Explore every episode of the podcast Relentless Health Value
| Title | Pub. Date | Duration | |
|---|---|---|---|
| EP508: Why Don't More Self-insured CEOs Take Bold Action in Health Benefits Strategy? With Lee Lewis | 23 Apr 2026 | 00:44:02 | |
Episode 508 is the first Ask Me Anything installment of Relentless Health Value, where Stacey Richter and Lee Lewis (Chief Strategy Officer and GM Medical Solutions at the Health Transformation Alliance and host of Broken Benefits) address a question from benefits procurement leader Sarah Monroe about why executives rarely take bold action on health benefits despite large opportunity. Lewis describes three false C-suite "dogmas" that lead to "stay in the herd and keep it quiet": health benefits are a fixed expense, saving money hurts people (via cost shifting, low quality, or narrow networks), and fixing healthcare isn't worth the risk or disruption. They also discuss external deterrents including CEOs' proximity to health system leaders, "balance of trade" retaliation threats, vendor-provided personal incentives, and executives' limited empathy for deductibles/costs faced by lower-wage employees. Lewis offers de-risking tactics (same-network TPAs, carrier-enabled vendor changes, narrow pilots, mid-year tests) and advises CEOs to encourage bold action, tie bonuses to plan performance, and staff benefits teams with diverse skills. === LINKS === https://cc-lnk.com/EP508 📺 Visit Lee's YouTube Channel https://www.youtube.com/@brokenbenefits ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls= 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === 00:00 Introduction to this episode. 00:43 Ask Me Anything Question 1: Why don't more self-insured executives take bold action toward their benefits strategy? 03:09 A summary of the three dogmas covered in the following conversation. 05:53 A look ahead at next week's episode. 06:36 An introduction to today's guest, Lee Lewis. 08:23 Why there is an aversion to digging into health benefits for some executives. 09:43 The first dogma: Healthcare costs are fixed expenses. 09:56 The second dogma: Saving money in healthcare hurts people. 12:01 The third dogma: Fixing healthcare is never worth the effort. 12:26 How these dogmas trickle down to HR teams. 13:47 Anecdote: One company that turned down saving $50 million and why. 16:28 A quick reminder about the context behind where CEOs' mindsets are. 17:10 The kinds of employers HTA seeks out. 19:20 EP500 with Stacey. 20:03 The power of C-suites in health systems. 21:33 EP466 with Vivian Ho, PhD. 21:36 EP404 with Suhas Gondi, MD, MBA. 21:42 Why a CEO may pull the plug on health plan/health benefit improvements. 22:37 An anecdote about Lilly cancelling their health plan. 23:21 Items that CEOs need to be thinking about. 24:33 EP506 with Jerry DiMaso. 26:07 EP501 with Ivana Krajcinovic, PhD. 26:32 A summary of why CEOs should care about their health benefits costs now. 29:02 How do personal incentives play into CEOs' decisions about health benefits? 30:44 Another quick reminder about C-suites. 31:53 Why perverse incentives make it difficult for C-suites to accept change. 33:11 LinkedIn post by Patrick Moore. 33:28 Why the salary gap plays into health benefit decisions in a perverse way. 34:58 EP488 with Mark Cuban and Cora Opsahl. 36:13 Lee Lewis's advice to people in benefits who are aligned to the mission. 40:06 Lee Lewis's advice for CEOs.
Lee Lewis of @HTACOOP discusses #benefitsstrategy for #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast #financialhealth #commercialpayermarketplace #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation
Recent past interviews: Click a guest's name for their latest RHV episode! Stacey Richter with 15 experts (EP507); Jerry DiMaso; Dr Ahilan Sivaganesan; Ryan Jacobs; Stacey Richter (INBW46); Ryan Wells, Dr Leo Spector, and Adam Stavisky; Brian Machut; Ivana Krajcinovic
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| EP507: 4 Core Concepts to Buy or Deliver the Highest-Value Healthcare—A Review | 16 Apr 2026 | 00:33:58 | |
In this episode of Relentless Health Value, Stacey Richter summarizes 4 core concepts for getting highest-value healthcare and we hear from 15 experts who weigh in on the following concepts: (1) "Buy healthcare," not insurance, by focusing on unit prices and avoiding administrative extraction like spread pricing and layered fees, illustrated by examples from Jonathan Baran, Cynthia Fisher, Mark Newman, and Justin Leader; (2) avoid the "myth of less expensive care," emphasizing that price often doesn't correlate with quality and that better, safer care can cost less, with support from Elizabeth Mitchell, Dr. Sam Flanders, Shane Cerone, Jerry DiMaso, and Ivana Krajcinovic, plus transparency-file rate disparities; (3) consider direct contracting and collaboration between plan sponsors and clinicians (and pharmacies), including centers of excellence, to reduce middlemen and align incentives, with clips from Krajcinovic, Ryan Jacobs, Adam Stavisky, and Ryan Wells; and 4) buy true value—outcomes over cost—measured across the care journey and grounded in patient goals, with Dr. Mick Connors, Dr. Siva, and Dr. Kenny Cole. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue
Featured Experts by Core Concept Concept 1: Buy Healthcare, Not Insurance Jonathan Baran, CEO, Self Fund Health (EP483) Cynthia Fisher, founder and chairman, PatientRightsAdvocate.org; co-founder and chairman of Power to the Patients (EP457) Mark Newman, co-founder and CEO, Nomi Health (EP496) Justin Leader, founder and CEO, BenefitsDNA (EP433) Concept 2: Avoid the Myth of Less Expensive Healthcare Elizabeth Mitchell, president and CEO, Purchaser Business Group on Health (EP436) Sam Flanders, MD, senior advisor, Kada Health (EP490) Shane Cerone, CEO, Kada Health (EP492) Jerry DiMaso, co-founder and CEO, Payerset (EP506) Ivana Krajcinovic, PhD, former vice president for healthcare delivery (retired), UNITE HERE HEALTH (EP501) Concept 3: Consider Direct Contracting Ivana Krajcinovic, PhD, former vice president for healthcare delivery (retired), UNITE HERE HEALTH (EP501) Suhas Gondi, MD, MBA, chief medical officer, HealthStrategy (EP404) Ryan Jacobs, senior vice president of health plan strategy and partnerships, Marathon Health (EP504) Komal Bajaj, MD, professor of obstetrics and gynecology, Albert Einstein College of Medicine (EP458) Adam Stavisky, business advisor, Stavisky LLC (EP503) Cristin Dickerson, MD, founder and CEO, Green Imaging (EP485) Stan Schwartz, MD, chief medical officer, ZERO.health (EP486) Leo Spector, MD, MBA, CEO, OrthoCarolina (EP503) Ryan Wells, founder and CEO, Health Here (EP503) Concept 4: Buy the Highest-Value Healthcare Mick Connors, MD, pediatric emergency medicine physician, Dayton Children's Hospital (EP495) Ahilan Sivagenesan, MD, neurosurgeon, Hospital for Special Surgery; Head of Quality and Value, Mishe Health (EP505) Kenny Cole, MD, System VP, Clinical Improvement, Ochsner Health (EP473)
00:00 Introduction to this episode and guests. 01:38 The four core concepts to buy or deliver highest-value healthcare: a summary. 06:01 An exciting show announcement. 07:32 Core Concept 1: Why buy highest-value healthcare, not "best" coverage? 11:28 Core Concept 2: Will employers fall victim to the myth of inexpensive care? 13:00 Why better-quality care vs. more affordable care is a false choice. 17:09 Core Concept 3: Direct contracting. 17:58 Why demand curve matters in healthcare cost. 22:08 How Centers of Excellence play into all of this. 22:54 Core Concept 4: How do you conceive of and buy high-value healthcare? 23:48 The value equation in healthcare. 25:35 What is value? 28:20 What whole-person care looks like. 30:24 Relentless Health Value Chatbot sneak peek announcement. 32:14 Coming up: looking at the episodes ahead. | |||
| EP500: This Is Episode 500, and It's All About You, Tribe | 12 Feb 2026 | 00:38:21 | |
In the milestone Episode 500 of the 'Relentless Health Value' podcast, Stacey Richter reflects on the significant influence and community formed around the platform. Initiated by a conversation with Cora Opsahl, the episode transforms into a heartfelt ode to the listeners — healthcare entrepreneurs, executives, and change-makers, whom Stacey refers to as 'the tribe.' Featured contributions from several listeners highlight themes such as moving from theory to practical transformation, the power of collective momentum, and 'unplugging from the Matrix' of opaque healthcare practices. Notable testimonials underline how the podcast has guided real-world decisions, fostered community connections, and provided actionable insights that have tangibly influenced the healthcare sector. The episode concludes with gratitude for the tribe's effort toward transforming the healthcare system and a forward-looking encouragement to remain relentless in their mission. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === 00:00 Introduction and episode 500 announcement. | |||
| EP443: Let Us Never Pay the First Bill in Honor of Marshall Allen | 04 Jul 2024 | 00:36:17 | |
Episode 443 of Relentless Health Value pays tribute to the late Marshall Allen, an investigative journalist dedicated to exposing injustices within the American healthcare system. Hosted by Stacey Richter, the episode features Dave Chase, founder of Health Rosetta, who shares memories and insights into Marshall's tireless work in investigative reporting. The episode highlights Marshall's impact on healthcare legislation, his significant contributions to ProPublica, and his book 'Never Pay the First Bill,' which empowers patients and employers to fight back against corrupt billing practices. The episode also includes an earlier interview with Marshall, focusing on his perspective as an investigative reporter, the exploitation within the healthcare system, and the importance of patients and employers demanding transparency and fairness. The episode encourages listeners to continue Marshall's legacy by subscribing to the Marshall Health Academy and purchasing access for employees. === LINKS === 🔗 Healthcare Industry Acronyms and Terms ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b === CONNECT WITH THE RHV TEAM === 09:28 What's the point of view that Marshall is coming from with his investigative reporting? 09:57 "How does this affect the people who are paying for it and the people who are undergoing the care?" 10:49 "There's a lot of good people working within this very messed up system." 11:03 Why are patients considered outsiders in the healthcare system? 11:45 "What's happened in healthcare is that the stakeholders treat each other more as the customer." 13:45 What is upcoding? 17:18 "These are schemes that have been created within the industry to increase revenue." 17:46 "This system is not set up for the benefit of the patient." 18:13 "On the financial side, the industry is actually oppressing the American people." 19:14 "We have been expected to pay whatever aggregate sum is thrown at us." 20:21 Why have patients been so passive toward this crooked healthcare system so far? 22:05 What's the difference between making a profit and profiteering? 29:45 What are the first-order and second-order consequences of what's happening in health care right now, and which of these consequences will actually drive change? 30:45 "When you tell the truth about what's going on … they become so ashamed … that they change their behavior." 32:00 "The patient … is not their most important customer." 32:50 "The sleeping giant is the employers." | |||
| EP442: A Short Rumination on Saving Money, Except Not Saving Money. Oncology Side Effect Management as a Case Study, With Andreas Mang | 27 Jun 2024 | 00:18:51 | |
