Specialists manage many of the most complex and costly patients in healthcare, yet they have often remained outside the center of the accountable care conversation. As value-based care models mature, ACOs and specialty practices must find better ways to coordinate care, align incentives, and share responsibility for outcomes across the patient journey.

In this episode of Perspectives with Pinnacle, John P. Carter is joined by David Klebonis, President and COO of Palm Beach Accountable Care Organization, and Dr. Alex Liang, President and CEO of Dallas Nephrology Associates, to examine what effective collaboration between ACOs, primary care physicians, and specialists looks like in practice.

Using nephrology as a real-world example, the conversation explores why earlier specialist involvement can help slow the progression of chronic kidney disease, delay the need for dialysis when possible, and give patients more time to understand and prepare for their treatment options. The guests also discuss the infrastructure required to support this work, including patient education, care navigation, performance measurement, and active feedback between primary and specialty care teams.

The discussion also addresses one of the most difficult parts of collaboration: creating financial and operational models that recognize the specialist’s contribution while maintaining shared accountability for the patient’s overall care. Together, the guests offer practical insight into how ACOs and specialty practices can move beyond traditional referral relationships and build a more coordinated approach to value-based care.

Key Takeaways

• ACOs cannot effectively manage total cost of care without meaningful relationships with the specialists treating complex, high-cost patients.
• Earlier nephrology involvement can help slow the progression of kidney disease and give patients more time to consider dialysis, home-based care, and transplant options.
• Patient education is most effective when it is structured, personalized, and reinforced across primary and specialty care teams.
• Specialist incentives should be connected to measurable actions and outcomes, including timely referrals, home dialysis, optimal dialysis starts, and transplantation.
• Care navigators, shared performance measures, and active communication can help ACOs, and specialists coordinate responsibility across the patient journey.

What You’ll Learn

03:21 – Why specialists are essential to an ACO’s ability to manage care, influence outcomes, and address total cost

10:37 – How earlier nephrology involvement can slow kidney disease progression and reduce new dialysis starts

15:03 – How physician-led education helps patients understand kidney disease, treatment options, home dialysis, and transplantation

20:58 – How specialist incentives and performance measures can be structured around quality, outcomes, and shared accountability

29:04 – What ACOs and specialty practices need to build internally to ensure success

The ability to call for help is one of the most basic expectations in any care setting. Yet for patients and residents with limited mobility, progressive neurological conditions, spinal cord injuries, or other physical limitations, traditional nurse call systems can leave that access out of reach. The presence of a call button does not always translate into meaningful access to care.

In this episode of Perspectives with Pinnacle, John P. Carter sits down with Dr. Bob Kaiser, founder of Will-Call, to explore how a deeply personal family experience revealed a much broader challenge across healthcare.

Bob shares how early prototypes evolved into a voice-activated solution designed to work within existing nurse call infrastructure without requiring Wi-Fi, Bluetooth, or changes to staff workflows. He also discusses how feedback from patients, families, and caregivers has shaped the solution and expanded its potential across hospitals, skilled nursing facilities, assisted living, hospice, and home care.

The conversation looks beyond the device itself to examine the larger implications for patient safety, dignity, compliance, risk management, caregiver confidence, and accessible care. At its core, this is a discussion about rethinking a fundamental part of care delivery so more people can independently ask for help when they need it.

Key Takeaways

• Traditional call buttons can leave people with limited mobility, vision loss, neurological conditions, or other physical limitations unable to independently request help.
• Accessible nurse call systems affect more than emergency response. They also influence dignity, daily care, compliance, risk management, and trust.
• New technology is easier to adopt when it works with existing infrastructure and does not disrupt staff workflows.
• Offline voice activation reduces network and security concerns, while audible confirmation lets users know their call went through.
• Hands-free calling can support facility-based care and home caregiving, including aging in place, assisted living, and hospice.

