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Challenging the healthcare industrial complex.
The Value Based Care Advisory (VBCA) Podcast is a solution-focused platform dedicated to advancing the transformation of healthcare through value-based care 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.
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.
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Your Billing Problem Started in the Contract
Persistent underpayment, denials that don't respond to appeals, patterns nobody can explain — these are often contract problems wearing a billing problem's disguise.
How to Decide to Contract with a Payer: Should You be Joining "the Network"?
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? Alex breaks down the six-dimension evaluation framework every health operator should run before signing.
LEAD Model: The ACO Test Most Organizations Will Fail — Before They Apply
Most ACO applications fail before they're submitted — not because organizations are ineligible, but because they were never really built for risk. Alex breaks down the six scoring domains CMS will use to evaluate your application.
The Definitive Playbook for Choosing Behavioral Health Markets
Alex 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.
Medicare Negotiates Like an Owner. Commercial Doesn't.
Alex sits down with Dr. Kumar Dharmarajan (CMO, World Class Health; former CMO, Clover Health) to unpack why employers often pay 2–4x Medicare rates for identical procedures — and what that means for value-based care.
The Rural Health Transformation Fund: What States Are Funding in 2026
CMS is moving tens of billions into every state — not through rate increases, but through targeted investments in workforce, technology, care coordination, and alternative payment models.
Medicare Advantage 2026: How Payers Are Choosing Partners
Payers are quietly narrowing networks and rewriting delegation terms. Alex explains why waiting for regulatory clarity is already costing providers and health tech companies leverage.
Digital Health at a Crossroads: The Fallout from a $100M Adderall Fraud Scheme
The founders of Done were convicted for orchestrating one of the largest Adderall distribution and fraud schemes in U.S. history. What this means for the entire digital health ecosystem.
2026 Medicare Fee Schedule: 5 Big Opportunities for Providers & Startups
Medicare's 2026 physician fee schedule is packed with change — shorter billable windows for remote monitoring, new behavioral health add-ons, expanded telehealth reimbursement, and a major shift from inpatient to outpatient.
How to Win in Medicare Advantage 2026
A 5% increase in Medicare payment rates, scaled-back supplemental benefits, permanent telehealth for behavioral health, and a new risk adjustment model. What it takes to thrive in the evolving landscape.
Behind the Scenes of Power: Emotional Labor in Negotiation
Managing emotions plays a pivotal role in negotiations and leadership effectiveness. Alex shares how emotional labor can be both a powerful tool and a silent tax on leaders challenging dominant norms.
Meditate Like a CEO: Real ROI from Mindful Leadership
The neurological benefits of mindfulness, demonstrating its capacity to modulate stress and foster cognitive flexibility — enabling leaders to navigate the complexities of their roles with greater composure.
Managed Care Contracting for Health Tech Startups
How health tech startups can win at managed care contracting: insider strategies for scalable payer partnerships, risk-based contracts, and avoiding common pitfalls in healthcare financing.
Doulas and Value-Based Maternity Care: Driving Cost Reduction and Improved Outcomes
The historical context of childbirth, the current state of maternal mortality in the U.S., and the emerging role of doulas — plus how to strategically leverage the doula opportunity in risk-based contracting.
Uncovering the Hidden Influencers of Our Health System
How companies like CVS Caremark and pharmaceutical giants manipulate the system to maximize profits, Medicare Advantage cherry-picking, and the hidden influence of consulting firms like McKinsey.
2025 Opportunities in Healthcare: Navigating the Perfect Storm
Rising healthcare costs, increased patient demand, and intense scrutiny from lawmakers are converging. Industry giants like Humana and UnitedHealth are grappling with pressures that could redefine managed care.
EXPOSED: The MultiPlan Healthcare Cartel Costing Providers and Patients Billions
Hidden fees, surprise bills, and the alleged cartel controlling out-of-network reimbursements. The AMA's antitrust lawsuit accusing MultiPlan of working with UnitedHealthcare, Cigna, and Aetna to suppress payments.
Startup Pitfalls and Healthcare Horror Stories: Introduction to Value-Based Care
The rising tide of healthcare startups pursuing VBC with ambitious visions — but without a robust patient acquisition strategy, many founders find themselves struggling to meet volume requirements.
Understanding the Mental Health Parity Act: A Guide for Providers
Alex and Dr. Chris Esguerra (former Senior Medical Director, Blue Shield of CA; Deputy CMO, Health Plan of San Mateo) discuss navigating insurance plans and the barriers to accessing equitable behavioral health care.
Changing Demographics & Value-Based Care
How shifting U.S. demographics are reshaping the value-based care landscape and what providers need to know to stay ahead.
Paying for Biopsychosocial Care
The system used to pay for healthcare today does not encourage the integration of health care and social care. New financing approaches are needed to enable the health care sector to engage in activities that strengthen social care.
Telehealth Landscape Overview: 50 States + DC
No two states are alike in how telehealth is defined and regulated. A comprehensive review of telehealth policy across all 50 states and DC, including post-COVID regulatory shifts.
Florida Market Telehealth Rule & Controlled Substances
Florida's 2019 telehealth law establishes standards of practice including patient evaluations, record-keeping, and controlled substances prescribing — with one critical exception for psychiatric disorders.
How to Talk to Health Plans for Mental Health Coverage
California's SB 855 increases health and disability insurers' coverage obligations for mental health and addiction diagnosis, prevention, and treatment — and what it means for providers.