Even seasoned healthcare leaders—those with decades of clinical, financial, or operational experience—often miss the two most powerful levers behind how care gets paid for: the CPT process and the RUC committee. These aren’t just billing codes and obscure meetings. They’re the gatekeepers of what and how much is paid for care in the U.S. healthcare system.

To truly understand healthcare in the U.S., an understanding of CPT and RUC is fundamental.

In this special episode of Value Health Voices, we flip the script—Dr Anthony Paravati interviews co-host Amar Rewari, a nationally recognized expert in the CPT development process and the RUC (Relative Value Scale Update Committee). This is your backstage pass to the invisible forces that decide how doctors are paid, which services get valued, and why the U.S. healthcare system rewards what it does.

In this episode, we unpack:

• What the CPT process really is—far beyond billing codes

• How the RUC committee wields extraordinary influence over payment policy

• The lifecycle of a medical service’s valuation—from clinical utility to reimbursement

• How these processes directly affect hospital strategy, service line planning, and physician compensation

No deep dive into CPT and RUC is complete without exploring the critiques—many of which are long-standing and still unresolved:

• Specialty Bias: Procedural specialties often dominate the RUC, leading to higher valuations for procedures and lower ones for cognitive services like primary care.

• Lack of Transparency: Decision-making behind closed doors fuels frustration and distrust, especially among non-physician stakeholders.

• Inertia and Inequity: Efforts to revalue services often move at a glacial pace, creating systemic lag between innovation and payment.

We challenge assumptions, unpack the politics, and explore what meaningful reform could look like.

Whether you're a hospital executive, a health policy analyst, a medical director, or a clinician trying to understand your paycheck, this episode gives you what textbooks and boardrooms don’t: a clear, actionable understanding of the CPT and RUC systems and how they quietly influence everything from your budget to your workforce strategy.

You’ll walk away with:

• A framework to think critically about reimbursement strategy

• Insight into why your specialty is—or isn’t—being adequately valued

• Clarity on how to engage with these systems to advocate for fairer healthcare

Keywords: CPT process, RUC committee, physician reimbursement, healthcare payment reform, US healthcare finance, healthcare policy podcast, Medicare valuation, specialty society lobbying

In this episode of Value Health Voices, Dr. Vipan Nikore discusses his journey as an entrepreneur in the healthcare sector, focusing on the innovative concept of Home Care Hub. He shares insights on the challenges and opportunities in home-based care, the importance of metrics in measuring outcomes, and the regulatory hurdles faced in the industry. Dr. Nikore emphasizes the need for policy changes to support alternative care models and advocates for a future where smaller care homes provide dignified and personalized care for the aging population. He also offers advice for aspiring healthcare entrepreneurs, highlighting the importance of mentorship and networking.

takeaways

• Dr. Nikore's journey from software development to healthcare entrepreneurship.
• The importance of home-based care in improving patient outcomes.
• Home Care Hub aims to create smaller, community-based care homes.
• Metrics such as decreased readmissions are crucial for success.
• Regulatory challenges vary significantly across states and provinces.
• Advocacy for policy changes is essential for funding alternative care models.
• The future of healthcare will involve more personalized and accessible care options.
• Data collection from home care can drive better patient outcomes.
• Entrepreneurship in healthcare requires resilience and adaptability.
• Mentorship and networking are key for aspiring healthcare entrepreneurs.

Chapters

00:00 Introduction to Home-Based Care Innovations
01:39 The Journey of Dr. Vipan Nikore
10:15 Exploring Home Care Hub
17:13 Metrics and Outcomes in Home Care
20:29 Navigating Regulatory Challenges
22:34 Navigating Regulatory Challenges in Healthcare Innovation
23:49 Advocating for Alternative Care Models
25:05 The Importance of Personalized Care
26:20 Addressing Loneliness and Social Isolation
27:42 Leveraging Technology in Home Care
29:39 Policy Advocacy for Healthcare Solutions
32:18 The Role of Data in Improving Outcomes
33:03 Envisioning the Future of Home Healthcare
36:12 The Entrepreneurial Journey in Healthcare
39:16 Advice for Aspiring Healthcare Entrepreneurs

As the cost of healthcare continues to rise, more employers are turning to direct employer contracting and self-insured models to take control of their healthcare costs. But how do these models compare to fully insured arrangements? And what are the key considerations for health systems, PBMs, and employers looking to engage in value-based care?

In this episode of Value Health Voices, Dr. Anthony Paravati and Dr. Amar Rewari sit down with Ned Laubacher, CEO of Health Spectrum Advisors and an expert in direct-to-employer contracting, to break down:
✅ The shift toward self-insured models and employer-driven health benefits
✅ The role of quality metrics and shared savings in employer-provider contracts
✅ How data transparency is transforming healthcare finance and cost control
✅ The impact of legislation on employer health plans
✅ Common pitfalls in direct contracting and how to avoid them

💡 Key Takeaways:
🔹 Self-insured employers have more control over healthcare costs and provider networks
🔹 Direct contracts with health systems help improve cost transparency and health outcomes
🔹 Employers must take a proactive role in healthcare policy to navigate complex regulations
🔹 PBMs and cost-plus drug models are playing an increasing role in employer-led health plans
🔹 Analytics & data-driven decision-making are the future of value-based care