What You’ll Learn

02:58 – How Will’s medical journey exposed a gap in traditional nurse call systems and inspired Bob to create Will-Call

07:13 – How the first voice-activated prototypes developed into a reliable solution that operates without Wi-Fi or the internet

10:10 – Why having a nurse call button does not always mean a patient can access care

14:31 – How Will-Call connects to existing systems and responds when someone says, “I need help”

18:11 – How real-world feedback from people with different physical limitations continues to shape the device

22:02 – How the technology can support aging in place, family caregivers, hospice, and assisted living

Fraud, waste, and abuse cost the Medicare program billions each year, but what happens when the organizations accountable for managing costs have little authority to stop fraudulent claims?

In this episode of Perspectives with Pinnacle, John P. Carter sits down with David Klebonis, President and COO of Palm Beach ACO, to discuss his recent testimony before the United States House of Representatives Committee on Ways and Means Hearing on “Protecting Patients and Taxpayers: Cracking Down on Medicare Fraud”.

Drawing from Palm Beach ACO's experience uncovering fraudulent claims, David explains how physicians identified suspicious billing activity, the financial impact those claims had on shared savings, and why ACOs should play a larger role in preventing fraud before payments are made.

The conversation explores the growing need for accountability, transparency, and stronger collaboration between ACOs, regulators, and Medicare Administrative Contractors (MACs) contractors to protect patients, providers, and taxpayer dollars.

Key Takeaways

• ACOs are often financially impacted by fraudulent claims they cannot prevent.
• Physicians play a critical role in identifying suspicious billing activity.
• Fraud affects both provider compensation and patient trust.
• The current "pay and chase" approach leaves significant gaps in fraud prevention.
• Value-based care organizations can help strengthen Medicare program integrity through better data sharing and oversight.

What You'll Learn

02:00 – Why David testified before Congress and what it means to "deputize" ACOs in the fight against fraud

02:39 – How physicians uncovered fraudulent claims through claims data analysis

03:12 – The scale of the fraud identified by Palm Beach ACO and its impact on shared savings

05:03 – A real-world example of DME fraud and the investigation that followed

06:01 – How fraudulent claims affected physicians and Medicare beneficiaries

08:50 – What deputizing ACOs mean in action

11:10 – The limitations of the current "pay and chase" model and potential solutions

12:52 – If done correctly what does the next decade look like for value-based care

The first ninety days of an executive transition are critical.

For healthcare leaders stepping into a new organization, this early window is not just about learning the role or setting strategy. It is about building trust, understanding culture, earning credibility, and establishing the foundation for long-term success.

In this episode of Perspectives with Pinnacle, John Carter sits down with Neil Marshall and Kurt Mosley of HealthSearch Partners to discuss what separates leaders who build early momentum from those who struggle to gain traction. Drawing from thousands of executive interviews, healthcare leadership transitions, and recruiting engagements, the conversation focuses on what successful leaders do before they act, how they earn authority beyond their title, and why culture can either accelerate or derail a transition.

Throughout the conversation, the group also explored how small symbolic leadership actions often communicate more than formal strategy, helping executives shape culture and build credibility early in their tenure.

What emerged was a clear theme: the first ninety days are less about proving you have all the answers and more about earning trust, understanding culture, and establishing the credibility required to lead effectively.

Key Takeaways

• Trust matters more than strategy early on. Leaders who enter a new organization and immediately try to execute strategy often struggle. The most successful executives focus first on building relationships, listening, understanding the organization, and setting the tone for how they will lead.

• Authority is earned, not assigned. A title may provide positional authority, but it does not automatically create trust or supporters. Leaders earn credibility through consistency, visibility, listening, and action.

• Listening has to be intentional and structured. Passive listening is not enough. The conversation emphasized the importance of creating systems for listening, whether through leadership rounding, one-on-one conversations, or direct engagement with employees across the organization.

• Small symbolic actions can shape culture quickly. Actions often communicate more than speeches, emails, or formal announcements. Whether it is addressing a visible operational issue, walking the parking lot to pick up trash, eating in the cafeteria, or fixing something frontline staff have identified, symbolic acts can build trust when they are authentic and aligned with the leader’s values.

