Value-Based Care Insights

Artificial intelligence (AI) is making headlines everywhere—but how much of it is real, and how much is just hype? In this episode, host Daniel Marino is joined by Rick Howard, Chief Information and Data Officer at Brand Engagement Network, to unpack the growing role of AI in healthcare. Together, they separate fact from fiction, explore the opportunities and challenges AI presents, and discuss how healthcare organizations can responsibly integrate AI to improve operations and patient care. Whether you're excited, confused, or cautious about AI, this conversation offers clarity and insight for navigating the rapidly evolving digital landscape.

In this special episode of Value-Based Care Insights, host Daniel Marino is joined by Fred Goldstein, President of Accountable Health and podcast host of PopHealth Week, to unpack key takeaways from HIMSS25. They share their experience at this year’s conference, focusing on artificial intelligence (AI), digital technology, and future trends. Already, AI is transforming care delivery and decision-making, while digital technology is revolutionizing patient engagement and operational efficiency. Join us for an insightful conversation on the evolving healthcare technology landscape and the trends shaping the future of care delivery, driving a more connected and efficient healthcare ecosystem.

In this special episode of Value-Based Care Insights, host Daniel Marino brings you exclusive interviews recorded live at HIMSS25, where healthcare innovation took center stage. The first interview features Stephen Overman, CEO & Founder of Standpoint Solutions, who shares their groundbreaking technology aimed at improving communication within perioperative services. Next, Dr. Alan Young, Client Executive at Point B Solutions, dives into the transformative role of artificial intelligence in patient care. The future of AI-driven healthcare is explored, including the rise of intelligent agents and their potential to influence clinical decision-making. Tune in for an insightful discussion on the future of healthcare, technology, and how innovation is reshaping patient care.

National healthcare organizations like the Healthcare Financial Management Association (HFMA), American Hospital Association (AHA), and Medical Group Management Association (MGMA) offer valuable industry-wide insights and legislative guidance. However, state associations provide a more tailored, in-depth understanding of the specific challenges healthcare providers face in their local markets. In this episode of Value-Based Care Insights, host Daniel Marino sits down with fellow Illinois MGMA board members, Meghan Heiy and Jenny Kovich, and explores the growing importance of state healthcare associations in effectively navigating today’s rapidly evolving healthcare landscape.

The healthcare industry is grappling with a growing shortage of providers in every specialty, with primary care being hit the hardest. In this episode, host Daniel Marino is joined by primary care physician, Dr. Leila Obeid, to discuss how physician shortages and rising patient demands are forcing many primary care physicians to seek better work-life balance through alternative practice models. One solution? Concierge medicine. Tune in as we discuss how this model helps physicians regain control, improve patient care, and create a sustainable future in healthcare.

In 2025, the continued growth of Medicare Advantage underscores the increasing importance of specialists in value-based care, as healthcare models shift toward more integrated, patient-centered approaches. In this episode of Value-Based Care Insights, host Dan Marino sits down with Lynn Carroll, COO and Head of Strategy at HSblox, to explore how specialists can successfully engage in value-based care models. Tune in to explore current value-based programs that incorporate specialty providers, key challenges encountered, and the critical infrastructure required for success in this evolving healthcare landscape.

The Physician Fee Schedule (PFS) Final Rule for Calendar Year (CY) 2025 introduces several key updates to Medicare payment policies, aiming to enhance care delivery and reduce administrative burdens. In this episode, Daniel Marino is joined by Managing Partner, Lucy Zielinski, as well as Sarah Hartley, to explore the implications of the PFS Final on physicians and other billing professionals. Together, they discuss the key changes and opportunities for physician services furnished in a variety of settings including physician offices, hospitals, ambulatory surgery centers (ASCs), and others. Tune in to stay informed and gain valuable perspectives on navigating these critical regulatory updates.

Healthcare providers will continue to move toward value-based care, fostering a more equitable healthcare system that enhances accessibility, quality, affordability, and innovation. In this episode of Value-Based Care Insights, I sit down with Lumina’s Managing Partner, Lucy Zielinski, to explore the healthcare trends of 2025, the effects of new regulatory changes, and the pressures these developments place on providers. Tune in to learn about the top five trends that health systems should include in their strategic planning. 

