Value Based Care Advisory (VBCA) Podcast

Youth Loneliness & Chronic Conditions: The Shared Strength ProjectGuest: Esha Mittal, Founder, The Shared Strength ProjectExpert Words: Todd May, MD, Vice President & Medical Director, Health NetHost: Alex YarijanianEpisode SummaryOne in three young people in the U.S. live with a chronic condition, according to the National Library of Medicine — yet almost none of the funding, research, or attention going toward senior loneliness has followed youth loneliness into the room. Esha Mittal knows the gap firsthand. Diagnosed with a chronic condition in the fall of her freshman year of high school, she found that the diagnosis-based support groups meant to help her instead became what she calls "a pity party" — rooms where the illness was the only thing anyone had in common.In November 2025, Esha launched The Shared Strength Project, a mentorship program that pairs youth and young adults living with chronic conditions with mentors matched by shared interest, not shared diagnosis. The model grew directly out of her own experience at UCSF's Wellness Center for Youth and Young Adults with Chronic Conditions, where a nurse practitioner and social worker treated her as a whole person before they ever discussed her symptoms — and where she met the mentor whose own story became the blueprint for the project.In this episode, Esha walks through what that first isolating year actually felt like, why interest-based pairing works where diagnosis-based support groups didn't, and how a trauma-informed curriculum — built with a licensed social worker — structures every mentor meeting. We also hear from Todd May, MD, Vice President and Medical Director at Health Net, on why "youth loneliness" as a term hasn't yet made it into payer boardroom conversations — even as youth mental health broadly has.Esha will be speaking at Behavioral Health Tech 2026 in Nashville (September 22–24, Gaylord Opryland Resort and Convention Center) on a panel about designing tools youth and young adults will actually use.Timestamps00:00 — Cold open: the funding gap between senior and youth loneliness01:39 — Esha's diagnosis, freshman year of high school03:24 — "They did not get it" — the friend-group disconnect04:56 — Why the first (diagnosis-matched) support group made things worse, not better07:20 — Launching The Shared Strength Project (November 2025) and the interest-based pairing model09:19 — Todd May, MD (Health Net) on why youth loneliness hasn't reached payer conversations yet10:33 — The UCSF Wellness Center partnership and the mentor whose story inspired the project13:20 — Where to find Esha and what she's looking for next13:54 — BHT2026 — Esha's panel on designing tools for youth and young adultsKey QuotesEsha Mittal, on the diagnosis-matched support group:"Once we started talking about our chronic condition, it felt like that was all we could talk about. And it just became like a pity party."Esha Mittal, on the design principle behind The Shared Strength Project:"I chose to pair people up based on shared interest because... it would have been so valuable for me to understand myself again outside of my illness."Todd May, MD, on payer awareness of youth loneliness:"That term hasn't actually come up... The loneliness piece is just not getting a lot of airplay."Guest-cited statistics (attributed to source)Per the National Library of Medicine, as cited by Esha Mittal: one in three young people in the U.S. live with a chronic condition, and 20 million American children with serious or chronic conditions face a higher risk of isolation, bullying, and mood disorders.Where to find EshaEsha is currently reachable via LinkedIn and is building out a project website. She's looking for opportunities to scale The Shared Strength Project beyond California.UpcomingCatch Esha Mittal at Behavioral Health Tech 2026 — September 22–24, 2026, Gaylord Opryland Resort and Convention Center, Nashville, TN.Value-Based Care Advisory Podcast | vbcapodcast.comCompanies mentioned in this episode:Shared Strengths ProjectUCSF Wellness Center for Youth and Young Adults with Chronic ConditionsBehavioral Health Tech ConferenceNational Library of MedicineHealth NetLinkedInGaylord Opryland Resort & Convention CenterValue Based Care Advisory podcastEsha MittalEsha Mittal is a junior at Design Tech High School living with multiple chronic conditions. She founded the Shared Strength Project in 2025, aiming to reduce isolation among youth/young adults through meaningful mentorship.Todd May MD FAAFPDr. Todd May serves as Vice President Medical Director at Health Net where he provides clinical expertise for the Commercial Team. He is deeply engaged in quality improvement, population health management, health equity, advanced primary care, and implementation of innovative member engagement programs. He also provides key leadership in an innovative multi-payer initiative that promotes Advanced Primary Care in California, and another focused on improving hospital quality. Immediately prior to joining Health Net, Dr. May was a Professor at UCSF for over 20 years. During this tenure, he served as Chief of the Medical Staff and then as Chief Medical Officer at the San Francisco General Hospital campus. He has been practicing family medicine for over 30 years and continues to see patients at a community clinic in Half Moon Bay.