• Moving too fast can create lasting damage. Executives are often under pressure to make changes quickly, but the discussion emphasized the importance of being “quick, but not hurried.” Leaders need to assess quickly, listen quickly, and understand the culture before making major decisions.

• Misreading culture can derail a transition. Even the right leader in the right organization can struggle if they misread the culture early. Culture acts as a multiplier, strengthening effective leadership actions or magnifying missteps.

• Organizations play a major role in executive success. Successful transitions do not depend on the executive alone. Boards and leadership teams need to be intentional about what the organization truly needs, align on priorities, and help create the conditions for the new leader to succeed.

• The first ninety days set the tone, but the work continues. A strong first ninety days creates momentum, but long-term impact requires consistency. Leaders must continue building trust, communicating visibly, and following through beyond the initial transition period.

Final Takeaways

The first ninety days are not about making the loudest entrance or proving immediate expertise. They are about building the trust required to lead.

Successful executives follow a disciplined sequence during transition: observe, listen, assess, then act.

Leaders who move too quickly into strategy before understanding the people, culture, and operational realities around them often create resistance instead of momentum.

What stood out most throughout the conversation was the idea of earned authority.

Leadership does not begin simply because someone has been given a title. It begins when people believe that leader understands the organization, respects its culture, and is willing to take action in ways that support the people doing the work every day.

The first ninety days may only be the beginning of a leader’s tenure, but they often determine the momentum, trust, and credibility that define everything that follows.

What You’ll Learn

03:10 — Why the First 90 Days Matter

05:14 — Listening as a Leadership Strategy

08:42 — Small Actions That Shape Organizational Culture

11:44 — Moving Too Fast vs. Moving with Intention

14:33 — Trust, Culture, and Leadership Missteps

19:34 — Preparing Executives for Long-Term Success

33:42 — Leadership Visibility and Consistency

Rural healthcare is at an inflection point.

Across the country, rural hospitals are navigating a growing imbalance between what is required to deliver care and what is realistically sustainable. Workforce shortages persist, reimbursement pressures continue to mount, and in many communities, access to care is becoming increasingly fragile.

Against this backdrop, the Rural Health Transformation Program (RHTP) has emerged as a significant federal investment aimed at stabilizing and strengthening rural healthcare delivery. Positioned as a catalyst for long-term change, the program introduces new funding, new expectations, and a renewed national focus on rural health.

But for the leaders responsible for implementing this work, the conversation is less about transformation in theory, and more about execution in practice.

During this executive roundtable, leaders from Rural Health Networks across the country including Illinois Critical Access Hospital Network Executive Director, Tracy Warner, Montana Health Network Vice President of Strategy, Ward VanWichen, Western Healthcare Alliance CEO, Angelina Salazar, The Rural Collaborative Executive Director, Elya Prystowsky, and The National Cooperative of Health Networks Association Executive Director, Linda Weiss, sit down with John Carter from Pinnacle to share candid perspectives on what this moment actually looks like on the ground.

The discussion moved beyond policy headlines to focus on the operational realities facing rural providers today: where opportunities exist, challenges remain, and what it will take to create sustainable change over the long term.

What emerged was a clear theme: while RHTP introduces new momentum, the path forward will depend on how effectively national priorities align with local realities.

Key Takeaways

• Workforce and reimbursement are the defining pressures and they are inseparable. Rural hospitals are not just struggling to recruit and retain staff, they are doing so while facing payer denials and inadequate reimbursement for care already being delivered. Leaders emphasized that without sustainable payment, workforce challenges cannot be solved, and without workforce, access to care continues to erode.

• RHTP introduces a different structure, but not without skepticism. A national rollout, upfront funding, and new federal focus represent a shift from prior initiatives. At the same time, several leaders described the funding as feeling reactive, more of a response to broader financial pressures than a true investment in long term transformation.

• There is a clear disconnect between program design and rural realities. Policy priorities such as telehealth expansion and remote monitoring often do not reflect the conditions rural providers operate in today. Many communities still lack reliable broadband, while hospitals are working in aging facilities that require basic infrastructure investment before new technology can be effectively deployed.

