Value-Based Care Insights as we sit down with Vanessa Guzman, CEO of SmartRise Health, a healthcare thought leader...