Based on your feedback, our listeners, we've selected the top three episodes for 2024. We dive into the key challenges and opportunities defining healthcare trends this past year through three captivating Value-Based Care Insights episodes. In Episode 102, Sarah Hartley discusses the unique demands of managing Medicare Advantage contracts, offering creative strategies to align providers and patients. Episode 98 features Dr. Riya Pulicharam and Kevin Zhao exploring how integrating clinical data and fostering cultural change within care management transforms patient outcomes. In Episode 106, Tim Hanners and Dr. Dave Lebec tackle the anesthesia provider shortage and delve into tactics to boost financial performance, optimize staffing models, and improve payer reimbursement.

Care management is critical, especially for individuals with chronic conditions like dementia, because it ensures coordinated, comprehensive, and individualized care. Currently, more than 6.7 million Americans are living with dementia and Alzheimer’s disease, and this number is projected to continue rising. While the impact of the disease on individuals is widely recognized, the personal and financial burden it places on caregivers is less often highlighted. Today, on Values-Based Care Insights, Dan Marino sits down with JVS Health’s CEO Vanessa Guzman and Co-founder Seth Hyman to discuss the GUIDE Model, a Centers for Medicare & Medicaid Services (CMS) supplement for caregivers of patients with dementia and Alzheimer’s disease. Gain insights into the valuable services within the GUIDE model that can support and benefit individuals living with dementia and their unpaid caregivers.

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 episode of Value-Based Care Insights, Dan Marino sits down with Dr. Will Faber, to tackle several challenges, including the lack of structure among commercial payers to effectively handle value-based contracts and obstacles in negotiating such contracts with specialty providers. Gain insights into strategies and data utilization that will position your provider organization for success in 2025.

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 Administrative Officer of Providence Saint Joseph Medical Center, to explore the challenges nurses face in achieving alignment and how to overcome them. We’ll uncover insights into key strategies administrators can implement to empower nurses, giving them a voice and enabling them to not only align but also lead.

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, patients and families share an interest in doing better from the very beginning of the surgical journey. On today’s episode of Value-Based Care Insights, Daniel Marino explores how to identify and capture opportunities to streamline care and is joined by Alex Hannenberg, former President of the American Society of Anesthesiologists and Adjunct Clinical Professor of Anesthesiology at Tufts School of Medicine, and Art Boudreaux, Professor of Anesthesiology and Perioperative Medicine at the University of Alabama, Birmingham. Gain insights into the importance of aligning and standardizing perioperative processes, and how leveraging data can help reduce inefficiencies, reduce costs, and improve patient outcomes.

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 Value-Based Care at Silver Cross Health Systems, to look at challenges, as well as the benefits, in implementing successful care management programs. Gain insights into the importance of leadership buy-in, technology, and reinvestment in effective and cost-saving care management programs.

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-certified cardiologist who helps specialists transition to value-based care by focusing on a patient-centric approach to medicine. Gain insight into the healthcare provider ecosystem and how data and tools, patient engagement, and communication support the shift from volume-based to value-based care.

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 that includes input from all stakeholders, including the communities they serve. Uncover insights into how to transform a strategic plan into an actionable workplan that prioritizes activities and drives real success.

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 Vice Chair of NYU Langone’s Health Orthopedics, and Jeff Peters, a national expert in growth and service line strategies, to explore how academic medicine is addressing conflicting missions across their enterprise. Gain insight into growth models in academic medicine that prioritize clinician and geographic accessibility to keep patients in-network, while maintaining a strong focus on research, education, and quality care.

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 with Medicare Advantage plans, and explore how their responses impact both staff and patients. Gain insight into how geography and legislation influence the short- and long-term implementation of Medicare Advantage, and discover strategies for healthcare providers to safeguard patients from confusing plans and hidden costs.

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 adjustments and legal appeals. Gain insights into the FTC ruling on physician employment agreements, the required alignment between single-specialty groups health systems, and more.  

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 anesthesia groups. The discussion explores ways to improve financial performance by enhancing anesthesia outcomes, optimizing staffing models, and managing reimbursement from payers.

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 current trends in private equity and their implications on physicians and healthcare systems. Gain insights into physician employment models, the regulatory landscape, and effective strategies for healthcare transactions.

