Join us on Full Circle for a focused, actionable conversation with Nicole Bradberry — ACO architect, founder of the Florida and Texas Associations of ACOs, and now the person helping long-term care facilities realize they're sitting on a fundamentally different business model. Nicole spent 30 years learning what payers can and cannot do, built some of the first ACOs in the country, and now runs Value Service Management to bring that same playbook to SNFs. In this episode, she explains why bridge codes like CCM and RPM are transition fuel — not a revenue strategy — and what happens when practices treat them as the destination instead of the on-ramp. She also makes the SNF opportunity concrete: a facility with 5,000 long-term care patients manages $300M-$500M in medical costs. The question is whether they're participating in those savings or leaving them entirely on the table.

0:15 From Cigna and UnitedHealthcare to saving ~$1B off fully insured spend

1:29 The one thing payers could never crack — patient engagement stuck at 10-12%

2:00 Rice Health in 2009 — ahead of its time, before the ACA and before the money followed

2:24 Citra Health in 2012 — timing the ACA, building one of Florida's first ACOs, running 12 nationally

3:38 Florida Association of ACOs — 13 years in, 92% of Florida ACOs now achieving savings

4:08 Expanding to Texas — the next major value-based care growth market

5:35 Top-of-license medicine — building teams around physicians so doctors only do what only doctors can do

6:59 Risk contracts as the motivator — getting physicians off the fee-for-service treadmill

7:39 Rebuild workflows for every patient as if they're in a risk contract — not just the ones who are

8:44 The bridge code trap — treating CCM and RPM as revenue instead of infrastructure investment

9:01 Start with the end goal — work backward from full risk, not forward from billing codes

10:09 Evaluating existing contracts — showing practices how risk models beat fee-for-service on both income and care

11:36 Value Service Management — bringing the ACO playbook to SNFs and long-term care

13:14 SNFs can start today — they already control which providers enter their buildings

13:56 The math — 5,000 patients, $50M in medical costs, and a share of savings waiting to be claimed

14:33 Long-term care benchmarks of $60K-$100K per patient — the numbers add up very quickly

Guest: Nicole Bradberry | Founder, Value Service Management | Founder, FL & TX Associations of ACOs

Host: Circle Health