The Disrupted Podcast

Hosted by James Preston, Scott Middleton

Business Health Fitness Education

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Episodes

144

Latest episode

Aug 2026

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About the show

Entrepreneur and Chief Disruption Officer Scott Middleton share's his experiences of how he uses disruption to innovate and keep an organization moving forward and growing. Scott shares these weekly stories on The Disrupted Podcast with Scott Middleton.

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60 recent

August 17, 202641 min

Presence vs. Popping In: Why Most Facility Relationships Are Failing Patients

Most nursing homes think they're measuring success by how many patients move through their building. What they're not measuring is how many of those same patients end up right back in the hospital — and who pays the price when they do. In this episode of The Disrupted Podcast, Scott Middleton — Owner of Your Health and Chief Disruption Officer — pulls back the curtain on the facility partnership model Your Health is rolling out across the Southeast. It's a model that doesn't just serve patients in skilled nursing facilities; it pays those facilities for the care coordination work their staff is already doing, while creating the kind of presence that actually moves the needle on outcomes. Scott and Jamie cover the mechanics, the competitive landscape, and the cultural shift required to make it all work: Why Your Health is contracting with nursing homes to pay up to $20,000 a month for care coordination — and what that's worth annually to a facility with 200 Medicare patients The difference between "popping in" and genuine presence — and why only one of them drives real cost savings and keeps patients from bouncing back to the hospital Why physicians working in isolation are the biggest liability in a team-based care model, and how a September 1st bonus restructure is designed to change that culture How 80% of what used to require an in-person visit can now happen via telehealth — and the one thing technology will never replace: the relationship that makes a patient actually follow through Scott's 10-year urgency: why Your Health is already three steps ahead of the competition — and why that lead only matters if the model scales fast enough If you work in a nursing facility, lead a care team, run a healthcare organization, or believe the system needs a fundamentally better architecture — this is what building it actually looks like. Press play. www.YourHealth.Org

August 10, 202641 min

Medicare Is Already Paying for This — Your Facility Just Isn't Collecting It

Most nursing home administrators don't realize they're sitting on one of the most underutilized revenue streams in all of Medicare — and until someone shows up and tells them what it's worth, they never will. In this episode, Scott Middleton — founder and Chief Disruption Officer of Your Health — calls in from the road as he travels across rural Georgia on a multi-day facility tour, fresh off completing a major merger with TCPA. What follows is an unfiltered, on-the-ground breakdown of two transformational opportunities Scott is actively building: chronic care management (CCM) reimbursement and ACO cost savings — and the very specific reasons most of the industry is getting both wrong. In this episode, you'll hear: Why Medicare already pays $65/hour for care management performed by nurses, community health workers, and social workers — and how Your Health is now contracting with nursing home facilities to perform it, paying them up to $100 per patient per month The "Fuse" platform — a communication and documentation tool that routes care management notes directly into billing-ready buckets, syncing with point-of-care software so the minutes get captured and billed automatically How ACO risk scores work, why Your Health's scores have grown 30% under their current plan, and what failing to see hospice patients could cost the organization — up to $22 million in a single year The $4,800 per patient per year problem: how one physician in their network was quietly rated one of the worst under the ACO model simply because his patients were going home without any follow-up Scott's announcement that SSAs and TCPs are being restructured to report directly to peer group administrators — and why the confusion about their roles has cost the company If you lead a nursing home, an assisted living facility, a physician group, or any organization inside the long-term care ecosystem, this episode will change how you look at what you're already doing — and what you're leaving behind. www.YourHealth.Org

August 3, 202630 min

Closing The Merger

What does it look like the day a healthcare merger closes — not in a press release, but in real life? Scott Middleton was still signing DocuSign documents from his car when Jamie Preston hit record, and what followed is one of the most honest conversations yet about what it takes to grow a healthcare organization without losing the soul of why you started. Scott Middleton, Owner of Your Health and Chief Disruption Officer, joins the show to break down the just-completed acquisition of TCPA and Providence Care — and what it means to suddenly be responsible for 32 nursing home buildings, 900 new patients, and the enormous operational lift of pulling it all together under one roof. In this episode, Scott and Jamie cover: Why Your Health is immediately deploying two nurses and two community health workers per building — and how the revenue model makes them essentially self-funding from day one The continuous care hospice strategy: how night nurses on call can simultaneously generate $67/hour in Medicare reimbursement and ensure no patient dies alone The critical failure Scott discovered — hospice patients who haven't been seen by a provider since January, and the financial and human cost of letting that slide Why strategic planning lives in the field, not the boardroom — and what happens when leaders stop getting out from behind their desks The 30-day integration sprint: switching all providers to Athena, connecting hospice nurses to nurse practitioners, and getting risk scores captured before it's too late This is what disruption actually sounds like — not a keynote, not a case study, but a leader in motion, making decisions in real time, building something the healthcare system has never seen. If you're in healthcare, business, or just believe the way things have always been done is not good enough — this one's for you. www.YourHealth.Org

