Episodes

  • The PACN Podcast - Dr. Sanjay Doddamani, GuideHealth

    The PACN Podcast - Dr. Sanjay Doddamani, GuideHealth
    May 11 2026
    In this timely episode, Dr. John Pagan welcomes Dr. Sanjay Doddamani to discuss two urgent and interconnected topics: the August 1st deadline for physicians to signal intent to join the PACN ACO for 2025, and the role that Guide Health — one of PACN's newest partners — is playing in helping independent practices manage complex Medicare patients and capture the full value of their quality care. This is a must-listen for any Pennsylvania physician considering ACO participation.Key HighlightsAbout Guide Health Guide Health is a 25-year-old organization — expanded through a recent MSO acquisition — that specializes in making value-based care delivery more affordable and manageable for independent practices. Its model centers on medically trained health guides (medical assistants) supervised by registered nurses, who work remotely within a practice's existing workflows to support care gap closure, patient engagement, and documentation. Guide Health operates across four states and has been recognized as a best-in-class, number-one ranked provider of value-based managed services.Dr. Doddamani brought a personal perspective to the work: having driven the length and breadth of Pennsylvania conducting home visits, he has seen firsthand how easily things slip through the cracks for complex Medicare patients — missed medications, repeated hospitalizations, unaddressed care gaps. Guide Health was built to close those gaps systematically and affordably.How Guide Health Works With Practices Guide Health meets patients where they are — via text, voice, video, and direct connectivity to the practice — without creating new workflows or adding new burdens for the physician. Its technology platform aggregates clinical data from multiple sources: EHR records, claims, lab feeds, administrative data, and discharge summaries. Health guides have direct access to the medical record and are supported by nurses and care team members, ensuring that no patient slips through the cracks. The model is tiered: the sickest patients receive high-touch coordination, while lower-risk patients receive automated reminders and specialist connection support.The PACN ACO: Why It Matters The PA Clinical Network ACO, active since 2022, allows independent practices to participate in Medicare Shared Savings — earning a share of the cost reductions generated by delivering better, more coordinated care. PACN is the only state medical society-sponsored clinical network and ACO of its kind in the country. With flat fee-for-service reimbursements continuing to decline, ACO participation represents one of the most meaningful opportunities for independent primary care physicians to be compensated fairly for the quality of care they already deliver.The August 1st Deadline — Act Now CMS requires that any practice intending to participate in a Medicare ACO for 2025 submit a letter of intent by August 1st. Critically, this LOI is non-binding — it is simply a signal of interest that reserves a place at the table while both the practice and PACN evaluate fit. The final decision to join can be made several weeks later, into September. Any physician with interest — even preliminary — should reach out immediately.What's at Stake: Hundreds of Moving Parts Dr. Doddamani outlined the complexity behind value-based care success: hundreds of individual tasks spanning quality gap closure, documentation, patient engagement, care coordination, and risk coding — all of which are nearly impossible for a busy independent practice to manage alone. Key opportunities include triple-weighted quality measures that significantly impact scoring, HCC documentation to ensure Medicare accurately reflects the complexity of each practice's patient population, and avoidable hospitalization reduction, which is one of the primary drivers of shared savings. Guide Health's infrastructure handles much of this behind the scenes, allowing physicians to focus on patient care while the network and its partners ensure that care is fully recognized and rewarded.Key TakeawaysThe August 1st deadline to signal intent to join the PACN ACO for 2025 is firm — practices with any interest should reach out to PACN immediately.The letter of intent is non-binding. Expressing interest now preserves your option to join; the final decision can come in September.Guide Health provides remote health guides and technology infrastructure that work within your existing workflows to close care gaps, improve documentation, and reduce avoidable hospitalizations — without adding burden to the practice.Value-based care has hundreds of moving parts. PACN and partners like Guide Health exist to handle the administrative lift so physicians can concentrate on the care they trained to deliver.Triple-weighted quality measures and accurate HCC documentation can significantly impact ACO performance and shared savings distributions — getting these right is essential.The PACN ACO is the only state ...
    Show More Show Less
    11 mins
  • The PACN Podcast - Dr. Damian McHugh, Curi (Part 3)