In Episode 442 of 'Relentless Health Value,' host Stacey Richter shares an intriguing outtake from a previous episode featuring Andreas Mang, senior managing director at Blackstone, discussing the critical issue of cost management in oncology side effect treatment. The conversation delves into the inefficiencies and patient harms caused by inadequate side effect management, particularly dehydration due to chemotherapy, and the resulting financial burdens on employers, taxpayers, and patients. Stacey explores the importance of a value-based mindset in drug purchasing, integrating oncology care, and the potential financial and health benefits of better side effect management. She highlights various expert opinions and studies supporting these points, encouraging listeners to reconsider their approach to healthcare cost structures and patient care protocols. === LINKS === 🔗 Healthcare Industry Acronyms and Terms ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b === CONNECT WITH THE RHV TEAM === 01:12 Andreas Mang on oncology medication side effect management. 03:12 Mark Lewis, MD's Tweet. 03:39 Celena Latham's response. 04:22 How integrative oncology can save money and what it looks like. 04:47 EP157 with Ethan Basch, MD. 06:20 Why PBMs saving money doesn't necessarily mean savings for employers and payers. 07:36 EP435 with Dan Mendelson. 08:20 EP372 with Cora Opsahl. 08:40 EP331 with Al Lewis. 09:50 Stacey's second rumination. 10:19 Why having a value mindset when purchasing is a thing. 10:42 Stacey's third rumination. 12:03 EP370 with Erik Davis and Autumn Yongchu. 13:07 Why FFS does not pay or pay adequately for side effect management. 14:31 Stacey's final rumination. 17:08 Summarizing Stacey's four ruminations on this topic. | |||
| EP441: Tables Get Turned. This Is Me Interviewed by Abby Burns From Radio Advisory About What Is Value | 20 Jun 2024 | 00:40:18 | |
In this episode, Abby Burns from Radio Advisory interviews Stacey Richter, host of the Relentless Health Value podcast, during the Raising the Bar Value Summit. They discuss the complexities of defining and creating value in healthcare, focusing on the roles of various stakeholders including patients, providers, and payers. Stacey shares insights on the challenges and tensions in the healthcare system, such as the fragmentation of care, financial toxicity, and the cultural norms that inhibit progress. The conversation also highlights practical examples and potential strategies to drive value and sustain positive changes within the industry. === LINKS === 🔗 Healthcare Industry Acronyms and Terms ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b === CONNECT WITH THE RHV TEAM === 03:33 Stacey's journey and mission. 04:16 The story of Scott Conard, MD (EP391). 09:28 Why it's important not just to drive change but to sustain it. 12:23 Heart Failure: A Case Study in Value. 14:13 EP438 with John Lee, MD. 15:07 Why patient positive value often fails instead of succeeds. 18:07 How financial toxicity has become clinical toxicity in healthcare. 19:44 How cultural norms have evolved into healthcare challenges. 23:38 The story of Mike Tuggy, MD, in Washington. 25:13 Looking at the four tensions in measuring value as continuums. 25:37 Why timeline is important in creative value in healthcare. 27:52 Finding Allies by Michael Leavitt. 28:34 What are the four ways to measure value in healthcare? 29:27 How do payers and providers collaborate to align on value metrics? 31:26 Why will proven versus experimental treatments become more important in the next few years? 34:54 Stacey's manifesto (EP400) and values for personal integrity in healthcare. 38:55 Stacey's parting advice. | |||
| EP440: What Is the Optimal Size for a Medical Practice? With David Muhlestein, PhD, JD | 13 Jun 2024 | 00:38:15 | |
In Episode 440 of 'Relentless Health Value,' host Stacey Richter engages with David Muhlestein to explore the optimal size for a medical practice, concluding that 10 to 20 physicians supported by a capable team provide the best balance of economies of scale and community integration. The conversation transitions into the challenges large healthcare systems face, particularly the Diversification Discount. This diversification often impedes patient care and operational efficiency by misaligning values with business practices. The episode delves into the paradox of optimizing primary care while still supporting specialty care, reflecting on how organizational values impact healthcare outcomes. Muhlestein suggests implementing business units or decentralized models to realign with patient care values and efficiencies. === LINKS === 🔗 Healthcare Industry Acronyms and Terms ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b === CONNECT WITH THE RHV TEAM === 08:12 From a business and patient/better outcomes standpoint, what does an optimal provider practice look like? 11:48 EP412 with Robert Pearl, MD. 13:06 Why isn't the current landscape what David considers optimal? 14:53 What leads to the "crisis of autonomy"? 15:13 How do medical practices get to the phase of delegation? 17:39 EP438 with John Lee, MD. 18:55 EP437 with Brian Klepper, PhD. 20:53 EP432 with Kate Wolin, ScD. 20:55 EP421 with Jodilyn Owen. 23:48 Medicare Meet-Up podcast with Mai Pham, MD. 24:45 What metrics should boards of directors also be held accountable for? 28:48 Why is an efficiency-focused business not necessarily the best at managing population care? 31:13 What is the "diversification discount"? 32:49 Pivot podcast with Kara Swisher and Scott Galloway, MBA. 35:53 What can primary care doctors do to optimize their practices? 36:48 Why do we need to shift the mindset from "bigger" and "more"?
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| EP439: Fixing the Generic Drug Pricing Problem, Where Patients Pay More When They Use Their Insurance, With Luke Slindee, PharmD | 06 Jun 2024 | 00:28:56 | |
In Episode 439 of 'Relentlessly Seeking Value,' host Stacey Richter discusses the convoluted issues surrounding generic drug pricing with pharmacy consultant Luke Slindee. They delve into the ways traditional Pharmacy Benefit Managers (PBMs) exploit the system to make immense profits, often leading patients to pay more even with insurance. The conversation explores various solutions, such as the removal of "Usual and Customary Prices" from PBM contracts, the advantages of bypassing insurance, and giving patients direct payment tools like health savings accounts. Luke Slindee, with his extensive background in pharmacy and consulting, provides valuable insights into rebalancing the generic drug market to benefit patients, pharmacies, and plan sponsors alike. Additionally, the broader implications of these dysfunctional systems on pharmacy operations and staff conditions are discussed. === LINKS === 🔗 Healthcare Industry Acronyms and Terms ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b === CONNECT WITH THE RHV TEAM === 08:12 Where do cash prices fall when pharmacies have contracts with PBMs? 08:39 What is a usual and customary price? 12:14 How is the usual and customary price affected by PBMs? 16:49 Should pharmacies be allowed to have two sets of cash prices? 17:14 Where does GoodRx fit into this because of the pharmacy/PBM dilemma? 19:06 What's happening with Amazon and the anticompetitive contract lawsuit, and how does it relate back to pharmacy contracts with PBMs? 20:38 EP395 with Brennan Bilberry. 21:05 EP420 with Ge Bai, PhD, CPA. 23:27 Why is there a new wave of cash-only pharmacies? 24:02 EP418 with Mark Cuban and Ferrin Williams, PharmD, MBA, from Scripta. 25:41 What would allow the generic market to return to normal competitive pricing? 26:39 How does this dysfunction create a negative downstream effect? | |||
| EP438: Recognizing Cognitive Dissonance and Thinking About How to Overcome It When in the Belly of the Beast, With John Lee, MD | 30 May 2024 | 00:38:58 | |
In this episode of Relentless Health Value we dive into the concept of Cognitive Dissonance in the healthcare industry with Dr. John Lee, an ER physician and chief medical information officer. We explore how healthcare professionals navigate the conflict between their beliefs and actions, especially in large healthcare organizations. Dr. Lee shares practical advice on celebrating small wins, incremental improvements, and fostering a supportive culture among colleagues. This conversation sheds light on the challenges and solutions for those striving to deliver better patient care despite systemic obstacles. === LINKS === 🔗 Healthcare Industry Acronyms and Terms ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b === CONNECT WITH THE RHV TEAM ===
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| EP437: The Most Powerful Committee No One Ever Heard of and Their Role in Primary Care and Mental Health Struggles, With Brian Klepper, PhD | 23 May 2024 | 00:15:34 | |
The Unseen Influence of the RUC on Healthcare This episode of 'Relentless Health Value' features a discussion with Brian Klepper, a healthcare analyst and former CEO of the National Business Coalition on Health, about the powerful yet obscure RUC (RBRVS Update Committee) and its significant impact on the economics of primary care and the broader healthcare system. The RUC, a committee within the American Medical Association, plays a critical role in determining the relative value of medical procedures, which directly influences Medicare payments. The episode reveals how the RUC's composition—dominated by specialists over primary care physicians—skews the financial incentives in healthcare, affecting the viability of primary care practices and mental health services. The discussion also explores the flawed assumption that the financial value assigned to healthcare services by the RUC equals their true value to patients, highlighting the need for a better understanding of the inner workings of American healthcare to address its shortcomings. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === 00:00 Introduction 02:29 Unpacking the RUC: The Power Behind Healthcare Economics 04:26 The Financial Impact of the RUC on Primary Care 07:43 Exploring the Value of Healthcare Services 10:29 The Real-World Consequences of RUC Decisions 12:50 Debunking the Equivalence of Value and Money in Healthcare 15:09 Final Thoughts and How to Stay Informed | |||
| EP436: Let's Talk About TPA and Health Plan Inertia Instead of Jumbo Employer Inertia, With Elizabeth Mitchell | 16 May 2024 | 00:41:33 | |
In this episode of Relentless Health Value we follow up on the topic of employer inertia discussed with Lauren Vela in episode 406, turning our focus to third-party administrators (TPAs), administrative services only (ASOs), and health plans. Elizabeth Mitchell from the Purchaser Business Group on Health (PBGH) joins us to discuss the roles of TPAs and ASOs, highlighting the gap in the market for independent, efficient TPAs not owned by health plans. We also delve into the trend of direct contracting between employers and providers to enhance access, quality, and outcomes. Bottom line, right now, there's a gap in the market. What is needed are indie TPAs who are effective and efficient and not owned by a health plan because, if history is any predictor of the future, the second the TPA gets owned by a health plan, the TPA sort of ceases to be a TPA and becomes a health plan. The conversation today with Elizabeth Mitchell pretty quickly gets into the shift toward direct contracting between employers and providers to improve access quality and outcomes. If you can't beat them, get ruthlessly practical is my takeaway. I have to say, I truly admire some of these HR folks and their leadership willing to do what it takes on behalf of protecting the people that work for them. There are certainly some health plans at least trying here, so I don't want to imply otherwise. There are some interesting initiatives that are afoot at, I'm gonna say, usually regional health plans. Elizabeth Mitchell has talked about some of these and made this clear also elsewhere. Join us for a deep dive into these critical components of the healthcare system and their impact on self-insured employers. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === | |||
| Encore! EP363: How to Cut Healthcare Admin Burden in Half, With David Scheinker, PhD | 09 May 2024 | 00:33:59 | |