• Collaboration across rural health networks is accelerating. Organizations are increasingly working together at regional and state levels to solve problems locally. Whether through shared services, workforce strategies, or specialty access, networks are stepping in to fill gaps and scale solutions in ways that individual hospitals cannot do alone.

• Focus is shifting from innovation to execution and scale. A consistent theme across the discussion was that rural providers are already doing much of the work RHTP is designed to support. The challenge now is not identifying solutions, but scaling them in a way that is sustainable and aligned with the realities of each community.

• Near term impact will be limited, with progress happening incrementally. Most leaders do not expect communities to feel significant change in year one. Efforts are focused on maintaining access to care, improving operational efficiency, and positioning organizations to take advantage of funding as it becomes available.

• Success will be defined by sustainability, not activity. At the end of the five-year program, success will come down to whether access, stability, and care delivery look meaningfully different. Preventing additional rural hospital closures and enabling communities to better support their populations were consistently highlighted as key metrics.

• Rural health networks are central to making RHTP work. Networks serve as the infrastructure that translates policy into action. They enable collaboration, support implementation, and help ensure that funding is applied in ways that reflect real community needs rather than theoretical models.

Final Takeaways

RHTP represents a meaningful investment in rural healthcare, but funding alone will not determine its success.

The leaders in this discussion made it clear that the real work is already underway. Rural hospitals and networks have been navigating workforce shortages, financial pressure, and access challenges for years, often with limited resources and little margin for error. What RHTP introduces is not a starting point, but an opportunity to accelerate and scale what is already in motion.

At the same time, the path forward is not without risk. Misalignment between policy design and operational reality, combined with constraints around funding and implementation, creates the potential for activity without meaningful change. Ensuring that resources are directed toward practical, community-defined needs will be critical.

What stood out most throughout the conversation was not uncertainty, but resolve.

Across markets, rural health leaders are continuing to collaborate, adapt, and push forward, regardless of whether funding timelines or program structures align perfectly. There is a clear understanding that sustaining access to care is not dependent on a single initiative, but on the ability to execute consistently at the local level.

If RHTP is successful, it won’t be because of the dollars, but because they were aligned with real community needs and put to work by the people on the front lines.

What You'll Learn

03:56 — Biggest Threat to Rural Healthcare Sustainability

07:33 — What Makes This Moment Different

11:18 — Policy Gaps and Path to Sustainability

19:25 — From Funding Activity to Real Transformation

31:53 — Quick Wins vs. Long-Term Impact

38:12 — Defining Success After Five Years

41:56 — State-Level Initiatives

59:53 — How RHTP Accelerates Existing Models

1:04:50 — Ensuring Independent Hospital Sustainability

1:11:40 — What Gives You Optimism

As artificial intelligence rapidly embeds itself into healthcare workflows, leaders face a defining question: how do you govern a technology that behaves less like a tool and more like a non-human team member?

On this episode of Perspectives with Pinnacle, John P. Carter is joined by AI governance expert, Bryan Rotella to explore what responsible AI adoption truly requires in healthcare. Together, they unpack the risks of unchecked AI use, the emerging phenomenon of “Bring Your Own AI” (BYOAI), and why traditional IT oversight alone is insufficient in a regulatory environment where patient safety, institutional reputation, and legal accountability are on the line.

Drawing from historical parallels like early automobile safety reforms and modern compliance frameworks, the conversation reframes AI governance as a structured, clinical-style risk assessment: diagnose the baseline risk, identify workflow exposure, and implement a clear treatment plan. The episode ultimately underscores that we are at a “trust tipping point.” AI’s promise is enormous, but only if organizations build simple, visible, and supervised rules that protect patients and preserve trust.

Key Takeaways from the Conversation

• AI as a Non-Human Team Member: Artificial intelligence is not just software, it operates like an intelligent coworker embedded in workflows. That means it must be selected, vetted, supervised, and continuously audited just like any other member of the care team. Treating AI as “just technology” underestimates both its impact and its risk.