    The PACN Podcast - Dr. Damian McHugh, Curi (Part 3)
    May 11 2026
    In the third and final installment of the Curi series, Dr. John Pagan and Dr. Damian McHugh turn their attention to one of the most urgent challenges facing the physician community: burnout. They explore how Curi and PACN are working together to address the systemic roots of physician distress, why collective advocacy is essential, and how bringing physicians together around shared experiences and honest dialogue may be the most powerful tool available. The conversation closes with a forward-looking vision for what the PACN–Curi partnership can accomplish together.New to this series? Parts 1 and 2 cover Curi's origins as a physician-owned liability mutual, its expanded services through Curi Capital and Curi Advisory, and the implications of Pennsylvania's recent venue change ruling.Key HighlightsBurnout Is a System Problem, Not a Physician Problem Dr. McHugh opened with a reframing of the burnout conversation that he finds most meaningful in the recent literature: the shift away from telling physicians to build more resilience — do more yoga, exercise more — toward recognizing burnout as a signal of systemic toxicity. His analogy was vivid: when the canary in the coalmine starts turning gray and falls off its perch, that's not a reflection of the canary's weakness. It reflects the toxicity of the mine. Physicians are among the most capable and resilient people on the planet; when they are burning out at rates higher than the general population, the system needs to change — not the physicians.What Curi Is Doing About It Even before Dr. McHugh joined the company, Curi was already having conversations with its member-owners about burnout — not just acknowledging it, but actively encouraging physicians to talk to each other and to Curi about it. Since joining, Dr. McHugh has worked with a cross-company team to take those initiatives further, vetting and partnering with organizations that can support physicians who self-identify as being in distress. The goal is not a single solution, but a range of supports that address the wide spectrum of what a physician in difficulty might need.The Quadruple Aim: Physicians Cannot Be Left Out Dr. Pagan connected the burnout conversation to the evolution of healthcare's governing framework — from the Triple Aim (better care, better health, lower costs) to the Quadruple Aim, which adds physician and care team wellbeing as a fourth essential dimension. His point: you cannot achieve quality, efficient, patient-centered care if the people delivering that care are suffering. Advocacy for physician wellbeing must extend beyond the hospital C-suite to the legislature and the public, because many of the regulations and EMR burdens that compound physician stress are written into law by well-meaning policymakers who don't fully understand their impact on the people providing care.The Value of Bringing Physicians Together Dr. McHugh described a recent Curi Community Advisory Board dinner in Pennsylvania — a think tank-style gathering where physicians from different specialties came together over a meal to share experiences, identify common challenges, and offer each other perspective. He noted that some physicians drove two hours through traffic to attend. His observation: this kind of peer-to-peer dialogue is becoming increasingly rare as physicians spend more time with computers and less time with each other. Both Curi and PACN see themselves as conveners — creating the trusted spaces where these conversations can happen and where ideas and concerns can be heard and acted upon.Together We Are Stronger Both Dr. Pagan and Dr. McHugh returned to a central theme: the power of collective action. Dr. Pagan put it plainly — if physicians are not at the table when healthcare decisions are being made, they are likely on the menu. The bonds that unite physicians — the shared sacrifice of training, the common commitment to patients — are a foundation for collective strength that too often goes untapped. Curi and PACN both exist to change that.An Open Invitation Dr. McHugh closed with a direct invitation to PACN physicians: whether already a Curi member or considering joining, he encouraged physicians to reach out, share ideas, and bring their concerns directly to him. Curi's role, as he sees it, is to be a trusted listener and a reliable repository for the ideas and observations of the physicians it serves.Key TakeawaysPhysician burnout is a systemic issue, not a personal failing. Addressing it requires changing the conditions of practice, not simply building individual resilience.Curi has been actively engaged on burnout for years — facilitating physician conversations, vetting support organizations, and building internal teams focused on physician wellbeing.The Quadruple Aim is not optional: physician wellbeing is inseparable from care quality, and advocacy for it must extend to legislatures and the public.Peer connection — physicians talking honestly with each ...
    Show More Show Less
    16 mins
  • The PACN Podcast - Dr. Damian McHugh, Curi (Part 2)