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, Managing Director at AArete, and Darren Ghanayem, a seasoned expert in healthcare and IT. SueEllen and Darren Ghanayem join us to share their insights on building trust between payers and providers and strategies for improving governance. Gain insights into fostering contract collaboration, improving patient care, and reducing the administrative burden often associated with Medicare Advantage contracts.

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 discussions. Gain insights into how thorough analysis and strategic positioning can ensure fair reimbursement for provider organizations and support organizational growth.

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 efforts needed to align providers and patients. Gain insights into the administrative challenges, diverse strategies for effective patient data management, and the essential cultural shift required to promote collaboration between provider organizations and payers.

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 and strategies that revolutionized healthcare delivery, and how they are still being tackled today. Gain insights on the evolving focus towards preventative care, the measures used to evaluate healthcare delivery, and the pivotal role of primary care in bolstering the entire healthcare ecosystem.

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 challenges and opportunities of strengthening the workplace culture in order to improve organizational effectiveness, financial performance, and overall patient care. Gain insights on the importance of vision alignment, a healthy culture, team collaboration, and the delicate balance between “steering the ship” and delegating responsibility.

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 determinants and behavioral medicine are addressing the clinical needs of patients. Gain insights into the challenges and opportunities involved in integrating behavioral health into patient care, in prioritizing quality outcomes over services, and in recognizing the importance of preventative measures to establish a more comprehensive patient-centric care delivery system.

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 integrating clinical data, lifestyle criteria and clinical pathways. In this episode of Value-Based Care Insights, we sit down with Dr. Riya Pulicharam and Kevin Zhao, as they delve into the limitations of the current care management process and discuss attributes essential to support enhanced patients outcomes while increasing care managers productivity. Gain valuable insights into how to optimize care pathways, leverage technology, and foster cultural change to ultimately achieve better outcomes.

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), their history and how they help leaders decide which new technologies or devices provide interventional benefits to patients that includes clinical outcomes in addition to cost analysis. Listen to gain insights into how HTAs consider clinical outcomes, the incorporation of health equity, and how social determinants provide a broader understanding of the benefits that shape healthcare decisions.

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 investments and the general support of Medicaid programs. Discover how the New York program sets a precedent for other states, addresses DEI initiatives, and strategically allocates funds to improve the care delivery infrastructure and overall patient outcomes.

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. Gain insights on the top trends that are the greatest hurdles for healthcare providers and the importance of collaborative leadership.

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 networks and how providers can flourish in the VBC ecosystem.

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 strategic growth of hospitals, financial performance of medical groups and successes in risk-based contracting.

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, Dan sits down with Dr. Will Faber to explore the effects of value-based care on physicians, dissect payer pressures, and uncover why value-based care presents a golden chance for providers to enhance the quality of patient care.

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 on the frontline of change. Vanessa highlights the key priorities and challenges encountered by organizations and offers actionable solutions for effective integration of health equity into care delivery models. Gain valuable insights on leadership requirements, data collection, and what it takes to bridge the disparities to promote health equity.

Electronic health record (EHR) systems can be powerful management tools, but using them improperly can present challenges for both physicians and patients. In this episode, we dive into the role of EHR systems in value-based care. Our guest, Dr. Kim Furry, a seasoned orthopedic surgeon and an Epic-certified Physician Builder, unveils the intricate challenges physicians encounter while building and augmenting EHR systems. Discover the time-saving techniques, the crucial importance of data quality, and the key enhancements that improve both physician efficiency and patient care.

The added pressures for medical groups, coupled with the limited resources and high demands, require an intentional, strategic roadmap to success. On this episode of Value-Based Care Insights, we sit down with Jeff Peters to discuss the evolving healthcare landscape and what medical groups should be thinking about to position themselves for the future. Gain valuable insights into innovative strategies for aligning with providers, improving financial performance, and fostering a healthy, physician-driven culture.

In the world of academic service lines, the alignment of physician executives and physician assistants is paramount. On this episode of Value-Based Care Insights, Jason Raidbard, Executive Administrator at the University of Chicago, unveils the challenges and strategies of crafting a dyad partnership of leaders within academic service lines. Gain insights on the importance of a shared patient-centric culture that unites academic, research and clinical operations under one resolute purpose. 

