Can Maryland’s All-Payer Model Fix Health System Economics? Mark Shaver, Chief Strategy Officer, University of Maryland Medical System

Can Maryland’s All-Payer Model Fix Health System Economics? Mark Shaver, Chief Strategy Officer, University of Maryland Medical System

Maryland’s all-payer model, value-based reimbursement, health system scale, AI, rural care, and health equity- Mark Shaver and Roy Bejarano unpack what makes the University of Maryland Medical System one of the most unique healthcare platforms in the U.S. In this episode of Analyzing Healthcare, Roy Bejarano, CEO at SCALE Healthcare, speaks with Mark Shaver, Chief Strategy Officer at the University of Maryland Medical System, about how Maryland’s regulated reimbursement model changes the economics, strategy, and mission of care delivery. A strategic conversation for healthcare veterans, payors, investors, health system leaders, and U.S. healthcare enthusiasts interested in what sustainable care delivery could look like beyond traditional fee-for-service economics. What You’ll Learn ✅ Why Maryland’s all-payer model is unlike any other state healthcare market ✅ How global budgets change hospital margin, growth, and access strategy ✅ Why value-based care is built into Maryland’s reimbursement structure ✅ Why Medicare Advantage adoption is much lower in Maryland ✅ How UMMS balances public-private partnerships, mission, and scale ✅ Why advanced therapies must also address health equity ✅ How AI and virtual care are moving from hype to practical systemwide use ✅ Why rural workforce development is central to healthcare transformation Key Timestamps • (00:03) Introduction to Mark Shaver and UMMS • (01:42) “For-profit mindset and nonprofit heart” • (03:41) Why nonprofit healthcare needs business discipline • (06:36) Maryland’s all-payer reimbursement model • (08:53) Value-based care built into the system • (12:39) Global budget: stability vs. innovation capital • (22:30) Low Medicare Advantage adoption • (40:22) Specialty care closer to the community • (45:42) CAR-T therapy, multiple myeloma, and health equity • (48:03) AI, virtual care, and workflow value • (50:04) Rural workforce development Key Takeaways • 💎 Maryland’s all-payer model changes how hospitals think about margin, access, and growth. • 💎 Value-based care in Maryland is not a pilot—it is built into reimbursement. • 💎 Global budgets create stability but can limit surplus capital for innovation. • 💎 Low Medicare Advantage adoption changes primary care and payer strategy. • 💎 UMMS is focused on bringing specialty and advanced care closer to communities. • 💎 AI and virtual care are becoming practical tools, but leaders must separate hype from real workflow value. • 💎 Workforce development is a major lever for rural healthcare transformation. Guest Bio Mark Shaver is Chief Strategy Officer at the University of Maryland Medical System, where he leads enterprise strategy across one of Maryland’s most important healthcare platforms. With experience across nonprofit health systems, Welltower, Johns Hopkins, and earlier Wall Street roles, Mark brings a unique mix of growth strategy, operating discipline, and mission-driven leadership. His work spans systemness, ambulatory strategy, rural transformation, academic partnerships, AI, virtual care, and care delivery innovation across Maryland’s all-payer healthcare environment. Resource Links Guest: Mark Shaver – Chief Strategy Officer, University of Maryland Medical System Host: Roy Bejarano – CEO & Co-Founder, SCALE Healthcare Podcast: Analyzing Healthcare by SCALE Community SCALE Community: https://www.scale-community.com [https://www.scale-community.com] SEO Keywords Healthcare Strategy, University of Maryland Medical System, UMMS, Mark Shaver, Roy Bejarano, SCALE Healthcare, SCALE Community, Maryland Healthcare, All-Payer Model, Value-Based Care, Global Budget Healthcare, Medicare Advantage, Rural Healthcare, Healthcare AI, Virtual Care, Telemedicine, Ambulatory Strategy, Academic Medical Center, Health Equity, Healthcare Leadership, Healthcare Podcast

Stamford Health’s Strategy for Growth Beyond the Hospital, Ben Wade, SVP, Chief Strategy Officer