    The PACN Podcast - Dr. Damian McHugh, Curi (Part 2)
    Apr 24 2026
    In this follow-up conversation, Dr. John Pagan and Dr. Damian McHugh pick up where Part 1 left off — moving beyond Curi's core medical liability product to explore the company's expanding suite of services for physicians. The conversation also takes a timely turn toward one of the most pressing legal developments affecting Pennsylvania physicians: a recent Pennsylvania Supreme Court ruling on venue change and what it may mean for malpractice exposure in the years ahead.Haven't heard Part 1? Start there for the story of Curi's origins, Dr. McHugh's path from emergency medicine to physician advocacy, and why the PACN–Curi partnership is a natural fit.Key HighlightsCuri Has Grown Well Beyond Liability Insurance While medical professional liability remains Curi's foundation, the company has expanded into two additional service areas in direct response to what its physician member-owners asked for.Curi Capital — A wealth management arm staffed by approximately 25 registered independent advisors with deep expertise in both physician personal finance and practice asset management, including retirement plan administration. The arm grew out of member physicians who admired how prudently Curi managed its own investment portfolio and asked whether they could access similar expertise for their own financial lives.Curi Advisory — A business consulting arm that provides physicians with software tools for practice management, online reputation management, and organic growth strategies. Curi initially partnered with an analytics company called Alytics, found it so effective that it acquired the company outright, and built Curi Advisory around it. The result is a suite of business consulting and risk management solutions designed to make practices more successful operationally.Dr. McHugh signaled that continued innovation is coming — additional services are in development as Curi works to support physicians in medicine, business, and life.Legislative Advocacy: A Core Commitment Dr. McHugh shared a personal story from 2011, when a looming malpractice crisis in North Carolina brought him and Curi together in the legislative arena for the first time. Curi invested significant time, talent, and resources assembling medical and legal experts, equipping physicians to meet directly with lawmakers, and bringing firsthand bedside stories to the legislature — a form of advocacy Dr. McHugh has found consistently effective. Curi has since maintained an active legislative presence across multiple states, including Pennsylvania.The Venue Change: A Significant Development for Pennsylvania Physicians A substantial portion of the conversation focused on a recent Pennsylvania Supreme Court ruling that effectively overturned the venue protections established by the MCare Act of 2002. Under that law, malpractice cases had to be heard in the county where the medical event occurred. The Supreme Court has now ruled that cases can be filed in almost any county in the state — opening the door to plaintiffs choosing favorable jurisdictions, most notably Philadelphia, regardless of where care was provided.Curi has been tracking this issue for six to seven years and has been an active supporter of efforts to address it, including through the work of its general counsel, Jason Newton, whom Dr. McHugh described as one of the foremost medical-legal minds in the region. The venue change takes effect January 1st of the upcoming new year. While neither Dr. McHugh nor Dr. Pagan expected an immediate flood of filings on that date, both acknowledged that an uptick in litigation activity in plaintiff-friendly counties is anticipated at some future point, given the typical lag between a medical event and a filed suit.Curi is already working at the advocacy and legislative level to explore potential solutions, including whether it may be feasible for physicians to ask patients to sign agreements consenting to venue in the physician's home county in the event of a dispute. In the meantime, Curi noted it has existing experience defending cases across the Commonwealth's major counties and feels well-prepared to defend its member-owners wherever cases may be filed.Key TakeawaysCuri has evolved from a single-product liability carrier into a three-legged platform: medical professional liability, wealth management (Curi Capital), and business consulting (Curi Advisory) — all built around what physician members asked for.Curi Capital offers independent financial advisory services tailored specifically to physicians, covering both personal wealth and practice retirement plans.Curi Advisory provides practice management software, online reputation tools, and growth strategies through its Alytics platform.The Pennsylvania Supreme Court's venue ruling is a material development for physician liability exposure in the state. Physicians should be aware it takes effect January 1st and should discuss its implications with their liability carrier.Curi is ...
    Show More Show Less
    14 mins
  • The PACN Podcast - Dr. Damian McHugh, Curi (Part 1)

    The PACN Podcast - Dr. Damian McHugh, Curi (Part 1)
    Apr 24 2026

    In this episode, Dr. John Pagan introduces PACN's newest partner, Curi — a physician-founded medical professional liability company with deep roots in the medical society movement. Dr. Damian McHugh, a former emergency physician turned physician advocate, shares the story of Curii's origins, what makes it different from conventional malpractice carriers, and why the partnership with PACN is a natural fit for independent physicians across Pennsylvania.


