Carenodes

A child in New Jersey is medically cleared for discharge. There's no nurse to send them home with. This is what a "ghost network" actually costs.

On paper, New Jersey has roughly 200 agencies that can provide pediatric private-duty nursing under Medicaid managed care. In practice, our reporting for Episode 26 found that number closer to 8 — the agencies willing and staffed to take high-acuity pediatric cases.

The gap between those two numbers is where kids get stuck in hospital beds they no longer need to be in.

The hours are authorized. The equipment is ready. The discharge plan is signed. What's missing is a nurse the plan's own directory says exists.

This isn't a clinical failure — it's a directory-accuracy failure, and it's exactly the kind of gap CMS's 2024 Medicaid Managed Care Access final rule was written to close: appointment wait-time standards, mandatory secret-shopper network audits, 90% availability thresholds. The rule exists because "in-network" and "actually available" have been allowed to mean different things for too long.

We spoke with families and operators living this gap for Episode 26. Full breakdown, including how to spot a ghost network before you're relying on it: www.vbcapodcast.com/your-billing-problem-started-i…

#MedicaidManagedCare #ValueBasedCare #PediatricCare #NJMedicaid #HealthPolicy

3 weeks ago | [YT] | 0

Carenodes

The business case is clear: Doula integration in maternity care produces healthier mothers and babies, while driving down costs and enhancing value-based performance. For hospital executives and insurance leaders, this model represents a win-win opportunity – improving clinical outcomes and financial outcomes in tandem. In an era when maternal health quality is under the microscope, doubling down on evidence-based supports like doulas is a prudent leadership decision

1 year ago | [YT] | 0

Carenodes

Youth mental health is in crisis across the U.S. 🚨 With Texas leading in untreated cases (19.4%) and California performing best (8.2%), thousands of young lives still lack support. Discover which states are leading in mental health care—and where urgent change is needed. Let's secure a healthier future for the next generation. 🧠💡 #YouthMentalHealth #MentalHealthAwareness

1 year ago | [YT] | 1

Carenodes

🎙️ NEW EPISODE ALERT: The Perfect Storm in Healthcare Insurance 🌩️

👉 Rising healthcare costs.
👉 Surging patient demand.
👉 Relentless policy pressures.

As we head into 2025, the health insurance industry is standing at the brink of transformation. Medicare Advantage, once a goldmine for insurers, is now facing unprecedented challenges. Giants like Humana and UnitedHealth are navigating mounting utilization costs, tighter margins, and increased scrutiny. But where there's uncertainty, there’s opportunity.

🔥 In this episode of the VBCA Podcast, host Alex Yarijanian dives deep into:
✅ The forces driving disruption in the insurance landscape.
✅ Key insights into Medicare Advantage and Medical Loss Ratios (MLRs).
✅ Actionable strategies for healthcare providers and entrepreneurs to thrive amidst change.

💡 Whether you’re a provider, payer, or innovator, this episode is packed with insights to help you lead the way in a rapidly evolving industry.

📌 Highlights:
✔️ How rising utilization is reshaping profitability.
✔️ The growing role of value-based care solutions.
✔️ Entrepreneurial opportunities to disrupt the market.

👀 Watch now to stay informed, stay sharp, and stay ready.

💬 Have thoughts on how healthcare is evolving? Drop a comment and join the conversation!

#HealthcareTransformation #ValueBasedCare #MedicareAdvantage #HealthInsurance #VBCApodcast

1 year ago | [YT] | 2

Carenodes

Shocking revelations in the courtroom! The pretrial judge handling the complex and high-stakes case involving the murder of UnitedHealthcare CEO Brian Thompson, #LuigiMangione, isn't just another law professional - she's linked to the hues of Healthcare and Pharma industry through marriage.

Learn the full story from Ken Klippenstein ->

www.kenklippenstein.com/p/luigi-mangione-judge-mar…

#LegalNews #HealthcareIndustry #UHC

1 year ago | [YT] | 6

Carenodes

EXPOSED: The MultiPlan Healthcare Cartel

Discover how providers and patients lose billions annually due to suppressed out-of-network payments. Join the VBCA Podcast as Alex Yarijanian dives into the antitrust lawsuit against MultiPlan, accused of leading a cartel alongside major insurers like UnitedHealthcare, Cigna, and Aetna. Real stories, hidden fees, and a call for healthcare reform.

🎧 Listen now and join the conversation!

#HealthcareReform #MultiPlan #HiddenFees #VBCAPodcast

1 year ago | [YT] | 1

Carenodes

Startup Pitfalls and Healthcare Horror Stories 🚨

In this eye-opening episode of the VBCA Podcast, we dig into the biggest challenges healthcare startups face, especially those focused on value-based care. From the struggle to build a solid patient base to the reality of balancing patient volume with quality care, this episode pulls back the curtain on what it really takes to succeed in healthcare innovation.

🧠 Key insights include:

Why securing steady patient volume is more challenging than it sounds.
How community partnerships and local engagement are essential for VBC success.
Strategies to avoid common startup traps and maintain high-quality standards.
The episode also introduces "Tough Calls in Healthcare", where we dive into real-world negotiation dilemmas like payer reimbursement standoffs and tricky contract clauses. Plus, we end with "Should This Really Be Happening?", a segment highlighting the most absurd and frustrating healthcare stories—think $18,000 baby naps and emergency room nightmares! 😱

Tune in now for valuable insights on navigating the complex healthcare landscape. 👉 https://youtu.be/BvLXybJGCMk


#HealthcareStartups #ValueBasedCare #HealthcareChallenges #VBCA #HealthcareInnovation #HealthcareProfessionals #NegotiationStrategies
‪@carenodes‬

1 year ago | [YT] | 3

Carenodes

Five Crucial Areas in Healthcare's Future

1. Patient Acquisition: Vital for a provider's success and a key metric for insurance plans.
2. Value-Based vs. Volume-Based Care: Balancing quality and quantity is essential for revenue generation.
3. Administrative Efficiency: Startups could simplify processes for operational efficiency.
4. Ethical Safeguarding in Home Care: Quality control is crucial to protect seniors, and startups may provide solutions.
5. Maternity Care Opportunities: Regulatory changes in Medicaid create new possibilities for improved care.

Embracing these focus areas can lead to a more responsive and compassionate healthcare system.

3 years ago (edited) | [YT] | 4

Carenodes

Engaging Discussion regarding #payvider movement in Healthcare

3 years ago | [YT] | 4