The Disrupted Podcast: Recent Episodes
James Preston, Scott Middleton
Entrepreneur and Chief Disruption Officer Scott Middleton share's his experiences of how he uses disruption to innovate and keep an organization moving forward and growing. Scott shares these weekly stories on The Disrupted Podcast with Scott Middleton.
Most nursing home administrators don't realize they're sitting on one of the most underutilized revenue streams in all of Medicare — and until someone shows up and tells them what it's worth, they never will.
In this episode, Scott Middleton — founder and Chief Disruption Officer of Your Health — calls in from the road as he travels across rural Georgia on a multi-day facility tour, fresh off completing a major merger with TCPA. What follows is an unfiltered, on-the-ground breakdown of two transformational opportunities Scott is actively building: chronic care management (CCM) reimbursement and ACO cost savings — and the very specific reasons most of the industry is getting both wrong.
In this episode, you'll hear:
- Why Medicare already pays $65/hour for care management performed by nurses, community health workers, and social workers — and how Your Health is now contracting with nursing home facilities to perform it, paying them up to $100 per patient per month
- The "Fuse" platform — a communication and documentation tool that routes care management notes directly into billing-ready buckets, syncing with point-of-care software so the minutes get captured and billed automatically
- How ACO risk scores work, why Your Health's scores have grown 30% under their current plan, and what failing to see hospice patients could cost the organization — up to $22 million in a single year
- The $4,800 per patient per year problem: how one physician in their network was quietly rated one of the worst under the ACO model simply because his patients were going home without any follow-up
- Scott's announcement that SSAs and TCPs are being restructured to report directly to peer group administrators — and why the confusion about their roles has cost the company
If you lead a nursing home, an assisted living facility, a physician group, or any organization inside the long-term care ecosystem, this episode will change how you look at what you're already doing — and what you're leaving behind.
www.YourHealth.Org
What does it look like the day a healthcare merger closes — not in a press release, but in real life? Scott Middleton was still signing DocuSign documents from his car when Jamie Preston hit record, and what followed is one of the most honest conversations yet about what it takes to grow a healthcare organization without losing the soul of why you started.
Scott Middleton, Owner of Your Health and Chief Disruption Officer, joins the show to break down the just-completed acquisition of TCPA and Providence Care — and what it means to suddenly be responsible for 32 nursing home buildings, 900 new patients, and the enormous operational lift of pulling it all together under one roof.
In this episode, Scott and Jamie cover:
- Why Your Health is immediately deploying two nurses and two community health workers per building — and how the revenue model makes them essentially self-funding from day one
- The continuous care hospice strategy: how night nurses on call can simultaneously generate $67/hour in Medicare reimbursement and ensure no patient dies alone
- The critical failure Scott discovered — hospice patients who haven't been seen by a provider since January, and the financial and human cost of letting that slide
- Why strategic planning lives in the field, not the boardroom — and what happens when leaders stop getting out from behind their desks
- The 30-day integration sprint: switching all providers to Athena, connecting hospice nurses to nurse practitioners, and getting risk scores captured before it's too late
This is what disruption actually sounds like — not a keynote, not a case study, but a leader in motion, making decisions in real time, building something the healthcare system has never seen. If you're in healthcare, business, or just believe the way things have always been done is not good enough — this one's for you.
www.YourHealth.Org
What if the most powerful growth strategy in hospice and primary care had nothing to do with your clinical protocols, your technology stack, or your marketing budget — and everything to do with who shows up, and how often?
In this episode of The Disrupted Podcast, Scott Middleton — founder and Chief Disruption Officer of Your Health — unpacks the real-world lessons shaping how your Health is staffing, growing, and rebuilding trust as it integrates the newly merged TCPA and Providence Care organizations. Scott spent the week in the field — Monroe, Georgia; Beaufort, South Carolina; Atlanta and beyond — sitting in care team meetings, talking to nurses, watching exercise classes, and rethinking everything from staffing ratios to personality matching. What he found is both a warning and a blueprint.
In this episode:
- Why minor service failures — a nurse who didn't show up once — can cost you an entire facility relationship, and what it actually takes to earn it back
- The strategic case for pulling a nurse off a shared caseload and planting her full-time in a single building — even when the numbers don't fully justify it yet
- The story of a nurse so embedded in one facility that an administrator told Your Health: "I will cut you if you move her"
- How DISC personality profiles should determine which staff member walks into which building — and why getting it wrong creates friction that kills referrals
- Why the best talent you'll ever hire is already living in the community you serve — and why your recruiters will never find them on Indeed
- The centralize-then-decentralize model Your Health deploys every time it launches something new — and why it's the only way to scale without losing quality
If you lead a care team, run a hospice program, manage a building, or are trying to grow in any direction in healthcare right now — this episode is your field guide.
www.YourHealth.Org
What if the reason your boss wants you in the office has nothing to do with your productivity — and everything to do with their ego? Scott Middleton admits it: he walked around his 30,000-square-foot corporate office on a Friday afternoon, found nobody, and got irritated. Then he caught himself. The data said his team was productive. The irritation was his ego talking.