    Key Highlights

    Dr. McHugh's Path from Emergency Medicine to Curi Dr. McHugh practiced emergency medicine for 21 full-time years in the UNC system in North Carolina after completing a second emergency medicine residency at Chapel Hill. Originally from Britain, he came to the U.S. in 1997 and over time grew increasingly involved with what was then the Medical Mutual Insurance Company of North Carolina — the company that would rebrand as Curi in 2018. What drew him in wasn't just the liability product, but the company's culture: a genuine dedication to physicians at a time when physicians have fewer and fewer advocates. As his clinical career wound down, the move to Curi was a natural evolution. He now serves as Senior Vice President and Physician Liaison, working to bring a physician's perspective into the company's leadership and strategy.

    What Is Curi? Curi is a physician-owned medical professional liability company — a mutual organization owned by its approximately 14,000 physician members, roughly 1,700 to 1,800 of whom practice in Pennsylvania. It was born in 1975 out of crisis: when malpractice providers began exiting the market en masse, the North Carolina Medical Society brought concerned physicians together and rapidly formed Medical Mutual to protect, support, and indemnify them. That physician-society origin is not just history — it continues to shape Curi's culture and priorities today. The company is selective about which practices it works with, deliberately associating itself with patient-centered, safety-focused physicians who prioritize quality and customer service.

    Natural Synergy Between Curi and PACN Both organizations trace their roots to state medical societies — Curi to the North Carolina Medical Society, PACN to the Pennsylvania Medical Society — and both exist to serve the independent physician community with tools, advocacy, and support that larger institutions don't provide. Dr. McHugh described PACN's membership as precisely the kind of practice Curi wants to work with: hardworking, patient-centered physicians who also attend to the wellbeing of their partners, their staff, and themselves. He noted that practicing in an environment that prioritizes safety and service is not just ethically right — it actively reduces the risk of burnout.

    Why Curi Over Other Carriers? In a market with many malpractice options, Dr. McHugh pointed to Curi's mutual ownership structure as the defining differentiator. As a physician-owned mutual, Curi's interests are aligned with its members — not with outside shareholders. Its mission explicitly extends beyond liability protection to improving the lives of physicians not just in medicine and business, but in life overall. That mission aligns directly with PACN's own goal of reducing barriers and restoring the joy of medical practice.

    The Broader Stakes: Choice and Burnout Both Dr. McHugh and Dr. Pagan reflected on the connection between physician autonomy and burnout. When independent practice is not a viable option, even employed physicians lose leverage — and the sense of helplessness that comes with no meaningful alternatives is itself a driver of burnout. Curi and PACN share a belief that supporting independent practice is not just good for independent physicians, but for the entire physician community.


    Key Takeaways

    • Curi is a physician-owned mutual liability company — not answerable to outside shareholders, but to its 14,000 physician members, including roughly 1,700–1,800 in Pennsylvania.
    • Its origins in the North Carolina Medical Society's response to a malpractice crisis give it a physician-first culture that has remained consistent through its evolution from Medical Mutual to Curi.
    • The PACN–Curi partnership is rooted in shared values: both organizations were born from medical societies, both serve independent physicians, and both are committed to reducing the burdens of practice.
    • Curi is selective — it works with practices that demonstrate a commitment to quality, safety, and patient-centered care, which aligns naturally with PACN's membership.
    • Physician autonomy and physician wellness are connected. Preserving the option of independent practice protects not just those who choose it, but the entire physician workforce.
    Show More Show Less
    11 mins
  • The PACN Podcast - Dr. Nader Rahmanian and Cheryl Rahmanian (Part 2)

