VBC One

🦷 Dental care isn’t just “nice to have” — it’s a critical part of plan design for seniors and adults with disabilities. In Part One of my conversation with Joyce Go, MS, MBA, Chief Business Development Officer at Enable Dental, we dive into why portable, comprehensive dental care matters for Medicare Advantage and beyond. Joyce explains how Enable Dental partners with PACE programs and health plans to make dental care accessible at home, reducing costs tied to transportation, multiple visits, and unnecessary sedation. More importantly, she connects the dots between oral health and chronic conditions like diabetes and cardiovascular disease — showing how integrated care truly drives outcomes. Programs like PACE are growing fast because they help participants age in place with dignity, while keeping costs in check for Medicare and Medicaid. As Joyce put it, the right modality for dental care isn’t just about smiles — it’s about member health, engagement, and solvency across the system. 💡 For health plans designing benefits, this is a reminder: dental is no longer elective — it’s essential. 🎙️ Catch Part One of our conversation below. ⭐ Want to be a guest on our podcast? Sign up here: https://lnkd.in/dfSpXV-S ⭐ Have an idea for a future topic? Send it to info@vbcone.com ⭐ NEVER MISS an episode. Subscribe today! https://lnkd.in/gpeTjCwp 👍 Like for content ♻️ Repost if this helped or inspired 🔔 Follow me, Dr. Shannon I. Decker, PhD., MBA, MBA, M.Ed., M.Ed., & my company, VBC One, for more insights on risk, quality, & value-based care #OneTakePodcast #VBCOne #ValueBasedCare #DentalBenefits #PACE #MedicareAdvantage #Medicaid #IntegratedCare #HealthEquity #AgingInPlace #CareDelivery #HealthcareInnovation

💡 Dental care is healthcare. In the latest edition of VBC One One Take, I sat down with Joyce Go, MS, MBA, Chief Business Development Officer at Enable Dental, to explore how portable, comprehensive dental care is transforming the way seniors and adults with disabilities access essential services. What struck me most is Enable Dental’s intentional focus on portable (not just mobile) care. This isn’t about quick screenings—it’s about creating a true dental home for those who cannot get to traditional offices. We covered: 🦷 The direct connections between oral health and chronic conditions like diabetes and cardiovascular disease 🏠 The role of dental care in keeping seniors aging at home and reducing costly institutionalization 🚐 How portable dentistry saves transportation and sedation costs while improving outcomes 👩👩👦 Stories of dignity restored—like a patient rejoining community life after finally receiving dentures 📊 Why value-based care needs integrated dental strategies, and how legislation and coding reform could unlock new models This is a conversation about more than teeth—it’s about equity, access, cost, and dignity. You can find our entire interview on YouTube by following this link here or you can follow me and check my feed all week for shorter segments--great for busy professionals with limited time. Find it here on our You Tube channel: https://lnkd.in/dXdDfe6n ⭐ Want to be a guest on our podcast? Sign up here: https://lnkd.in/dfSpXV-S ⭐ Have an idea for a future topic? Send it to info@vbcone.com ⭐ NEVER MISS an episode. Subscribe today! https://lnkd.in/gpeTjCwp 👍 Like for content ♻️ Repost if this helped or inspired 🔔 Follow me, Dr. Shannon I. Decker, PhD., MBA, MBA, M.Ed., M.Ed. & my company, VBC One, for more insights on risk, quality, & value-based care #DentalCare #ValueBasedCare #MedicareAdvantage #EnableDental #HealthcareInnovation #OralHealth #AgingInPlace #PopulationHealth #HomeBasedCare #VBCOne #OneTake

The future of healthcare is here, and Value-Based Care is leading the way. 💡 Check out the latest Insurance360 Podcast with Dr. Shannon I. Decker, PhD., MBA, MBA, M.Ed., M.Ed. to learn about this shift and what that means for not only agents and brokers, but the entire healthcare system. 🎙️ See the Full episode here: 👉 https://lnkd.in/eEwGm7_F 🎧 Check out Pinnacle's latest Training sessions: 👉 https://lnkd.in/drsGh-hS #insurancepodcast #podcast #insurance360 #DrDecker #valuebasedcare #CSNP #healthcare #medicare #fmotraining #insuranceagent #insurancebroker #independentagents #fmo #medicare #investing #marketing #learnandgrow #agenttraining #insuranceindustry #insurancenews #insuranceadvice #agentresources #pfsinsurance #pinnaclefinancialservices #pfs