That moment of self-awareness opens a much bigger conversation about what happens when leaders — in business and in healthcare — stop reading the evidence and start acting on assumption. In this episode of The Disrupted Podcast, Scott and Jamie dig into:
- Why most CEOs pushing return-to-office mandates are solving for ego, not outcomes — and the New York Times data that proves it
- How Your Health is shifting from counting patients to measuring risk scores — and why that changes everything about how care teams are built
- The "legs grow back on January 1st" problem: how the Medicare system loses patient diagnoses every year and why hospice patients often appear healthier right before they die
- Why misinterpreting hospice rules is putting patients on the wrong track — and costing providers in ways they don't see coming
- The role of chaplains in advanced care planning, and why getting that right could reduce hospitalizations and change end-of-life outcomes
- South Carolina's jump from 49th to 26th in healthcare quality rankings — and what it means for the rest of the country
Scott closes with a mission statement that's hard to argue with: at 67, he could have retired. He didn't. If this conversation lights something up in you, share it with someone who needs to hear it.
www.YourHealth.Org
What happens when the rules everyone follows weren't actually rules to begin with?
In this episode, Scott Middleton — Owner of Your Health and Chief Disruption Officer — shares what he's seeing on the ground as the TCPA and Providence Care merger moves toward its final close. But the real conversation goes deeper: the quiet, dangerous habit of staff making up policies, enforcing phantom restrictions, and defaulting to "no" when the answer should have been "let's figure it out."
Key topics covered:
- Why fabricated rules (like requiring a psych NP referral for talk therapy) become embedded in organizations — and how to stop it
- How Scott is approaching the merger with radical transparency, and why "don't tell until it's done" has no place in his culture
- The one thing that will get you fired fast: "don't tell Scott"
- What TCPA's nursing home model is teaching Your Health about patient frequency, hospitalizations, and what actually works
- Why the chaplain conversation changed Scott's entire philosophy — and how advanced care planning pays for it
The system doesn't need more rules. It needs more people willing to ask. Listen now and ask yourself: what rule in your organization did somebody just make up?
www.YourHealth.Org
What if the patient you discharged three years ago is still costing you money today? In this episode of The Disrupted Podcast, Scott Middleton pulls back the curtain on the mechanics of value-based care most providers never see — and the merger bringing it all into focus.
With the July 15th closing date approaching, Scott walks through what the merger of Your Health with TCPA and Providence Care actually means on the ground: new contracts, new provider numbers, a reimbursement model built on RAF scores and revenue rather than guesswork, and a technology stack — from the Clini app to QR-coded patient wristbands — designed to capture what was previously left on the table.
In this episode:
- Why patient attribution under value-based contracts follows you for years — and what hospice discharges are really costing the organization
- How the new bonus structure ties pay to billing, RAF scores, and quality measures (and why you can never be paid to put someone on hospice)
- The difference between care management, facilitated visits, and what providers have been under-billing all along
- How skilled nursing facilities became the highest-leverage opportunity in the entire model
- Why advanced care plans aren't just clinical — they're a 30% income increase hiding in plain sight
If you've ever wondered why the "why" behind a process matters more than the process itself, this episode is the answer. Press play.
www.YourHealth.Org
What if the fastest way to grow your healthcare organization is to slow down? In this episode of The Disrupted Podcast, Scott Middleton returns from Scotland straight into the thick of a merger — and what he's learning is reshaping how he thinks about change itself.
Scott takes us inside the integration of TCPA and Providence Care into Your Health, where two very different models are colliding. One organization built 640 billing codes last year; the other built 40. One puts a single nurse practitioner in a building with no support; the other surrounds providers with nurses and community health workers. The opportunity is enormous — but so is the risk of moving too fast and scaring everyone away.
What if the fastest way to grow your healthcare organization is to slow down? In this episode of The Disrupted Podcast, Scott Middleton returns from Scotland straight into the thick of a merger — and what he's learning is reshaping how he thinks about change itself.
Scott takes us inside the integration of TCPA and Providence Care into Your Health, where two very different models are colliding. One organization built 640 billing codes last year; the other built 40. One puts a single nurse practitioner in a building with no support; the other surrounds providers with nurses and community health workers. The opportunity is enormous — but so is the risk of moving too fast and scaring everyone away.
In this conversation, Jamie and Scott explore:
- Why a nurse practitioner alone is a "single source of failure" — and how staffing changes everything
- How to enter a building without threatening the provider they already love
- Why billing isn't bureaucracy — it's how Medicare knows you made a difference
- The art of giving people what they think they need now, and the rest over time
- Advanced care planning, DNRs, and why the right message sometimes needs a different voice
This is a masterclass in change management disguised as a healthcare conversation. Listen now — and rethink what "disruption" really requires.
- Why a nurse practitioner alone is a "single source of failure" — and how staffing changes everything
- How to enter a building without threatening the provider they already love
- Why billing isn't bureaucracy — it's how Medicare knows you made a difference
- The art of giving people what they think they need now, and the rest over time
- Advanced care planning, DNRs, and why the right message sometimes needs a different voice
This is a masterclass in change management disguised as a healthcare conversation. Listen now — and rethink what "disruption" really requires.
www.YourHealth.Org
It was 3 o'clock in the morning when Scott Middleton finally signed the papers. The merger was official. And within days, he was already on the road — visiting facilities, riding along with providers, and spotting the same gap everywhere he went: brilliant clinicians doing real work that was completely invisible to the system.
In this episode of The Disrupted Podcast, Jamie sits down with Scott Middleton, calling in from Boston, to unpack what he's discovering on the ground in the newly merged Your Health organization — and why tracking your time isn't about paperwork. It's about protection, proof, and getting paid for every minute of care you're already delivering.
