The Value Shift by Protera Health

Fixing MSK: How Health Plans Can Recognize and Reduce Imaging and Surgery Overspend | Featuring Clem Foltz, FSA

44 min · 9 de abr de 2026
Portada del episodio Fixing MSK: How Health Plans Can Recognize and Reduce Imaging and Surgery Overspend | Featuring Clem Foltz, FSA

Descripción

What happens when an Actuary and a Surgeon look at the same claims data? In our latest episode of The Value Shift, we’re joined by Clem Foltz, FSA, an expert in specialty value-based care. While doctors see patients, actuaries see the "sequences" and "intensity" of care journeys—and that’s where the opportunity for true value lies.

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episode How Can We Get Surgeons to Value Value-Based Care? | Featuring Dr. Ahilan Sivaganesan artwork

How Can We Get Surgeons to Value Value-Based Care? | Featuring Dr. Ahilan Sivaganesan

Welcome to the Season 2 premiere of The Value Shift. We’re kicking off the new season with a deep dive into one of the biggest hurdles in modern medicine: aligning surgical incentives with patient outcomes. In this episode, host Eric sits down with neurosurgeon Dr. Ahilan Sivaganesan to tackle the fundamental question: How can we get surgeons to value value-based care? The current fee-for-service model often rewards volume over value, leading to "CPT Envy" and misaligned incentives. Dr. Sivaganesan shares his firsthand experience navigating these hurdles—from his viral advocacy on LinkedIn to resolve insurance denials to his work with Mishe Health and Mark Cuban’s Cost Plus Wellness to build a direct, transparent healthcare ecosystem.

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