Stacey Richter speaks with David Scheinker, PhD, to explore practical strategies for halving the administrative burden in healthcare. The discussion delves into the significant costs of healthcare transactions, the inefficiencies within the system, and actionable steps to reduce these costs. Key highlights include the potential of standardizing healthcare contracts, the role of telemedicine in building efficient systems, and the importance of competitive pressure in driving sector-wide improvements. The episode emphasizes real-world examples and research-backed recommendations to illustrate the financial and operational benefits of reducing administrative waste in the healthcare industry. If you'd like to read the full transcript, article or signup for our free weekly newsletter, see the links below. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === 10:39 What's the quantitative administrative cost in an average transaction? 11:05 What's the quantitative administrative cost in a healthcare transaction? 11:58 What does the healthcare billing and administration cost add to the US's overall healthcare spend? 12:53 Is it possible to cut billing and administrative costs in healthcare? 14:17 "In some ways, the problem for healthcare should be simpler." 15:30 What does the complexity of the current system look like in a doctor's office? 18:42 How did David go about studying healthcare administrative costs? 21:34 "It doesn't have to be simple; it should be standardized." 24:50 What would be the pushback on standardizing contracts in healthcare? 25:43 Why is it possible to gain more value by losing customization in contracts? 27:20 "Never let a good crisis go to waste." 27:41 "It's much easier in healthcare to build something new than to change something that exists." 30:47 What benefits does telemedicine have to cutting administrative costs? 32:17 What is another significant benefit of using standardized contracts? 33:26 Why haven't standardized contracts become a common thing in the current healthcare system? | |||
| EP435: Optimized Pharmacy Benefits Are Required if You Want to Do or Buy Value-Based Care, With Dan Mendelson | 02 May 2024 | 00:35:25 | |
Optimizing Pharmacy Benefits in Value-Based Care: A Conversation with Dan Mendelson In Episode 435 of 'Relentless Health Value,' Stacey Richter hosts Dan Mendelson from Morgan Health to discuss the importance of integrating pharmacy benefits into the broader context of value-based care. The conversation stems from a LinkedIn post by Mendelson outlining five key considerations for optimizing pharmacy benefits. Topics include the total cost of care, the need for value-based decision-making in pharmacy benefits, the integration of clinical teams in formulary development, and the critical role of patient engagement. The episode also explores how employers can better manage healthcare costs by aligning incentives and navigating the complexities of the pharmaceutical landscape. Key advice for various healthcare stakeholders, including pharma companies, hospitals, and primary care doctors, is also provided. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === 00:00 Introduction 00:28 The Intersection of Pharmacy Benefits and Value-Based Care 00:57 The Critical Role of Pharmacy in Healthcare Outcomes 03:16 Exploring Pharmacy Benefits Optimization with Dan Mendelson 03:39 Morgan Health's Mission and Healthcare Innovation 04:46 The Conversation with Dan Mendelson: Deep Dive into Pharmacy Benefits 06:13 Strategies for Optimizing Pharmacy Benefits in Value-Based Care 11:19 The Future of Pharmacy Benefits and Employer Concerns 12:40 Advice for Pharma Companies in a Value-Based Healthcare System 16:13 Innovative Approaches to Managing Pharmacy Benefits 16:56 Engaging Patients in Pharmacy Benefit Decisions 18:06 Experimental Drug Tiers and Formulary Design 21:49 The Importance of Value-Based Contracting for Pharma 31:23 Lightning Round: Advice for Various Healthcare Stakeholders 34:47 Closing Thoughts and Invitation to Engage Further
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| EP499: Self-insured Employers and Other Plan Sponsors Are Paying Millions for MSK (Musculoskeletal) Injuries That Would Have Healed Themselves, With Jay Kimmel, MD | 05 Feb 2026 | 00:28:04 | |
In this episode of Relentless Health Value, host Stacey Richter talks with Dr. Jay Kimmel, an orthopedic surgeon and co-founder of Upswing Health, about the significant costs associated with musculoskeletal (MSK) injuries and conditions for self-insured employers and other plan sponsors. They explore how a large portion of MSK-related expenses are for low-acuity injuries that often heal on their own without the need for emergency room visits or unnecessary treatments. Dr. Kimmel discusses the importance of addressing the 'white space'—the critical initial moments when a patient decides whether or not to seek emergency care. He emphasizes the value of immediate access to knowledgeable professionals to help guide these decisions and prevent avoidable high-cost care. They also touch on historical practices where physicians would consult each other informally, suggesting that modern solutions like Upswing Health can replicate those beneficial spontaneous interactions to improve patient care and reduce costs. === LINKS === 🔗 Visit Upswing Health: ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue
07:49 EP472 with Eric Bricker, MD, on high-cost claimants. 08:01 What is the "white space" in MSK spend? 10:43 Statistics on Connecticut's spending on plan members with low-acuity MSK injuries. 13:30 How back pain also easily transitions from a low-acuity issue to a high-acuity problem. 15:11 How plan sponsors can detect their white space downstream spend. 16:58 EP464 with Al Lewis. 17:02 EP470 with Nikki King, DHA. 18:15 Why where patients start their journey often dictates where they wind up and how costly that medical pathway is. 20:48 Where PCPs fit into this MSK spend issue. 25:26 EP468 with Matt McQuide. 25:34 EP471 with Christine Hale, MD, MBA. 25:39 Why access is key.
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| EP434: 5 Surprises About Bundled Payments, With Benjamin Schwartz, MD, MBA | 25 Apr 2024 | 00:39:31 | |
In Episode 434 of 'Relentless Health Value,' host Stacey Richter interviews Dr. Ben Schwartz, an orthopedic surgeon and prolific writer, about bundled payments in the healthcare industry. The discussion focuses on four key surprises related to bundled payments: the all-encompassing nature of the 90-day post-surgery cost coverage; the reluctance of commercial payers to engage with bundled payment models; the shifting dynamics towards more integrated care between primary care physicians and specialists; and the complex realities of Centers of Excellence (COE) programs. The episode also highlights lessons learned from existing bundled payment models and potential future directions for more sustainable and efficient healthcare practices. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === 06:07 Where are we in the development of the bundled payments space? 08:09 What are the four types of bundled payments? 09:52 How can bundled payments create perverse incentives? 11:04 What are the positives in bundled payments, and how can they help push us toward value-based care? 13:02 What is surprising about bundled payments? 18:50 EP415 with Rob Andrews. 27:03 How do Centers of Excellence connect back to bundled payments? 29:00 EP346 with Peter Hayes. 30:29 EP294 with Steve Schutzer, MD. 33:38 EP331 with Al Lewis. 33:43 EP372 and EP373 with Cora Opsahl. 37:13 What does Dr. Schwartz think the future is for bundled payments? Recent past interviews: Click a guest's name for their latest RHV episode! Justin Leader, Dr Scott Conard (Encore! EP391), Jerry Durham (Encore! EP297), Kate Wolin, Dr Kenny Cole, Barbara Wachsman, Luke Slindee, Julie Selesnick, Rik Renard, AJ Loiacono (Encore! EP379)
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| EP433: The Mystery of the Weekly Claims Wire: What Are Plan Sponsors Actually Paying For Each Week? With Justin Leader | 18 Apr 2024 | 00:40:00 | |
Episode 433 of Relentless Health Value dives into the complexities of weekly claims wires that self-funded employers receive. Host Stacey Richter speaks with Justin Leader about the hidden fees embedded in these claims, including shared savings fees, prior authorization fees, prepayment integrity fees, pay and chase fees, and TPA claims review fees. Learn how these undisclosed charges impact plan sponsors and why transparency is crucial for fiduciary responsibility. This episode is a must-listen for plan sponsors, HR executives, and healthcare entrepreneurs seeking to understand and manage their healthcare costs better. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === | |||
| Encore! EP391: A Case Study for Anyone Trying to Level Up Primary Care That I'm Gonna Call "How Margin Shoves Mission Off the Bus," With Scott Conard, MD | 11 Apr 2024 | 00:36:53 | |
In this encore episode, Stacey Richter discusses the challenges and opportunities in primary care transformation with Dr. Scott Conard. The conversation explores the conflict between mission-driven healthcare and profitability, drawing from Dr. Conard's personal and professional experiences. Key topics include advanced primary care models, perverse incentives in the healthcare system, the impact of large health systems on local communities, and the complex dynamics of healthcare management. The episode illustrates the importance of leadership, systemic change, and balancing patient care with business imperatives. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === 06:54 What triggered Scott's career journey? 07:31 What caused Scott to rethink what is good primary care? 08:11 Why did Scott realize that he is actually a risk-management expert as a primary care doctor rather than someone who treats symptoms? 09:25 EP335 with Brian Klepper, PhD. 09:53 How did Scott's practice change after this realization? 10:04 What is a "Whole-Person Risk Score"? 11:08 Scott's book, The Seven Numbers (That Will Save Your Life). 13:05 "You start to move from a transactional model to a relationship model." 15:31 Did Scott have any risk-based contracts? 16:08 Why is it so important to look at total cost of care and not just primary care cost? 21:08 Scott's book, The Art of Medical Leadership. 22:13 EP381 with Karen Root. 30:43 Why did Scott move over to help corporations? 33:10 EP364 with David Muhlestein, PhD, JD. 33:51 "Everybody thought they were honoring their fiduciary responsibility, and the incentives are completely misaligned." 34:31 EP384 with Wendell Potter. 34:43 "It's the system that's broken; it's not bad people." | |||
| Encore! EP297: A Driver of Patient Engagement and Clinician Team Success That Is Almost Always Overlooked, With Jerry Durham | 04 Apr 2024 | 00:34:32 | |
In this encore episode of Relentless Health Value, host Stacey Richter delves into a crucial yet often ignored aspect of patient engagement and clinical success with Jerry Durham from the Client Experience Company. The discussion emphasizes how the front desk can significantly influence positive patient outcomes and mitigate clinician burnout. Jerry outlines the 'patient life cycle' and the vital role of the front desk in establishing trust and setting up provider success. Highlighting real-world examples and research, the conversation explores how proper front desk management can enhance patient satisfaction, retain patients, and contribute to the overall efficiency of healthcare practices. The episode also addresses common issues in patient-provider interactions and offers practical solutions for integrating the front desk into a cohesive, patient-centered care team. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === 05:49 What is the patient life cycle? 06:48 What are the milestones of the patient life cycle? When does it start? 10:05 "This isn't a business solution; this is a patient-driven solution." 10:21 "What is best for the patient is best for business." 13:25 "The takeaway there is that your team members are all driving toward the same goal." 14:34 How does the front desk impact health outcomes? 16:41 What is the objective of a front desk to reduce provider burden? 20:03 EP236 with Liliana Petrova. 21:18 "There's actually three roles at the front desk." 30:37 EP228 with Julie Rish, PhD. | |||