How can independent health systems compete in a consolidating market? Ben Wade shares strategies for outpatient growth, partnerships, and community access. Hospital strategy, outpatient growth, healthcare partnerships, and community access are becoming critical priorities for independent health systems. In this episode of Analyzing Healthcare Jason Schifman, President at SCALE Healthcare, sits down with Ben Wade, Senior Vice President and Chief Strategy Officer at Stamford Health, to discuss how independent providers can compete in increasingly consolidated markets. Ben shares why Stamford Health has prioritized ambulatory care, physician alignment, strategic partnerships, and consumer-focused access, with outpatient services now accounting for nearly 70% of revenue. The conversation explores partnerships with HSS and Dana-Farber/Brigham, the role of ambulatory surgery centers, and the growing impact of Medicaid eligibility changes on community health systems. Ben also explains why cultural alignment is often the deciding factor behind successful healthcare partnerships. What You'll Learn ✅ How Stamford Health competes as an independent health system ✅ Why outpatient services drive nearly 70% of revenue ✅ The role of physician alignment in long-term growth ✅ What makes healthcare partnerships successful ✅ Why cultural fit matters as much as economics ✅ How ambulatory surgery centers improve access and affordability ✅ The impact of Medicaid eligibility changes on community care ✅ Strategies for protecting access amid rising uncompensated care Key Timestamps * (00:01) Introduction to Ben Wade and Stamford Health * (00:56) Market position and uncompensated care challenges * (04:11) Stamford Health's strategic framework * (06:50) Why outpatient care drives growth * (10:26) Ambulatory surgery centers and physician alignment * (12:33) Stakeholder response to outpatient expansion * (14:53) Partnerships with HSS and Dana-Farber/Brigham * (19:48) Why cultural fit matters in partnerships * (23:02) PE-backed physician groups as partners * (25:15) Medicaid eligibility changes and community access Key Takeaways * 💎 Independent systems can stay competitive through focused strategy and local relevance * 💎 Outpatient care is central to health system sustainability * 💎 Successful partnerships require meaningful integration, not just branding * 💎 Ambulatory investments can strengthen access, affordability, and physician relationships * 💎 Cultural alignment is a major predictor of partnership success * 💎 Community health systems must prepare for coverage disruptions and rising uncompensated care Guest Bio Ben Wade is Senior Vice President and Chief Strategy Officer at Stamford Health, where he leads strategy, ambulatory growth, partnership development, and market positioning. His work focuses on helping independent health systems remain competitive through physician alignment, outpatient expansion, and community-centered innovation. Resource Links Guest: Ben Wade Host: Jason Schifman Podcast: Analyzing Healthcare by SCALE Community SCALE Community:www.scale-community.com SEO Keywords Healthcare Strategy, Hospital Strategy, Outpatient Growth, Ambulatory Care, Health System Partnerships, Stamford Health, Ben Wade, Jason Schifman, Independent Health Systems, Physician Alignment, Ambulatory Surgery Centers, Medicaid Eligibility, Community Health, Healthcare Leadership, Healthcare Innovation, Hospital Growth Strategy, Healthcare Podcast, Healthcare Industry Insights, SCALE Healthcare, SCALE Community.

How URAC Is Setting Standards for AI, Telehealth, and Healthcare Trust | Shawn Griffin

Healthcare accreditation, telehealth accreditation, AI governance, and healthcare quality are reshaping modern care delivery. In this episode of Analyzing Healthcare, Roy Bejarano, CEO of SCALE Healthcare, speaks with Shawn Griffin, MD, CEO of URAC, about how accreditation builds trust, improves quality, and supports accountability across healthcare. Shawn discusses URAC’s evolution from utilization review into a leading accreditation organization with programs spanning telehealth, specialty pharmacy, credentialing, health plans, and AI. The conversation explores what makes accreditation meaningful, how quality standards are developed, and why consistent oversight matters. They also examine telehealth quality, global access challenges, and the growing need to distinguish credible healthcare organizations from poor performers. The episode concludes with a discussion on healthcare AI, including privacy, bias, governance, and accountability, and why URAC launched one of the industry's first AI accreditation programs. What You'll Learn ✅ How URAC fits into the healthcare accreditation landscape ✅ Why accreditation matters for trust, quality, and credibility ✅ How URAC differs from facility-based accreditors ✅ The role of reviewer consistency in accreditation outcomes ✅ What telehealth accreditation evaluates ✅ Why telehealth quality standards matter globally ✅ How URAC approaches healthcare AI accreditation ✅ Key AI governance considerations, including privacy and bias ✅ How accreditation can become a strategic differentiator ✅ Why quality standards may grow in importance as innovation accelerates Timestamps • {00:00} Introduction to Shawn Griffin and URAC • {00:45} URAC and the accreditation ecosystem • {02:18} Origins in utilization review and governance • {04:09} How accreditation programs are developed • {06:14} URAC's scale and reviewer model • {13:28} Reviewer independence and conflict avoidance • {15:24} How URAC differs from other accreditors • {22:20} Telehealth, access, and quality assurance • {35:00} Why URAC launched AI accreditation • {38:10} Evaluating AI developers and users • {41:27} AI oversight in patient care • {50:54} The practical realities of AI accreditation Key Takeaways • 💎 Accreditation creates trust where risk and complexity are high • 💎 Quality oversight goes beyond basic compliance requirements • 💎 Consistent review processes strengthen accreditation outcomes • 💎 Telehealth growth increases the need for trusted standards • 💎 AI adoption requires governance, oversight, and accountability • 💎 Demonstrating best practices is more valuable than simply claiming them • 💎 Accreditation can help distinguish credible organizations from opportunistic ones • 💎 Standards may become increasingly influential as healthcare innovation accelerates Guest Bio Shawn Griffin, MD, is the CEO of URAC, a leading independent healthcare accreditation organization. A physician executive with experience in clinical practice, hospital leadership, health information technology, and healthcare quality, Dr. Griffin has dedicated his career to improving patient outcomes through accountability and innovation. Under his leadership, URAC has expanded its accreditation programs across telehealth, specialty pharmacy, credentialing, digital health, and artificial intelligence, helping healthcare organizations demonstrate quality, trust, and operational excellence. Guest: Shawn Griffin, MD – CEO, URAC Host: Roy Bejarano – CEO, SCALE Healthcare Podcast: Analyzing Healthcare by SCALE Community SEO Keywords: Healthcare accreditation, URAC, Shawn Griffin, Roy Bejarano, telehealth accreditation, healthcare quality, healthcare AI, AI governance, utilization review, healthcare standards, credentialing, specialty pharmacy, patient safety, digital health, healthcare trust, healthcare oversight, healthcare podcast, SCALE Healthcare.