What you'll hear in this episode:
- The Dr. Jeeve story: a high-producing doc who managed a nursing home crisis by phone, saved a patient from an unnecessary ER visit — and never billed for it, leaving Medicare with no record of his intervention
- Why not documenting a visit before a hospitalization doesn't just cost you revenue — it makes you look like a bad provider, even when you did everything right
- How insurance companies like United Healthcare boldly take 15% off the top of every healthcare dollar — and why that math means providers can't afford to give their time away for free
- The TCPA pattern Scott keeps seeing: 15,000–18,000 visits a month, almost entirely in nursing homes, with zero follow-up once patients go home
- The new post-discharge standard: every patient leaving a nursing home gets a telehealth visit within 48 hours, then weekly follow-up for four weeks — no one gets left in the gap
This episode is a masterclass in understanding that documentation isn't bureaucracy — it's how you tell your story, protect your reputation, and keep the care you've already given from disappearing.
www.YourHealth.Org
What does it actually cost when a doctor writes a verbal order over the phone instead of seeing the patient? Scott Middleton has the receipts — and the answer is going to make you rethink everything about how American healthcare spends its money.
In this episode of The Disrupted Podcast, Scott announces a landmark three-way merger bringing Your Health together with Transitional Care Professionals of America (TCPA) out of Georgia and Providence Care, a hospice organization in South Carolina. The combined organization will serve approximately 55,000 active patients — not patients on a list, but people being seen regularly — and Scott lays out exactly how he's going to run it.
What you'll hear in this episode:
- Why Scott's family owning 80% of the merged company changes everything about how decisions get made — and who they get made for
- The difference between fee-for-service and value-based care, and why the ACO model means every unnecessary hospitalization literally comes out of Your Health's pocket
- How Your Health's risk-adjustment-based visit model (16 visits per year per risk point) was independently validated by a new government study — and why it works
- The three things Scott is asking every new employee to do in the first weeks: align with a nurse practitioner, track every minute of care management, and recruit like their livelihood depends on it — because it does
- Why Scott's new management philosophy is six words: "Keep them out of the hospital and see your damn patients"
This isn't a corporate announcement. It's a playbook for how healthcare can actually work when operators run the company, providers see their patients, and every minute of care gets counted.
www.YourHealth.Org
Most organizations will tell you their people are their greatest asset — then build compensation systems that prove they don't believe it.
In Part 2 of this conversation, Scott Middleton — owner of Your Health, founder, and Chief Disruption Officer — gets honest with Jamie Preston about what it actually takes to build, pay, and keep the team an administrator is going to lead.
In this episode:
- Why "can I have a raise?" is the wrong conversation — and what apprenticeship-based compensation solves
- How a nurse practitioner can quietly hit $200K by working the bonus structure the right way
- The math behind every hire: why every team member costs roughly $10,000 a month — and how to pay for yourself
- The 5,000-patient hospice gap no one wants to talk about — and what it's costing families
- Why every hospice patient gets a custom plan, not a copy-pasted template
- The DISC profile Scott looks for in administrators — and why it's not what you'd guess
- The honest state of hiring: 30 care groups, growing, and actively recruiting
If you lead people, hire people, or are thinking about stepping into healthcare leadership — this is the episode where the economics get real.
www.YourHealth.Org
Most healthcare organizations wait until they're drowning to add administrative support. Your Health is doing the opposite — and it's changing the math on what a primary care practice can actually deliver.
In Part 1 of this two-part conversation, Scott Middleton — owner of Your Health, founder, and Chief Disruption Officer — sits down with Jamie Preston to unpack why a dedicated administrator is now sitting beside the executive director of clinical services at every care group. With hospice added to the model, a single care group can now be responsible for more than 80 staff members across four care teams — bigger than most medical organizations in the country. Asking a nurse to run that alone was breaking people and burying clinical judgment under scheduling concerns.
In this episode:
- Why the care group exploded overnight — and what hospice changed about staffing ratios
- What the administrator does on Monday morning before the clinical team even looks at the dashboard
- The Bridget story: how a "we're not allowed to do one-on-ones" response nearly cost a dementia patient her home
- Why "what could we have done today" is the wrong question — and what to ask instead
- How fee-for-service quietly incentivizes the wrong decisions at the hospital level
- The team structure every administrator now sits inside: nurse, HR, marketing, engagement
If you've ever wondered what's actually supposed to stand between a great clinician and burnout, this is it.
www.YourHealth.Org
What if the people case-managing your care had a financial reason to keep you sicker? That's the uncomfortable question Scott Middleton puts on the table in this episode — recorded live from the American Case Managers Conference in Orlando, where Scott went to learn, and ended up being told Your Health didn't "fit" because they weren't a hospital.
Jamie and Scott unpack what the nurse case manager role actually looks like at Your Health — and why moving case management out of hospitals and into patients' homes isn't just better care, it's better economics. Scott shares the research proving the model works: 50% reduction in Medicare spend when patients are seen at the right frequency by the right people.
In this episode:
- Why hospitalists may be "the demise of the American healthcare system"
- The difference between nurse practitioners (diagnose and treat) and nurse case managers (assess and guide) — and why blurring them costs patients
- The 16.05-visits-per-risk-point model David Clemens' research validated
- How coding departments are quietly diagnosing patients with diseases they don't have
- Why Medicare's 6-year insolvency window may be the disruption we need
- Head-to-toe assessments, delegation rights, and the real job of an RN in the home
If you've ever suspected the system is working exactly as designed — just not for the patient — press play.
www.YourHealth.Org
What if the reason healthcare teams burn out isn't the workload — it's the org chart?
On this episode of The Disrupted Podcast, Jamie and Scott, break down the evolution of The Care Group Model — and why the instinct to build a "separate hospice team" is exactly the wrong move. Scott walks through what a true care team looks like when nurse practitioners, nurses, community health workers, social workers, chaplains, and triage nurses are orchestrated around the patient — not siloed around a diagnosis.
