Value-Based Care Insights

Medicare Advantage (MA) continues to grow and reshape the healthcare landscape, with CMS projecting that 34 million people, approximately 47.4% of Medicare beneficiaries, will be enrolled in MA plans in 2027. At the same time, financial pressures, rising denial rates, administrative complexity, and changing risk models are creating new challenges for health plans and providers alike.

In this episode of Value-Based Care Insights, Daniel J. Marino welcomes Cliff Frank, President and Founder of Healthcare Management Solutions, to examine the forces shaping Medicare Advantage as organizations prepare for 2027. With more than 30 years of experience in payer strategy, managed care contracting, and provider relationships, Cliff shares his perspective on the struggle to protect margins while navigating an increasingly complex reimbursement environment.

For healthcare executives, physician groups, and clinically integrated networks, this conversation highlights the importance of evaluating payer partnerships, aligning financial incentives with clinical outcomes, and developing sustainable strategies for succeeding in Medicare Advantage.

Care management is often viewed as one component of value-based care. But what if it is actually the engine that drives the entire model?

In this episode of Value-Based Care Insights, Daniel Marino sits down with Patty Resnik, a healthcare executive with deep experience in care management, population health, quality, and value-based care, to explore what it takes to build a high-performing and financially sustainable care management model.

For organizations looking to move beyond value-based care contracts and build the infrastructure needed to improve outcomes, reduce avoidable utilization, and create a stronger patient experience, this conversation offers a practical look at where care management can make the greatest impact.

As CMS continues to refine its approach to value-based care, healthcare organizations face critical decisions about how to participate in accountable care models. With ACO REACH coming to an end and new opportunities emerging through LEAD and the evolving Medicare Shared Savings Program (MSSP), 2027 marks an important inflection point for providers.

In this episode of Value-Based Care Insights, Daniel Marino sits down with Emily Brower, President and CEO of the National Association of ACOs (NAACOS), to explore what these changes mean for healthcare organizations and the future of accountable care. Emily shares insights into the key differences between LEAD and MSSP, the importance of understanding an organization’s population and network strengths, and how longer-term models can support investments in care management, clinical transformation, and population health.

Register for the conference: NAACOS Fall Conference Registration

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If you are not an ACO but are interesting in attending the conference go to NAACOS.com or email conference@naacos.com

Healthcare organizations are under increasing pressure to improve access while balancing patient expectations, provider capacity, and operational complexity. In this episode of Value-Based Care Insights, Daniel Marino is joined by healthcare access leaders Jon Fullerton and Jenny Hart to discuss what it takes to create a more coordinated and sustainable access strategy.

The discussion highlights real-world barriers that often prevent organizations from achieving meaningful improvement, including fragmented workflows, underused tools, inconsistent processes, and limited alignment across clinical and administrative teams.

Healthcare leaders will gain a practical perspective on how providers can evaluate current access challenges, engage stakeholders, and begin moving toward a more connected model that supports both care delivery and the patient experience.

As healthcare organizations advance value-based care strategies, clinically integrated networks remain a key vehicle for aligning physicians, improving performance, and building the infrastructure needed to succeed under new payment models. But sustaining a high-performing CIN requires more than contracting activity; it takes clear governance, physician engagement, and a shared commitment to measurable outcomes.

In this episode of Value-Based Care Insights, Daniel Marino discusses the stages of CIN maturity, from launching the network to optimizing operations and scaling for growth. He explores how organizations can define a strong value proposition, strengthen care management and utilization management capabilities, improve network integrity, and position the CIN for long-term high performance.

Whether your organization is developing a CIN, improving an existing network, or expanding value-based opportunities, this episode offers practical insights for building the alignment, infrastructure, and capabilities needed to drive sustainable success.

While value-based care has gained significant traction in adult medicine, pediatric care has often been left out of the conversation. Yet investing in children's health may be one of the most effective ways to improve long-term outcomes, strengthen communities, and reduce the total cost of care.

