Mark sits down with Tom Campanella, President of Campanella Consulting, Professor Emeritus of Health Economics at Baldwin Wallace University, and a former VP of healthcare finance at Blue Cross Blue Shield of Ohio.

At Blue Cross, Tom saw firsthand that no payment model fit rural hospitals, and the plan never built one that did. Today, he’s making the case for a hybrid model that pays for what fee-for-service ignores: the cost of keeping an ER staffed for the nights no one comes in. And he argues the fix doesn’t have to wait on insurers; CMS and the states fund Medicare Advantage and Medicaid managed care, and they could require plans to adopt a rural payment model as a condition of contracting. He also traces how decades of Medicare payment policy pushed physicians out of primary care and independent practices into large systems, and how that left rural working-age adults 43% more likely to die from natural causes. Tom’s message is that a health system is shaped by what you pay for and how you pay for it. Rural America needs a different “how,” and the government already holds the purse strings to demand it.

Connect with Tom on LinkedIn HERE

Apply to be a guest on the show HERE

In this episode of the Regional Hospital Voice, Mark interviews Scott Ellsworth, a former health plan executive who spent 30 years on the payer side, including Market President at Excellus BlueCross BlueShield and President and CEO of Centene's seven-state western region. In 2022 he left the payer side and built a firm that works only for providers, after a health system brought him in to help undo a bad Blue Cross contract.

Scott explains how hospitals can use price transparency data to anchor rate requests and why he targets the 75th percentile of the market. He lays out the payer playbook of “start late, go slow, run the clock out.” He describes how dropping the bottom half of Medicare Advantage plans can lift yields by 200 to 300 basis points, and shares his view on why value-based contracts favor payers.

Scott’s message to hospital leaders is that every hospital has leverage. The key is knowing how to use it.

Learn more about Scott's work HERE

Connect with Scott on LinkedIn HERE

Apply to be a guest on the show HERE

In this episode of the Regional Hospital Voice, host Mark Craig speaks with Marc Mertz, CEO of Kaweah Health in Visalia, California.

Mertz discusses the mounting pressures facing regional hospitals, including surging emergency department volumes, nursing shortages, and the devastating financial impact of Medicaid cuts under H.R. 1, projected to cost Kaweah $40 million annually. He highlights innovative solutions like launching an in-house nursing school, reducing vacancies from 270 to under 60. Mertz also addresses unfunded state mandates, OB care deserts, and his commitment to community health, emphasizing that sustainable Medicaid reimbursement is critical to keeping regional hospitals operational.

Learn more about Marc's work at Kaweah Health HERE.

Connect with Marc on LinkedIn HERE.

Apply to be a guest on the show HERE.