Care Management: The Engine Driving Value-Based Care

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 RegistrationUse this promo code: VBCInsightsIf you are not an ACO but are interesting in attending the conference go to NAACOS.com or email  [email protected]

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.