👀 Watch the Replay

Blake Madden, Hospitalogy, with Dana Brandenstein, VP of Provider Enablement, Privia Health, and Dana McCalley, VP of Value-Based Care, Navina. Recorded September 30, 2026.

💡 Blake sat down with two leaders who run value-based care across millions of patient lives to talk about timing. Their shared view is that most VBC problems get expensive because they're found too late, and the fix lives in the exam room. It's a practical hour for population health, quality, coding, and clinical leaders building next year's operating plan.

🔑 Key takeawaysCopy anchor linkCopied

1: Documentation lag is now a balance sheet problemCopy anchor linkCopied

• ✅ Audit exposure scales with the contract. Dana B walked through how the 2023 RADV final rule allows penalties to be extrapolated across an entire contract. Combined with the V28 code changes, this makes it much harder to append diagnoses months after an encounter.
• ✅ Late capture can quietly sink your benchmark. In MSSP, conditions that go uncaptured during the benchmark period leave you with a population that looks healthier on paper than it is. That gap is very hard to fix later.

"The right thing for the patient isn't adding a code 10 months after they left our practice." (Dana McCalley)

2: Prospective only works if it's easy for cliniciansCopy anchor linkCopied

• ✅ Evidence, incentives, and a full year. Dana M attached clinical evidence to every suggested condition, paid providers for the extra documentation work, and let unaddressed conditions roll to the next visit. Her target was to have everything documented by October 1.
• ✅ Triage by visit pattern. Dana B suggests front-loading documentation for patients who come in once a year, like snowbirds. Frequent visitors can be worked through over a series of encounters.

"I did not want my physicians to have to be coders. I wanted them to be expert clinicians." (Dana McCalley)

3: Audit-ready means watching the whole claim journeyCopy anchor linkCopied

• ✅ Know the red flags regulators are chasing. Dana B named three patterns from recent enforcement: acute stroke codes billed without supporting facility claims, retrospective data mining, and coding partners paid on contingency. OIG publishes its focus areas, and both Danas use those lists to aim concurrent review.
• ✅ Codes can fall off after the clinician signs. Many EHRs only send 4 to 12 diagnoses on a claim, and E&M coders sometimes strip risk codes by accident. Privia reconciles what left the building against MAO-004 and CCLF files to confirm CMS saw the full picture.

"Often you discover that there is a pinch point somewhere in there, and bits and pieces have fallen off." (Dana Brandenstein)

4: Judge AI by whether clinicians would fight to keep itCopy anchor linkCopied

• ✅ Satisfaction beats RAF lift as a metric. Privia evaluates documentation tools on clinician satisfaction and time saved, and leaves RAF score changes out of the scorecard. Dana B's gut check is how loudly clinicians object when you suggest taking a tool away.
• ✅ Redeploy staff instead of cutting them. Dana M moved coders freed up by AI into concurrent review and higher-touch patient work. Culture is the fourth pillar of VBC alongside risk, quality, and utilization, and it's the one that separates good from great.

"When the clinicians say don't you dare, then you know that you've made a good choice." (Dana Brandenstein)

Slides and resourcesCopy anchor linkCopied

• See Navina's VBC copilot in action

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Hospitalogy x R1 Happy Hour · November 15, 2026, Las Vegas, NV

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