The Rainfall Health Podcast

CMS ACCESS model, value-based care, and chronic care at home: Patrick Sheehan, VP of Value-Based Care at Withings Health Solutions, on getting paid for clinical outcomes instead of activity.

Rainfall Health CEO Eddie Qureshi sits down with Patrick Sheehan, VP of Value-Based Care at Withings Health Solutions, where he partners with risk-bearing organizations to design and scale programs that improve affordability, outcomes, and the care experience. His recent work includes a MedStar Health partnership that brings connected devices into concierge primary care, and Withings' acceptance into the CMS ACCESS model for technology-enabled chronic care for Medicare beneficiaries. Patrick started in value-based care at Dartmouth during the early ACO policy era, then worked at a Medicaid ACO and with virtual care companies before joining Withings.

In this episode:
• How the CMS ACCESS model pays for clinical outcomes like blood pressure, weight, and cholesterol improvement, not activity
• Why patient choice and direct outreach to Medicare beneficiaries are core pillars of ACCESS
• Why integration back to the PCP and health system is a must-have, not a nice-to-have
• Where Withings applies AI, from administrative automation to helping clinicians know when to make a decision
• Why FDA-cleared devices turn "here's what you can do" into "here's what we can do together"
• How symptom surveys on a blood pressure monitor raised heart failure survey adherence from 30 to 35% to 89%, as Patrick describes it
• Remote monitoring vs. ACCESS: which patient fits which model, and where episode-based and longitudinal models meet

Read the episode article: https://www.rainfallhealth.com/post/cms-access-model-chronic-care-at-home-patrick-sheehan/
Free eBook, "Time to Control": https://www.rainfallhealth.com/downloads/eBook_time_to_control_patrick_sheehan.pdf
Read the full CMS TEAM Guide: https://www.rainfallhealth.com/cms-team/
Hospital Leader's Guide: https://www.rainfallhealth.com/post/navigating-the-cms-team-mandate-ebook/
Learn more: https://www.rainfallhealth.com

In Episode 11 of the Rainfall Health Podcast, host Eddie Qureshi sits down with Cora Han, Chief Health Data Officer at University of California Health (UC Health) and former senior enforcement attorney in the Federal Trade Commission's (FTC) Division of Privacy and Identity Protection.

Managing data across one of the nation's largest academic health systems requires balancing two competing imperatives: unlocking patient data to drive clinical innovation, while rigorously safeguarding privacy, cybersecurity, and patient trust.

In this episode, we discuss:

• From the FTC to UC Health: How regulatory enforcement at the intersection of consumer protection and health data informed Cora's governance philosophy.
• Process Over Tools: Why governance, clinician buy-in, and operational alignment must happen before buying software.
• Real-World Interoperability: What it actually takes to share patient data seamlessly between acute hospitals and skilled nursing facilities (SNFs).
• The Economics of Innovation: How vendors must approach hospital systems operating on thin (0.75%) margins.
• Generative AI & Oversight: Modernizing data agreements, vendor contracts, and model monitoring in healthcare.
• A "Car Is Not a Fast Horse": Why the next wave of healthcare technology will fundamentally redefine workflows rather than just speeding up legacy tasks.

Episode Chapters:
00:00 - Introduction & Meet Cora Han
01:07 - From FTC Privacy Enforcement to UC Health
03:44 - The Dual Duty: Data Access vs. Patient Trust
06:20 - Aligning Stakeholders Before Deploying Technology
10:07 - Real-World Interoperability Across the Care Continuum
13:22 - Purpose-Bound Data Agreements
17:25 - Hospital Margins & Vendor Economics
20:22 - What Hospital Leaders Need From Health Tech Partners
22:15 - AI Governance, Cybersecurity & Vendor Oversight
25:47 - Modernizing Contracts & BAAs for Generative AI
27:26 - A "Car Is Not a Fast Horse": The Future of Care Delivery

