The Outer Shell

Season 2 opens with a panel on the Rural Health Transformation Program as it enters year two, joined by Giovanni Infante-Still of ‪@CovalenceHealth‬ and Dr. Mike Vanskoy of Heartland Health Management. They review where year one funding stands, the program’s spending caps and milestone requirements, and the December 31, 2027 deadline for state policy commitments. They also cover how rural providers can sustain new services after federal funding ends, and how RHTP overlaps with the CMMI LEAD model, the Flex model, and ACO decisions arriving in 2027.

The conversation closes on program management: the core functions, the expertise required, and the build, borrow, or buy decision for technology. Next episode: risk assessment and care gap closure in the payer space. Follow #TheOuterShell on #Spotify, #Apple, or #YouTube, and follow Covalence Health on LinkedIn or at covalencehealth.com.

Physicians train for a decade to practice medicine and rarely learn to run the business. Dr. Eric Mann, ophthalmologist and founder of Lucens, joins Mike Rawaan to unpack payer contracts, vendor risk, and why independent providers need both peer community and paid expertise. Season 1 finale of The Outer Shell.

In Episode 5, Effie Carlson, CEO of Watershed Health - a healthcare technology company that provides a care coordination and interoperability platform to connect different medical and community providers during patient care transitions - joins Mike to discuss why  American healthcare has spent twenty years and billions of dollars making data available - and almost nothing making data actionable.

In this episode, Mike sits down with Nicole Bradberry — a veteran operator who has built management companies, run ACOs, and founded a partner-aggregation company — to unpack why partner selection in value-based care isn't a procurement decision. It's an existential one.

We get into:

• The "risk pool game" — how some aggregators' algorithms sort providers into a pool built to win and a pool built to "learn," before the provider sees a single patient under the contract
• Why you can do everything right clinically and still walk away with nothing
• The questions providers should ask before signing with any ACO or MSO
• How to vet a partner and figure out who's actually doing the work

Providers weighing VBC options — or aggregators wondering why providers are getting smarter about diligence — this one's for you.

The Outer Shell is produced by Covalence Health: covalencehealth.com

#ValueBasedCare #ACO #HealthcareStrategy #VBC

Just about every move in the U.S. Healthcare is driven by analytics and data models. Risk scores, predictive analytics, and actuarial projections drive the industry ... And we treat the outputs like gospel because the math looks rigorous and the dashboards look clean.

However, the models used today are flawed - especially those used in value-based care.

The flaw isn't in the arithmetic. It's in the assumptions buried underneath it. Bad inputs, biased training data, and models built for one population deployed on another.

Dr. Aaron Wells, PhD, joins Mike to dissect the problem.

Aaron takes us inside the statistical models that drive billions in healthcare decisions — and shows us exactly where they break.

Guest Rebecca Baker, BSN, RN, BS Ed, ACHE, joins Mike Rawaan to dive deep into what it takes to succeed in value-based care. Becki breaks down the operational changes - including tools, staff, and workflows - necessary for primary care providers to succeed in value-based care (VBC).

You don't want to miss these insights if you are ...
👉 A physician or physicians' group considering getting into VBC
👉 An existing ACO considering expanding its footprint
👉 An #investor looking for #investment opportunities in VBC
👉 A healthtech vendor looking to deliver greater value to VBC organizations

Gary Jacobs⁠, a lobbyist, a healthcare executive, and the author of ⁠The Zen Lobbyist⁠, joins ⁠Mike Rawaan⁠ to discuss how lobbying actually works: who lobbyists represent, what a win looks like, and why mindfulness and compassion aren't soft concepts; they're strategic ones. Using real examples, including the creation of the ⁠CMMI LEAD⁠ model and the ⁠Medicare Advantage ⁠Reimbursement Final Rule, to show how advocacy shapes policy from first draft to final rule.