Value Based Care Advisory (VBCA) Podcast

Medicare Advantage 2026: How Payers Are Choosing Partners

While most providers are waiting on CMS, payers are already narrowing networks and rewriting delegation terms.Payers are quietly narrowing networks and rewriting delegation expectations. This playbook explains how to do business with MA business for 2026.If you’re waiting, you’re already reacting—not positioning.In this episode, Alex Yarijanian breaks down what’s actually showing up in payer conversations right now, long before final CMS rules are published. Drawing from real contracting, network, and delegation discussions, Alex explains why waiting for regulatory clarity is already costing providers and health tech companies leverage.You’ll hear how payer priorities have shifted from enrollment growth to margin durability, why network narrowing is accelerating quietly, how delegation has become a stress test, and what “value-based care” really means in Medicare Advantage today.This episode also outlines who is most at risk heading into 2026, the three types of organizations positioned to win, and what provider and health tech leaders should do in the next 90 days to stay relevant.Who should listen: Provider executives, payer leaders, value-based care operators, and health tech founders navigating Medicare Advantage.

Digital Health at a Crossroads: The Fallout from a $100M Adderall Fraud Scheme

A federal jury has convicted the founders of Done, one of the fastest-growing telehealth companies in the stimulant-prescribing space, for orchestrating one of the largest Adderall distribution and fraud schemes in U.S. history. More than 40 million stimulant pills, over $100 million in revenue, and a business model engineered around speed, volume, and automated prescribing — all built with no real clinical guardrails.In this episode, host Alex Yarijanian breaks down not only what happened, but what this case means for the entire digital health ecosystem, especially behavioral health and companies prescribing controlled substances. When a company like Done collapses — and its founders now face up to 20 years in federal prison — it doesn’t just take itself down. It drags trust, access, and payer willingness down with it.Alex outlines how this case will reshape:Payer contracting and credentialingPrescribing oversight and compliance expectationsTrust in telehealth platformsThe future of value-based behavioral healthWhy incentives — good or bad — always scaleAnd most importantly, he explains why value-based care is the antidote to the shortcuts and misaligned incentives that fueled this scandal.If you’re building, funding, regulating, or partnering with telehealth organizations, this is a must-listen.Takeaways:The case of the telehealth startup highlights the critical importance of clinical oversight in health services. Payers are likely to impose stricter regulations on telehealth providers following recent fraudulent activities. Building a sustainable healthcare model requires prioritizing patient interests over profit maximization strategies. The future of digital health will hinge on trust, necessitating alignment between clinical and business models.

2026 Medicare Fee Schedule: 5 Big Opportunities for Providers & Startups

Medicare’s 2026 physician fee schedule is packed with change — but change means opportunity. In this episode of the VBCA Podcast, Alex Yarijanian breaks down the five biggest updates every provider and startup should know:Shorter, billable windows for remote monitoringNew behavioral health add-ons to primary careIncentives that reward value-based careExpanded reimbursement for digital therapeutics & telehealthA major shift from inpatient to outpatient proceduresWhether you’re running a clinic or building the next health tech solution, this playbook will help you turn policy into profit and thrive in the future of care.

How to Win in Medicare Advantage 2026

Welcome back to the Value-Based Care Advisory podcast! In this episode, host Alex Yarijanian delves into the significant updates and strategies for 2026 in the Medicare Advantage space. He covers essential news and policy changes, including a 5% increase in Medicare payment rates, the scaling back of supplemental benefits, and the permanence of telehealth for behavioral health. Alex also discusses updates to the Medicare physician fee schedule, redesigned enrollment forms, new health risk assessment requirements, and the transition to a new risk adjustment model. Learn how these changes will impact care delivery, compliance, and strategy, and discover what it takes to thrive in this evolving landscape. Tune in and prepare for the Medicare Advantage showdown of 2026!00:00 Welcome to the Value-Based Care Advisory Podcast00:15 2026 Medicare Advantage Showdown Overview01:24 Key Policy Updates for 202603:11 Telehealth and Virtual Care Innovations04:39 Enrollment and Form Updates06:12 Risk Adjustment and Star Ratings08:52 Strategic Focus Areas for 202614:44 Final Thoughts and ConclusionTakeaways:The 2026 Medicare Advantage payments are set to increase by approximately 5%, contributing an excess of $25 billion to the plans. Significant changes have been initiated regarding supplemental benefits, particularly affecting non-medical services like transportation and meals. Telehealth services for behavioral health will become a permanent fixture, with no geographic restrictions imposed from 2026 onward. New billing codes will be introduced for digital therapeutics and remote monitoring, enhancing the infrastructure for virtual care delivery. The upcoming risk adjustment model will utilize the full 2024 CMS HCC risk model, significantly impacting financial strategies for Medicare Advantage organizations. Plans must prioritize compliance and operational integrity to navigate the complexities of changing regulations and maintain their competitive edge.

Behind the Scenes of Power: Emotional Labor in Negotiation

In this episode of the VBCA podcast, host Alex Yarijanian delves into the often overlooked yet crucial aspect of leadership: emotional labor. Discover how managing emotions plays a pivotal role in negotiations and leadership effectiveness. Alex shares personal experiences and insights on how emotional labor can be both a powerful tool and a silent tax on leaders, especially for those challenging dominant norms. Tune in to learn how to harness emotional intelligence to build trust and lead with empathy and strength.Takeaways:In the realm of healthcare leadership, emotional labor serves as an essential yet often unacknowledged component that significantly influences negotiation outcomes. Effective leadership necessitates an acute awareness of emotional dynamics, as managing feelings is integral to fostering productive dialogue among stakeholders. The notion of emotional labor encompasses not just personal emotional management, but also the responsibility to create a supportive environment for others. A leader's capacity to engage in emotional labor can lead to profound transformations, underscoring the importance of empathy and understanding in professional interactions.