Download the companion 14-page executive eBook at:
https://rainfallhealth.com/post/the-trust-gap-health-data-governance-cora-han/

Dr. Sandra Scott, CEO of One Brooklyn Health — a safety-net system serving Central and East Brooklyn with more than 7,000 employees — joins Rainfall Health founder and CEO Ahmed "Eddie" Qureshi. Dr. Scott spent her entire career in safety-net institutions, including Kings County and Lincoln in the South Bronx, before becoming the first woman, first physician, and first person of color to lead Brookdale Hospital in its roughly 100-year history, as its Executive Director. She's also a leading advocate for Black women's maternal health.

In this episode, Dr. Scott and Eddie discuss her journey from ER physician to health system CEO, why safety-net and rural hospitals face a harder version of the CMS TEAM (721 hospitals) and CJR-X (2028) mandates, the missing infrastructure between good health policy and real-world care coordination, and why community-based organizations are an underused part of the care continuum. They close on where Dr. Scott is finding hope in AI and robotics on the hospital front lines.

Dr. Scott Cooper, board-certified orthopedic surgeon at Mercy in Northwest Arkansas, joins Rainfall Health founder and CEO Ahmed "Eddie" Qureshi to talk private practice versus integrated health system leadership, why patient-reported outcomes — not X-rays or alignment — are the real measure of surgical quality, and what the shift from CMS TEAM's 30-day episode to CJR-X's mandatory 90-day episode means for hospitals, surgeons, and more than 2,500 acute care hospitals nationwide.

Dr. Cooper, MD, FAAOS, has spent nearly three decades in orthopedic practice spanning private practice and health system leadership. He's a Fellow of the American Academy of Orthopaedic Surgeons and a past president of both the Arkansas Orthopaedic Society and the Arkansas Medical Society.

Bundled payments pioneer Dr. Steve Schutzer (co-founder and CMO of Upswing Health, founding medical director of the Connecticut Joint Replacement Institute) on building the physician-led blueprint behind CMS TEAM and CJRX — and why mandatory bundled payments may be the best deal orthopedics has ever been offered.

In this episode of the Rainfall Health Podcast, founder and CEO Ahmed "Eddie" Qureshi sits down with Dr. Steve Schutzer to trace 20 years inside bundled payment — from getting ten competing orthopedic surgeons into one room in Hartford in 2006, to writing part of the policy language behind BPCI, to what today's mandatory CMS TEAM and CJRX models get right about aligning surgeons, hospitals, and patients around value.

Dr. Steve Schutzer is co-founder and Chief Medical Officer of Upswing Health, and founding medical director of the Connecticut Joint Replacement Institute (CJRI) in Hartford, Connecticut — a program he built from scratch that grew from 2,000 to 4,000 cases in two years, ran a 1.5-day length of stay, sent more than 90% of patients directly home, and maintained a validated registry of over 56,000 patients. Over 36 years as an orthopedic trauma and joint replacement surgeon and 16 years as physician executive over four institutes, he contributed to the policy language behind BPCI, Medicare's first major bundled payment program.

WHAT YOU'LL LEARN:
→ Why joint replacement fits an episode of care almost too neatly — and why fee-for-service doesn't
→ How ten "egomaniac" orthopedic surgeons and a co-management agreement doubled case volume in two years
→ The two sentences a hospital C-suite said that made physician-led alignment work
→ Why he was "surgeon number eleven" for two years — and what it took to trust his own data
→ The asymmetry at the heart of CJRX: the hospital holds the risk, but the surgeon's hands make the calls
→ Three ways CJRX improved on CJR: a quality gate, risk adjustment (3 factors → 29), and a 5% stop-loss for rural hospitals
→ Why he helped write BPCI policy language, then declined to participate in it
→ His case for physician-led hospitals, backed by CMS's own MedPAC data
→ Why the value in value-based care has to accrue to one stakeholder: the patient

ABOUT RAINFALL HEALTH
Rainfall Health is the first and only recognized standard for Medicare-mandated models like CMS TEAM. Our R.A.I.N. Compliant™ platform helps the 721 IPPS hospitals mandated under the Transforming Episode Accountability Model quantify, capture, and maximize Medicare reimbursements across all 5 surgical episodes and the mandatory 30-day post-discharge window — with R.A.I.N. Compliant status achievable in approximately 10 weeks.

