Episode Details

Most nursing home administrators don't realize they're sitting on one of the most underutilized revenue streams in all of Medicare — and until someone shows up and tells them what it's worth, they never will.

In this episode, Scott Middleton — founder and Chief Disruption Officer of Your Health — calls in from the road as he travels across rural Georgia on a multi-day facility tour, fresh off completing a major merger with TCPA. What follows is an unfiltered, on-the-ground breakdown of two transformational opportunities Scott is actively building: chronic care management (CCM) reimbursement and ACO cost savings — and the very specific reasons most of the industry is getting both wrong.

In this episode, you'll hear:

• Why Medicare already pays $65/hour for care management performed by nurses, community health workers, and social workers — and how Your Health is now contracting with nursing home facilities to perform it, paying them up to $100 per patient per month
• The "Fuse" platform — a communication and documentation tool that routes care management notes directly into billing-ready buckets, syncing with point-of-care software so the minutes get captured and billed automatically
• How ACO risk scores work, why Your Health's scores have grown 30% under their current plan, and what failing to see hospice patients could cost the organization — up to $22 million in a single year
• The $4,800 per patient per year problem: how one physician in their network was quietly rated one of the worst under the ACO model simply because his patients were going home without any follow-up
• Scott's announcement that SSAs and TCPs are being restructured to report directly to peer group administrators — and why the confusion about their roles has cost the company

If you lead a nursing home, an assisted living facility, a physician group, or any organization inside the long-term care ecosystem, this episode will change how you look at what you're already doing — and what you're leaving behind.

www.YourHealth.Org