231 Payor Advocacy and Payment Systems

Expanding Bluebird Kids Health: Access, Value-Based Pediatrics, and Payment Advocacy

Host Dr. Her Bravo welcomes Dr. Shannon Fox Levine and talk about her move into Bluebird Kids Health, which is expanding Palm Beach Pediatrics’ value-based, technology-forward model to new de novo sites in Florida to address pediatric care deserts for Medicaid populations, including new offices in Jacksonville and Broward County, and the use of a partnered mobile clinic. They discuss keeping Athena Health, hiring and training new clinicians, and interest in ambient AI to reduce documentation burden and improve patient relationships. Levine outlines Florida AAP concerns, including school vaccine mandate changes, Medicaid payment advocacy (including Medicare parity via incentives), and a pilot workflow to diagnose autism in primary care using tools like RITA-T and CARS-2 with appropriate reimbursement. She also describes her national AAP payer advocacy role, addressing issues like downcoding, EOB monitoring, and use of a price transparency tool, emphasizing sustainable payment to reduce burnout and maintain access.

00:00 Podcast Intro and CME
00:55 Meet Shannon Levine
01:46 Bluebird Kids Expansion
03:35 Tech and Mobile Clinics
06:55 Ambient AI for Notes
11:27 Training New Clinicians
14:13 Florida Advocacy Updates
16:37 Autism Diagnosis Pilot
20:11 Medicaid Contracts and Pay
22:31 Value Based Care Future
23:14 Florida MPIP Basics
24:08 Incentives Versus Quality
25:39 Risk Models And Proformas
28:11 Care Coordinators In Action
31:10 Stop Loss And Carve Outs
32:54 Metrics And Vaccine Denominators
35:35 AAP Payer Advocacy Workflow
40:11 Price Transparency Tool
42:26 Negotiating With Payers
45:11 Burnout And Closing Thoughts