In this episode of Value-Based Care Insights, Daniel Marino welcomes Dr. Suzanne Brixey, Executive Director of Fortify Children's Health, to discuss how Virginia's statewide pediatric clinically integrated network is advancing a new approach to value-based care. Dr. Brixey explains why pediatric payment models and quality measures must differ from those designed for adults, how early intervention and preventive care can improve lifelong health outcomes, and why addressing behavioral health, social drivers of health, and family well-being is critical to supporting healthier children. She also shares how her organization is leveraging data, care management, and innovative partnerships to help pediatric practices succeed in value-based arrangements while delivering meaningful results for patients, families, and payers.

Learn more about Fortify Children's Health at FortifyChildrens.org

The conversations at this year's HFMA Annual Conference made one thing clear: value-based care is no longer just about reimbursement; it's becoming the foundation for how healthcare organizations operate.

In this episode of Value-Based Care Insights, Daniel Marino is joined by Katie Gilfillan, Director of Healthcare Finance Policy at HFMA, to discuss four themes from the conference: the transition from value-based contracting to enterprise-wide performance management, capital allocation toward scalable care delivery and digital infrastructure, the practical use of AI to improve access and operational efficiency, and affordability as a key indicator of value-based care success, reflecting the need to improve outcomes while reducing unnecessary cost.

Whether you're a healthcare executive, finance leader, physician leader, or payer, this conversation offers practical insights into where the industry is headed and how organizations can prepare for the next phase of value-based care.

Medicare Advantage enrollment continues to grow, but for many health systems, the administrative burden, prior authorization requirements, delayed care, and financial pressures are prompting leaders to reassess whether these plans continue to support their mission and patients.

In this episode of Value-Based Care Insights, Daniel Marino sits down with Ivan Mitchell, CEO of Great Plains Health, to discuss why his organization made the difficult decision to terminate its Medicare Advantage contracts. Ivan shares the real-world experiences that shaped this decision, including prolonged prior authorization delays, denied rehabilitation services, increased administrative complexity, and the operational and financial challenges that ultimately affected both patients and providers.

As hospitals face increasing financial pressures, workforce shortages, and growing demands for surgical efficiency, perioperative performance has never been more critical. Yet one of the most overlooked drivers of success may be sitting right in the operating room.

In this episode of Value-Based Care Insights, Daniel Marino is joined by Dr. Angel Martino-Horrall, anesthesiologist, consultant, and perioperative operations expert, to discuss the evolving role of anesthesia leadership in surgical services governance. Together, they explore why traditional perioperative leadership structures are no longer sufficient, how anesthesiologists provide a unique system-wide perspective across the surgical continuum, and why leading organizations are giving anesthesia a stronger voice in operational decision-making.

Whether you're a hospital executive, perioperative leader, surgeon, or anesthesia professional, this conversation offers valuable insights into building stronger governance structures and improving surgical performance across the organization.

Get in touch with Dr. Angel:LinkedIn, https://halo-consultants.com/

Emergency department overcrowding has become one of healthcare's most pressing operational challenges, yet many organizations continue to focus on symptoms rather than underlying causes. As patient acuity rises and hospital capacity constraints intensify, emergency departments are increasingly serving as the front door to complex care delivery.

In this episode of Value-Based Care Insights, Daniel Marino speaks with Dr. Marty Lucenti, a nationally recognized emergency medicine physician and operational performance expert, about the evolving role of the emergency department and the factors driving persistent overcrowding. Marty discusses why today's emergency department functions more like an acute diagnostic center than a traditional emergency room, explores the impact of patient complexity and inpatient capacity limitations, and shares strategies healthcare leaders can use to improve patient flow, optimize capacity management, and better align care delivery with growing demand.

