What if the most powerful person on your care team isn't a nurse, a doctor, or a specialist — but someone showing up at 8:00 AM to check blood pressure, eat lunch with residents, and play vital signs bingo?

In this episode, we go deep on the Community Health Worker role: what it is, what it isn't, and why most organizations are dramatically underusing it. Scott pulls no punches on the disconnect between what CHWs are doing and what they should be doing — and why the difference is costing patients their health and workers their bonuses.

What you'll hear in this episode:

If you hire, manage, or are a community health worker, this episode will reshape how you think about the role. Hit play.

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What does it actually take to say yes in healthcare when the system is wired to say no?

In this episode of The Disrupted Podcast, Scott takes you straight into the field — from a brand-new administrator in Marietta, Georgia who's already revolutionizing her building eight days in, to a 190-patient facility in Charleston where the real conversation isn't about hospice referrals, it's about whether you have the staff to back it up.

Scott gets honest about the moments where healthcare organizations talk a big game but fold when it matters — refusing acute visits to non-panel patients, locking providers into rigid workflows, and hiring bodies instead of talent. He challenges all of it. And he does it with the kind of clarity that only comes from someone who's actually in the buildings, at the dinner tables, and on the phone doing the hard work every day.

From a nurse who deserves a Tesla to a wristband that could change emergency response forever, this episode is packed with real stories, bold ideas, and a simple but radical belief: that getting to the yes isn't just good business — it's the whole point of healthcare.

If you're a provider, administrator, nurse, or healthcare leader who's tired of the way things have always been done, this one's for you.

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Healthcare didn’t get expensive because patients got worse — it got expensive because the system got fragmented. In this episode of The Disruptive Podcast, Scott Middleton breaks down why hospice can’t live “over there,” separate from primary care, nursing, therapy, and care management.

Scott explains the Your Health Hospice rollout, the staffing reality that determines whether integration is real, and the math behind a new model: caseload reductions for nurses when hospice patients are added, plus incentives that acknowledge the complexity of end-of-life care.

This conversation is about building a care system where the patient doesn’t have to juggle providers, phone numbers, and handoffs — because they shouldn’t have to. One team. One plan. One umbrella.

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In this episode, Jamie and Scott discuss a simple leadership posture that changes outcomes: default to “yes” when it protects patients—then solve the obstacles. Scott shares real examples from winter-storm outreach, hospice and palliative care misconceptions, and operational “rules” that block care (often driven by language, software, or habit—not true limitations). They dig into how patient-centered thinking, clearer communication (ditch the acronyms), and smarter systems—like a new mapping tool—can drive more visits, better coordination, and better results.

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In this episode of The Disrupted Podcast, Scott Middleton returns from the JP Morgan healthcare conference with a blunt takeaway: the future of care is not a magic pill, another telehealth platform, or a clever financial structure — it’s showing up. Scott breaks down why healthcare has become unnecessarily complicated, how fee-for-service incentives distort decision-making, and why “easy-entry” models won’t hold up long-term.

He makes the case that Your Health’s home-based care model is hard to replicate because it requires operational excellence—routing, scheduling, team coordination, and intentional touchpoints. Scott also challenges internal culture issues: finger-pointing, poor communication, inefficient scheduling, and employees misunderstanding the mission. The solution is both simple and demanding: build systems that make weekly in-person encounters possible for high-risk patients and hold the line on execution.

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In this first Disrupted Podcast episode of 2026, Jamie and Scott unpack the reality of a new “High Needs ACO” and what it demands from frontline care teams. Scott explains why spending more in primary care reduces total cost, how care management codes are expanding, and why the real win is keeping patients out of the hospital through proactive, consistent engagement.

The centerpiece is a clear operational playbook for facilitated visits: facilitators gather the full story in the home or facility, loop in the provider through audio/video when possible, document in the system, and never delete encounters—because billing isn’t just revenue, it’s the data trail that proves prevention works. The conversation closes with the bigger picture: this isn’t a workflow tweak—it’s a way to reduce hospital dependency, protect families, and help stabilize the healthcare economy.

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In this episode of The Disrupted Podcast, Jamie and Scott break down what’s really happening inside healthcare facilities—and why the problem isn’t complexity, but misalignment. Through a real-world walkthrough of one provider’s experience, Scott unpacks the Facility Model, explaining how proper staffing, proactive care, and smarter use of hospice, telehealth, and community health workers can radically improve outcomes for patients, providers, and facilities alike. This conversation pulls back the curtain on how healthcare systems unintentionally block good care—and how simple, human-centered adjustments can change everything.

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In this episode of The Disrupted Podcast, Jamie sits down with Chief Disruption Officer Scott Middleton to unpack what’s really holding healthcare organizations back from sustainable growth — and it’s not demand. From inefficient scheduling and fragmented care teams to missed opportunities in behavioral health, hospice, and regional expansion, Scott lays out a candid blueprint for how ownership thinking, smarter systems, and physical presence in communities can radically improve outcomes.

Through real-world examples, Scott explains how a new map-based scheduling model, regional restructuring into divisions, and empowered frontline teams can increase productivity by 20% overnight — while simultaneously reducing ER visits, hospitalizations, and burnout. The conversation ultimately reframes growth not as a staffing problem, but as a leadership, coordination, and accountability challenge.

www.YourHealth.Org

KEY TAKEAWAYS

• The new ACO model increases funding for high-risk Medicare patients but requires disciplined execution.
• Visits — frequent, short, meaningful ones — are the #1 driver of reduced hospitalizations and better outcomes.
• The target is four visits per patient per month for those with a 2.4–2.8 risk score.
• Current numbers show only 2.5 visits per patient per month — leaving savings and outcomes on the table.
• Facilitators are essential: their job is to start conversations, gather information, and initiate telehealth visits.
• Notes, Mobius recordings, and consistent communication make providers more effective over time.
• Small, weekly touchpoints outperform long, infrequent visits in both outcomes and cost savings.
• Every team member plays a role in preventing hospitalizations and improving patient stability.

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00:00 – Welcome & Atlanta Traffic Humor
03:12 – Why Atlanta’s Senior Healthcare System Is “Almost Nonexistent”
09:15 – Hospitals begging for help & broken discharge processes
14:00 – Upcoming cuts to home health and rehab penalties
18:45 – Why therapy services need massive, immediate expansion
23:18 – The dementia support group story and the power of proactive care
30:52 – How storytelling improves patient and family understanding
36:44 – Hospice misconceptions & how Your Health does it differently
43:17 – Explosive growth in Atlanta and why competition is failing
49:10 – Creativity as a core ingredient of healthcare
54:40 – Why every associate needs a mentor immediately
59:25 – A call to action: show up, ride along, and support Atlanta providers

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