This bonus episode is the full recording of Alex Yarijanian's HBMA continuing-education webinar. It runs longer than a standard VBCA episode — treat it as a resource, not a highlight reel.Most revenue cycle teams treat denials and underpayments as billing problems. A meaningful share of them are actually contract problems wearing a billing costume — and you can't fix a contract problem at the claims desk. This session walks through the five payer-contract provisions that generate the most downstream billing failures, a three-phase audit framework for finding them before they cost you, and a denial-routing model that keeps contract-based underpayments from getting silently written off in a clinical appeals queue.What you'll learn:Why contract language — not coding errors — is where most systematic underpayment actually startsThe five provisions to check first: fee schedule effective dates, carve-outs/exclusions, coordination of benefits, authorization & notification, and timely filingWhy "rates effective upon execution by both parties" can quietly cost you weeks of underpaid claimsWhy vague terms like "experimental" or "time to time" in a contract are a red flag, not boilerplateWhy state law — not the payer's internal policy — governs coordination-of-benefits primacyWhy retroactive denial of an already-issued authorization is not just bad practice — it's against federal law for government-funded productsA three-phase contract audit framework: highest-leakage provisions → highest-volume services → highest-friction appeal/recoupment timelinesA three-bucket denial-routing model (clinical / administrative / contract-based) so contract-based underpayments get escalated instead of written offSession outline:Introduction — Alex's background: clinic operations, Cardinal Health/HCA, head negotiator for Humana's West Territories, then founding Carenodes to close the payer/provider information asymmetry.The framing stat — a striking share of providers don't actually know what they're supposed to be paid, and contract language is where the error is born.Provision 1 — Fee schedule effective dates & updates.Provision 2 — Carve-outs & exclusions.Provision 3 — Coordination of benefits.Provision 4 — Authorization & notification.Provision 5 — Timely filing.The three-phase audit framework.Denial routing: clinical vs. administrative vs. contract-based.Close — pick your top two payers, run the checklist, renegotiate.Resources: Contract audit checklist referenced in this session — request it at vbcapodcast.comAbout the host: Alex Yarijanian is CEO & Founder of Carenodes. He spent seven years managing payer contracting operations for 600+ provider organizations across 48 states, including a prior role as leadership and negotiator for Humana's West Territories contracting and network management team.

17 minutes. That's how long Lindsay Clancy's last psychiatric visit lasted — the day before her three children died. Nine prescribers. Two hospitals. A suicide hotline called twice. And allegedly, not one person connecting the dots.Before you listen: This episode discusses allegations from a civil complaint and public criminal-trial testimony only. We do not cover the criminal case, describe what happened to the children, or speculate on Lindsay Clancy's state of mind. None of the allegations below have been proven, and no defendant has been found liable. One named defendant has petitioned for a Massachusetts medical malpractice tribunal — a screening step, not a liability ruling. South Shore Health and the Women & Infants Health Hospitals operator have said they cannot comment on pending litigation; Astor Mental Health has not responded to requests for comment.This is the care coordination failure hiding inside the Lindsay Clancy civil complaint (Norfolk Superior Court, filed January 2026) — postpartum psychiatric care, telehealth psychiatry's blind spots, and the reimbursement incentives nobody wants to talk about. Alex and Jasmine break down what the complaint alleges went wrong in the system, not the person.In this episode:Why access without coordination isn't the same as coordinated careThe alleged medication cascade — nine to ten prescriptions, no single clinician alleged to own the regimenA courtroom cross-examination over one comma in a clinical note, and what it says about documentation standardsTwo crisis hotline contacts that reportedly didn't meet the "emergency" threshold, and why postpartum psychiatric crises fall outside standard screening calibration14 consecutive telehealth visits during an acute stabilization period — and testimony on what an in-person exam might have caughtWhere AI can actually help operationally, and where it can'tWhy reimbursement incentives, not individual clinicians, are the root of this gapHosted by Alex Yarijanian and Jasmine Singh.#ValueBasedCare #CareCoordination #BehavioralHealth #PostpartumCare #HealthcarePolicyLinks referenced in this episode:risewestconference.comlindseyclancycase.comnewbedfordsuicidehotline.comCompanies mentioned in this episode:South Shore HealthMcLeanNew Bedford

