CMS is moving tens of billions of dollars into every state to stabilize rural healthcare heading into 2026—not through across-the-board rate increases, but through targeted investments in workforce, technology, care coordination, and alternative payment models.

In this episode, Alex Yarijanian breaks down what the Rural Health Transformation Program / Rural Health Fund (RHTF) actually is, what state strategies reveal about the future of rural access, and why this matters far beyond rural hospitals—impacting payer strategy, provider contracting, network adequacy, and healthcare economics.

You’ll hear key highlights from state plans including California, Texas, Florida, New York, and Illinois, plus the cross-state themes showing up everywhere: hub-and-spoke models, shared services, EMS reform, telehealth hubs, and AI-driven admin reduction (including automated fax processing).

1. What the Rural Health Transformation Program actually is
2. Why this funding wave is different (state plans are concrete and approved)
3. What state strategies reveal about access risk + reimbursement limits
4. How payers should interpret this as a network adequacy / access signal
5. Why providers should see this as both opportunity + accountability shift

California

1. Hub-and-spoke maternal + specialty access models
2. Example of rate + infrastructure working together (Health Plan of San Mateo specialty rate increases)

Texas

1. Technology as a force multiplier
2. AI-enabled specialty access, telehealth coordination, clinically integrated networks
3. Tech becomes a parallel lever to reimbursement in high-dispute markets

Florida

1. Remote patient monitoring (RPM) + community paramedicine
2. Utilization management upstream in MA-heavy environments

New York

1. Patient-centered medical homes + workforce pipelines
2. Care coordination over unit cost expansion in concentrated payer markets

Illinois

1. Integrated primary + behavioral health infrastructure
2. EMS treat-not-transport models
3. Alternative models as a response to inflation vs lagging rates

1. Hub-and-spoke models are returning at scale
2. Shared services (centralized EHR, billing, analytics) to reduce admin burden
3. AI...

While most providers are waiting on CMS, payers are already narrowing networks and rewriting delegation terms.

Payers are quietly narrowing networks and rewriting delegation expectations. This playbook explains how to do business with MA business for 2026.

If you’re waiting, you’re already reacting—not positioning.

In this episode, Alex Yarijanian breaks down what’s actually showing up in payer conversations right now, long before final CMS rules are published. Drawing from real contracting, network, and delegation discussions, Alex explains why waiting for regulatory clarity is already costing providers and health tech companies leverage.

You’ll hear how payer priorities have shifted from enrollment growth to margin durability, why network narrowing is accelerating quietly, how delegation has become a stress test, and what “value-based care” really means in Medicare Advantage today.

This episode also outlines who is most at risk heading into 2026, the three types of organizations positioned to win, and what provider and health tech leaders should do in the next 90 days to stay relevant.

Who should listen: Provider executives, payer leaders, value-based care operators, and health tech founders navigating Medicare Advantage.

A federal jury has convicted the founders of Done, one of the fastest-growing telehealth companies in the stimulant-prescribing space, for orchestrating one of the largest Adderall distribution and fraud schemes in U.S. history. More than 40 million stimulant pills, over $100 million in revenue, and a business model engineered around speed, volume, and automated prescribing — all built with no real clinical guardrails.

In this episode, host Alex Yarijanian breaks down not only what happened, but what this case means for the entire digital health ecosystem, especially behavioral health and companies prescribing controlled substances. When a company like Done collapses — and its founders now face up to 20 years in federal prison — it doesn’t just take itself down. It drags trust, access, and payer willingness down with it.

Alex outlines how this case will reshape:

• Payer contracting and credentialing
• Prescribing oversight and compliance expectations
• Trust in telehealth platforms
• The future of value-based behavioral health
• Why incentives — good or bad — always scale

And most importantly, he explains why value-based care is the antidote to the shortcuts and misaligned incentives that fueled this scandal.

If you’re building, funding, regulating, or partnering with telehealth organizations, this is a must-listen.

Takeaways:

• The case of the telehealth startup highlights the critical importance of clinical oversight in health services.
• Payers are likely to impose stricter regulations on telehealth providers following recent fraudulent activities.
• Building a sustainable healthcare model requires prioritizing patient interests over profit maximization strategies.
• The future of digital health will hinge on trust, necessitating alignment between clinical and business models.