EP410: The Imperative and a 201-Level Financial How-To for Payers and Provider Organizations to Collaborate to Help CKD Patients and Others With Chronic Conditions, With Dan Serrano

Provider organizations without capitated contracts or access to premium dollars are stuck in what Stacey Richter calls "the messy middle" — treating patients with chronic conditions well, without getting paid for the value they create. In this episode, Stacey talks with Dan Serrano, a healthcare finance consultant at COPE Health Solutions with 20+ years of experience across payers and providers (Aetna, Healthfirst, ChenMed, Mount Sinai), about the financial mechanics of payer-provider collaboration, using chronic kidney disease (CKD) as the worked example: a condition that's notoriously expensive, underdiagnosed, and undertreated, but where meaningfully better care is not actually hard to deliver.

WHAT YOU'LL LEARN

✅ Why CKD makes such a useful case study for payer-provider collaboration: two out of five ESRD patients don't even know they have kidney disease, and the local standard of care is often so low that meaningful improvement is genuinely achievable

✅ What the financial "messy middle" looks like for provider organizations that don't yet have capitated contracts or access to premium dollars, and why that's the stage where payer collaboration matters most

✅ Why payers have a real financial incentive to help local PCPs and provider organizations level up chronic care management, rather than relying solely on third-party point solutions to capture at-risk patients

✅ Why community-rooted clinicians consistently seem to outperform "snazzy tech" point solutions at actually moving the needle on chronic disease outcomes

✅ What a realistic timeline and risk-sharing structure looks like for a provider organization starting from shared savings and working toward eventually capturing a share of the premium dollar

WHY THIS MATTERS

The bar for improving CKD care is low enough that meaningful gains don't require heroic innovation — just payer-provider collaboration that gets local clinicians the financial support to actually manage these patients well. Every patient who falls through the cracks between a fee-for-service PCP visit and an expensive, unmanaged point-solution referral represents both a preventable cost and a preventable harm. As Dan Serrano lays out, the financial mechanics to fix that already exist; the work is building the collaboration to use them.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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00:00 Introduction.

09:08 What is the importance of payer/provider partnerships in reducing costs with chronic condition care?

10:52 Josh Berlin, JD, of rule of three; look out for his episode in a few weeks.

11:19 What's the endgame here with this payer/provider collaboration?

11:43 What advice does Dan have for providers who want to do better by patients with chronic conditions?

15:11 Who's driving costs in the system?

15:50 Why is lowering the average cost of chronic condition care important?

17:03 Why is there a meaningful delta between well-controlled CKD patients and those who aren't well managed or identified?

21:57 What does a realistic time horizon look like for addressing chronic condition care?

22:38 Why is it important to start in a shared savings place?

25:25 William Shrank, MD, of Andreessen Horowitz; look out for his episode in the fall.

26:35 Financially, what is the goal and how are we achieving a sustainable goal?

29:06 What is the balance between progress and risk here?