| EP432: The Knifepoint Intersection of Margin and Mission and the Peril of Cutting Clinical "Waste," With Kate Wolin, ScD | 28 Mar 2024 | 00:38:18 | |
In Episode 432 of 'Relentlessly Seeking Value,' host Stacey Richter discusses with behavioral epidemiologist and digital health entrepreneur Kate Wolin about the challenges and opportunities in merging clinical care with efficient business practices. They explore the pitfalls of scaling healthcare services while maintaining patient outcomes and why human-centered approaches are vital. They stress the importance of aligning investors, founders, and clinical leaders, measuring meaningful outcomes, and fostering a mission-driven culture to ensure both financial sustainability and high-quality patient care. The episode also highlights relevant episodes and resources for further exploration. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === | |||
| EP431: How Accountability for Outcomes Works in the Real World With Kenny Cole, MD | 21 Mar 2024 | 00:39:24 | |
In Episode 431 of 'Relentlessly Seeking Value,' Stacey Richter interviews Dr. Kenny Cole from Ochsner Health System, discussing the complexities of achieving accountability for outcomes in U.S. healthcare. They explore how understanding the real-world contours is crucial for devising effective strategies, particularly in the healthcare industry. Dr. Cole emphasizes the importance of measurable outcomes, trust-building with patients, and the implementation of care pathways to achieve clinical and financial success. They discuss practical examples, such as managing diabetes treatment with metformin, and address broader issues of care standardization and systemic incentives in healthcare. The conversation highlights the need for cultural alignment, proper measurement of outcomes, and innovative care models to improve patient health and prevent burnout among clinicians. The episode is a comprehensive look at operationalizing clinical excellence and aligning it with financial viability in the healthcare sector. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === 07:38 Is there an optimal care pathway where there might be a lot of treatment variability? 11:01 Why doesn't Dr. Cole like the terms "noncompliant" and "nonadherent"? 11:45 EP412 with Robert Pearl, MD. 13:50 Why is it important to start with the end in mind? 17:20 How do you scale clinical excellence? 20:21 EP315 with Bob Matthews. 21:15 EP242 with Marty Makary, MD. 23:49 Why is it important simply to demonstrate what's possible for better health outcomes? 24:58 EP427 with Rik Renard. 26:10 How do we reinvent the business model of healthcare? 27:50 EP415 with Rob Andrews. 30:06 EP391 with Scott Conard, MD. 38:37 Dr. Cole is published in various healthcare journals; check out his most recent article. | |||
| EP430: Advice for Digital Health Vendors Selling to Employers, With Barbara Wachsman | 14 Mar 2024 | 00:38:45 | |
In Episode 430 of Relentless Health Value, host Stacey Richter discusses strategies for digital health vendors aiming to sell their solutions to employers with guest Barbara Waksman. The episode covers why targeting employers can be lucrative, along with Waksman's four key pieces of advice for entrepreneurs: ensuring there is a significant market need, offering truly differentiated products, understanding and navigating internal politics of employer organizations, and managing investor expectations. Emphasis is placed on aligning product development with actual market needs and planning for lengthy sales cycles. Examples of successful strategies include improving patient engagement and predictive analytics for health outcomes. Waksman also highlights the importance for health tech entrepreneurs to broaden their focus beyond healthcare to include disability and occupational health in their offerings. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM ===
06:55 Why have people cottoned on to selling to employers, and is it a good direction to focus? 07:28 What are the three ways healthcare gets paid for in America? 07:46 Where is the profit in the healthcare system? 08:32 What does an entrepreneur really need to understand in order to sell to employers? 13:05 "It really is about producing a productive employee." 17:49 Why it's not enough to understand the market but you must also differentiate. 21:01 What's the biggest misunderstanding entrepreneurs have about per member per month? 24:10 What companies are standing out right now as differentiators? 28:02 Why is it important to also show that you are improving quality? 28:51 EP331 with Al Lewis. 28:55 EP427 with Rik Renard. 29:33 EP372 with Cora Opsahl. 30:07 Why is it important to find a strong champion who will advocate for you as a partner? 35:05 Why is it important to manage your investors and set appropriate expectations around the timeline of a sale? 36:21 What's the lesson to be learned behind Livongo? | |||
| EP429: Following the Dollar Through Pharmacy Acronyms Like WAC, AWP, and NADAC, With Luke Slindee, PharmD | 07 Mar 2024 | 00:38:20 | |
Episode 429 of 'Relentless Health Value' discusses complex pharmacy pricing acronyms like AWP (Average Wholesale Price), WAC (Wholesale Acquisition Cost), and NADAC (National Average Drug Acquisition Cost). Host Stacey Richter speaks with Luke Slindee about the convoluted drug supply chain, explaining how manufacturers, wholesalers, pharmacies, and pharmacy benefit managers (PBMs) interact. The episode explores how these interactions influence drug prices, rebates, and discounts, illuminating the opaque middleman transactions that often occur. Additionally, the conversation highlights the economic pressures on independent pharmacies and the resultant impact on pharmacy staff and access to medications. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === 09:52 Why is it important for plan sponsors to understand the going rate for every point in the supply chain? 10:21 How do manufacturers come up with a list price? 10:40 What does AWP stand for? 10:59 What does WAC stand for? 11:06 How are AWP and WAC numbers chosen by the manufacturer? 13:22 What is the difference between AWP and WAC? 14:54 How much are wholesalers paying to manufacturers? 16:43 How much is the pharmacy paying for branded drugs from a wholesaler? 17:34 Why might pharmacies be buying drugs for less than what wholesalers are paying? 18:17 Substack article by Benjamin Jolley, PharmD, on this topic. 19:22 EP423 with Joey Dizenhouse. 20:33 Why do things get weird when a PBM gets involved? 21:58 How does all of this work for generic manufacturers? 25:20 EP344 with Steven Quimby, MD. 26:15 How did Civica Rx come about? 32:21 What's the difference between the NADAC and the AWP value? 36:04 Luke discusses the downstream effects to pharmacies. | |||
| EP428: Do-It-Now Advice From the J&J and the DOL v BCBS Lawsuits, With Julie Selesnick | 29 Feb 2024 | 00:41:52 | |
In Episode 428 titled 'Do It Now Advice From the J&J and the DOL versus BCBS lawsuits,' host Stacey Richter discusses the implications of two major legal cases on plan sponsors with guest Julie Selesnick, an attorney specializing in fiduciary responsibilities. The episode covers essential actions for plan sponsors, brokers, and employee benefit consultants to avoid conflicts of interest and ensure fiduciary compliance. Selesnick, a senior counsel at Berger Montague's Employee Benefits and ERISA Group, emphasizes the importance of obtaining and effectively using claims data, renegotiating administrative services agreements, and conducting independent claims reviews. The discussion also highlights practical strategies like carving out certain high-cost services and establishing a health and welfare fiduciary committee. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === 05:48 What's happening with the J&J lawsuit? 07:38 What's going on with the DOL v BCBS case? 08:49 What do these cases mean for plan sponsors? 09:21 Why is engaging with claims data critical? 12:30 EP408 with Chris Deacon. 14:20 EP379 with AJ Loiacono. 16:58 What's one solution to avoiding a conflict of interest? 18:02 Why there's still not a total understanding about what to do with claims data once acquired. 20:58 NADAC (National Average Drug Acquisition Cost) to check pharmacy prices. 21:31 What advice do plan sponsors need to know that never gets recommended to them when dealing with conflicting interests? 27:02 EP337 with Olivia Webb. 28:41 EP285 with Dawn Cornelis. 30:24 "As a fiduciary, your money should only go to pay your plan's benefits, not to other plan benefits." 30:59 What's Julie's advice to advisors? 33:17 "Giving nonconflicted advice … is something you really can only do if you have no conflicts." 35:57 What's Julie's advice for administering whole plans? | |||
| EP427: How Do Digital Health Vendors Deliver Patient Outcomes and Experiences? With Rik Renard | 22 Feb 2024 | 00:36:23 | |
In this episode of Relentless Health Value, host Stacey Richter speaks with Rik Renard from Awell about the significance of standardized care flows in digital health. The discussion covers the impact these care processes have on patient outcomes, clinician efficiency, and the healthcare system's overall performance. Highlights include an overview of a survey conducted with Health Tech Nerds, revealing that while 84% of digital health vendors use care flows, only 16% are based on evidence. The episode emphasizes the need for real-time data integration, continuous improvement, and addressing clinician autonomy to ensure the effective and scalable implementation of care flows. Renard shares insights from experts like Dr. Ali Khan of Oak Street Health and the importance of transitioning from basic documentation to advanced, integrated systems. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM ===
09:26 Why should clinicians care about care processes and care flows? 12:05 Why do care flows and care processes have a bad reputation? 12:31 What components does a good pathway include? 14:51 Why pathways need to be looked at as a process of continuous reconfiguration. 17:15 Who did Awell survey about care processes and flows? 18:42 How many clinicians were using care flows, and what did those care flows look like? 25:45 EP315 with Bob Matthews. 26:44 EP392 with Emily Kagan Trenchard. 28:21 EP412 with Robert Pearl, MD. 30:01 "Just document something." 30:14 What was a shocking find from this care process survey? 31:06 Is AI the answer? 34:13 Why is it important to get the foundation of data correct before introducing AI? 34:51 How should employers use this information to vet vendors
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| EP498: The Payment Integrity Arms Race—RCM (Revenue Cycle Management) and Plan Sponsors, With Mark Noel | 29 Jan 2026 | 00:34:35 | |
In Episode 498, host Stacey Richter converses with Mark Noel of ClaimInsight about the critical aspects of payment integrity within self-insured employers and plan sponsors, focusing on the arms race with revenue cycle management (RCM). The discussion reveals three main insights: the substantial impact of small claim errors, the inherent flaws and conflicts within prepayment analysis by TPAs, and the problematic financial incentives influencing claim processing. Noel emphasizes the importance of prepayment integrity for both plan savings and protecting members, underscoring the need for meticulous oversight and proactive management in payment processes. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: ✉️ Visit ClaimInsight 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === 06:03 How millions of dollars can be recovered per year from smaller claims under $500. 07:46 EP486 with Stan Schwartz, MD. 09:10 How to get to payment integrity prepayment. 11:20 How payment processing efficiency is necessary to payment integrity. 13:59 How TPAs fit into the claims payment process and how they can add to payment integrity. 15:59 LinkedIn post from Chris Deacon. 16:50 EP433 with Justin Leader. 17:04 LinkedIn post from Justin Leader. 17:10 How shared savings incentives can be perverse incentives. 23:05 How employers are doing retrospective reviews. 24:29 How employers should be negotiating their TPA contracts. 25:41 EP285 with Dawn Cornelis. 25:43 EP480 with Kimberly Carleson. 27:40 Why it's imperative that payment integrity vendors are up-to-date on all policies. 30:00 EP497 with Zack Kanter. 31:13 What should self-insured employers do to assess their payment integrity? | |||