    The PACN Podcast - Dr. Nader Rahmanian and Cheryl Rahmanian (Part 2)
    Apr 24 2026
    In this follow-up conversation, Dr. John Pagan welcomes back Dr. Nader Rahmanian and Cheryl Rahmanian for a practical, step-by-step look at how their practice approaches the annual wellness visit — one of the highest-value touchpoints in Medicare care. From pre-visit preparation to post-visit documentation, the Rahmanians share their workflow in detail and offer their template to any colleague who wants it. Dr. Rahmanian also delivers a passionate call to action for independent physicians to engage with their medical society and clinical network.Haven't heard Part 1? Start there for the full story of Dr. Rahmanian's 35-year career in independent practice, his candid take on employed medicine, and what it takes to build a sustainable independent practice.Key HighlightsMaking the Most of the Annual Wellness Visit Dr. Rahmanian opened with a note of genuine appreciation for Medicare's decision to cover annual wellness visits comprehensively for geriatric patients — a recognition that older patients need yearly preventive attention in a way younger patients do not. The visit is structured to cover past medical and surgical history, medication review, physical exam, psychiatric review, and — critically for geriatric patients — advanced care planning including living wills and durable power of attorney discussions. Dr. Rahmanian emphasized that the reimbursement is attractive enough that every practice should be performing these visits routinely, and that a well-run annual wellness visit combined with a regular office visit can yield close to $300 in Medicare reimbursement with relatively little additional physician time.A Team Approach to Pre-Visit Preparation Cheryl Rahmanian walked through the practice's step-by-step preparation workflow. Annual wellness dates are tracked directly in the EMR using a pinned note. When a patient schedules their next appointment, Cheryl reviews whether they are due — always scheduling more than 365 days out to avoid Medicare timing issues. Before the visit, she researches and updates the chart, reviews preventive care status (mammograms, colonoscopies, immunizations, smoking history), and ensures the patient completes their depression screening. The nurse then sees the patient before the physician, conducts the wellness portion of the visit including the cognitive screening, and flags any deficiencies for the physician before he enters the room.Cognitive Screening: Choosing the Right Tool Dr. Rahmanian noted that not all cognitive screening tools are accepted by Medicare for the annual wellness visit. The practice uses the MoCA (Montreal Cognitive Assessment), which meets Medicare's requirements. He cautioned colleagues that some commonly used tools — such as the clock drawing test — are not considered sufficient by Medicare, and encouraged practices to verify which assessments qualify.Coupling the Wellness Visit with the Regular Visit A key efficiency point: the annual wellness visit can be billed alongside a regular office visit on the same day. If the physician identifies a problem during the wellness visit — a new finding, an abnormal screening result — it can be addressed and billed separately as a problem visit in addition to the wellness visit. This structure maximizes both care quality and reimbursement without requiring patients to make a separate trip.Documentation and the Template Cheryl developed a documentation template when Medicare first introduced the annual wellness visit, building it directly from Medicare's requirements so nothing is missed. The Rahmanians offered to share this template with any PACN colleagues or Pennsylvania Medical Society members who would like it — emphasizing that it is not proprietary and is theirs to use.At the End of Every Visit: A Preventive Care Summary Each patient leaves their annual wellness visit with a printed summary of their preventive care history — flu shots, pneumococcal vaccines, mammograms, colonoscopies, and other services — so they stay informed and engaged in their own care.A Strong Argument for PACN Membership Dr. Rahmanian closed with a passionate case for why every physician — employed or independent — should be a member of the Pennsylvania Medical Society and engaged with PACN. His argument: physicians are among the most educated professionals in the country, yet too many fail to advocate for their own interests collectively. No hospital employer has a physician's best interests at heart. Without organized representation — in the legislature, in contract negotiations, in the community — independent physicians have no voice. PACN gives them the collective power of a large organization without the headaches of a large partnership, and opens doors to contracts, recognition, and resources that no solo practice could access alone.Gratitude for the Pennsylvania Medical Society Dr. Rahmanian concluded by thanking the Pennsylvania Medical Society for having the vision and the ...
    Show More Show Less
    18 mins
  • The PACN Podcast - Dr. Nader Rahmanian and Cheryl Rahmanian (Part 1)

