Andy Vailas

President of Delphi HC
UNH Football Alum.

[Brian Blase @brian_blase]

As a result of a key ACA policy (the MLR), insurers make more $ when premiums rise.

Thus, insurers have incentives to raise premiums!

They often look at the market leader, typically Centene, and then raise premiums.

The ACA needs a lot of fixes, including repealing the MLR.

[Andy Vailas @availas14]

@DutchRojas 100%. If you could also remove the 80/20 MLR portion, that would be great. Need to create incentives for insurance companies to encourage competition

[Nick Freitas @NickJFreitas]

Charlie was the best of us.

[Andy Vailas @availas14]

I want to preface this by saying I am a big supporter of transparency in healthcare. It's necessary. It's important. But it’s not enough.

Yes, patients deserve to know what care costs but they don't know what care they need. If you don’t have a trusted, accessible primary care provider who's truly advocating for you, that transparency doesn’t change much.

At the end of the day, doctors are the true consumers of healthcare. They’re the ones making clinical decisions, guiding referrals, and helping patients navigate a system that’s anything but simple.

If your doctor isn’t easily reachable, doesn’t know you well, or is burned out from volume-based care, a transparent price list won’t protect you from unnecessary visits, missed diagnoses, or avoidable costs. Let's be honest, we already know the ER is expensive yet we still utilize because it's accessible.

The foundation of better care and better value isn’t just price, it’s relationship-driven primary care.

That’s where real healthcare transformation begins.

#HealthcareReform #Healthcare #Transparency #Quality #Value #Access #PrimaryCare

[Andy Vailas @availas14]

I recently reviewed claims data for a local employer and saw they spent over $200,000 last year on Emergency Room and Urgent Care visits — and that’s just for the visits, not including the tests, imaging, or follow-up care that came after.

Now, to be fair — some of those visits were necessary and unavoidable. But this pattern is common across many employers. Why?

Because ERs and Urgent Cares are accessible.

They’re not the best option financially, but patients know they’ll be seen. Most don’t even bother calling their PCP — because they already know the answer.

Employers, you're already spending this money. How about investing it? What if that employer reallocated a portion of that $200,000 toward Enhanced Primary Care? A program that guarantees access.

Imagine how many of those costly visits could have been prevented — and the downstream savings that follow?

#EnhancedPrimaryCare #CostSavings #EmployerHealthcare #PrimaryCare

[Andy Vailas @availas14]

@DanCrenshawTX How's the Primary Care Enhancement Act looking? Any updates?

[Andy Vailas @availas14]

Companies everyday invest in resources to improve efficiency. As they should.

For most businesses, healthcare is the second-largest expense after salaries. Yet, fail to invest in making their health plans more efficient.

As Stacey Richter highlights in the @RelentlesHealth Podcast, quoting Dr. Scott Conrad: “Good primary care is an investment. Everything else is a cost. If you don’t invest in primary care, you’ll end up paying for it—in the most expensive place possible: the ER."

You optimize operations, identify waste, and create inefficiencies in every other part of your business. So why not do the same for your health plan? Your second largest line item.

#Healthcare #Efficiency #Access #PrimaryCare #Savings

[Andy Vailas @availas14]

Doctors/Providers are the real consumers of healthcare.

Unlike other services, patients hardly “shop” for healthcare. Instead, their providers dictate the journey—deciding what they need and where they should go. While patients may request certain treatments, it’s ultimately the provider who sends the referral.

Because of this, most patients rarely question costs or explore alternatives. If a doctor refers them for an MRI at a hospital, they follow that referral—without realizing they could get the same scan for $500 at an independent facility instead of $3,000 at the hospital.

This is why employers need to rethink how and where their employees access and engage with healthcare system. It’s not just about making care available—it’s about ensuring employees receive high-quality, cost-effective care. Employees need providers who guide them toward affordable, top-tier alternatives for labs, imaging, and even surgery—not just whatever the big systems dictate.

That’s why more companies are integrating Direct Primary Care (DPC) and Concierge Primary Care into their benefits because they are independent of these large systems. These models don’t just improve access and overall health—they also refer towards high value treatment options, ensuring employees receive better care at lower costs.

#Healthcare #EmployeeBenefits #CostTransparency #DirectPrimaryCare #ConciergeMedicine

[Rep. Lloyd Smucker @RepSmucker]

Direct Primary Care (DPC) lowers costs and improves healthcare outcomes. Our bipartisan Primary Care Enhancement Act expands access to DPC for millions of Americans using Health Savings Accounts. Read more: https://t.co/PcNM7WfJV3

[Andy Vailas @availas14]

This would be huge for patients nationwide to improve access to their own healthcare. There’s a big difference between healthcare and health insurance. This is #care and should be treated as such. Glad to see some bipartisan action taking place. Hopefully this moves forward!

[Rep. Chip Roy Press Office @RepChipRoy]

We need a way out of our broken healthcare system. Short of the massive industry-wide overhaul that we need, radical expansion of health savings accounts and direct medical care are the best ways to improve the healthcare system for everyday Americans.