“If risk adjustment is just about ‘getting every possible code’ you miss the point. The real differentiator is embedding value into your client’s care journey.” 🎙️ New Podcast Episode Alert! I recently joined The Agent Survival Guide Podcast to dig into one of the most misunderstood—and under-leveraged—areas in health insurance: risk adjustment. 👉 Risk Adjustment & Finding Value Beyond Coding Changes Listen here: 🔊 Spotify: https://lnkd.in/g_-TibCn 🍎 Apple:  https://lnkd.in/gi6E-wvy 🫛 Podbean:  https://lnkd.in/gSFeR5Js 🔍 Why this matters In our conversation, I made a point that coding (V24 → V28 changes) is just one piece of the puzzle. The real value lies in how agents and brokers can: 🌏 Think holistically about quality, care, and process design — not just maximizing codes 💰 Align incentives so that member health outcomes and financial sustainability both improve 🤗 Use risk stratification and data as tools for client advocacy, not just cost control One thing I emphasized: “If risk adjustment is just about ‘getting every possible code’ you miss the point. The real differentiator is embedding value into your client’s care journey.” We also unpacked the biggest challenges agents face in navigating coding updates and regulatory noise, and how to stay proactive rather than reactive. 🎯 Who should tune in This episode is ideal for: 🕴 Agents & brokers seeking to differentiate themselves in a crowded market 🏢 Payors or partners exploring how to unlock higher value beyond compliance 💪 Anyone curious about how value-based care, coding, and outcomes intersect I’d be honored if you gave it a listen—and I’d love to hear your thoughts. What part resonates most with your work? Drop a comment or reach out directly. #RiskAdjustment #ValueBasedCare #MedicareAdvantage #HealthTech #AgentStrategy #Podcast #ACO #ACA #Medicaid

📢 Telehealth Update: Medicare Operations Amid the Shutdown In my recent article, I highlighted the uncertainty facing telehealth as Congress approaches the October 1 deadline. CMS has now issued additional guidance clarifying what happens to Medicare operations, telehealth coverage, and claims processing if legislative “extenders” are not renewed. 🔑 Key updates: 🩺 Claims Processing: Medicare Administrative Contractors (MACs) will implement a temporary claims hold (up to 10 business days) when statutory provisions expire. This prevents reprocessing large volumes of claims if Congress acts after the deadline. Providers can continue submitting claims, but payment will be held until the freeze is lifted. ☎️ Telehealth Services: Unless Congress acts, pre-PHE restrictions return Oct 1, 2025 for non-behavioral telehealth. That means: 👩🌾 No coverage for most telehealth provided in the home or outside rural areas 🕊️ Hospice recertifications will again require in-person encounters 📱 Some practitioners will not be payable for telehealth services 📨 Providers may need to consider Advance Beneficiary Notices of Noncoverage (ABNs) for non-covered services 🏡 ACO Exception: Clinicians in Medicare Shared Savings Program ACOs retain the ability to provide covered telehealth without geographic restrictions and into the home, regardless of Congressional action. 🔗 CMS Telehealth Coverage: https://lnkd.in/gkZzCMih 🔗 ACO Telehealth Fact Sheet: https://lnkd.in/giXrjZYu 👉 Bottom line: Behavioral health telehealth remains protected, but most other telehealth flexibilities end without legislative renewal. Organizations should be preparing for operational adjustments, ABN workflows, and close monitoring of Congressional updates. For stakeholders in Medicare Advantage, ACA, and Medicaid, these developments ripple out to risk adjustment capture, quality gap closure, and access strategy—reinforcing the importance of hybrid and in-person alternatives where needed. #ValueBasedCare #RiskAdjustment #QualityMeasures #StarsRatings #CareDelivery #PopulationHealth #Telehealth #Medicare #MedicareAdvantage #Medicaid #ACA #CMS #HealthcarePolicy #HealthCareReform

🚨 With the federal shutdown looming, telehealth is once again at the center of uncertainty. The reality is more nuanced than headlines suggest: behavioral health telehealth flexibilities are permanent, some broader waivers are set to expire October 1, and the OBBB’s HDHP/HSA safe harbor is now law for good. In my latest article, I break down: ✅ What’s actually permanent vs. what’s still temporary ✅ How this impacts Traditional Medicare, Medicare Advantage, ACA plans, and Medicaid ✅ What value-based care organizations must do now to protect risk adjustment capture and quality gap closure 👉 Read my article where we break this down and explore the implications of the shutdown to telehealth in depth. This isn’t just about reimbursement—it’s about access, compliance, and performance across programs. 💡 Partner with VBC One Policy changes don’t have to stall your performance. At VBC One, we help health plans, provider groups, and enablement vendors translate shifting regulations into actionable strategies for: 💫 Risk adjustment capture 💫 Quality gap closure 💫 Compliance & delegated oversight 💫 End-to-end MSO support 👉 Connect with us today to future-proof your operations: 📨 info@VBCOne.com | 🌐 www.VBCOne.com #Telehealth #ValueBasedCare #Medicare #MedicareAdvantage #Medicaid #ACA #RiskAdjustment #QualityMeasures #HealthEquity #HealthcarePolicy #DigitalHealth #HealthPlans