| Encore! EP379: How Much Money, Really, Are Employee Benefit Consultants and/or Brokers Making From Plan Sponsors? With AJ Loiacono | 15 Feb 2024 | 00:35:13 | |
In this encore episode of 'Relentlessly Seeking Value,' Stacey Richter interviews A.J. Loiacono, CEO of CapitalRx. They delve into the hidden compensation practices of Employee Benefit Consultants (EBCs) and brokers engaging with plan sponsors. The discussion unveils the potential conflicts of interest and self-serving behaviors of these intermediaries, who sometimes prioritize their own financial gain over the best interests of employers and employees. With the enforcement of the Consolidated Appropriations Act (CAA), plan sponsors now have the power and responsibility to request full disclosure of all direct and indirect compensations being made. The conversation brings to light the murky and often unethical practices within the industry and emphasizes the importance of transparency and diligence for self-insured employers to avoid unreasonable and secretive fees that ultimately increase their total costs. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM ===
07:09 Who can get in trouble for mismanaging employee funds? 07:48 "When you talk about conflicts of interest, they're everywhere." 13:13 "You're paying for access." 13:34 Why is it important to request that they disclose direct and indirect compensation? 14:04 What are the layers to these hidden fees and compensations? 18:13 What is a reasonable fee for a good plan admin? 19:27 "I think people need to take a step back and say, 'How many different ways are they getting compensated?'" 24:50 "The compensation is not just unreasonable, but if they were to move it, they would lose access to an entire column of revenue." 25:06 "For every good broker consultant, there's a horrible individual lurking out there and it's easy to figure out: Ask for them to disclose their fees." 28:08 "You can't win if you can't even pay the house fee to come in." 31:35 Why do you need to ask for disclosure, and what do you need to ask specifically? 32:21 What are some of the characteristics of a good plan consultant?
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| EP426: Cost Containment Versus Value-based Drug Purchasing, With Nina Lathia, RPh, MSc, PhD | 08 Feb 2024 | 00:33:26 | |
In this episode of 'Relentless Health Value,' host Stacey Richter discusses with Nina Lathia the complex debate between cost containment and value-based drug purchasing strategies. They delve into the negative impacts of poor pharmacy benefit strategies, such as increased healthcare costs, bankruptcies, and reduced member satisfaction. They explore why employers struggle with value-based purchasing due to factors like lack of price negotiation power, siloed pharmacy spending, short-term actuarial horizons, and FDA's approval based on limited evidence. The episode provides actionable advice on establishing a value-based formulary, including having a clear goal, considering overall healthcare spend, understanding drug value-based pricing, exploring risk-sharing agreements, and ensuring effective communication with plan members. Lathia, a pharmacist and consultant with a Ph.D. in health economics, shares her expertise on making evidence-based drug purchasing decisions that balance cost and clinical effectiveness. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM ===
06:34 What does cost containment mean? 07:43 Why is it important to consider health outcomes? 10:00 What does value-based purchasing mean in Pharma? 11:09 What are the principles of cost-effectiveness analysis? 12:50 Pharmacy plan time horizons versus employer time horizons. 14:42 Why is it increasingly important for payers to take a more global look at health and cost outcomes? 16:14 Why is the first step establishing a value-based price for drugs? 16:43 Why is the second step thinking about risk-sharing agreements with manufacturers? 18:57 LinkedIn article by Bryce Platt, PharmD. 19:20 What should an employer do if there's only one drug option and the price is too high? 21:20 What's a specialty carve-out solution? 21:26 EP352 and EP353 with Pramod John, PhD, of VIVIO. 22:10 Why should employers get more comfortable with saying "no" to certain drugs? 25:36 Why is patient engagement key? 28:23 What does "good" look like for employers implementing drug-spend changes? 29:51 EP337 with Olivia Webb.
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| EP425: Three Ways for "Regular" Clinical Practices to Take Cash When It's Cheaper for a Patient Than Using Their Insurance, With Marshall Allen | 01 Feb 2024 | 00:39:20 | |
In this episode of Relentless Health Value, Stacey Richter speaks with Marshall Allen about how clinical practices can implement cash payment options for patients, which can often be cheaper than using insurance. They discuss the growing trend of patients struggling with high deductibles and the legal considerations for providers accepting cash, including using HIPAA to navigate insurance constraints. Allen shares insights on setting competitive cash prices, the potential financial benefits for practices, and resources like fairhealthconsumer.org to benchmark pricing. He also touches on the broader movement towards direct contracting and the importance of fostering healthcare financial literacy among patients. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === 07:04 What Allen Health Academy is doing. 11:01 What's the problem with the system now? 14:19 EP363 with David Scheinker, PhD. 14:27 EP413 with Will Shrank, MD. 14:34 What's the hack Marshall Allen shares for insured patients paying cash? 15:06 How can patients cite HIPAA to pay cash instead of using their insurance? 19:00 What's the first recommendation Marshall Allen has when dealing with healthcare billing? 21:26 EP297 with Jerry Durham. 21:48 What are the other benefits of a clinic accepting cash payments? 25:36 Why do we need to have more direct pay happening? 26:36 How should a medical provider set a cash price? 27:12 Research tools for fair pricing: fairhealthconsumer.org, BILLY, colonoscopyassist.com, Jason Health, Green Imaging. 32:36 How do you find the win-win between a patient and a doctor? 32:51 What's the final tier of partners in creating more direct-pay opportunities? 34:30 What's Marshall Allen's opinion on having to pay credit card fees?
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| INBW39: The Narcissism of Small Differences Is a Really Must-Know Concept When Attempting to Fix the Healthcare Industry | 25 Jan 2024 | 00:19:09 | |
In this inbetweenisode of 'Relentlessly Seeking Value,' Stacey Richter discusses the concept of the 'Narcissism of Small Differences' and its implications for the American healthcare industry. Richter explores how minor disagreements can prevent collaboration among healthcare professionals who share the same overarching goals. She emphasizes the need for unity to combat the profit-driven motives of large healthcare corporations and improve patient care. The episode also examines the role of conferences, the moral complexities faced by individuals within large entities, and the importance of focusing on collective goals rather than getting bogged down by insignificant differences. Richter encourages building a village of diverse yet aligned individuals to achieve meaningful healthcare reform. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === 00:42 What "the narcissism of small differences" means. 02:18 How does this narcissism of small differences show up in the effort to fix the healthcare industry? 05:26 Quote from Jeff Hogan. 10:12 "What did the work we do add up to?" 16:31 Why we shouldn't judge someone for working within the "belly of the beast." | |||
| EP424: Five Things for Hospital System Execs to Get Real About in 2024, With Peter Hayes | 18 Jan 2024 | 00:45:07 | |
In episode 424 of Relentless Health Value, host Stacey Richter speaks with Peter Hayes about five critical topics hospital system executives must address in 2024. They discuss the implications of the Consolidated Appropriations Act, the necessity for hospitals to become more administratively and technologically efficient, the shift from fee-for-service to episode-based care, the need for transparency and accountability regarding tax-exempt statuses and 340B drug pricing, and the imperative of ensuring high-quality and safe patient care. The episode emphasizes the growing demand for hospital systems to adapt to regulatory changes and market pressures while maintaining fiduciary responsibility, quality care, and trust within their communities. For more on the wild problems with hospital pricing, check out this of episodes in the Show Notes (link below). But, spoiler alert, some of these are hair-raising. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === 08:04 Why do hospitals need to get real about the implications of the Consolidated Appropriations Act? 10:09 What is considered fair pricing for hospitals? 13:00 EP390 with Gloria Sachdev, PharmD, and Chris Skisak, PhD. 15:59 The medical transparency tool, Billy. 16:34 How does lowering prices become more challenging with consolidated hospital systems? 18:07 What is one of the solutions available to combatting this now? 19:31 Why do hospital systems need to get real about administrative and technology efficiencies? 22:27 EP373 with Cora Opsahl. 26:51 Why do hospitals need to get real about pivoting from fee-for-service reimbursement to episode-based care? 30:16 EP415 with Rob Andrews. 30:53 Why do hospitals need to get real about the 340B program and their tax-exempt status? 35:38 EP394 with Vikas Saini, MD, and Judith Garber, MPP. 38:19 What are the ethical and moral issues that are coming to a head with healthcare costs? 39:03 Why do hospitals need to reexamine their care quality and patient safety? 40:05 "We just need to make sure that the health industry is as accountable as some of our other industries." 42:53 Why does Peter think it's going to take regulation to move the dial? | |||
| EP423: Maximizers and the "the Drugs Aren't Covered" Schemes Employers Use to Save Money (or Not) on Pharmacy Benefits, With Joey Dizenhouse | 11 Jan 2024 | 00:44:17 | |
Episode 423 of 'Relentless Health Value' features a conversation with Joey Dizenhouse about the tactics employed by PBMs and pharmacy benefit schemes to manage drug costs, often leading to misaligned incentives. Joey outlines how maximizer programs work, differentiating between spread and transparent models, and the potential consequences for plan sponsors and patients. The discussion dives deep into copay assistance programs and the complex dynamics behind drug pricing and patient access. Key advice for plan sponsors includes applying purchasing discipline, understanding program structures, and being aware of the broader implications on patients. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === 06:21 How was the first iteration of maximizers conceived? 10:59 "I'd always encourage you to come back to the underlying incentives." 11:18 What does maximizer acceleration look like? 12:24 What are the two kinds of maximizers? 12:43 What is the spread model for a maximizer? 13:02 What is the transparent model for a maximizer? 15:26 "Ask the questions: How do you make money? Prove it!" 15:56 EP419 with Andreas Mang. 16:25 How might Pharma be making more money with maximizers? 26:14 What is the "it's not covered" approach? 32:29 "The right kind of program has been properly narrowed." 33:51 Is there a purpose that some of these programs can serve, issues aside? 35:57 How does a free drug program actually cost money?