July 27, 202637 min

Presence & Consistency

What if the most powerful growth strategy in hospice and primary care had nothing to do with your clinical protocols, your technology stack, or your marketing budget — and everything to do with who shows up, and how often ? In this episode of The Disrupted Podcast, Scott Middleton — founder and Chief Disruption Officer of Your Health — unpacks the real-world lessons shaping how your Health is staffing, growing, and rebuilding trust as it integrates the newly merged TCPA and Providence Care organizations. Scott spent the week in the field — Monroe, Georgia; Beaufort, South Carolina; Atlanta and beyond — sitting in care team meetings, talking to nurses, watching exercise classes, and rethinking everything from staffing ratios to personality matching. What he found is both a warning and a blueprint. In this episode: Why minor service failures — a nurse who didn't show up once — can cost you an entire facility relationship, and what it actually takes to earn it back The strategic case for pulling a nurse off a shared caseload and planting her full-time in a single building — even when the numbers don't fully justify it yet The story of a nurse so embedded in one facility that an administrator told Your Health: "I will cut you if you move her" How DISC personality profiles should determine which staff member walks into which building — and why getting it wrong creates friction that kills referrals Why the best talent you'll ever hire is already living in the community you serve — and why your recruiters will never find them on Indeed The centralize-then-decentralize model Your Health deploys every time it launches something new — and why it's the only way to scale without losing quality If you lead a care team, run a hospice program, manage a building, or are trying to grow in any direction in healthcare right now — this episode is your field guide. www.YourHealth.Org

July 20, 202640 min

Lost In Misinterpretation

What if the reason your boss wants you in the office has nothing to do with your productivity — and everything to do with their ego? Scott Middleton admits it: he walked around his 30,000-square-foot corporate office on a Friday afternoon, found nobody, and got irritated. Then he caught himself. The data said his team was productive. The irritation was his ego talking. That moment of self-awareness opens a much bigger conversation about what happens when leaders — in business and in healthcare — stop reading the evidence and start acting on assumption. In this episode of The Disrupted Podcast, Scott and Jamie dig into: Why most CEOs pushing return-to-office mandates are solving for ego, not outcomes — and the New York Times data that proves it How Your Health is shifting from counting patients to measuring risk scores — and why that changes everything about how care teams are built The "legs grow back on January 1st" problem: how the Medicare system loses patient diagnoses every year and why hospice patients often appear healthier right before they die Why misinterpreting hospice rules is putting patients on the wrong track — and costing providers in ways they don't see coming The role of chaplains in advanced care planning, and why getting that right could reduce hospitalizations and change end-of-life outcomes South Carolina's jump from 49th to 26th in healthcare quality rankings — and what it means for the rest of the country Scott closes with a mission statement that's hard to argue with: at 67, he could have retired. He didn't. If this conversation lights something up in you, share it with someone who needs to hear it. www.YourHealth.Org

July 13, 202634 min

Stop Making Up Rules Already!

What happens when the rules everyone follows weren't actually rules to begin with? In this episode, Scott Middleton — Owner of Your Health and Chief Disruption Officer — shares what he's seeing on the ground as the TCPA and Providence Care merger moves toward its final close. But the real conversation goes deeper: the quiet, dangerous habit of staff making up policies, enforcing phantom restrictions, and defaulting to "no" when the answer should have been "let's figure it out." Key topics covered: Why fabricated rules (like requiring a psych NP referral for talk therapy) become embedded in organizations — and how to stop it How Scott is approaching the merger with radical transparency, and why "don't tell until it's done" has no place in his culture The one thing that will get you fired fast: "don't tell Scott" What TCPA's nursing home model is teaching Your Health about patient frequency, hospitalizations, and what actually works Why the chaplain conversation changed Scott's entire philosophy — and how advanced care planning pays for it The system doesn't need more rules. It needs more people willing to ask. Listen now and ask yourself: what rule in your organization did somebody just make up? www.YourHealth.Org

June 29, 202646 min

A Value-Based Merger

What if the patient you discharged three years ago is still costing you money today? In this episode of The Disrupted Podcast, Scott Middleton pulls back the curtain on the mechanics of value-based care most providers never see — and the merger bringing it all into focus. With the July 15th closing date approaching, Scott walks through what the merger of Your Health with TCPA and Providence Care actually means on the ground: new contracts, new provider numbers, a reimbursement model built on RAF scores and revenue rather than guesswork, and a technology stack — from the Clini app to QR-coded patient wristbands — designed to capture what was previously left on the table. In this episode: Why patient attribution under value-based contracts follows you for years — and what hospice discharges are really costing the organization How the new bonus structure ties pay to billing, RAF scores, and quality measures (and why you can never be paid to put someone on hospice) The difference between care management, facilitated visits, and what providers have been under-billing all along How skilled nursing facilities became the highest-leverage opportunity in the entire model Why advanced care plans aren't just clinical — they're a 30% income increase hiding in plain sight If you've ever wondered why the "why" behind a process matters more than the process itself, this episode is the answer. Press play. www.YourHealth.Org