Inside the episode:
- Why adding hospice to existing care groups beats building a parallel hospice division
- The new non-clinical "administrator" role Your Health is rolling out — and why every nurse needs one at their side
- Using DISC assessments to build teams that actually function (and why nurses aren't the same personality type)
- How mutual accountability and group-based bonuses fix the "don't bill too much CCM" problem
- Why matching a chaplain to a patient's faith tradition matters more than checking the box
- The $110 million Medicare savings story the industry still doesn't understand
If you lead a clinical team, run an operation, or care about what healthcare could look like when it's built around people instead of paperwork — press play.
www.YourHealth.Org
A man is dying — literally in his last hour, the death rattle audible — and the hospital team arrives to take him for a radiation treatment. His family had no idea. No one had told them. No one had started the conversation. This is not a rare exception. This is what happens when social services is treated as an afterthought.
In this episode of The Disrupted Podcast, host Jamie Preston and Scott Middleton, Owner and Chief Disruption Officer of Your Health, go deep on one of the most overlooked levers in healthcare — social services. From the social determinants that drive healthcare costs more than healthcare itself, to the care team structures Your Health is building to close the gap, this is a candid, unfiltered look at what's broken, what's possible, and what it actually costs when we don't act.
What you'll hear in this episode:
- Why social determinants of health — food access, medication literacy, housing instability, social isolation — are the real drivers of healthcare spending, and why most systems still ignore them
- The truth about advanced care planning: why it's quietly dropping, why every patient within two to three years of death needs that conversation, and the story of Janet Denino's cousin that makes the cost of silence impossible to ignore
- How the mental health stigma is shifting generationally — and how telehealth, AI-assisted tools, and a smarter therapy cadence are changing who actually gets support
- The billing math behind 280,000 possible care management hours that were built down to 110 — and why that gap isn't just a business problem, it's a human one
- What it actually takes to build a social services program that works: the right roles, the right ratios, and why getting out to see patients is non-negotiable
The system won't fix itself. But the people in it can. This episode shows you how.
www.YourHealth.Org
In this episode of The Disrupted Podcast, Jamie and Scott have a raw, specific, and deeply personal conversation about Care Managers: who they are, what they're actually supposed to do, and why getting this role wrong is costing patients their health and organizations millions of dollars.
Scott opens with a story that hits hard: his 91-year-old father's recent hospitalization, the mistakes that nearly happened, and what it cost him — financially and emotionally — to navigate a system that wasn't built for the patient.
What you'll hear in this episode:
- Why care managers are controllers, not schedulers — and what happens when organizations get that wrong
- The medication reconciliation crisis: how discharge errors are sending patients straight back to the ER
- How Your Health's new geographic mapping tool is transforming how care teams schedule 30 days of visits in advance
- The shared bonus model designed to stop care team members from fighting over visits — and start winning together
- What care managers should never be doing — and the analytical skill set that separates great ones from average ones
If you're building care teams, leading a healthcare organization, or just trying to keep a loved one safe in a broken system, this episode will change how you think about the people standing between your patients and the hospital.
www.YourHealth.Org
What if the most powerful person on your care team isn't a nurse, a doctor, or a specialist — but someone showing up at 8:00 AM to check blood pressure, eat lunch with residents, and play vital signs bingo?
In this episode, we go deep on the Community Health Worker role: what it is, what it isn't, and why most organizations are dramatically underusing it. Scott pulls no punches on the disconnect between what CHWs are doing and what they should be doing — and why the difference is costing patients their health and workers their bonuses.
What you'll hear in this episode:
- Why the #1 complaint about CHW visits ("you're seeing our patients too much") is actually a communication failure, not a frequency problem — and how to fix it
- The specific visit types every community health worker should be scheduling: vital signs, medication reconciliation, lab draws, wound care, advanced care plans, and more
- How Mary White, a CHW in Gainesville, Georgia, goes in with 5 patients on her list and leaves having seen 15 — and what her approach reveals about what this role is really for
- Why buildings that aren't growing have either the wrong person or not enough people — and how to think through both
- The full compensation breakdown: base salary, guaranteed bonus, and how the right CHW can earn close to $80,000 a year
If you hire, manage, or are a community health worker, this episode will reshape how you think about the role. Hit play.
www.YourHealth.Org
What does it actually take to say yes in healthcare when the system is wired to say no?
In this episode of The Disrupted Podcast, Scott takes you straight into the field — from a brand-new administrator in Marietta, Georgia who's already revolutionizing her building eight days in, to a 190-patient facility in Charleston where the real conversation isn't about hospice referrals, it's about whether you have the staff to back it up.
Scott gets honest about the moments where healthcare organizations talk a big game but fold when it matters — refusing acute visits to non-panel patients, locking providers into rigid workflows, and hiring bodies instead of talent. He challenges all of it. And he does it with the kind of clarity that only comes from someone who's actually in the buildings, at the dinner tables, and on the phone doing the hard work every day.
From a nurse who deserves a Tesla to a wristband that could change emergency response forever, this episode is packed with real stories, bold ideas, and a simple but radical belief: that getting to the yes isn't just good business — it's the whole point of healthcare.
If you're a provider, administrator, nurse, or healthcare leader who's tired of the way things have always been done, this one's for you.
www.YourHealth.Org
Healthcare didn’t get expensive because patients got worse — it got expensive because the system got fragmented. In this episode of The Disruptive Podcast, Scott Middleton breaks down why hospice can’t live “over there,” separate from primary care, nursing, therapy, and care management.