From its humble origins as an academic gathering of a few attendees, the Population Health Colloquium has evolved into a diverse gathering of brilliant minds in the field of population health and value-based care. In this episode of Value-Based Care Insights, we sit down with Dr. David B. Nash as he discusses the Population Health Colloquium taking place September 18-20th in Philadelphia. We dive into the colloquium’s focus on value-based care, health equity and AI’s innovation within population health.  Speakers will discuss the crucial link between delivering value and transforming the future of healthcare.

When it comes to making big decisions, strategic plans often overshadow the critical aspect of leadership culture. This episode of Value-Based Care Insights welcomes Keith Hadley, whose expertise lies in building healthy organizations and improving organizational decision-making through building high-performing teams. Discover the roots of misalignments in leadership teams and the significance of transparent communication in creating a unified voice to advance the culture of the organization.

Risk-based contracts are revolutionizing the healthcare industry, prompting a transition to value-based care. In this episode of Value-Based Care Insights, guests Cliff Frank and Dr. George Mayzell explore the key aspects of risk-based contracts and provide actionable insights for physicians and practitioners navigating this transformative shift.

Rising prices and sky-high interest rates are posing significant operational and care delivery challenges for hospitals. In our latest episode of Value-Based Care Insights, Nillie Djassemi, CFO of Houston Physician’s Hospital, shares valuable insights on navigating these challenges. Together, Dan and Nillie explore the importance of investing in vendor management and capital expansion to thrive in today’s economy.

To provide value-based care, providers need to address their process, their technology, and their people. But stakeholder priorities don’t always align. Knowing where and how to start can be the difference between a successful implementation and one that falls short.  

Tune into the latest episode of Value-Based Care Insights featuring host Daniel J. Marino as he welcomes Sarah Hartley and Dr. Purvi Shah, whose expertise in ambulatory clinical documentation improvement (CDI) will help illustrate the need to improve clinical workflows.  In addition, they discuss the risks, challenges and obstacles providers need to navigate in order to better deliver meaningful patient outcomes. 

Many issues are impacting today’s clinical service lines, especially cardiovascular services. Health systems, hospitals and physician groups are focusing on growing their cardiovascular service lines to address shifts in site-of-service, improve patient access and position themselves for enhanced financial performance under value-based contracts. 

In this episode of Value-Based Care Insights, Daniel J. Marino talks with Dr. Hani Salti, a clinical cardiologist and Clinical Assistant Professor at large academic-based health system.  Dr. Salti shares his insights on the growth of cardiovascular service lines, the need to develop strong physician leadership and the growing impact on population health on cardiovascular services.

As more and more provider organizations engage in risk-based contracts, including Medicare Advantage, understanding quality and performance along with clinical workflow integration is critical to contract success. On our third episode of our three-part series focusing on risk-based contract and performance, we invited two special guests from QRC to join the show to  dive deeper into Risk Adjustment Factor (RAF) scores and the impact of Hierarchical Condition Category codes (HCCs).

Tune into the latest episode of Value-Based Care Insights, as our host Daniel J. Marino speaks with Gene Rondenet and Paula Gallagher on how data and information critical to proactively build a prospective risk model is key to to manage the potential risks of health care cost increases and prepare the organization for the future. 

For the second part of our three-part series, we invited Cliff Frank back to discuss the changes among risk-based contracts. Daniel and Cliff explore the pushback with RAF scores, new CMS announcements with potential health equity indicators, and much more.

Listen now to our latest episode of Value-Based Care Insights, as our host Daniel J. Marino and guest, Cliff Frank, dive further into value-based contracts and what has changed over the last few months.

Many hospitals are experiencing increasing workflow challenges due to high inflation rates. As a result, government and commercial payers are responding in unique ways.  

On this episode of Value-Based Care Insights, host Daniel J. Marino discusses economic challenges in health care, particularly hospitals and physicians. We’re joined by commercial insurance and government reimbursement expert, Cliff Frank. 

KEY TAKEAWAYS: 

• Hospitals and other health care facilities are facing a number of challenges, and inflation is a key component to internal issues. It’s essential that providers have an understanding on how to navigate an ever-changing infrastructure. 

• Risk contracting has been a common issue for hospitals as payers are making money on empty hospitals and slower ORs. This obviously increases the need for better contracts between payers and providers. 

• The ACO module has changed drastically, impacting how care is coordinated for Medicare patients.