In this episode, Jim Burke and Steve Pratt discuss the intricacies of Value-Based Enterprises (VBEs) in healthcare, focusing on their regulatory framework, key components, and practical applications. They explore the differences between Stark Law and AKS Safe Harbor, the importance of risk models, and how to effectively engage physicians in these initiatives. The conversation also highlights common mistakes in implementing VBEs and emphasizes the need for credible data and physician leadership to ensure success.
In this episode of How Health Systems Work, hosts Jim Burke and Steve Pratt sit down with Gwen Sandifer, interim president at Henry Ford Genesis Hospital and founder of Loud Minds. Gwen brings over 25 years of experience in healthcare administration and a deeply personal perspective shaped by her upbringing in a small rural town.
She shares powerful stories—from a near-paralyzing injury in high school to her mother’s struggles accessing mental health services—that inspired her mission to improve healthcare systems. Gwen discusses how the sector has evolved, what’s stayed the same, and why relationships and real conversations remain at the core of progress.
We dive into everything from the loss of informal collaboration spaces to the challenge of truly centering the patient in a fragmented system. Gwen offers bold ideas for healthcare transformation, including radically shifting incentives to put consumers in control of their care. Her perspective is rooted in deep compassion, operational experience, and a clear-eyed view of what’s not working.
In this episode of How Health Systems Work, Jim Burke and Steve Pratt are joined by Andrew Dick, a healthcare real estate attorney with 18 years of experience helping hospitals and health systems navigate complex property decisions.
Andrew breaks down why real estate strategy is no longer just about buildings—it’s about survival. From the explosive growth of ambulatory surgery centers (ASCs) to the shifting role of nonprofit ownership, Andrew explains how health systems can strengthen their financial position, improve patient access, and avoid costly pitfalls.
The conversation explores:
Why ASCs are transforming care delivery and hospital margins
How partnerships, acquisitions, and management companies can help health systems adapt
What health systems should know about property tax risks and pilot agreements
How nonprofit foundations can help structure smarter real estate deals
Why health systems need to critically assess what they own, what they lease, and how they use it
Whether you’re a healthcare executive, board member, or operations leader, this episode offers practical guidance on using real estate strategy as a tool for resilience and growth.
In this conversation, Dr. Larry Bucshon shares his extensive experience in healthcare, discussing the evolution of payment systems, the impact of government regulations, and the importance of collaboration between physicians and hospitals. He emphasizes the need for alternative payment models, the role of data in improving healthcare quality, and the unique challenges faced by rural healthcare. Dr. Bucshon also highlights the significance of physician leadership in reform discussions and the implications of immigration policies on the healthcare workforce. The conversation concludes with insights on the path forward for healthcare reform, focusing on transparency, regulatory review, and consumer involvement.
In this episode, Jim and Steve talk with James Junger, a healthcare attorney at Hall Render who works with hospitals and health systems to strengthen their operations through strategic compliance and data-driven decision-making.
Drawing from his work with safety-net providers, James explains how health systems can better leverage programs like 340B and provider-based rural health clinics, not just for compliance, but as essential tools for sustainability. He discusses how claims data, payment analysis, and regulatory alignment can uncover new opportunities for financial stability in even the most resource-limited environments.
This is a practical, insight-packed episode for healthcare leaders working to make every dollar count while staying mission-aligned.
In this episode, Jim and Steve sit down with Bain Farris, a veteran healthcare executive with decades of leadership experience across hospitals, health systems, and payers. Bain shares what he learned over a career spent building stronger partnerships between hospital leadership and physicians—and why real engagement is key to meaningful change.
From the early days of physician-hospital collaboration to today’s push toward ambulatory and home-based care, Bain discusses what’s worked, what hasn’t, and what future leaders need to understand about how healthcare delivery is shifting. Along the way, he reflects on the transition from hospital-centered care to a more distributed system and how systems must adapt if they want to stay relevant.
If you’re leading or working inside a healthcare organization today, Bain’s stories and insights offer lessons that are as relevant now as ever.
In this episode, healthcare attorney Mike Greer from Hall Render joins the show to help health system leaders understand how federal antitrust enforcement is shifting—and what it means for provider networks, hospital partnerships, and managed care contracts.
With deep experience advising systems, hospitals, and physicians, Mike breaks down the key changes happening at the FTC and DOJ, including the withdrawal of prior guidance, the use of new merger guidelines, and what triggers scrutiny in today’s regulatory climate. He also unpacks how clinical integration, managed care contracting, and network formation can be structured to avoid antitrust violations while still achieving strategic alignment.
Whether you’re working on a CIN, PHO, or MSO—or just trying to make sense of what’s safe to build—this conversation delivers clear, grounded insight on how to move forward without stepping into legal risk.
In this episode, Jim and Steve talk with Anthony Long, partner at Pinnacle Healthcare Consulting, about one of the most critical challenges facing healthcare organizations today: the growing disconnect between system leadership and frontline teams.
Anthony shares what he’s seeing inside hospitals and health systems across the country—from strained physician relationships and stagnant strategies to the gaps in communication that derail progress. He makes the case for shared governance, stronger physician engagement, and the kind of operational discipline that turns big goals into practical results.
Drawing on decades of experience in value-based strategy, cost reduction, and system redesign, Anthony offers a candid, practical look at what’s holding health systems back—and what it will take to move forward.
In this episode, healthcare attorney Amy Mackin joins us to unpack what’s changing in the world of healthcare contracting. From shifting payer dynamics to negotiating under tighter regulatory scrutiny, Amy offers practical insights for health systems and providers navigating today’s complex environment.
Amy Mackin’s practice focuses on healthcare regulatory law for hospitals, health systems, clinical laboratories, and other providers. She brings deep expertise in managed care contracting, advising providers on negotiations with both commercial and governmental health plans. Her work spans reimbursement models like capitation and pay-for-performance, contract disputes, out-of-network transitions, and compliance with fraud and abuse laws, privacy regulations, EMTALA, and more. She also regularly advises on physician contracting and professional service agreements.
Whether you’re in legal, strategy, or operations, this episode will sharpen your understanding of what it takes to negotiate and manage healthcare contracts in today’s evolving landscape.
This podcast episode features a discussion on the evolving landscape of healthcare, focusing on the importance of quality in patient care and the challenges of aligning physician incentives with quality goals. The guests share insights on how healthcare delivery is influenced by reimbursement policies and the need for a collaborative approach to improve patient outcomes. In this conversation, Brian Betner discusses the critical gaps in clinical leadership and the importance of understanding success and failure in quality initiatives. He emphasizes the need for cultural change within healthcare organizations and the role of Value-Based Enterprises (VBE) in redefining physician engagement. The discussion also highlights the significance of actionable data in quality improvement and looks ahead to the future of healthcare, focusing on the evolving expectations of patients and the necessity for healthcare systems to adapt.
In this episode, we introduce Steve Pratt, co-host of How Health Systems Work. Steve shares his perspective on the evolving landscape of healthcare, from shifting payment models to the challenges and opportunities ahead for hospitals and providers. Join us as we set the stage for what’s to come—real conversations, expert insights, and a deep dive into how healthcare systems navigate change.
In this introductory episode of 'How Health Systems Work', host Jim Burke outlines the purpose and vision of the podcast, emphasising the importance of sharing insights from leaders in the healthcare sector. He discusses his background in healthcare consulting and leadership, and the need for innovative ideas to address the challenges facing health systems today. The podcast aims to provide listeners with practical stories and strategies from industry leaders, fostering a community of change-makers in healthcare.