Scott explains the Your Health Hospice rollout, the staffing reality that determines whether integration is real, and the math behind a new model: caseload reductions for nurses when hospice patients are added, plus incentives that acknowledge the complexity of end-of-life care.
This conversation is about building a care system where the patient doesn’t have to juggle providers, phone numbers, and handoffs — because they shouldn’t have to. One team. One plan. One umbrella.
www.YourHealth.Org
In this episode, Jamie and Scott discuss a simple leadership posture that changes outcomes: default to “yes” when it protects patients—then solve the obstacles. Scott shares real examples from winter-storm outreach, hospice and palliative care misconceptions, and operational “rules” that block care (often driven by language, software, or habit—not true limitations). They dig into how patient-centered thinking, clearer communication (ditch the acronyms), and smarter systems—like a new mapping tool—can drive more visits, better coordination, and better results.
www.YourHealth.Org
In this episode of The Disrupted Podcast, Scott Middleton returns from the JP Morgan healthcare conference with a blunt takeaway: the future of care is not a magic pill, another telehealth platform, or a clever financial structure — it’s showing up. Scott breaks down why healthcare has become unnecessarily complicated, how fee-for-service incentives distort decision-making, and why “easy-entry” models won’t hold up long-term.
He makes the case that Your Health’s home-based care model is hard to replicate because it requires operational excellence—routing, scheduling, team coordination, and intentional touchpoints. Scott also challenges internal culture issues: finger-pointing, poor communication, inefficient scheduling, and employees misunderstanding the mission. The solution is both simple and demanding: build systems that make weekly in-person encounters possible for high-risk patients and hold the line on execution.
www.YourHealth.Org
In this first Disrupted Podcast episode of 2026, Jamie and Scott unpack the reality of a new “High Needs ACO” and what it demands from frontline care teams. Scott explains why spending more in primary care reduces total cost, how care management codes are expanding, and why the real win is keeping patients out of the hospital through proactive, consistent engagement.
The centerpiece is a clear operational playbook for facilitated visits: facilitators gather the full story in the home or facility, loop in the provider through audio/video when possible, document in the system, and never delete encounters—because billing isn’t just revenue, it’s the data trail that proves prevention works. The conversation closes with the bigger picture: this isn’t a workflow tweak—it’s a way to reduce hospital dependency, protect families, and help stabilize the healthcare economy.
www.YourHealth.Org
In this episode of The Disrupted Podcast, Jamie and Scott break down what’s really happening inside healthcare facilities—and why the problem isn’t complexity, but misalignment. Through a real-world walkthrough of one provider’s experience, Scott unpacks the Facility Model, explaining how proper staffing, proactive care, and smarter use of hospice, telehealth, and community health workers can radically improve outcomes for patients, providers, and facilities alike. This conversation pulls back the curtain on how healthcare systems unintentionally block good care—and how simple, human-centered adjustments can change everything.
www.YourHealth.Org
In this episode of The Disrupted Podcast, Jamie sits down with Chief Disruption Officer Scott Middleton to unpack what’s really holding healthcare organizations back from sustainable growth — and it’s not demand. From inefficient scheduling and fragmented care teams to missed opportunities in behavioral health, hospice, and regional expansion, Scott lays out a candid blueprint for how ownership thinking, smarter systems, and physical presence in communities can radically improve outcomes.
Through real-world examples, Scott explains how a new map-based scheduling model, regional restructuring into divisions, and empowered frontline teams can increase productivity by 20% overnight — while simultaneously reducing ER visits, hospitalizations, and burnout. The conversation ultimately reframes growth not as a staffing problem, but as a leadership, coordination, and accountability challenge.
www.YourHealth.Org
KEY TAKEAWAYS
- The new ACO model increases funding for high-risk Medicare patients but requires disciplined execution.
- Visits — frequent, short, meaningful ones — are the #1 driver of reduced hospitalizations and better outcomes.
- The target is four visits per patient per month for those with a 2.4–2.8 risk score.
- Current numbers show only 2.5 visits per patient per month — leaving savings and outcomes on the table.
- Facilitators are essential: their job is to start conversations, gather information, and initiate telehealth visits.
- Notes, Mobius recordings, and consistent communication make providers more effective over time.
- Small, weekly touchpoints outperform long, infrequent visits in both outcomes and cost savings.
- Every team member plays a role in preventing hospitalizations and improving patient stability.
www.YourHealth.Org
00:00 – Welcome & Atlanta Traffic Humor
03:12 – Why Atlanta’s Senior Healthcare System Is “Almost Nonexistent”
09:15 – Hospitals begging for help & broken discharge processes
14:00 – Upcoming cuts to home health and rehab penalties
18:45 – Why therapy services need massive, immediate expansion
23:18 – The dementia support group story and the power of proactive care
30:52 – How storytelling improves patient and family understanding
36:44 – Hospice misconceptions & how Your Health does it differently
43:17 – Explosive growth in Atlanta and why competition is failing
49:10 – Creativity as a core ingredient of healthcare
54:40 – Why every associate needs a mentor immediately
59:25 – A call to action: show up, ride along, and support Atlanta providers
www.YourHealth.Org
Show Notes / Summary
- Why launch hospice now: continuity, fewer hospitalizations, value-based alignment
- Clarifying myths: CNA hours on hospice, attending provider still leads care
- RAF & staffing logic: ~$6k/mo hospice per diem ↔ RAF ~5; translating RAF → weekly CNA/CHW hours
- Nurse incentives: $150 per admission; double telehealth-assist credit on hospice patients
- Software + workflow: Athena ↔ WellSky (care plans, documentation, pull-through)
- Facility model: converting buildings; estimating FTEs from hospice census + RAF
- Chaplain/social work: leverage in-region LSWs; connect to patient’s faith community
- Respite options: Medicare respite/GIP + GUIDE program for dementia (up to $2,500yr)
- Therapy as palliative strength: weekly PTA/COTA; telehealth support
- After-hours model: optional call, $300 RN death/critical visit; $150 for non-nurse critical checks
- Guardrails: clinical judgment first; financials inform—not dictate—care
www.YourHealth.Org
Key Takeaways (for on-air recap & social)
- Presence prevents: Being in the building daily beats any remote administrative stack.