    The PACN Podcast - Dr. Nader Rahmanian and Cheryl Rahmanian (Part 1)
    Apr 24 2026
    In this episode, Dr. John Pagan sits down with Dr. Nader Rahmanian and his wife and practice manager, Cheryl Rahmanian, of their internal medicine and geriatrics practice in Wyomissing, Pennsylvania. A longtime PACN member with consistently high performance levels, Dr. Rahmanian brings nearly 36 years of independent practice experience — including a brief but instructive stint in employed medicine — and a candid perspective on what it takes to build and sustain an independent practice. Cheryl offers a ground-level view of what patient loyalty and trust actually look like day to day.Key HighlightsA Career Built on Independence Dr. Rahmanian completed his internal medicine residency in Philadelphia and earned board certifications in both internal medicine and geriatrics. Rather than pursue additional fellowship training at the time, he transitioned into private practice and has remained independent — with one notable exception — ever since. He took over an established practice near Community General Hospital, moved to Wyomissing after the hospital closed in 1997, and built a practice serving patients 18 and older, with roughly 75% of his panel being geriatric patients. He previously served as medical director of several nursing homes and managed complex ventilator-dependent patients — responsibilities he has since stepped back from to focus on his outpatient practice.A Brief but Telling Experience in Employment At the request of the hospital CEO, Dr. Rahmanian helped establish the Reading Hospital Medical Group in the early 2000s and joined it as a board member from January 2007 through November 2009. He left when it became clear that even board membership wasn't enough to hold the institution to its commitments. He returned to private practice and hasn't looked back. More recently, in April 2020, when Reading Hospital made clear that remaining independent hospitalists were unwelcome, Dr. Rahmanian and a colleague chose to stop doing inpatient work rather than sell their practice to the system. He occasionally works a few days per year as a hospitalist to maintain his skills, but his practice remains firmly independent and outpatient-focused.The Case for Independence — And the Fear That Holds Physicians Back Dr. Rahmanian offered a frank assessment of why physicians choose employment despite the costs to their autonomy. On one hand, medicine attracts independent-minded people — yet medical training provides virtually no preparation for the business side of running a practice. The result is a pervasive fear of billing, ledger sheets, staffing, and financial management that drives many physicians into employment simply because it feels safer. His counterargument: running a practice is not fundamentally different from managing a household budget. Once you learn the basics, it's manageable — and the alternative, having a hospital administrator with entirely different incentives dictating your patient volume, your time, and even your referral patterns, is far worse.A Vision for the Future of Independent Practice Dr. Rahmanian articulated what he hopes the future holds: organizations that handle all the administrative and operational complexity of running a practice — billing, staffing, compliance — in exchange for a percentage, while staying entirely out of clinical decision-making. He sees this model as the key to unlocking independence for a new generation of physicians who want autonomy but don't know where to start. He also called for medical schools to add a basic practice finance and business management course to their curricula — a gap he sees as one of the most consequential oversights in physician training.The Partner Behind the Practice Cheryl Rahmanian has been with the practice nearly from the beginning, and Dr. Rahmanian credits her as the smarter half keeping everything on track. Her perspective on what makes the practice special comes directly from patients: new patients frequently remark that they finally feel like they're in a real practice, seeing an actual doctor who spends real time with them. Many arrive having left larger systems frustrated by constant provider turnover and rushed appointments. That gratitude, Cheryl noted, is what makes the work rewarding.Key TakeawaysNearly 36 years of independent practice — with eyes wide open about what employment looks like from the inside — gives Dr. Rahmanian a uniquely credible perspective on why independence is worth protecting.The biggest barrier to independent practice for most physicians isn't operational complexity — it's fear born from a lack of business education in medical training.Institutions that claim not to interfere with clinical autonomy routinely do so through patient volume requirements, EMR mandates, and referral pressures — often with real consequences for physicians who don't comply.The patient experience in a well-run independent practice — continuity, time, personal attention — is something ...
    Show More Show Less
    13 mins
  • The PACN Podcast - Dr. James Galasso (Part 2)