🎧 Dr. Shannon I. Decker, PhD., MBA, MBA, M.Ed., M.Ed., healthcare leader and value-based care expert, joins Insurance 360 to unpack the massive shift transforming Medicare and the insurance industry. 🎙️ Don’t miss this episode: https://lnkd.in/egYDSBJS From star ratings and compliance to CSNP growth and CMS’s 2030 mandate, we’re diving into what value-based care really means for agents, brokers, and the clients they serve. Dr. Decker breaks down how prevention, quality, and cost management are shaping the future — and why now is the time for agents to adapt and lead. #Insurance360 #ValueBasedCare #Medicare #CSNP #DSNP #HealthcareInnovation #InsurancePodcast #Podcast #FMOTraining #InsuranceAgent #InsuranceBroker #IndependentAgents #AgentTraining #InsuranceIndustry #AEP2026 #Healthcare

RADV Extrapolation Vacated: The Eye of the Storm, Not the End of It The recent court ruling striking down CMS’s 2023 RADV Final Rule on extrapolation feels like relief — but in truth, it’s just the eye of the storm. The court faulted CMS’s treatment of actuarial equivalence and elimination of the FFS adjustor. That misalignment toppled the rule, but it didn’t end audits or eliminate future extrapolation. This is a lull, not a victory. The winds will circle back. CMS will regroup, and scrutiny of Medicare Advantage payments will continue. So what now? 🌐 Rebuild documentation quality & provider training 📊 Model downside financial scenarios with extrapolation back in play 🛡️ Align governance, reserves & oversight 🚀 Pilot innovations in care delivery & analytics during the calm The calm eye is temporary. The smart orgs will reinforce during calm skies so they don’t get swept when the next wave hits. VBC One helps plans & provider groups reinforce documentation, stress-test financials, and pilot innovations now — so you’re ready when the winds return. #RADV #HCC #CMS #MedicareAdvantage #RiskAdjustment #HealthplanOperations #HealthplanLeadership

📰 Today’s CMS MLN Connects Newsletter highlights a critical issue: duplicate enrollment across Medicaid and the ACA Marketplace. CMS found that: 🩺 2.8 million Americans may be dually enrolled (either in multiple states’ Medicaid/CHIP programs or in both Medicaid and subsidized Marketplace plans). 🩺 This creates up to $14 billion in waste annually — and significant downstream risks. On the surface, this looks like a program integrity and compliance issue. But for those of us in value-based care, it goes much deeper: 👻 Risk Adjustment: Distorted attribution and ghost risk. 💫 Quality & Stars: Inflated denominators compromise measures. ⚡ Financial Exposure: Retroactive reversals and clawbacks can derail risk contracts. 😩 Operational Burden: Staff confusion, denied claims, disrupted continuity of care. CMS is tightening eligibility rules, enhancing data matching, and pushing states to clean up duplication. The question is: are health plans, risk-bearing providers, and enablement partners ready for the downstream impact? This is another reminder that data integrity is not a back-office task — it’s the backbone of risk, quality, and total cost of care in VBC. How are you preparing your organization for this shift? 👉 The full MLN Connects newsletter is here: https://lnkd.in/gsfJhXfQ #ValueBasedCare #Medicaid #ACAMarketplace #RiskAdjustment #QualityImprovement

COMING SOON: Value-Based Care Isn’t Coming… It’s Already Here. In our latest episode of Insurance 360, Bob and Rob sat down with Dr. Shannon I. Decker, PhD., MBA, MBA, M.Ed., M.Ed. to unpack: ✅ Why value-based care is reshaping Medicare and beyond ✅ How agents & brokers can prepare for the shift ✅ The role of CSNPs, compliance, and quality in this new ecosystem ✅ What it means for patients, providers, and the entire healthcare system If you’re an insurance agent, broker, or healthcare professional, this conversation is a must-listen. 🎧🎙️ Stay tuned here: https://lnkd.in/eNDsBdwY #Medicare #ValueBasedCare #VBC #Insurance360 #CSNP #DSNP # #HealthcareInnovation #DrShannonDecker #insurancepodcast #podcast #insurance360 #medicare #fmotraining #insuranceagent #insurancebroker #independentagents #fmo #medicare #investing #marketing #learnandgrow #agenttraining #insuranceindustry #insurancenews #insuranceadvice #agentresources #pfsinsurance #pinnaclefinancialservices #pfs