How Fairview Health Turned Around a $600M Performance Gap, Sameer Badlani, Fairview Health Services

Health system turnaround, payer pressure, ambulatory growth, diversified revenue, partnership strategy, and AI-enabled transformation- Sameer Badlani, MD, and Jason Schifman unpack what it takes for health systems to survive in today’s margin-constrained environment. In this episode of Analyzing Healthcare, Jason Schifman, President at SCALE Healthcare, speaks with Sameer Badlani, MD, Chief Strategy and Digital Officer at Fairview Health Services, about navigating healthcare inflation, concentrated payer dynamics, operational turnaround, and long-term sustainability. The conversation explores throughput improvement, physician alignment, joint ventures, specialty growth areas, interoperability, and why healthcare leaders must move beyond endless pilot programs toward scalable execution. What You’ll Learn • ✅ How payer concentration pressures health system margins • ✅ What drove Fairview’s turnaround — and what nearly derailed it • ✅ Why nonprofit systems still need strong margins to survive • ✅ How Fairview decides what to own, partner on, or exit • ✅ Why behavioral health, pharmacy, and home health require different models • ✅ How consumer expectations are reshaping healthcare growth • ✅ How Fairview approaches payer, pharma, medtech, and AI partnerships • ✅ Why healthcare must move beyond endless pilot programs Timestamps • (00:01) Meet Sameer Badlani • (00:31) Fairview's footprint and the Minnesota market • (01:54) Why Minnesota is innovative but hard on providers • (08:40) The turnaround and return to operating profit • (10:57) Throughput, length of stay, and operational discipline • (14:26) Service line exits, pivots, and new partnerships • (17:49) Specialty pharmacy as a diversified revenue engine • (18:33) Behavioral health, JVs, and the EMPATH model • (21:23) Strategic priorities today • (21:40) Women's health and consumer-led growth • (27:44) Physician strategy and flexible partnership models • (32:42) Payer, medtech, pharma, and AI partnerships • (35:25) How Fairview decides what to pursue — and what to walk away from • (38:28) Biggest opportunities in the next 24–36 months • (40:38) Interoperability: the difference between data and insight Key Takeaways • 💎 Margin pressure in healthcare is often structural — not just operational • 💎 Sustainable turnarounds require alignment across operations, labor, analytics, and finance • 💎 Nonprofit systems still need strong margins to reinvest and remain stable • 💎 Leading health systems focus on core strengths and partner for the rest • 💎 Not every service line should be owned — JVs and exits can create more value • 💎 Revenue diversification is becoming essential for long-term resilience • 💎 Strong strategy requires focus and discipline, not endless experimentation Resource Links • Guest: Sameer Badlani, MD – Chief Strategy and Digital Officer, Fairview Health Services • Host: Jason Schifman – President, SCALE Healthcare • Podcast: Analyzing Healthcare by SCALE Community • SCALE Community: https://www.scale-community.com [https://www.scale-community.com] Guest Bio Sameer Badlani, MD is Chief Strategy and Digital Officer at Fairview Health Services, where he leads strategy, digital transformation, partnership development, and innovation across one of Minnesota’s major integrated health systems. His work focuses on how health systems can improve sustainability, diversify revenue, modernize care delivery, and use data, partnerships, and disciplined execution to navigate a difficult healthcare landscape. SEO Keywords Healthcare strategy, health system turnaround, Fairview Health Services, Sameer Badlani, Jason Schifman, payer pressure, healthcare margins, nonprofit health systems, diversified revenue, specialty pharmacy, behavioral health, ambulatory surgery centers, physician alignment, digital transformation, AI in healthcare, interoperability, women’s health, perimenopause care, healthcare innovation, SCALE Healthcare, SCALE Community, healthcare podcast