• The Rise of BYOAI (Bring Your Own AI): Much like the BYOD smartphone era, clinicians and staff are already using AI tools on personal devices often without formal authorization. Every interaction is recorded and potentially discoverable in litigation or government investigations. Without guardrails, organizations may be exposed to negligent supervision claims.

• “Simple, Seen, and Supervised” Governance: Borrowing from early traffic safety reforms, the answer is not to stop innovation, but to teach it manners. Clear policies, visible disclosures, defined oversight structures, and active supervision are essential. Governance must be understandable and operational, not buried in technical jargon.

• Compliance as a Competitive Advantage: Healthcare organizations are not consistently informing patients when AI is involved in care decisions. Additionally, documentation, coding, or preauthorization processes create risk without an effective compliance program. Transparent disclosure and oversight can become differentiators in the marketplace. Governance, done well, builds trust and trust sustains innovation.

• Board-Level Liability and Oversight: AI developers are not currently bearing product-liability-style responsibility. Instead, healthcare organizations may face exposure for negligent supervision. Boards must move beyond ROI questions and begin asking: How does AI impact patient care? How does it affect revenue integrity? What reputational risks are we accepting? AI governance must be elevated to the board level, and not simply siloed within IT.

• The Case for an AI Preparedness Director: AI governance should not live exclusively within the IT department. Organizations need a designated AI Preparedness Director or safety committee focused on human-AI interaction, workflow auditing, training, and continuous monitoring. Governance must be active and effective, and not static documentation.

Ultimately

The episode makes clear that healthcare is at a critical inflection point. AI offers transformative potential in oncology, radiology, administrative efficiency, and value-based care. But adoption without structure invites risk.

By reframing AI governance in healthcare’s own language such as risk diagnosis, gap analysis, treatment plans, and continuous monitoring, leaders can integrate innovation responsibly. The winners of the AI era will not be those who adopt the fastest, but those who build trust through safety, transparency, and accountability.

Want to Go Deeper?

This episode only scratches the surface of what AI governance requires in today’s healthcare landscape. If your organization is evaluating AI tools, building internal oversight structures, or preparing your board for increased liability exposure, now is the time to move from experimentation to structured governance.

To explore how Pinnacle can help your organization build an active and effective AI governance framework, contact us today.

What You’ll Learn

00:45 — AI as a Non-Human Team Member

03:55 — The Risks of BYOAI and Discoverability

09:10 — Teaching AI “Manners”: Simple, Seen, Supervised Rules

17:27 — Patient Disclosure and Trust as Differentiators

30:24 — Board-Level Liability and Negligent Supervision

31:20 — Building an AI Preparedness Framework

As hospitals and health systems navigate the shift from fee-for-service to value-based care, leaders face a pressing question: how do you move beyond compliance checkboxes and build real frameworks for transformation?

On this episode of Perspectives with Pinnacle, John P. Carter is joined by Pinnacle Partner Anthony Long and Jim Burke from Hall Render Advisory Services to unpack the opportunities of using, and an implementation roadmap for, Value-Based Enterprises (VBEs). Together, they explore how VBEs can be more than just another Stark exception or AKS Safe Harbor, serving instead as a strategic tool for physician alignment, care redesign, and long-term sustainability.

From governance structures and outcome metrics to the challenges of implementation, this conversation offers a roadmap for hospitals and health systems seeking to innovate while staying compliant.

Key Takeaways from the Conversation

• Strategy vs. Tactics in VBE Design: While some organizations use VBEs to solve immediate compliance concerns, the most successful health systems are leveraging them as enterprise-wide strategies that engage physicians, elevate governance, and drive care delivery innovation.

• Physician Engagement as the Catalyst: True transformation begins by involving physicians early—not just as participants, but as co-creators of the care model. This shifts the dynamic from physicians being “on the menu” to having a genuine seat at the table.

• Governance and Accountability Matter: The strength of a VBE lies in its accountable body. Success requires the right mix of operators, executives, physicians and clinicians working together, supported by ongoing communication and a culture of transparency.

• Metrics That Measure What Matters: VBEs allow systems to move away from time-based inputs to outcome-driven outputs. This opens the door to innovative metrics that link payment to process improvements, patient outcomes, and true cost savings.

