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Value Based Care Advisory (VBCA) Podcast

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by Carenodes

5.0(4 reviews)

23 episodes

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Podcast Overview

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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Recent Episodes

May 31, 2026

Deciding to Contract with a Payor: Joining "the Network"

You've built the operation — clinicians credentialed, tech stack running, compliance buttoned up. Then a regional Medicaid managed care plan wants to talk about contracting. Your first instinct: great, let's do it. Then someone pulls up the 40-page contract with a 43-code prior authorization matrix and a data-sharing provision you're not sure sits cleanly with your other obligations.The fee schedule is fine. Not great — fine. And now the question isn't can we do this. It's should we, and on what terms?In this episode, Alex breaks down the payer contracting decision as what it actually is: a market entry and operational alignment commitment that happens to include a rate negotiation inside it. He walks through the six-dimension evaluation framework every health operator should run before signing anything.On the Out-of-Network AlternativeStaying out of network intentionally can be a viable model — particularly in specialty markets where a practice can command premium rates on a self-pay or direct-pay basis. But it requires an honest accounting of trade-offs:<ol><li>Payment at UCR (usual and customary rates) — not your billed charges, not in-network contracted rates</li><li>Limits on what patients can recover from their own plans, affecting your ability to attract and retain members</li><li>Collection burden shifts to the practice, along with associated staff time and friction</li><li>The No Surprises Act materially changed the out-of-network landscape for behavioral health providers in certain care settings — understand your exposure before assuming OON is a clean alternative</li></ol> Key Takeaways<ul><li>Treat payer contracting as a market entry and operational alignment decision — not just a rate negotiation</li><li>In high-concentration markets, staying out of network often means locking out of the majority of the addressable population</li><li>Your value proposition — especially HEDIS gap closure and measurement-based care data — is a negotiating asset most practices leave on the table</li><li>Operational alignment costs don't show up in the fee schedule. Map them before you sign</li><li>The intersection of payer data sharing requirements and 42 CFR Part 2 is not hypothetical risk — it's real compliance exposure</li><li>For contracts involving risk-sharing, value-based payment terms, or complex data provisions, involve experienced healthcare counsel before execution</li></ul> Chapter Markers00:00: Opening scenario — the 40-page contract lands in your inbox01:30: Reframing the network decision — it's not a rate negotiation02:40: Dimension 1 — Market access and concentration reality04:00: Dimension 2 — Knowing and articulating your value proposition05:10: Dimension 3 — Operational alignment and hidden administrative costs06:20: Dimension 4 — Payer's past performance and claims adjudication reality07:30: Dimension 5 — Physician profiling and measurement programs09:00: Dimension 6 — Data sharing, 42 CFR Part 2, and compliance exposure10:15: The out-of-network alternative — honest trade-offs11:20: Practical takeaways and when to involve healthcare counsel

April 30, 2026

LEAD Model: The ACO Test Most Organizations Will Fail — Before They Apply

CMS has posted the LEAD (Long-Term Enhanced ACO Design) model application materials. Preliminary scoring is due April 27, 2026. Full applications are due May 17, 2026. LEAD replaces ACO REACH in 2027 and runs as a 10-year demonstration with enhanced payments and care coordination flexibility.Most ACO applications fail before they're submitted — not because organizations are ineligible, but because they were never really built for risk. This episode breaks down the six scoring domains, in order of importance, that CMS will use to evaluate your application.WHAT WE COVER<ol><li>Financial Risk Readiness Define your risk corridor tolerance and downside exposure thresholds before anything else. Build a three-year proforma with utilization and trend assumptions. The CFO gut check: if trend runs 2% worse than expected, do you still survive? Secure financial guarantees and a reinsurance strategy before you submit.</li><li>Data and Interoperability It is not enough to collect data. CMS wants to see integrated clinical, claims, and SDOH data feeds with real-time or near real-time performance tracking. Demonstrate evidence of data-driven interventions — not just reporting. The core question CMS is asking: can you act on data, or just collect it?</li><li>Care Model Differentiation Define your care coordination infrastructure. Are you using RNs, community health workers, behavioral health integration? Do you have programs targeting high-cost, high-need (HCHN) populations? Are you integrating non-traditional services like doula care or CHWs? Reviewers want to see biopsychosocial care — not just medical management. Medical management alone is a red flag.</li><li>Network and Contracting Strategy CMS wants to see documented value-based contracts downstream — not just your arrangement with CMS. Can you push risk one step further? Do you have a specialist and post-acute alignment strategy? Note: roughly 80% of costs occur in the 90 days post-hospital discharge. Weak alignment equals leakage equals missed savings equals poor financial performance.</li><li>Operational Execution Plan Submit named executives and clinical leadership. Define your care workflows and escalation pathways. Provide a clear go-live and scale timeline. CMS reviewers are specifically watching for the "nice idea, no operator" red flag. They want robust operators behind every submittal.</li><li>Equity and Access Strategy Health disparities planning is no longer a narrative — it is a scoring mechanism. Whether or not you call it equity, operationalizing access will directly impact your financial outcomes. Integration with community-based organizations signals this. If you cannot operationalize access, you cannot succeed in this program.</li></ol> THE BRUTAL TRUTHMost organizations won't fail LEAD because they're ineligible. They'll fail because they realize too late they were never built for risk. LEAD isn't the program — it's a mirror. Start with your assumptions, not your application.