Why Doctors Are Pushing Back on Certification, Shortages, and Medical Monopolies | Dr. Paul Teirstein, Scripps Health

Physician shortages, board certification, medical monopolies, residency bottlenecks, telemedicine policy, and healthcare regulation—this episode with Dr. Paul Teirstein explores why parts of U.S. healthcare may be structurally broken by design. Drawing from his experience as a cardiologist and founder of a competing physician certification board, Dr. Teirstein discusses physician frustration with maintenance of certification, residency bottlenecks, telemedicine restrictions, and how monopolistic structures across healthcare can drive higher costs, reduced access, and clinician burnout. What You’ll Learn• ✅Why many physicians are pushing back on maintenance of board certification• ✅ How the American Board of Internal Medicine became a gatekeeper in medicine• ✅ Why Dr. Paul Teirstein launched the National Board of Physicians and Surgeons• ✅ How certification requirements may contribute to burnout and early retirement• ✅ Why physician shortages stem from broader structural and funding challenges• ✅ How telemedicine restrictions continue to limit access to care• ✅ Why monopolies in healthcare often drive higher costs and weaker service• ✅ Why continuing medical education may matter more than repetitive testing• ✅ How policy and regulation continue to shape physician supply in the U.S. Timestamps• (00:04) Introduction to Dr. Paul Teirstein and Scripps Health• (01:43) Why Dr. Teirstein challenged the American Board of Internal Medicine• (03:12) How board certification became a de facto requirement to practice• (05:28) Revenue growth, maintenance requirements, and physician frustration• (07:12) Why Dr. Teirstein started the National Board of Physicians and Surgeons• (09:25) Payers, hospitals, and the barriers to alternative certification• (11:37) What initial certification gets right—and where ongoing requirements fail• (15:37) How AI and OpenAI’s ChatGPT expose weaknesses in board testing• (18:52) Is maintenance certification a real quality measure—or just a tax?• (20:32) Physician shortages, burnout, and unnecessary administrative burden• (22:27) Medical schools, residencies, and the supply bottleneck• (26:57) Why residency funding remains central to physician supply• (31:41) Telemedicine, regulation, and access to care• (36:07) The broader problem of monopoly power in healthcare Key Takeaways• 💎 Board certification requirements have become a major pain point for many physicians.• 💎 CME may do more to keep doctors current than repetitive testing.• 💎 Physician shortages stem from broader structural barriers, including residency limits.• 💎 Telemedicine can expand access, but policy hurdles remain.• 💎 Healthcare monopolies often drive higher costs and poorer service.• 💎 Reducing administrative burden could improve physician retention and care access. Resource LinksGuest: Dr. Paul Teirstein – Cardiologist, Scripps HealthHost: Roy Bejarano, CEO & Co-founder at SCALE HealthcarePodcast: Analyzing Healthcare by SCALE CommunitySCALE Community: ⁠https://www.scale-community.com⁠ [https://www.scale-community.com/]Guest BioDr. Paul Teirstein is a Chief of Cardiology at Scripps Health in San Diego, where he leads within the cardiology division and performs minimally invasive heart procedures including coronary stents and transcatheter valve interventions. In addition to patient care, training, and research, he is also the founder of the National Board of Physicians and Surgeons, created in response to growing physician frustration with the maintenance of certification processes. His work sits at the intersection of clinical excellence, medical policy, and physician advocacy. SEO KeywordsHealthcare, U.S. Healthcare, Physician Shortage, Board Certification, Maintenance of Certification, American Board of Internal Medicine, ABIM, National Board of Physicians and Surgeons, NBPAS, Paul Teirstein, Scripps Health, Telemedicine, Residency Funding, Medical Education, Physician Burnout, Healthcare Regulation, Medical Monopolies, Healthcare Policy