📖 CMS TEAM Guide: https://www.rainfallhealth.com/cms-team/
📘 Hospital Leader's Guide: https://www.rainfallhealth.com/post/navigating-the-cms-team-mandate-ebook/
📰 More CMS TEAM articles & press: https://www.rainfallhealth.com/about/blogs-press-cms-team
Learn more about Rainfall Health: https://www.rainfallhealth.com

Subscribe for more conversations on Medicare reimbursement, bundled payments, and value-based care — new episodes monthly.

In this episode of the Rainfall Health Podcast, founder and CEO Ahmed "Eddie" Qureshi sits down with Dr. Mark Adams, Partner at Two Bear Capital — the firm that led Rainfall Health's Series A — to talk about where AI is actually moving the needle in healthcare, why "narrow but reliable" beats "fully autonomous" in patient-facing care, and what convinced a venture investor that value-based care technology is one of the rare businesses with social good, near-term ROI, and long-term data value all at once.

Dr. Mark Adams brings more than 25 years of bioinformatics and data analytics leadership to the conversation. He previously served as Chief Operating Officer and Chief Technology Officer at Adaptive Biotechnologies, Chief Information Officer at both Good Start Genetics and Celmatix, and Managing Director of Healthcare Advanced Analytics at SVB Leerink. He holds a Ph.D. in Cell Biology from Baylor College of Medicine and is now a Venture Capital Partner focused on artificial intelligence, life sciences, and cybersecurity at Two Bear Capital.

WHAT YOU'LL LEARN:
→ Where AI is having the biggest impact in healthcare right now — from drug discovery to eliminating administrative burden
→ Why "narrow but reliable" AI is the safer near-term model for patient-facing care coordination
→ How AI scribes and automated care-coordinator calls are already changing physician and nurse workflows
→ The "Waymo taxi" analogy: why limited, well-guardrailed AI deployment beats rushing toward full autonomy
→ What convinced a venture capital investor to back Rainfall Health
→ Why healthcare's "small-c conservative" caution is rational — and how to weigh the risk of inaction against the risk of adopting AI
→ Advice for founders and innovators building in AI and life sciences right now

Rainfall Health is the first and only recognized standard for Medicare-mandated models like CMS TEAM. Our R.A.I.N. Compliant™ platform helps the 721 IPPS hospitals mandated under the Transforming Episode Accountability Model quantify, capture, and maximize Medicare reimbursements across all 5 surgical episodes and the mandatory 30-day post-discharge window — with R.A.I.N. Compliant status achievable in approximately 10 weeks.

CMS TEAM Guide: https://www.rainfallhealth.com/cms-team/
Hospital Leader's Guide: https://www.rainfallhealth.com/post/navigating-the-cms-team-mandate-ebook/
More CMS TEAM articles & press: https://www.rainfallhealth.com/about/blogs-press-cms-team
Learn more about Rainfall Health: https://www.rainfallhealth.com

In this episode of the Rainfall Health Podcast, founder and CEO Ahmed "Eddie" Qureshi sits down with Steve Ganyard — retired Marine Corps fighter pilot, former Deputy Assistant Secretary of State, and Rainfall Health board member — to talk about what happens when the federal government finally applies real market discipline to healthcare spending. From the CMS TEAM model to CJRX to the $40 trillion national debt, Steve and Eddie unpack why this moment for value-based care and AI adoption in Medicare may be the first of its kind in generations.