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| EP422: Some Indie Pharmacy Upshots That Surprised Me—and I Thought I Was Pretty in the Know, With Benjamin Jolley, PharmD | 04 Jan 2024 | 00:36:43 | |
Episode 422: The Financial Struggles and Unexpected Insights of Independent Pharmacies with Benjamin Jolley In this episode, Stacey Richter interviews Benjamin Jolley, a multi-generational pharmacy leader and consultant, who discusses the financial challenges faced by independent pharmacies. Jolley reveals that a significant portion of a pharmacy's profits comes from a mere 10% of prescriptions. The conversation dives into the detrimental impact of Pharmacy Benefit Managers (PBMs) on pricing and reimbursement, the inefficiencies in the system, and explores potential models like direct pharmacy care to create more sustainable business practices. The discussion also touches on the broader implications for local communities and the healthcare system overall. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM ===
04:47 Benjamin Jolley's recent revelation. 06:14 What are the 10% of drugs that provide all the profit for pharmacies? 09:21 What's happening with the other 90% of drugs that pharmacies are filling? 11:05 What is the breakdown of costs when fulfilling prescriptions and running a pharmacy? 18:50 EP379 with AJ Loiacono. 21:42 What is the "cost savings" within the "insane system" of PBMs not sharing profit with independent pharmacies? 23:00 What is one of the things that PBMs and pharmacies don't often talk about? 26:39 What can employers do so that patients aren't getting overcharged by PBMs? 27:51 "How do I make the PBMs irrelevant?" 33:30 What's the difference between an independent pharmacy delivery service and a service like Express Scripts? 34:36 What's the other potential solution in solving the problems independent pharmacies face, and why does Benjamin Jolley feel that it's not the best solution to pursue? | |||
| Encore! EP392: When Patient Journeys Don't Fit in the EHR, With Emily Kagan Trenchard | 28 Dec 2023 | 00:30:48 | |
In this encore episode of 'Relentless Health Value,' Stacey Richter speaks with Emily Kagan Trenchard about the limitations of Electronic Health Records (EHR) in capturing comprehensive patient journeys. Emily, SVP and Chief of Consumer Digital Solutions at Northwell Health, discusses the importance of integrating other platforms such as Customer Relationship Management (CRM), cloud data platforms, and data exchanges to create a more holistic and efficient healthcare experience. Emphasizing the importance of reducing friction for providers and patients, Emily outlines how health systems can move beyond traditional EHR architectures to support patients not just in clinical settings but throughout their daily lives. The episode also touches on the need for proactive outreach, team-based care, and the crucial role of accurate and comprehensive data in enhancing patient care. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === 07:08 How does customer digital solutions fit into the larger technology infrastructure in healthcare? 09:07 "Where else do you have centers of gravity that you should respect in the architecture?" 09:25 "There is a constellation of need here." 11:05 "We interact with way more than just patients." 13:42 "We have to be able to understand the network of relationships in a population." 14:25 How do EHRs and CRMs interact as two tentpoles in healthcare? 16:45 "The question is, where does a human being work?" 19:07 How are patients staying on a nonfragmented care journey in a proactive way? 23:00 "Anybody who's a consumer of our digital offerings has a relationship with us." 28:46 "The medicine is being practiced not only on our physical bodies but on our digital bodies." | |||
| Encore! EP372: Step One for Employers and Unions—Get Your Data, With Cora Opsahl | 21 Dec 2023 | 00:31:43 | |
Harnessing Data for Smarter Health Fund Management with Cora Opsahl from 32BJ In this encore episode of Relentlessly Seeking Value, Stacey Richter talks with Cora Opshal, Director of the 32BJ Health Fund, about the imperative for employers and unions to obtain and effectively use their health data. The conversation details the significant benefits of data analytics, such as smart decision-making, reducing waste, and forecasting financial trends. Various case studies, including kicking out an expensive hospital network to save millions and offering low-cost maternity and joint replacement programs, are discussed. The episode emphasizes the critical role of data ownership and transparency in managing healthcare costs and improving benefit designs for members. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe.
✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b === CONNECT WITH THE RHV TEAM === 06:53 How much data does 32BJ Health Fund have, where do they get it, and how do they use it? 08:52 How did 32BJ Health Fund successfully demand their data from 100% of their vendors? 09:42 "We feel it's really important that we own this information ourselves." 10:05 "It always concerns me—if a vendor doesn't want to give you the information, what are they hiding?" 10:32 "It's not just getting the data; it's then using the data." 13:41 "Without data, you're really just taking a guess; and guesses are never gonna get you where you need to go." 15:19 EP285 with Dawn Cornelis. 15:40 Is the cost of creating a data analytics team worth the cost savings of those data discoveries? 19:03 "The use of data has really built our knowledge." 20:52 "It's really important to us that as we make benefit decisions, we're doing it smartly." 25:27 EP358 with Wayne Jenkins, MD. 25:38 How is 32BJ Health Fund making their data knowledge actionable? 28:11 "If we can figure out how to make telehealth accessible … there may be an opportunity for telehealth … to upset some of these … monopoly systems or low-choice options." 30:22 "It's really easy to think that we can solve this problem through benefit design … but in the end … it's the price." | |||
| EP421: Wildly Improving Outcomes When the Patient Is, for Reals, in the Center—For Maternity and Beyond, With Jodilyn Owen | 14 Dec 2023 | 00:35:35 | |
Improving Maternity Outcomes: The Role of Trust and Community-Based Care To read the full article and show notes with links mentioned as well as a full transcript, click here. In Episode 421, 'Wildly Improving Outcomes When The Patient Is, For Reals, In The Center. For Maternity and Beyond,' host Stacey Richter interviews Jodilyn Owen, clinical director of the Rainier Valley Birth and Health Center. They discuss the systemic issues in the U.S. healthcare system where financial incentives do not align with patient outcomes, especially in maternity care. They highlight Jodilyn's clinic's successful outcomes despite being located in a medically underserved area. They explore the importance of relationship-based care, the economic challenges of quality care provision, and the failures of venture-backed healthcare startups to understand community needs. The conversation underscores the need for trust, listening, and community integration in improving maternal health outcomes. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 07:12 How much cost savings is there when you avoid a NICU admission? 09:43 How is "slow care" feasible among an ob-gyn shortage in many communities? 10:42 "Start people at the risk that they are appropriate for." 11:37 EP407 and Summer Shorts 3 with Vivek Garg, MD, MBA. 13:50 "To effect change, we have to unwind what has been wound so tightly and so carefully through medical … education." 14:13 "It's not a people problem; it's a system problem." 18:46 What does relationship-based care mean? 22:32 "Everything in pregnancy at least is a trend." 28:01 How does Jodilyn's practice work with payers? 31:08 EP409 with Larry Bauer, MSW, MEd. 32:24 Why is it important to address the root of this problem in the education space?
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| Take Two: EP341: The "Just Spend Everything You're Given" Trap—Lessons in True Provider Fiscal Discipline, With Gary Campbell | 22 Jan 2026 | 00:36:56 | |
In this Take Two episode of Relentlessly Seeking Value, host Stacey Richter speaks with Gary Campbell, CEO of Johnson Health Center, an FQHC in Virginia. The discussion centers around the importance of fiscal discipline in healthcare, especially in federally qualified health centers where there's no opportunity to cost-shift inefficiencies. This episode also revisits the notable experience and practices of Nikki King, CEO of Alliance Health Centers, focusing on her innovative methods to overcome operational challenges without additional funding. The conversation highlights the importance of visionary leadership, cultural alignment, and operational efficiency to deliver high-quality patient care and maintain financial health. Gary Campbell emphasizes the necessity of strategic planning, involving clinicians in decision-making, and standardizing processes to create a better work environment and optimize patient care. === LINKS === ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === 09:03 Why is there no opportunity to cost shift in an FQHC? 09:34 What happens when an FQHC is operating inefficiently? 10:00 "Have you workflowed it out? … You can overstaff yourself in a way that your cost per patient goes way up." 10:23 Why is taking a lean approach not an excuse to cut staff? 11:27 EP490 and EP492 with Shane Cerone and Sam Flanders, MD. 11:35 EP438 with John Lee, MD. 11:38 EP455 with Beau Raymond, MD. 11:40 EP402 with Amy Scanlan, MD. 11:42 EP405 with Eric Gallagher. 12:48 "The nurses are linchpins to everything." 13:44 LinkedIn post from Eve Cunningham, MD, MBA. 15:10 How does standardizing care lead to personalization of care? 16:34 "Our clinical teams see that we care." 16:53 "If you don't have a vision for where you want to be two and three years down the road, you're struggling." 17:09 "I want everybody to understand, What is their why?" 19:45 Lean & Meaningful by Roger E. Herman and Joyce L. Gioia. 24:44 "You have to project plan things out that you want." 25:51 "They don't teach leadership in most medical schools."—Dr. Robert Pearl 26:46 Outlive by Peter Attia, MD. 27:55 "Get to know these clinicians." 29:39 "From a core values perspective, you can make every single decision … on core values." 30:03 "We always start with those values. … They're embedded in everything we do." 30:20 How does an FQHC or private practices that are patient-oriented attract talent? 35:24 EP297 with Jerry Durham. 35:54 "First and foremost, be visible." | |||
| EP420: Paying Cash for Generic Drugs—Some Finer Points That Had Totally Gone Over My Head, With Ge Bai, PhD, CPA | 07 Dec 2023 | 00:36:57 | |
Uncovering the Economics of Paying Cash for Generic Drugs with Ge Bai To read the full article and show notes with links mentioned as well as a full transcript, click here. In this episode, Stacey Richter talks with Dr. Ge Bai, a professor at Johns Hopkins, about the rationale and financial implications of paying cash for generic drugs instead of using insurance. The discussion highlights the inherent inefficiencies and high administrative costs associated with PBMs (Pharmacy Benefit Managers) and insurance systems when it comes to low-cost generics. Key insights from studies are discussed, revealing that for a significant portion of generics, paying cash is often cheaper than using insurance. The conversation also explores alternative solutions such as Health Savings Accounts (HSAs) and the role of policy and market dynamics in improving drug affordability. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 06:13 What is the background on generic drugs that is need-to-know? 06:39 EP344 with Steven Quimby, MD. 07:04 Do we have affordability for generic drugs? 15:40 What's the policy failure around generic drugs? 18:34 Why is there a huge health equity issue? 20:13 How do PBMs have both a monopoly and a monopsony? 21:59 What should be the goal for cheap generics? 23:36 "Whenever we have no competition, we'll see high price." 26:00 What's the best approach to addressing operational challenges behind generic drug costs? 28:42 How do we solve generic drug costs on the back end? 31:15 "Healthcare insurance is not the same as health." 36:07 "It's time for us to reflect and think whether there is a better way to try." | |||
| EP419: The Financialization of Health Benefits for Boards of Directors and C-Suites of Self-Insured Employers, With Andreas Mang | 30 Nov 2023 | 00:38:20 | |
The Financialization of Health Benefits: A Boardroom Imperative To read the full article and show notes with links mentioned as well as a full transcript, click here. In episode 419 of Relentless Health Value, Stacey Richter interviews Andreas Mang from Blackstone on the financialization of healthcare benefits for corporate boards and C-suite executives. The discussion highlights the transformation of healthcare benefits into a significant business aspect, emphasizing the importance of C-suite involvement to combat waste and financial exploitation by vendors. Andreas offers practical steps to save companies up to 10% on healthcare costs while improving employee satisfaction, including self-insurance and careful selection of brokers. The episode underscores the need for enhanced purchasing discipline and strategic alignment among company leadership to manage healthcare expenses effectively. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 04:19 Why Andreas starts every conversation with the question, "How's your healthcare company?" 07:04 Why is it important, as a self-insured employer, to treat your business as a small healthcare company? 08:42 Why is it unnatural for companies to be providing health insurance? 10:13 What can be achieved when there is alignment between employers and insurers? 12:07 What things can a company do to reduce spend by 10%? 13:40 Why is it better to have CFO engagement in the benefits plan throughout the year? 15:51 Why does self-insurance save 5% to 9% for companies automatically? 17:41 "The funding isn't a healthcare thing; it's a CFO thing." 17:54 Why is it vital to have a reliable, trustworthy broker? 24:38 When is the last time your company has RFP'd their health plan? 27:06 Why does changing a health plan feel scary but is necessary? 27:58 What is a dependent eligibility audit? 30:48 Why are employers better together? 34:02 How do employers truly get a flat-fee model with brokers?