April 1, 2026

The Definitive Playbook for Choosing Behavioral Health Markets

Rate sheets don't tell the whole story.In this episode, Alex Yarijanian breaks down the 8-indicator playbook he uses to evaluate any tele-behavioral health market before committing capital — and names the specific states he'd enter today and why.Most operators default to the biggest states: California, Texas, Florida, New York. But population size alone is one of the weakest predictors of a winning market. The real levers live in parity law enforcement, workforce economics, MCO concentration, and infrastructure readiness.WHAT YOU'LL LEARN<ul><li>Why the biggest states are rarely the best markets for tele-behavioral health</li><li>The 8 indicators that separate win-win markets from cheap-rate mirages</li><li>How to build a weighted scoring model before entering a new market</li><li>What associate-level billing eligibility does to your workforce margins</li><li>How MCO concentration affects contracting speed and rate-cut risk</li><li>Which states Alex rates as best all-around, high-risk, and growth-stage bets</li></ul> THE 8 MARKET INDICATORS<ol><li>Medicaid market size: Total addressable population and realistic capture potential</li><li>Payment parity: State-level mental health parity laws and strength of enforcement</li><li>Cost of living index: The single best proxy for labor margin on clinical staff</li><li>Associate-level billing: Whether licensed associates can bill independently</li><li>HRSA HPSA demand mapping: Documented unmet need in mental health shortage areas</li><li>Broadband & 5G coverage: Infrastructure required for reliable telehealth delivery</li><li>MCO landscape: Plan count, behavioral carve-outs, any-willing-provider law exposure</li><li>Tax & corporate climate: State-level business environment and regulatory posture</li></ol> MARKET ARCHETYPES<ul><li>Best all-around: Arizona, Nebraska, Delaware, Oregon</li><li>Volume, thin margins: Arkansas, North Dakota</li><li>High rate, high cost niche: Alaska</li><li>Growth stage bets: New Mexico, Montana</li></ul> 4 ACTION STEPS<ol><li>Build a scroll scoring model — layer all 8 indicators into a weighted scorecard</li><li>Validate demand on the ground — overlay HRSA HPSA maps + FCC broadband gap data</li><li>Check your plan mix — count Medicaid MCOs and behavioral carve-outs</li><li>Run a payroll stress test — model cost of living vs. your target clinician pay band</li></ol> RESOURCES MENTIONED <ul><li>HRSA Mental Health HPSA maps: data.hrsa.gov</li><li>FCC broadband coverage maps: broadbandmap.fcc.gov</li><li>NCSL mental health parity law tracker</li><li>Licensure compact maps: PSYPACT, ASWB Compact, Nurse Licensure Compact State Medicaid rate databases</li></ul>

23 total episodes available

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What is Value Based Care Advisory (VBCA) Podcast?: 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.
How often does this podcast release new episodes?: This podcast updates daily.
Where can I listen to this podcast?: This podcast is available on 4 platforms including Apple Podcasts, Spotify, and more. You can also use the RSS feed directly.
Does this podcast accept guests?: Yes, this podcast regularly features guests.

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