The Direct Medical Care Freedom Act puts patients back in control by letting them go directly to a doctor for care with tax-advantaged dollars that they control. If we want to Make America Healthy Again, we need to work around the crony government-insurance racket, and this bill is a critical part of doing that.

[Andy Vailas @availas14]

Healthcare has changed dramatically over the past few decades, yet many people don’t realize just how much. We’re paying more than ever for medical care, yet overall health outcomes haven’t improved. Nowhere is this shift more evident than in primary care...

Primary Care Doctors in the Past (Pre-1990s)

Full-Spectrum Care – Doctors managed everything from minor illnesses to chronic disease care.

Long-Term Relationships – Patients often had the same doctor for decades, and doctors knew entire families personally.

More Time with Patients – Appointments lasted longer (often 30-60 minutes), allowing for thorough evaluations and meaningful discussions.

House Calls – Doctors often visited patients at home, especially for the elderly or those with mobility issues.

Lower Patient Volumes – A doctor typically managed a smaller patient panel, allowing for more personalized care.

And not to mention far less Administrative burden

Primary Doctors Today (Modern Healthcare System)

High Patient Volumes – Doctors often manage 2,000–3,000+ patients, often treating 20-30 Patients a day.

More Administrative Burden – Physicians spend significant time on electronic medical records (EMRs), insurance approvals, and regulatory compliance.

Fragmented Care – Wait times to schedule an appointment with a PCP average over 20 days, Patients see multiple specialists, ER and urgent care providers, leading to less continuity in care.

Less Time with Patients – Visits are often rushed, focusing more on immediate issues rather than preventive care (10-15 minutes a patient)

Numerous studies show that greater investment in primary care leads to significantly improved health outcomes and substantial cost savings. It’s no surprise that Medicare and other major payers are prioritizing primary care—because when patients receive better, more proactive care, the results are clear: healthier lives and lower healthcare costs.

#PrimaryCare #Healthcare #Access #EnhancedPrimaryCare #Savings #Affordability #Value #Delphi #DEPC

[Andy Vailas @availas14]

Value Based Care (VBC)

Not everyone is familiar with Value-Based Care (VBC), but it’s transforming how healthcare is delivered. Simply put, instead of paying doctors based on the number of visits or procedures (fee-for-service), VBC rewards providers for keeping people healthy. This shift prioritizes quality over quantity, leading to better patient outcomes and lower costs.

Many insurance carriers—specifically Medicare and Medicare Advantage plans—have embraced this model, because they understand by partnering with primary care providers and specialists, they can improve health outcomes while reducing unnecessary spending.

Why Should Employers Pay Attention?

Because it works! Healthier employees mean:
> Lower healthcare costs
> Fewer sick days
> Increased productivity

Employers who partner directly with local healthcare providers can implement value-based concepts and solutions that lead to better employee health and long-term cost savings.

Is Value-Based Care Under Scrutiny?
Of course like a lot of healthcare solutions, some VBC arrangements have faced criticism—whether for flawed implementation, excessive administrative burden, or concerns about cost savings. However, when done right, VBC delivers meaningful results. The key is working with trusted healthcare providers who focus on true long-term health improvements, not just cost-cutting measures.

I'm happy to discuss more with those who are looking to provide solutions to their company. It can be done.

hashtag#Value hashtag#VBC hashtag#Delphi hashtag#Access hashtag#Affordability hashtag#Costs hashtag#Savings hashtag#PrimaryCare

[Becker's Hospital Review @BeckersHR]

Listen Here: https://t.co/qSMg4tESJc
In this episode, Nick Vailas , CEO at Bedford Ambulatory Surgical Center (BASC) joins the podcast to discuss his background, the biggest issues he is following in healthcare today, and more.

[Ottawa REDBLACKS @REDBLACKS]

He’s baaaaack @RjHarris15

[Elon Musk @elonmusk]

🚀💫♥️ Yesss!!! ♥️💫🚀

[Kyle York @kyork20]

“To be successful you have to put yourself in situations and places you have no right being in. You shake your head and learn from your own stupidity. But through sheer will, you wear the world down, and it gives you what you want.” Steve Schwarzman

[Jason Kuhn @jasonkuhn255]

Adversity creates a struggle. Appreciate it's value. The struggle creates the reward. There is no reward without the struggle, and the greater the struggle, the greater the reward.

So eyes up and embrace that suck, because it's supposed to be hard. #mentaltoughness

[Barstool Sports @barstoolsports]

Every player on Army came out with an American flag 🇺🇸🇺🇸🇺🇸

[Barstool Sports @barstoolsports]

Welcome back, McKenzie Milton

[Jason Kuhn @jasonkuhn255]

When we react emotionally to adversity by complaining and blaming, we then surround ourselves with others who will affirm our self-loathing, helpless feelings.

Mentally tough people seek out those who will challenge and mentor them to overcome and be forged by adversity.