- Rituals > heroics: Small, repeatable actions (exercise + vitals + lunch checks) compound.
- Caregivers stabilize: A modest weekly schedule creates 40 hours of reliable on-site support.
- Therapy cadence matters: Spread the care; keep people moving longer to reduce falls.
- Document to decide: Specific behavioral notes → faster NP decisions → fewer crises.
- Mission creates growth: Aligning to “no hospitalizations” reduces noise and increases referrals.
www.YourHealth.Org
Show NotesWhy transitional care is at the heart of Your Health’s model
How incentives for early post-hospital visits worked (and why they didn’t)
Why in-person care matters more than telehealth alone
The growing role of respiratory therapists, physical and occupational therapists, and community health workers
The challenge of patient perception: “too many visits” vs. “too many calls”
Why insurance companies trying to become providers is dangerous for patients
Scott’s philosophy: nothing should be written in stone — adapt and evolve
The simple but powerful call to action for providers: “Go see your damn patients.”
www.YourHealth.Org
Key Topics:
- How sudden insurance and policy changes disrupt patients and providers
- The importance of prevention and primary care in lowering long-term costs
- What fully staffed care teams look like and why they matter
- Balancing productivity and patient-centered care
- Why disruption is necessary for a healthier future
- Takeaway: Healthcare continues to be shaped more by profit and red tape than by prevention and patient outcomes. But with innovative care models and a relentless focus on what patients truly need, leaders can shift the system toward better health and lower costs.
www.YourHealth.Org
Episode Notes What Health Connectors are and why they matter. * The danger of a provider-centered workflow—and how to avoid it. * Real examples of how proactive home visits catch problems early. * Why vital signs can be the key to preventing 50% of heart attacks. * The culture shift needed: salaried roles with responsibility, not clock-in/clock-out mindsets. * Scott’s challenge to all healthcare workers: “Go see your damn patients.”*
www.YourHealth.Org
Episode Notes* Scott shares a story about meeting a compliance pharmacist who unexpectedly became the solution to a major organizational challenge. * The importance of pharmacy compliance and direct-to-manufacturer drug purchasing. * Why God’s timing plays a role in healthcare growth and leadership decisions. * The danger of miscommunication across facilities and how to “season” a team for long-term effectiveness. * How leaders can emerge from any position — from providers to CNAs to medical assistants. * Why job descriptions must be clear, but leadership requires flexibility.
www.YourHealth.Org
Episode Notes Why disruption in healthcare often means simplifying, not complicating. * The critical role of Senior Solutions Advisors as navigators, educators, and advocates. * Real-world stories: from a weight loss patient’s experience to common Medicare misunderstandings. * How word-of-mouth becomes the best marketing strategy when patients feel truly cared for. * Scott’s challenge to SSAs: prioritize patient contact, ask deeper questions, and don’t be afraid to admit when you don’t know—just commit to finding the answer. * Why employers and patients alike need value-based care models that prioritize health outcomes over hospital incentives*.
www.YourHealth.Org
Episode Notes* Why each patient-facing role at Your Health was created and the specific problems they solve * How Medicare’s new Community Health Worker reimbursement is shaping care delivery * The bonus structures that align staff incentives with patient outcomes * Real-world examples of how metrics reveal opportunity — and lost income — for staff * The difference between “helping” and staying focused on core role responsibilities * How community health workers improve care by tackling social determinants of health * The daily expectations and earning potential for nurses, pharmacists, social workers, and providers * Why facilitated visits dramatically increase provider efficiency and patient touchpoints * How sharing the wealth in healthcare creates stronger teams and better care * The direct connection between role clarity, accountability, and reduced costs for Medicare
www.YourHealth.Org
Episode Notes
- Behind-the-scenes look at Your Health’s move to a High-Needs Accountable Care Organization (ACO)
- How Medicare calculates risk scores and allocates funding for high-risk patients
- Why Your Health is delivering a 32% savings over Medicare’s projected spend — at scale
- The flaw in most investment-backed healthcare models (and why they’re losing millions)
- The urgency of same-day or next-day post-hospital visits to prevent readmissions
- Blending leadership across divisions to improve care coordination
- Why Scott believes corporate thinking — not just individual effort — changes outcomes
- The real role of community health workers and how to measure their impact
- How South Carolina’s primary care spend has shifted because of Your Health’s approach
- A direct challenge to healthcare leaders: own the gaps and fix them together
www.YourHealth.Org
Episode Notes (Key Takeaways) Why "customer satisfaction" can be the wrong metric in healthcare * What Scott learned from a meeting with JPMorgan Chase CEO Jamie Dimon * The difference between perceived value and actual* healthcare needs * A candid story about overprescribing pain meds and the cultural shift required * Why the healthcare "customer" is more complicated than we think * Breaking down Your Health’s value-based care results: $75M saved * The danger of over-collaboration and inefficiency in care coordination * Realigning roles: Why community health workers need to drive proactive care * Your Health’s shift toward specialty divisions and wellness clinics * The staggering ROI of early interventions: $1.1 million in bonuses justified * Why United Healthcare and others may be falling behind on data access
www.YourHealth.Org
Episode Show Notes* Why “Hyper Healing” could be the future of integrated specialty care * How telehealth and AI (like Naveena) are changing case management * What red flags (like a simple red spot) can mean for long-term patient health * Why documentation isn't just clinical—it's legal protection * How facility partnerships can avoid unnecessary hospice referrals * The real cost of doing nothing, and why implementation beats intention
www.YourHealth.Org
Show Notes Why traditional healthcare marketing has failed seniors * The reemergence of Senior Solutions Advisors* — and why they matter now more than ever * The hidden costs behind "free" placement services like A Place for Mom * How healthcare leaders can (and should) show up in the field * Real stories about system failures — and how to fix them * A peek into the future of Hospice, sitter services, and customized care at scale * How title changes shift culture, mindset, and mission
www.YourHealth.Org
In this episode:
- Scott’s thoughts from a recent trip to Key West and Georgia
- The shocking gaps in primary care coverage in assisted living facilities
- Real examples of care breakdowns that led to avoidable hospitalizations—and even death
- The power of the Your Health model: 3 visits per week in facilities, 5 visits post-discharge
- How early, coordinated care reduces ER visits and saves millions
- Why United Healthcare is making a $122 million mistake—and how it could be avoided
- The role of respiratory therapy, PT/OT, and sleep studies in aging care
- Why primary care should be the centerpiece of healthcare funding
Key takeaway:
If it was your mom or dad, would once-a-month visits be enough?