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| Encore! EP381: For Reals, Becoming Customer-centric, Transforming, or Innovating at a Very Large Organization, With Karen Root | 23 Nov 2023 | 00:32:13 | |
Encore: Achieving Customer-Centric Transformation in Large Organizations with Karen Root To read the full article and show notes with links mentioned as well as a full transcript, click here. In this encore episode of 'Relentless Health Value', host Stacey Richter speaks with Karen Root, Director of Experience Strategy at BI, about achieving customer-centric transformation and innovation in large organizations. The discussion highlights the importance of change management, systems thinking, and effective leadership with a compelling vision. Key steps include identifying quick wins, leveraging influencer support, storytelling, and focusing on emotional 'moments that matter'. The conversation also delves into the J-curve, emphasizing the necessity for leaders to sustain hope and overcome the initial challenges during the transformation process. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 08:51 What skills does leading a large company in customer centricity require? 10:36 What needs to be included in a vision for customer-centric change? 11:01 "In transformation, we have to adjust the approach to that vision. We have to break it down into a couple of key steps." 11:39 What is the J curve? 12:26 "Disruption is going to happen; it's just how do we minimize its impact." 14:00 Why is hope so important for success in change? 17:22 "Leverage your people; understand where they are in the change curve." 26:24 "We can't manage what we don't measure." 26:33 "We have to not only measure in quantitative ways but qualitative." 27:35 What's the downside to not being able to innovate? 28:55 Why does leadership need to have a story to tell? 31:19 "We have to remember that these are human beings and to look for those tells."
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| EP418: Mark Cuban With Some Advice for CEOs and CFOs of Self-insured Employers, With Mark Cuban and Ferrin Williams, PharmD, MBA, From Scripta | 16 Nov 2023 | 00:54:42 | |
Episode 418: Mark Cuban's Insights on Reducing Healthcare Costs for Self-Insured Employers To read the full article and show notes with links mentioned as well as a full transcript, click here. In Episode 418 of Relentless Health Value, Mark Cuban, CEO and founder of Mark Cuban Cost Plus Drugs, joins host Stacey Richter, and guest Farron Williams, Chief Pharmacy Officer at Scripta, to provide critical advice for CEOs and CFOs of self-insured employers. The podcast delves into the financial intricacies of the healthcare industry in 2023, emphasizing the importance of direct involvement by company executives in managing healthcare benefits to save substantial costs. Cuban discusses how his company saves money on drug costs through transparency and direct purchasing from manufacturers, offering actionable steps for businesses to replicate these savings. The episode also highlights partnerships, like the one between Scripta and Mark Cuban Cost Plus Drugs, and discusses strategies for simplifying the healthcare benefits system. The conversation touches on the broader impact of these practices, legal implications under ERISA, and the importance of financial prudence and transparency in managing healthcare expenditures effectively. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 05:41 What was Mark Cuban's own journey as a self-insured employer with Cost Plus Drug Company? 06:56 What did Mark find when he decided to go through and look through his company's benefit program? 08:23 "When you think it through, you start to realize that money is being spent primarily by your sickest employees." —Mark 09:13 How do you get CEOs and CFOs of self-insured employers to realize that their sickest employees are the ones subsidizing their checks? 12:10 What is the role of insurance in healthcare? 13:42 "If you can't convince them, confuse them and hide it." —Mark 14:35 The reality behind getting a rebate check. 15:32 Why are rebates going away, and why isn't that changing PBM earnings? 18:17 How do you get CEOs and CFOs to dig into their benefits plan? 20:13 Does morally abhorrent move the needle? 20:47 "What we're trying to do is just simplify the [healthcare] industry." —Mark 23:33 What's been changing in consumer behavior? 24:18 "Transparency is a huge part of building that trust." —Ferrin 24:33 Why CEOs and CFOs really have the power to change healthcare. 31:42 What are Cost Plus Drugs' plans to expand? 38:36 Where is the future of the prescription drug market going? 41:25 What will happen to the prescription drug market in 10 to 20 years? 47:56 The wake-up call self-insured employers should be acknowledging now. 51:18 Where is the real change in the healthcare industry going to come from?
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| Encore! EP385: Morgan Health and the 5 Things Self-insured Employers Should Do Right Now, With Dan Mendelson | 09 Nov 2023 | 00:34:06 | |
5 Strategies for Self-Insured Employers to Enhance Employee Health To read the full article and show notes with links mentioned as well as a full transcript, click here. In this encore episode of Relentless Health Value, host Stacey Richter revisits her discussion with Dan Mendelson, CEO of Morgan Health at JPMorgan Chase. They delve into five pivotal actions self-insured employers can take to improve employee health significantly. These actions include expanding accountable care models, investing in data access for health outcomes, aligning health benefits with population health outcomes, prioritizing adaptable care models, and making care navigation central to benefit packages. The episode underscores the critical role of employer engagement in advancing healthcare quality, affordability, and equity within local markets. Mendelson also shares insights into Morgan Health's current initiatives, such as their new accountable care framework in Columbus, and emphasizes the importance of local provider partnerships and digital health accessibility. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 05:01 Why did Dan direct his article about health benefits at CEOs? 06:03 What does an accountable care model mean to a self-insured employer? 07:58 "This alignment of value will never work … if the 150 million Americans … getting their health insurance through their employer are not also aligned in the same way." 11:28 "We're offering them a higher level of service." 11:40 "Everything that we do is intended to be scalable and not just for us." 12:09 "We have an obligation to do better for our employees." 14:52 "Employers need to understand, the only way to get outstanding care is locally." 17:28 Encore! EP206 with Ashok Subramanian and EP358 with Wayne Jenkins, MD. 18:18 Why is getting quantitative metric data important? 18:50 Encore! EP308 with Mark Fendrick, MD. 20:58 "This is a much broader vision of accountable care than … primary care." 22:48 "Until everything is aligned, the employer is just not going to be providing an optimal product." 23:39 "There are substantial issues with … health equity, and employers are paying for the care of 150 million Americans in this country." 25:23 Is digital health access important for creating meaningful relationships between patients and providers? 29:50 What is the myth that employers need to tackle? 30:18 Why is care navigation important for employees? 31:44 EP334 with Sunita Desai, PhD.