    The PACN Podcast - Dr. James Galasso (Part 2)
    Apr 24 2026
    In this follow-up conversation, Dr. John Pagan welcomes back Dr. James Galasso to dig deeper into the quality and shared savings programs that have defined his approach to independent practice. Drawing on firsthand experience with Pennsylvania's Governor's Chronic Care Initiative and his current role on PACN's ACO Oversight Board, Dr. Galasso offers a practical, ground-level perspective on what it actually looks like to deliver high-quality, data-driven care in a small independent practice — and why it pays off for physicians and patients alike.Haven't heard Part 1? Start there for Dr. Galasso's full story — his path to medicine, his community, and why he chose independent practice over the large health systems that surround him.Key HighlightsRoots in the Governor's Chronic Care Initiative Dr. Galasso's experience with value-based care predates PACN. Under Governor Rendell, he was selected to participate in the Governor's Chronic Care Initiative — a statewide pilot program that partnered practices with Blue Cross to identify high-risk patients, particularly those with diabetes, and improve their outcomes through proactive management. Practices were organized by region, competed against each other, and learned from one another's approaches. The results were striking: in his first year, Dr. Galasso received a check from Blue Cross of over $100,000 — from his practice alone — simply by identifying uncontrolled diabetic patients, bringing them in, and hitting established clinical guidelines. Hospitalizations dropped. Costs dropped. The model worked.How PACN Amplifies What Works The Governor's Initiative gave Dr. Galasso a foundation, but PACN gives him scale. Where he once relied on one nurse to manage outreach, he now has an entire team behind the scenes scrubbing charts, generating reports, and flagging patients who have fallen out of care. His EMR system — MedEnt — is integrated with a red diamond alert that populates before each visit, telling him exactly what needs to be addressed before he walks into the room. The work that once required significant manual effort now happens largely in the background, freeing him to focus on patient care.PACN's ACO and the "Big Five" Dr. Galasso serves on PACN's ACO Oversight Board and helped shape the network's focus on five key care touchpoints that drive shared savings under the Medicare ACO program. PACN documented significant savings in its first year of ACO participation in 2022. The five focus areas are:Annual Wellness Visits — A cornerstone of preventive care and chronic condition capture. Dr. Galasso's entire patient panel is tracked for annual wellness visits, with staff trained to identify gaps at check-in and complete screenings — mini mental status exams, depression screenings, diabetic foot exams — as a matter of routine. Patients have come to expect and look forward to these visits. Critically, the annual wellness visit also allows practices to capture and revalidate all active chronic diagnoses, which directly affects risk adjustment and reimbursement.Transitional Care Management — Dr. Galasso identified this as one of the highest-impact opportunities in value-based care. When a patient is discharged from the hospital, he gets them in as quickly as possible — ideally within the week. Post-discharge visits catch medication errors that are surprisingly common when hospitalists reconcile discharge meds against admission lists, identify new diagnoses the patient may not fully understand, and ensure follow-through on referrals, home health, and rehab. This is also where the continuity advantage of independent practice shines: Dr. Galasso already knows the patient, their medications, their support system, and their history in a way no hospitalist can replicate.Chronic Care Management, Advanced Care Planning, and Behavioral Health — Dr. Pagan noted these remaining three elements of the "Big Five" will be explored in a future episode.The Case for Complete and Accurate Coding A recurring theme throughout the conversation was the importance of capturing the full complexity of each patient's health through accurate, specific diagnosis coding. Risk adjustment models used by Medicare and other payers assign higher resource allocations to more complex patients — but only if those conditions are properly coded each year. Conditions identified through specialist notes, ER visits, or hospitalizations that don't make it back into the primary care record represent missed opportunities. PACN's team actively surfaces these gaps, prompting Dr. Galasso's practice to code more completely and ensuring the network's population complexity is accurately recognized.An Open Invitation Dr. Galasso closed with a characteristic generosity: any physician who wants to know how Galasso Family Practice approaches these programs is welcome to reach out. He's not afraid to share what's worked.Key TakeawaysProactive chronic disease management — particularly for...
    Show More Show Less
    14 mins
  • The PACN Podcast - Dr. James Galasso (Part 1)