In this episode of Value Based Care Insights, host Daniel Marino is joined by ECG’s Amanda Adams and Jessica Wells to discuss key themes and takeaways from the Becker’s Healthcare 16th Annual Meeting in Chicago. Together, they explore how healthcare organizations are rethinking workforce development, physician leadership, and operational integration amid growing financial, regulatory, and staffing pressures.

The conversation highlights the evolving role of academic health systems, the need to break down silos across clinical, research, and educational missions, and the importance of preparing a workforce ready for the future of care delivery. They also discuss leadership development, rural health challenges, artificial intelligence’s growing influence on workforce strategy, and how healthcare provider organizations can create more sustainable, integrated care environments while improving engagement and performance across teams.

Connect with Amanda

Connect with Jessica

As healthcare organizations continue to expand their employed provider networks, physician compensation design is becoming far more complex and far more strategic than simply measuring productivity through work RVUs. Today’s healthcare employers must think differently about how compensation models support organizational performance, physician engagement, retention, and value-based care objectives.

In this episode of Value-Based Care Insights, Daniel Marino is joined by Jon Morris of ECG Management Consultants and Alex Krouse, Associate General Counsel for a large health system, to discuss the evolving challenges of physician compensation across growing provider enterprises. Together, they explore why traditional compensation structures are no longer sufficient, how health systems are managing increasingly sophisticated provider networks, and why compensation should be viewed as an enterprise-wide workforce strategy.

The conversation also examines how organizations can balance standardized compensation approaches with physician-specific needs, improve transparency and stability in compensation design, and better align incentives with value-based care goals, operational performance, and long-term physician engagement.

Alex: https://www.linkedin.com/in/alexkrouse/

Jon: https://www.linkedin.com/in/jonmorrisjdmba/

As healthcare continues to evolve, conversations from HIMSS 2026 offer a clear glimpse into what’s ahead. In this episode of Value-Based Care Insights, host Daniel Marino is joined by healthcare strategist and The AI Shift host Tom Foley to unpack the conference’s biggest themes.

Together, they explore how artificial intelligence (AI) is advancing into real clinical use, the persistent challenges of interoperability and data fragmentation, and the growing role of patient empowerment through wearables and remote monitoring. From AI-driven care delivery to the realities of data quality and integration, the discussion highlights both opportunities and gaps healthcare organizations must navigate.

Whether you're evaluating AI, strengthening your data strategy, or rethinking care beyond the hospital, this episode offers practical insight into moving from innovation to real impact.

As financial pressures intensify across healthcare, payers are rethinking traditional strategies and accelerating their transition to value-based care. In this episode of Value-Based Care Insights, host Daniel Marino speaks with Joe Mangrum, Partner at ECG Management Consultants, about how payers are adapting to rising medical costs, tightening Medicare Advantage margins, and increasing regulatory demands.

Together, they unpack how payer strategies are shifting from broad network expansion to more selective, high-performing partnerships, with a growing emphasis on disciplined, data-driven decision-making. The discussion highlights the critical role of payer-provider collaboration in managing total cost of care, along with the increasing importance of data sharing, risk stratification, and more mature value-based arrangements. The episode offers practical insights into aligning incentives, strengthening partnerships, and building sustainable care models for the future.

As the CMS Transforming Episode Accountability Model (TEAM) launched on January 1, 2026, healthcare organizations are now facing the realities of implementation and the pressure to perform. In this episode of Value Based Care Insights, host Daniel Marino speaks with healthcare strategist Heather Flynn Kearney about what organizations are experiencing during the early stages of this mandatory model.

They discuss TEAM’s goals, why CMS targeted specific high-cost procedures, and how hospitals are managing operational, financial, and clinical challenges. From data limitations and coding accuracy to care coordination and post-acute partnerships, the conversation highlights the core capabilities needed for success.

Whether you're directly involved in TEAM or preparing for future value-based models, this episode offers practical strategies to improve coordination, reduce variation, and drive better outcomes in episode-based care.