www.YourHealth.Org
Episode NotesIn this episode:
- The biggest misconceptions about assisted living and Medicaid
- Why “I’ll never put my parent in a home” might do more harm than good
- The financial reality of nursing homes and long-term care
- How to recognize early signs it’s time for more support
- The power of independent living and nutritional care
- Scott’s creation of the Senior Solutions Advisor role and how it’s changing the game
Real-world strategies to navigate elder care without guilt or guesswork
🔗 Learn more about Parent Talk the book on Amazon
🔗 Connect with a Senior Solutions Advisor at Your Health
🎧 Catch up on the full Parent Talk series in previous episodes
www.YourHealth.Org
Podcast Show Notes
- Why Medicare and supplemental insurance may not be the best combination — and what to consider instead.
- The myth that paying more for health insurance guarantees better care.
- Why value-based care plans like Humana are worth a closer look — especially for long-term cost and wellness.
- The emotional and financial weight of long-term care insurance — and who really needs it.
- Personal stories about estate planning, remarriage, and how inheritance issues can fracture families.
- Practical tips on reviewing your insurance plan yearly, using your agent wisely, and planning with clarity.
- How booking the Airbnb or family cruise now could shape who shows up for you later in life.
www.YourHealth.Org
Podcast Show Notes
- Scott updates us on Your Health’s rapid growth in Florida and the unique gaps in senior care across new markets.
- Jamie and Scott reflect on the impact of nutrition, daily routines, and how aging alters our needs and habits.
- Why arguing with a parent with dementia doesn’t help — and what to do instead.
- The emotional complexity of helping a parent shower — and how to preserve their dignity.
- Practical meal ideas, protein goals, and the surprising role of squats and puzzles in elder care.
- Stories of lipstick, cheesecake, and finding joy in the small things.
www.YourHealth.Org
Episode Notes:
- Scott shares the recent rapid decline of his father’s health and the emotional toll it has taken
- How missed diagnostic details revealed a larger issue in communication and coordination
- The critical role of a Senior Solutions Advisor in bridging care gaps
- Why primary care must evolve to become the quarterback of patient navigation
- A look back at models from 2012 and why older frameworks may hold the key to future innovation
- The call to hire 287+ RN Case Managers for the 23,000+ homebound patients currently served
- Personal reflections on legacy, family, and the power of leading with empathy
www.YourHealth.Org
Show Notes
[00:01] Jamie and Scott Middleton discuss personal stories of emergency devices like the Apple Watch.
[00:03] The resistance of seniors and some healthcare professionals to adopt wearable medical technology.
[00:06] The critical role of remote patient monitoring (RPM) in improving healthcare decisions.
[00:14] Real-life example where RPM detected sudden weight gain, preventing a serious health crisis.
[00:18] Advances in at-home diagnostics: spirometers, sleep study rings, and cardiac patches.
[00:23] How Your Health is rolling out RPM with 23,000 homebound patients and hiring respiratory and therapy staff.
[00:25] Call to action for healthcare workers, patients, and caregivers: use technology to prevent hospitalization and improve quality of life.
[00:33] Discussion on AI-driven predictive analytics and the untapped potential of connecting wearable data to providers.
[00:35] Challenges with FDA timelines and the potential for AI to expedite drug development.
www.YourHealth.Org
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Parent Talk
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Parent Talk Book
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https://thedisruptedpodcast.com
Today Scott is driving back from Savanah, Georgia, and has a ton to share. Scott talks about some of the meetings and discussions he's had this week, and their newest GA House Calls Office opening in Savanah on November 1st. Scott also shares the principle of looking at numbers and data first before having an emotional reaction. We hope you enjoy this episode of The Disrupted Podcast!
Today we talk about "The Score Board" and how we all have specific numbers and data to know if we are hitting the mark. Scott talks about the MIPS scores (Merit-based Incentive Payment System) that his providers have to be aware of and how they affect healthcare providers. Scott talks about how these numbers relate to providing the proper care that patients need and deserve.