    The PACN Podcast - Dr. James Galasso (Part 1)
    Apr 24 2026
    In the first of a two-part conversation, Dr. John Pagan sits down with Dr. James Galasso of Galasso Family Practice in Schwyz, Pennsylvania — a physician who grew up in the very community he now serves, came up through emergency medicine as a paramedic, and chose to return home to build a 30-year independent family practice rather than join the large hospital systems that dominate his region. Dr. Galasso shares what drives his commitment to independent practice, what joining PACN has meant for his ability to stay viable, and why continuity of care is the defining advantage of the independent physician.Key HighlightsA Hometown Doctor in Every Sense Dr. Galasso's path to medicine started early — his father was a Pfizer pharmaceutical rep and a volunteer for the local ambulance association, and Dr. Galasso followed suit, becoming an EMT and eventually a paramedic and president of that same association. Exposure to emergency physicians during his paramedic years sparked his interest in medicine. He initially planned to become an ER doctor, but took the advice of a seasoned emergency physician who told him to go into primary care and learn emergency medicine that way. He did — and came back to practice just three blocks from where he grew up.Serving a Close-Knit Community Schwyz is a blue-collar town of roughly 2,500 people with a high Medicare population and multigenerational families. Dr. Galasso's practice spans the full range — from newborns to geriatrics — and his wife, a physician assistant, practices alongside him. He previously attended deliveries, made hospital rounds, and visited nursing homes. The community is close-knit, and so is his relationship with it.Why He Joined PACN Operating in the shadow of two large regional systems — Geisinger and Commonwealth Health (a Tennessee-based corporation) — Dr. Galasso found that independent physicians weren't truly supported by hospital-affiliated networks. When Keith Taylor, PACN's Senior Director of Business Development, approached him about the network, he signed on. He calls it one of the best decisions he's made in private practice. The tangible benefits came quickly: group malpractice insurance at lower rates, reduced supply costs, and behind-the-scenes infrastructure support from the network that costs him nothing and helps him stay viable as an independent physician.The Value of Continuity After 30 years in practice, the majority of Dr. Galasso's patients have been with him for 25 years or more. He knows grandparents, their children, and their grandchildren. He knows family histories, first names, and the full context of every patient's life. When hospitals call about an admitted patient, he can recite their history from memory. That depth of relationship is simply not replicable in a large system, where patients routinely see different providers and often feel like a number. Many patients who have transferred to his practice cite exactly that frustration — never seeing the same doctor twice.On the Importance of Independent Practice for Everyone Dr. Galasso and Dr. Pagan discussed a point that often goes unspoken: a healthy independent practice environment doesn't just benefit independent physicians — it benefits employed ones too. When there's no viable independent option, employed physicians lose their negotiating leverage entirely. Non-compete clauses that force departing physicians to leave the area also harm patients, who lose access to a physician they've trusted. Choice — for physicians and patients alike — requires a thriving independent sector.His Own Experience on Both Sides Dr. Galasso has firsthand experience with employment. After the independent physician group he helped build — Intermountain Medical Group — was acquired by Commonwealth Health, he spent five years as an employed physician. He experienced the time restrictions, the revolving door of providers, and the inability to make autonomous decisions for his patients. When his non-compete window closed, he returned to independent practice in the same office where he had started. His message to any employed physician considering the same: it's still possible, and the path back is worth it.Key TakeawaysContinuity of care — knowing patients, their families, and their histories over decades — is the defining and irreplaceable advantage of independent family practice.PACN's behind-the-scenes infrastructure, group malpractice, and supply savings make independent practice more financially sustainable in markets dominated by large health systems.The survival of independent practice matters beyond independent physicians themselves — it preserves choice for patients and negotiating leverage for employed physicians alike.Non-compete clauses are a real and documented harm to patient care, not just physician career mobility.It's not too late to return to independent practice — Dr. Galasso did it, and encourages any employed physician who feels constrained to ...
    Show More Show Less
    13 mins