June 22, 202640 min

We NOT Them

What if the fastest way to grow your healthcare organization is to slow down? In this episode of The Disrupted Podcast, Scott Middleton returns from Scotland straight into the thick of a merger — and what he's learning is reshaping how he thinks about change itself. Scott takes us inside the integration of TCPA and Providence Care into Your Health, where two very different models are colliding. One organization built 640 billing codes last year; the other built 40. One puts a single nurse practitioner in a building with no support; the other surrounds providers with nurses and community health workers. The opportunity is enormous — but so is the risk of moving too fast and scaring everyone away. What if the fastest way to grow your healthcare organization is to slow down? In this episode of The Disrupted Podcast, Scott Middleton returns from Scotland straight into the thick of a merger — and what he's learning is reshaping how he thinks about change itself. Scott takes us inside the integration of TCPA and Providence Care into Your Health, where two very different models are colliding. One organization built 640 billing codes last year; the other built 40. One puts a single nurse practitioner in a building with no support; the other surrounds providers with nurses and community health workers. The opportunity is enormous — but so is the risk of moving too fast and scaring everyone away. In this conversation, Jamie and Scott explore: Why a nurse practitioner alone is a "single source of failure" — and how staffing changes everything How to enter a building without threatening the provider they already love Why billing isn't bureaucracy — it's how Medicare knows you made a difference The art of giving people what they think they need now, and the rest over time Advanced care planning, DNRs, and why the right message sometimes needs a different voice This is a masterclass in change management disguised as a healthcare conversation. Listen now — and rethink what "disruption" really requires. Why a nurse practitioner alone is a "single source of failure" — and how staffing changes everything How to enter a building without threatening the provider they already love Why billing isn't bureaucracy — it's how Medicare knows you made a difference The art of giving people what they think they need now, and the rest over time Advanced care planning, DNRs, and why the right message sometimes needs a different voice This is a masterclass in change management disguised as a healthcare conversation. Listen now — and rethink what "disruption" really requires. www.YourHealth.Org

June 8, 202632 min

If You Didn't Document It, Medicare Thinks It Never Happened

It was 3 o'clock in the morning when Scott Middleton finally signed the papers. The merger was official. And within days, he was already on the road — visiting facilities, riding along with providers, and spotting the same gap everywhere he went: brilliant clinicians doing real work that was completely invisible to the system. In this episode of The Disrupted Podcast, Jamie sits down with Scott Middleton, calling in from Boston, to unpack what he's discovering on the ground in the newly merged Your Health organization — and why tracking your time isn't about paperwork. It's about protection, proof, and getting paid for every minute of care you're already delivering. What you'll hear in this episode: The Dr. Jeeve story: a high-producing doc who managed a nursing home crisis by phone, saved a patient from an unnecessary ER visit — and never billed for it, leaving Medicare with no record of his intervention Why not documenting a visit before a hospitalization doesn't just cost you revenue — it makes you look like a bad provider, even when you did everything right How insurance companies like United Healthcare boldly take 15% off the top of every healthcare dollar — and why that math means providers can't afford to give their time away for free The TCPA pattern Scott keeps seeing: 15,000–18,000 visits a month, almost entirely in nursing homes, with zero follow-up once patients go home The new post-discharge standard: every patient leaving a nursing home gets a telehealth visit within 48 hours, then weekly follow-up for four weeks — no one gets left in the gap This episode is a masterclass in understanding that documentation isn't bureaucracy — it's how you tell your story, protect your reputation, and keep the care you've already given from disappearing. www.YourHealth.Org

June 1, 202635 min

The Merger

What does it actually cost when a doctor writes a verbal order over the phone instead of seeing the patient? Scott Middleton has the receipts — and the answer is going to make you rethink everything about how American healthcare spends its money. In this episode of The Disrupted Podcast, Scott announces a landmark three-way merger bringing Your Health together with Transitional Care Professionals of America (TCPA) out of Georgia and Providence Care, a hospice organization in South Carolina. The combined organization will serve approximately 55,000 active patients — not patients on a list, but people being seen regularly — and Scott lays out exactly how he's going to run it. What you'll hear in this episode: Why Scott's family owning 80% of the merged company changes everything about how decisions get made — and who they get made for The difference between fee-for-service and value-based care, and why the ACO model means every unnecessary hospitalization literally comes out of Your Health's pocket How Your Health's risk-adjustment-based visit model (16 visits per year per risk point) was independently validated by a new government study — and why it works The three things Scott is asking every new employee to do in the first weeks: align with a nurse practitioner, track every minute of care management, and recruit like their livelihood depends on it — because it does Why Scott's new management philosophy is six words: "Keep them out of the hospital and see your damn patients" This isn't a corporate announcement. It's a playbook for how healthcare can actually work when operators run the company, providers see their patients, and every minute of care gets counted. www.YourHealth.Org