As Medicare Advantage enrollment continues to rise, health systems and provider organizations are recognizing that these contracts demand more than traditional care delivery. In this episode of Value-Based Care Insights, host Daniel Marino is joined by value-based care expert Dr. Doug Ardoin to examine what drives performance in Medicare Advantage.

Together, they discuss why provider organizations often struggle after entering these arrangements and outline the core capabilities required to perform effectively, from accurate risk capture and attribution to utilization and care management. This conversation offers healthcare leaders practical insights on aligning clinical operations with contract expectations to improve financial and clinical outcomes in value-based models.

In this special episode of Value-Based Care Insights, host Daniel Marino announces an exciting new chapter: Lumina Health Partners has joined ECG Management Consultants. Dan is joined by Terri Welter, Partner and Leader of ECG’s Payer Strategy and Contracting Division.

Together, they explore the evolving dynamics between payers and providers, the growing role of advanced analytics and transparency data in negotiations, and how reimbursement models are shifting in response to mounting market pressures. The conversation dives into key trends in value-based care, physician compensation alignment, clinically integrated networks, and the strategic use of data to drive sustainable performance.

As healthcare organizations face increasing financial and operational strain, this episode highlights how deeper expertise, stronger analytics, and more collaborative payer-provider strategies can lead to smarter negotiations and stronger outcomes.

Emergency departments are under more pressure than ever as they are facing overcrowding, extended wait times, workforce strain, and rising patient demand fueled in part by primary care shortages. In this episode of Value-Based Care Insights, host Daniel Marino examines how these mounting challenges are reshaping the hospital’s front door and what they mean for patient care, operational performance, and long-term sustainability.

Daniel is joined by Dr. Richard Wolfe, Chief of Emergency Medicine at Beth Israel Deaconess Medical Center and a nationally recognized leader in emergency medicine operations. Together, they explore why emergency departments have become a critical pressure point for hospitals, how overcrowding affects quality, safety, and clinician burnout, and what forward-thinking health systems can do to better support their emergency medicine teams while continuing to serve their communities effectively.

As healthcare organizations move from AI curiosity to real-world implementation, many leaders are asking the same question: where do we actually begin? As the industry heads into 2026, providers are under pressure to move beyond experimentation and apply artificial intelligence in ways that deliver meaningful, workflow-driven impact without adding technology overload.

In this episode of Value-Based Care Insights, host Daniel Marino is joined by Don Woodlock, President of InterSystems, to explore how healthcare organizations can take a more strategic and disciplined approach to AI adoption. Drawing on InterSystems’ deep expertise in interoperability, data platforms, and AI-enabled solutions, the conversation focuses on where AI can truly enhance clinical workflows, reduce administrative burden, improve revenue cycle performance, and support better decision-making.

From ambient clinical documentation to smarter data connectivity and actionable AI insights, this discussion cuts through the hype to highlight how healthcare leaders can build an AI foundation that drives real value for clinicians, patients, and health systems, all while advancing the goals of value-based care.

Artificial intelligence (AI) is rapidly reshaping healthcare, yet many provider organizations still struggle to move from interest to practical application particularly when it comes to value-based care contracts. While AI promises efficiency and insight, turning it into measurable performance and financial advantage remains a challenge.

In this episode of Value-Based Care Insights, host Daniel Marino explores how AI can be used to address one of healthcare’s most complex challenges: evaluating and managing value-based contracts. Drawing on real-world experience, Daniel explores how AI can be used to build performance models that connect contract design with operational outcomes across clinically integrated networks, ACOs, and other value-based arrangements.

Joined by Eddie Diaz, a data scientist with more than 15 years of experience in value-based care analytics, the discussion highlights how AI can bring clarity to attribution, risk, quality, and financial performance to help CFOs, CMOs, and managed care leaders better understand contract opportunities, risks, and results. Together, they explore how AI can move beyond hype to deliver real, actionable value in value-based care contracts.