Episode SummaryA pediatric patient in a New Jersey hospital is medically ready for discharge — equipment arranged, family ready, nursing hours authorized by the health plan. The only missing piece: an actual nurse. This episode uses that scenario to examine the structural gap between authorized private duty nursing (PDN) hours and filled hours in Medicaid managed care, why standard provider directories overstate real pediatric home health capacity, and what CMS's 2024 Medicaid managed care access rule signals for how plans will need to prove — not just claim — network adequacy going forward."When the network looks broad on paper, but families still cannot get care, the question is not, do we have enough providers listed? The question is, can a child actually get home?"ChaptersThe Discharge That Doesn't Happen — A clinically ready child, an authorized care plan, and no nurse to staff it.The Directory Problem — Why a state can show hundreds of home health agencies while only a handful actually serve pediatric high-acuity cases.Authorized vs. Filled Hours — The distinction that matters most for families, and the 20–40% unfulfilled-hours range documented by MACPAC.What Makes a Network a "Ghost Network" — Six reasons a directory listing doesn't equal real access.Why Pediatric Home Health Is a Different Labor Market — Ventilators, trachs, feeding tubes, and why acuity narrows the real provider pool.The CMS Rule — Secret shopper surveys, wait-time standards, and the shift from "is the directory complete" to "can members get care."The Pediatric PDN Access Audit — A 7-step framework for MCOs to move beyond static network adequacy reporting.What Providers and Advocates Should Document — Turning anecdote into evidence health plans and regulators can act on.Companies mentioned in this episode:Affirmed Home CarePediatrics and Adolescent Therapy AssociatesActive Pediatrics Therapy ServicesGrowing HopePediatric Care for Kid CareFamily Care AgencyNew Jersey Children's HospitalNew Jersey Hospital AssociationCarenodesSources cited in this episode:Baxley, J. "Will increased pay solve North Carolina's home nursing shortage?" North Carolina Health News, via CityView NC.Brown, J. "Nurses for medically fragile kids are underpaid and hard to find. Parents want the state to step in." The Colorado Sun.AHA News. "OIG says MA, Medicaid managed care plans have limited, inaccurate behavioral health provider networks." American Hospital Association."Ghost Network Busters." Managed Healthcare Executive.Fierce Healthcare. "OIG report raises red flags about maternal health 'ghost networks' in Medicaid managed care."Key Data Points ReferencedMACPAC has documented that a meaningful share of authorized private duty nursing hours nationally go unfulfilled — often cited in the 20%–40% range.CMS's 2024 Medicaid Managed Care Access, Finance, and Quality final rule introduces secret shopper survey requirements, moving oversight from directory completeness toward actual service access.

Most revenue cycle teams are chasing the wrong fire. Persistent underpayment, denials that don't respond to appeals, patterns nobody can explain — these are often contract problems wearing a billing problem's disguise.In this episode, Alex breaks down the structural gap between contracting and RCM that costs providers real money every day, and delivers three things you can take to your next denial review right now.WHAT YOU'LL HEARThe real story behind a multi-specialty group underpaid for 12 months — and why their billing team did nothing wrongWhy contracting and RCM live in separate worlds — and why that gap is your biggest revenue riskFee schedule effective date clauses: the most dangerous amendment language in managed care contractsCarve-out clauses and why behavioral health denials keep looking like coding errorsContract dispute timelines vs. your denial management cycle — what happens when they don't matchThe one question to add to every denial reviewTHREE THINGS TO APPLY NOWCheck your fee schedule effective dates. Know the execution date on every amendment. Confirm your billing system actually flipped to the new rates. 73% of providers don't know what they're contracted to receive.Map your carve-out clauses. Know which services are excluded from the base agreement and where those claims need to route — behavioral health is the most common gap.Find the contract dispute window in every active agreement. If it's shorter than your internal denial cycle, that's a configuration problem costing you money today.THE DIAGNOSTIC QUESTIONWhen a denial pattern doesn't respond to standard appeals, ask: Is this a billing problem or a contract problem? They need entirely different escalation paths. If your team is routing both into the same queue, contract-based underpayments are being written off — silently.GO DEEPER: HBMA WEBINAR — AUGUST 12Alex presents the full framework — denial categorization methodology and a contract audit checklist — live through the Healthcare Business Management Association (HBMA). 1 CEU credit available. Your Billing Problem Started in the Contract: What Revenue Cycle Leaders Need to Know Before a Claim Is Ever Filed. Presented by Alex YarijanianRegister: https://www.hbma.org/meeting_calendar/details.php?event=3148Checklist directly: vbcapodcast.com