• Preparing for TEAM and Beyond: With the TEAM model set to go live in January 2026, VBEs provide a natural framework for hospitals to align strategy with mandatory participation. Positioning them not just for compliance, but for long-term competitive advantage.

Ultimately, the episode underscores how VBEs can serve as a bridge between regulatory flexibility and real-world change, enabling health systems to innovate responsibly while building stronger physician partnerships.

Want To Go Deeper?

Our podcast only scratches the surface of how Value-Based Enterprises (VBEs) can transform physician alignment and prepare hospitals for CMS’s TEAM model. For a full breakdown of why VBEs are the operating model hospitals need for tomorrow’s care and the practical steps to get started, read our latest thought leadership paper here.

What You’ll Learn

00:20 — Strategy vs. Tactic: Elevating Healthcare Models

09:45 — The Role of Physician Engagement in VBEs

21:30 — Building Effective Governance and Collaboration

34:50 — Metrics and Outcomes That Matter

47:15 — Using VBEs to Prepare for TEAM

49:55 — Payment Mechanisms and Performance Metrics

1:03:00 — Lessons Learned and Final Takeaways

Ready to explore how VBEs can strengthen your organization’s alignment strategy?

Connect with our strategy experts today.

As healthcare compensation and valuation grow more complex against a backdrop of regulatory shifts, evolving workforce needs, and increasing demands for accountability, professionals in this niche space often find themselves without a true community of peers. To fill that gap, the American Association of Provider Compensation Professionals (AAPCP) was formed, creating a collaborative platform that unites experts from hospitals and health systems, consulting firms, and valuation professionals to elevate both the work and the workforce.

But what exactly does this community provide, and how is it shaping the future of compensation practices, credentialing, and industry standards?

On this episode of Perspectives with Pinnacle, Partner Christopher Fete sits down with AAPCP Board member Alex Krouse to discuss the origins, growth, and vision of the AAPCP. From its start as a small professional network to its rapid expansion into conferences, credentials, and a recognized voice in the field, the AAPCP is redefining how compensation professionals connect and grow.

Key Takeaways from the Conversation

• Building a Professional Community Beyond Titles: What began in 2020 as a handful of professionals seeking peers has grown into a thriving community. Unlike traditional associations tied to specific credentials (CPA, JD, etc.), AAPCP brings together all who work in provider compensation—lawyers, accountants, consultants, and in-house leaders, creating a unique ecosystem where provider compensation professionals collaborate for the greater good.

• Credentialing for the Next Generation: Recognizing that most in the field are self-trained, the association is developing a credential designed to standardize expertise, elevate the profession, and prepare the next generation. Modeled in part after credentials in business valuation, this program equips early- to mid-career professionals with structured education, while also providing continuing education for seasoned experts navigating increasingly complex regulatory environments.

• Cross-Collaboration and Knowledge Sharing: By convening professionals from hospitals and health systems, private practices, advisory firms, and law firms the association creates space for sharing diverse perspectives. This collaborative model fosters innovation, strengthens internal capabilities for health systems, and ensures external experts remain strategic partners in addressing advanced challenges.

• A Growing Voice in Healthcare Policy and Strategy: While not a lobbying organization, the AAPCP is positioned to become an important voice in shaping policy by connecting government and industry leaders with true subject-matter experts. As healthcare organizations and regulators face unprecedented complexity, the association aims to ensure compensation practices balance financial sustainability with workforce alignment and patient outcomes.

Ultimately, the conversation underscores how the AAPCP is more than a credentialing body or conference organizer—it is a professional home for provider compensation experts, empowering them with knowledge, community, and credibility as they navigate a rapidly changing healthcare environment.

What You’ll Learn

00:15 — The Origin Story: From Isolation to Community

05:08 — Inter-firm Collaboration: A New Paradigm

12:30 — Elevating the Industry Through Credentialing

17:32 — Strategic Impact and Future Vision

Ready to enhance your organization’s strategic capabilities?

Connect with our compensation valuation experts today.