Steve Ganyard is a retired U.S. Marine Corps Colonel and twice-decorated fighter pilot with more than 4,200 flight hours across twelve tactical aircraft. He served as Deputy Assistant Secretary of State in the Bureau of Political-Military Affairs, overseeing global political-military security programs, and previously served as Military Assistant to the Deputy Secretary of Defense. He is now Vice President at Oliver Wyman's Aerospace, Defense, and Government practice, co-founder of China Beige Book, general partner and co-founder of Specific Impulse Capital, and a board member at Rainfall Health.

WHAT YOU'LL LEARN:
→ Why the TEAM model marks the first time the federal government has applied real "carrots and sticks" market discipline to a major slice of federal spending
→ How CJRX signals that TEAM-style accountability is expanding beyond a single model
→ Why bipartisan support for value-based care exists even amid a $40 trillion national debt — and why that pressure isn't going away
→ The case for extending Medicare-style outcome protections to the Veterans Administration and Defense Health Agency
→ Why most federal programs never get the KPI discipline of a Series A or B raise — and become "zombie programs" as a result
→ How Rainfall Health is building an AI-forward, human-first platform — and why trust, not capability, is the real adoption barrier
→ Why patient outcomes, quality, satisfaction, and cost — not AI itself — are the actual target CMS TEAM is designed to hit

Rainfall Health is the first and only recognized standard for Medicare-mandated models like CMS TEAM. Our R.A.I.N. Compliant™ platform helps the 721 IPPS hospitals mandated under the Transforming Episode Accountability Model quantify, capture, and maximize Medicare reimbursements across all 5 surgical episodes and the mandatory 30-day post-discharge window — with R.A.I.N. Compliant status achievable in approximately 10 weeks.

CMS TEAM Guide: https://www.rainfallhealth.com/cms-team/
Hospital Leader's Guide: https://www.rainfallhealth.com/post/navigating-the-cms-team-mandate-ebook/
More CMS TEAM articles & press: https://www.rainfallhealth.com/about/blogs-press-cms-team
Learn more about Rainfall Health: https://www.rainfallhealth.com

Medicare patient experience, health literacy, and value-based care — Dr. Charlotte Yeh (former AARP CMO, CMS Regional Administrator) on the "how-to gap."

Healthcare is exceptional at defining the should-dos — but patients live and die (literally, in cost and outcomes) by the how-tos. In this episode of the Rainfall Health Podcast, founder and CEO Ahmed "Eddie" Qureshi sits down with Dr. Charlotte Yeh, MD, FACEP, to unpack why the gap between clinical guidance and lived patient experience is one of healthcare's most expensive blind spots — and what it means for Medicare value-based care.

Dr. Yeh brings more than 30 years of healthcare leadership to the conversation: board-certified emergency physician and former Chief of Emergency Medicine at Tufts Medical Center and Newton-Wellesley Hospital; former Regional Administrator for the Centers for Medicare & Medicaid Services (CMS) in Boston; former Medical Director on the payer side for a Medicare Part B claims contractor; and, most recently, Chief Medical Officer for AARP Services, Inc. She is now Chief Experience Officer at Cherish and founder of Yeh Innovation.

CMS TEAM compliance isn't just about episode payments — the highest-stakes risks are the ones most hospitals aren't talking about yet: gain sharing agreements, data governance failures, and ungoverned AI. Rainfall Health's VP of Clinical Implementation Robby Wallace and VP of Compliance and Care Coordination Marla Merkle sit down with Paul Uhrig — former Chief Legal & Digital Health Officer at Bassett Healthcare Network, former Chief Administrative Officer at SureScripts, and member of the R.A.I.N. Advisory Committee — to break down what 721 mandated hospitals need to have documented, structured, and governed before regulators come knocking.

Paul has lived through the e-prescribing and meaningful use mandates firsthand. His message: the government follows through. History says so.

