Rethinking Medicare Advantage: One Health System's Decision

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 AmandaConnect 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.