Navigating Payer Strategy & Value-Based Care with Margaret Braxton | Health Equity, Risk Contracts & Market Trends
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Show Notes
Margaret Braxton, a seasoned healthcare executive leading payer strategy and research at Scale Healthcare. With over 35 years of experience spanning provider operations, health systems, and payer negotiations at UnitedHealthcare and Cigna, Margaret offers deep insights into value-based care, payer-provider partnerships, and the evolution of health equity in healthcare.
In this episode, Margaret shares her expertise on the shifting landscape of payer contracts, the challenges of implementing risk-based models, and how health systems are adapting to value-based initiatives. She also explores why Florida has become a hotspot for Medicare Advantage and direct primary care contracting, and how government programs are shaping the next wave of healthcare funding and innovation.
Timestamps:
- [00:01] Introduction to the podcast and guest, Margaret Braxton
- [05:00] Understanding Value-Based Care Programs – Shared savings, risk-based contracts & payer alignment
- [12:00] Why Value-Based Care Adoption Varies by State – Health system influence & regulatory differences
- [18:30] Florida’s Unique Role in Primary Care Expansion – Why major brands like Oak Street, Cano, and others scaled rapidly
- [24:45] Private Equity & Payer Partnerships – The rise of Optum, Evernorth, and vertically integrated care models
- [30:00] Health Equity & Government Incentives – How CMS, Medicaid, and federal programs are driving new funding
- [36:00] The Impact of Medicare Advantage on Value-Based Care – Understanding risk thresholds and member attribution
- [41:00] The Role of Hospitals in Value-Based Care – How health systems are shifting toward performance-based contracts
- [47:00] Future of Healthcare Funding & Policy Trends – What to expect in payer strategy, Medicaid expansion & hybrid models
Key Takeaways:
- Value-Based Care is Expanding, But Slowly. While risk-based contracting and total cost of care models are growing, fee-for-service still plays a dominant role, especially in smaller practices.
- Florida is the Epicenter of Medicare Advantage Growth. With high enrollment numbers and payer flexibility, Florida has attracted major primary care groups and risk-based provider models.
- Health Equity is Becoming a Payer Priority. Government and CMS initiatives are now tying funding to health equity efforts, requiring payers and providers to address social determinants of health (SDOH).
- Large Payers Are Diversifying Their Business Models. Optum, Evernorth, and Aetna are leveraging provider ownership, PBMs, and analytics platforms to dominate the market.
- Hospitals Are Being Pulled Into Value-Based Care. Health systems are under increasing pressure to shift reimbursement models and integrate value-based contracts into their long-term strategies.
Connect with the Guest:
- LinkedIn: Margaret Braxton
About Margaret Braxton:
Margaret Braxton is a healthcare strategy expert with extensive experience in payer negotiations, value-based contracting, and provider network development. Having worked at UnitedHealthcare and Cigna, she now leads payer strategy and research at Scale Healthcare, advising healthcare organizations on market trends, risk-based models, and payer-provider partnerships.