In this episode:
- Why gain sharing arrangements must be documented before care begins — not after
- How Anti-Kickback Statute and Stark Law apply to CMS TEAM downstream payments
- What the 2020–2021 OIG safe harbor for CMS-sponsored models actually requires
- Why your vendor's data use agreement may have loopholes you haven't found yet
- How information blocking and HIPAA create a compliance balancing act under TEAM
- Where AI governance is going wrong in health systems right now
- Why the e-prescribing mandate is the closest historical parallel to TEAM enforcement
- What Paul recommends every hospital prioritize in the next 90 days

Paul Uhrig is a healthcare attorney and digital health executive with decades of experience at the intersection of health law, regulatory compliance, and technology. He served as Chief Legal & Digital Health Officer at Bassett Healthcare Network and as Chief Administrative Officer at SureScripts, where he lived through the federal e-prescribing and meaningful use mandates in real time. Paul sits on the R.A.I.N. Advisory Committee at Rainfall Health.

Rainfall Health is the first and only recognized standard for Medicare-mandated models like CMS TEAM. Our R.A.I.N. Compliant™ platform helps the 721 IPPS hospitals mandated under the Transforming Episode Accountability Model quantify, capture, and maximize Medicare reimbursements across all 5 surgical episodes and the mandatory 30-day post-discharge window — with R.A.I.N. Compliant status achievable in approximately 10 weeks.

Read the full CMS TEAM Guide: https://www.rainfallhealth.com/cms-team/
Learn more: https://www.rainfallhealth.com

CMS TEAM model, Medicare reimbursement, and value-based care — former U.S. VA Secretary Dr. David Shulkin joins Rainfall Health.

In this episode of Team from the Top, Christina Keny — VP of Clinical AI at Rainfall Health, registered nurse, and researcher with experience at UCSF, Stanford, and the VA — sits down with Dr. David Shulkin, the 9th United States Secretary of Veterans Affairs and the only Cabinet member to serve under both President Obama and President Trump.

Dr. Shulkin has led healthcare from nearly every angle: as a physician, hospital CEO, federal policymaker, and now as an advisor and investor. In this conversation, he brings that full perspective to the CMS TEAM model — the first mandatory bundled payment program in Medicare history, which launched January 1, 2026, covering 721 hospitals across 188 metropolitan areas.

Overview:
→ Why CMS moved from voluntary to mandatory bundled payments — and why it won't reverse course
→ The Medicare trust fund math that makes value-based care politically inevitable
→ What operational capabilities will separate hospitals that capture TEAM upside from those that absorb losses
→ How AI and predictive analytics will reshape care coordination across the 30-day post-discharge episode
→ Where Medicare payment policy is headed over the next 5–10 years
→ The CJR-X expansion and which mandatory models are coming after TEAM
→ The one thing every hospital CEO needs to understand about Washington right now

The CMS TEAM model covers five high-cost surgical episodes — lower-extremity joint replacement, spinal fusion, coronary artery bypass graft, major bowel procedures, and hip/femur fracture treatment — and holds hospitals financially accountable for patient outcomes across a 30-day post-discharge window. For mandated hospitals, up to 20% of Medicare revenue is at stake.

ABOUT DR. DAVID SHULKIN
Dr. David Shulkin served as the 9th U.S. Secretary of Veterans Affairs, confirmed unanimously by the U.S. Senate. He previously served as Under Secretary for Health at the VA, leading the nation's largest integrated health system. A board-certified internist and Fellow of the American College of Physicians, Dr. Shulkin has served as CEO of Beth Israel Medical Center and Morristown Medical Center, CMO at the University of Pennsylvania Health System, and founder of DoctorQuality. He is currently President of Shulkin Solutions LLC, Senior Advisor at Alvarez & Marsal Healthcare, and Chair of the R.A.I.N. Advisory Committee at Rainfall Health. He is the author of It Shouldn't Be This Hard to Serve Your Country (PublicAffairs, 2019).

Read the full CMS TEAM Guide: https://www.rainfallhealth.com/cms-team/
Learn more about Rainfall Health: https://www.rainfallhealth.com