Today Scott talks about some of the conversations he has had with business leaders and local and state politicians. Scott shares the benefit of working together with political leaders and the importance of listening to one another. We hope you enjoy this episode!
Today Scott talks about the Corporate Medicine approach to healthcare and how he believes his providers are the ones to decide the treatments that their patients need. Scott also shares why he is so driven to keep pushing the limits of his businesses. We hope you enjoy this episode of the disrupted Podcast.
In a world where people in the hospitality industry work every weekend and struggle with work-life balance, Scott shares how they have taken steps so that people can have a better life in this industry. We hope you enjoy this conversation!
Today, Scott shares how a new Billing & Coding course they have been providing for their healthcare providers has been a game-changer. Scott gives some great examples of what insurance is looking for and how they are helping their patient's health and business at the same time. We hope you enjoy this episode!
Today Scott shares some of the new Medicare rules that are not serving some of their rural patients in Telehealth. Scott discusses how one rule that you create can affect another person that can be detrimental. Scott also shares some great leadership lessons we can all use. We hope you enjoy this episode!
Today Scott shares some of the new things his healthcare company SC House Calls is doing with automation. They are working with major insurance companies to help keep people out of the hospital through automation tools they are developing. We hope you enjoy this episode!
Scott is back with some exciting new things to share. Scott talks about some of the latest projects and changes in one of his healthcare company's SC House Calls. Scott discusses some of the ways they have decreased healthcare spending through more primary care visits. We hope you enjoy this episode!
Today Scott shares some of the things he has found since traveling the state. In this episode, Scott talks about making a blanket policy versus confronting the two or three people that are struggling with a problem. Scott also discusses the value of just being honest but not offensive. We hope you enjoy the show!
Scott is back and passionate as ever. Today Scott shares some of the things he is finding by traveling the state and speaking with his Doctors and Nurse Practitioners. Scott shares some great leadership principles on managing by walking around. We hope you enjoy this episode!
Today Scott gives us some great examples of how people struggle with change. He shares how systems are your best friend when making changes; thinking through those systems is critical to success. We hope you enjoy the show!
This week, Scott has been on the road in the Grand Strand of South Carolina, disrupting some healthcare providers. Scott loves data, but sometimes you have to get out of the office and see what's going on. Scott shares some of his experiences and disruptions he made this week. Enjoy the show!
Today, Scott clears up something from a couple of weeks ago about some of his healthcare companies' Medicare changes. Scott also brings in Kim Kennamer from SC House Calls to help explain some of the new changes. Enjoy the podcast!
Today Scott shares some great wisdom about the rules that we sometimes create in our organizations that can hold us back. Scott gives us some great examples of some of the rules that he broke this week to free up his healthcare company and their scheduling challenges. Enjoy the show!
We have a bonus episode for you this week and a special guest, Tim Vartanian, on The Disrupted Podcast. Tim is the manager at Goodlife Cafe, a vegan restaurant that Scott owns in downtown Columbia. We discuss how Goodlife has been able to disrupt the restaurant business by showing people that they can eat healthily. We hope you enjoy this episode!
Today, Scott jumps back in talking about the Medicare Disruptions and how they have changed SC House Calls' care model. Scott also gives us an update on the COVID-19 response in their hospitality division. We hope you enjoy the show!
Happy New Year! Today is the last podcast of 2020, and Scott makes some excellent points that will help your life or business. Scott shares a principle from the book, "It's Not The Big that Eat the Small...It's the Fast that Eat the Slow" by Jason Jennings, Laurence Haughton, and how that can make all the difference.
In today's episode, Scott shares about making decisions and doing your best to lean on data and not your feelings. We hope you enjoy the episode!
In this episode of The Disrupted Podcast, Scott shares some fundamental leadership principles that will ensure you have a good pulse on your company. Enjoy this episode!
Today Scott talks about making your Disruptions clear, or people might get the wrong idea. Scott also shares about the pandemic and how businesses need to get prepared for a potential shutdown. We hope you get a lot out of this new episode of The Disrupted Podcast!
Today Scott talks about what has him fired up and how he channels that to make his organizations more productive. Scott discusses some of the Telehealth issues at SC House Calls and how he works through that with his leadership. Enjoy our conversation!
Today we hear about Scott's new lenses and how he views proactive healthcare, and so much more. Enjoy the episode!
Today Scott discusses the disruption they made to bring Kosher Food to Goodlife Cafe and the challenges that brought. Scott also discusses some of the daily disruptions he made during the week. Enjoy our conversation!
Scott is back in action from some time of relaxation! Scott shares some of the takeaways from his time away on vacation and shares some of the new ways he is disrupting. Enjoy this episode of the Disrupted Podcast!
Today Scott shares some new changes he's been making in his business and how he deals with people resistant to change. Enjoy this episode!
Scott is back at it and creating change in his companies through the art of DISRUPTION. Scott shares some stories about working through uncomfortable moments in meetings to bring "GOOD" change. Enjoy the episode!
Today Scott is back at it and keeping things changing within his organizations. This episode is full of leadership principles, and we hope you gain practical things you can use in your leadership!
Hear how Scott is shaking things up this week on the second episode of The Disrupted Podcast. Thanks for listening!
This is episode one of The Disrupted Podcast with Scott Middleton. Scott is the owner and Chief Disruption Officer for LTC Health Solutions and several other hospitality businesses in South Carolina. In this inaugural episode, Scott shares the principle of DISRUPTION and why its necessary to keep businesses fresh and moving forward. Enjoy the podcast!