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| EP417: 5 Kinds of Payer and Provider Collaborations and 5 Must-Haves for Said Collaborations to Work, With Josh Berlin, JD | 02 Nov 2023 | 00:33:43 | |
Exploring Effective Payer-Provider Collaborations: Insights and Key Strategies To read the full article and show notes with links mentioned as well as a full transcript, click here. In episode 417 of Relentless Health Value, Stacey Richter engages in a detailed discussion with Josh Berlin from Rule of Three consulting firm about the dynamics and strategies behind successful provider and payer collaborations in the healthcare industry. They delve into the historically adversarial relationship between these entities and explore five distinct types of collaborations, ranging from data sharing to risk-bearing partnerships. Berlin outlines five crucial 'must-haves' for these collaborations to succeed, including scalability, sustainability, flexibility, effective collaboration, and compatible risk profiles. They further examine real-world examples of both successful and failed healthcare collaborations, emphasizing the importance of mutual goals and adaptive strategies to enhance patient outcomes and improve market competitiveness. The conversation offers practical insights for healthcare executives aiming to foster stronger, more innovative partnerships in a complex and evolving industry. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 06:06 Why should payers want to collaborate with providers? 09:46 "Collaboration … is bilateral. … Both sides, plan and provider, should be equally as interactive with the individual populations they work with." 12:37 What are the must-haves for collaboration between providers and payers? 13:10 What are the five different types of collaboration? 16:03 What are the five characteristics you want to be focused on in partnership? 21:35 EP359 with Dan O'Neill. 22:16 In order to collaborate, do you have to be collaborative? 26:11 Ochsner as a great example of collaboration. 27:46 Episodes with David Carmouche, MD, and Eric Gallagher. 28:51 A collaboration failure in Haven. | |||
| EP416: Why Should Med Schools Teach the Business of Medicine? With Adam Brown, MD, MBA | 26 Oct 2023 | 00:41:18 | |
Now, I'm being pretty careful here because med schools are super sensitive about their curriculums. And I am sensitive to the fact there's much to teach in four years. So, throwing no shade here, what do I know from the Krebs cycle? Choices of what to teach are tough. With that disclaimer, in this healthcare podcast I am speaking with Adam Brown MD, MBA, about an article he wrote entitled "Dear Medical Schools, Educate Students on the Business of Medicine—Without it, you are doing your students a disservice." Let me give you Dr. Brown's list for the "why teach the business of medicine." He says: 1. The role of physicians in medicine has changed, and we dig into this in the episode. 2. There's an expectation mismatch. Docs are investing 10 years and, on average, $200K to $300K in real dollars to get that MD or DO. You don't want those new physicians quitting on the quick because the reality is so different from what they thought it would be. Not being up front about the business of medicine is like hiding the reality of the situation instead of preparing them. 3. If you don't understand the business of medicine, you do not know how to advocate for yourself or the profession or even patients in a way that is compelling to the current set of decision-makers. As maybe a corroboration here, may I just report that I probably have gotten (conservatively) 100, 150 emails and LinkedIn notes from physicians who say basically some version of the same thing: Thanks so much for Relentless Health Value. I wish I would have learned even the basics of what you cover in med school. If I had, I would have been able to help myself and help myself help patients far better. 4. Docs are the ones with the prescription pads. Docs are just functionally the gang who are driving costs that patients and employers and taxpayers ultimately incur. Not knowing the how much or just the whole story here can inadvertently contribute to clinical morbidity, because patients who fear they cannot afford care do not follow doctors' orders. We should get real about that. Or if they do follow doctors' orders and go into debt … I mean, there's just study after study in oncology and otherwise that shows patients who cannot afford their care have worse outcomes. We cannot hide from this any longer. 5. The last reason is that there's lots of things that docs can do besides just be at the bedside. Not giving insight into these alternative paths seems unfortunate for any doc who maybe wants to mix it up some because they're feeling burned out or in a different season of their life looking for something more aligned with where they are as a person. So, now let's think about this whole question from the standpoint of the system itself—from the standpoint of doing better by patients. Why is it important to teach docs the business of medicine? Let's start here. When physicians do not understand the business of medicine, it's harder for docs to get into boardrooms and have their voices heard. Not teaching the business of medicine in med school might be one reason why there is such a shockingly small percentage of doctors on the boards of directors at major nonprofit hospitals (listen to the show with Suhas Gondi, MD, MBA [EP404]) and why there's so little "dyad leadership" in the ranks of both clinical and payer organizations, etc. And even fewer nurses are in organizational decision-making roles, by the way, despite nurses actually being the most trusted profession—even more trusted than doctors by 14 percentage points, according to Gallup. One way to interpret this lack of docs and other clinicians in the boardroom is simple cause and effect. Doctors are losing control and ownership—and I mean this in literal terms—of the organizations that run the business of medicine, which controls the medicine of medicine. Chad Erickson wrote a comment about this on LinkedIn that I thought was great. He wrote, "Opportunities for physicians to really control or even impact the 86% of healthcare outside of their practice are being reduced every year. We expect doctors to make the decisions and be accountable for patients and outcomes, yet we are taking away their ability to do so." And going one level deeper here on how not having enough docs in admin roles becomes a snowball rolling downhill kind of downward spiral, I'm gonna quote Jeremy Granger, MD, FAAP. He wrote, "When you are a physician administrator, it can be very strange. There is tremendous pressure from administrators to think and act like one of them and give insight into how to best coerce physician behavior to align with administrator-determined goals without necessarily involving the physician with setting those goals. When you advocate instead with your physician hat, you can find yourself ostracized from that administrator clique. You realize that they view physicians as knaves and you as the Judas goat. You either pick a side or, if you're lucky, you land with a team that has physician leaders equipped with equal power as administrators." So, you see what happens. Doc gets an admin role and either chucks their stethoscope and their patient-first mindset out the window to fit in, or they quit. And then we never get to any sort of critical mass of clinicians in leadership roles that would reset the organizational ethos. So, here we are. Too few mission-driven and business-savvy docs in boardrooms mean patients get the kind of care they're currently getting and at the prices we're all currently paying. From the standpoint of doing better by patients, I hear story after story about some doc who was under the impression that, I don't know, working with a private equity firm to do a roll-up of all the specialty practices in a local market was pretty cool and a totally victimless strategy. Or the surprisingly high number of docs prescribing drugs on that most wasteful spending list. There's one on that list, for example, that costs taxpayers or an employer $2000 when that drug consists of basically two $15 over-the-counter meds mashed together—and yet there's the impression that the $2000 drug is a better financial choice because there's a co-pay card and the patient out of pocket might conceivably be less … until it isn't, of course, because it's not like that additional $1970 in cost suddenly becomes free. Or what happens when a clinician is told to order largely unnecessary MRIs because workers' comp covers everything and no one cares—so this kind of thing continues to just happen … all this stuff. It takes a broader understanding to get the why and create the intrinsic motivation and necessary insight and right language and arguments to make things better. But all of this is about patients. If I'm talking to margin-driven people sitting around the conference room table with their calculators, are there any organizational consequences, meaning financial consequences, to not making sure doctors understand business and have a seat at the table? Here's two (there's probably more): 1. Staff turnover. If that's a concern for any organization now, and if moral injury is cited as a reason for that turnover (which it often is), moral injury doesn't happen when organizational demands are aligned with clinician values. 2. Successful value-based care isn't gonna happen if docs don't understand the business of medicine. Listen to the show with Eric Gallagher (EP405) or the one with Amy Scanlan, MD (EP402) or Larry Bauer (EP409). There's like 10 guests who essentially say the same thing. Docs who are in the dark about how the world actually works IRL cannot be an aligned force helping move past the FFS (fee-for-service) status quo and the whole business model that underpins that. Adam Brown, MD, MBA, my guest today, is a practicing emergency physician, board-certified ER doc. He recently founded ABIG Health, working with healthcare companies on communication strategies and advising investment firms. He's also a professor of practice at the University of North Carolina, Chapel Hill. Mentioned in this episode is a Tweet by Brendan Keeler. Also, Dr. Denver Sallee's very inspirational predictive scheduling work. I'll leave the last word on this to Michael R. O'Brien, MD: "You don't overcome the corrupting influence of money in medicine by ignoring its existence. … To slay the dollar-eyed dragon, we must be able to see like the dollar-eyed dragon."
You can learn more at ABIG Health and by reading Dr. Brown's bimonthly column.
Adam Brown, MD, MBA, is a board-certified emergency physician, entrepreneur, and accomplished healthcare executive whose professional journey traverses clinical practice to strategic leadership. Having risen through the ranks at Envision Healthcare, Dr. Brown's tenure there culminated in his role as president of emergency medicine, where he spearheaded the COVID-19 response and clinical communications. His impactful leadership led to his appointment as chief impact officer in 2021. In 2022, Dr. Brown left Envision and established ABIG Health, a healthcare strategic advisory firm. Additionally, he took on the mantle of professor at the University of North Carolina, Chapel Hill, Kenan-Flagler School of Business (his alma mater), teaching healthcare operations and strategy to MBA students. He is the advisory board co-chair at the Center for the Business of Health and on the business school Board of Advisors. A frequent media presence, Dr. Brown has been featured on CBS, Yahoo Finance, BBC, and local Washington, DC, outlets, speaking on various healthcare issues. His column, "Prescriptions for a Broken System" in MedPage Today, showcases his commitment to meaningful change in healthcare. His passion for empowering informed health decisions shines through his roles as a communicator, leader, and strategist. A recognized thought leader, his ability to connect, envision, and lead underscores his impact on shaping healthcare.
08:49 What does it mean to teach the business of medicine? 11:04 The four Ps that are key within the business of medicine. 13:27 Why is it important for doctors to understand the business of medicine? 21:46 "Things don't happen without a physician's signature." 27:27 Why physicians who understand the business side of medicine can broaden the view of outcomes for the business decision-makers. 28:30 Why is it important to make sure physicians are in the boardroom? 29:36 EP404 with Suhas Gondi, MD, MBA. 30:52 "We are getting what we designed." 33:37 Dr. Brown's advice for clinicians in the boardroom. 38:21 The work of Denver Sallee, MD, MMM, using artificial intelligence to do predictive scheduling.
You can learn more at ABIG Health and by reading Dr. Brown's bimonthly column.
@ERDocBrown discusses teaching the business of #medicine on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare #healthcare
Recent past interviews: Click a guest's name for their latest RHV episode! Rob Andrews, Justina Lehman, Dr Will Shrank, Dr Carly Eckert (Encore! EP361), Dr Robert Pearl, Larry Bauer (Summer Shorts 8), Secretary Dr David Shulkin and Erin Mistry, Keith Passwater and JR Clark (Summer Shorts 7), Lauren Vela (Summer Shorts 6), Dr Jacob Asher (Summer Shorts 5)
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| EP415: Some Jumbo Employers Buying Better Healthcare Outcomes While Saving 15% on Total Cost of Care, With Rob Andrews | 19 Oct 2023 | 00:43:10 | |
Improving Healthcare Outcomes and Reducing Costs: Insights from Rob Andrews of HTA To read the full article and show notes with links mentioned as well as a full transcript, click here. In Episode 415, Stacey Richter speaks with Rob Andrews, CEO of the Health Transformation Alliance (HTA), about how jumbo employers are achieving better healthcare outcomes while saving on total care costs. The discussion highlights the significant positive impact of targeted healthcare strategies on reducing readmissions and overall costs, particularly related to maternal health. Andrews elucidates how addressing root causes, negotiating data-driven contracts, and holding intermediaries accountable can create win-win scenarios for both employers and employees. The episode underscores the importance of using data to drive healthcare improvements and the role of self-insured employers in transforming healthcare delivery. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 07:29 How did Rob get to his current role? 09:11 The problem of maternal health and mortality rate, and how self-insured employers wind up directly and indirectly paying for this. 10:36 Why economic consequences move the needle, and why sometimes they don't. 12:36 Why the best way to address costs isn't to re-shift costs but to address them directly. 14:34 Why compensation that isn't dependent on outcomes is a problem. 18:09 "Strategy's not what people say; it's what they do." 21:40 How do you operationalize saving money with better outcomes? 29:46 How do employers turn conflict into collaboration? 31:41 What is the win-win-win structure among employers, payers, and providers in Rob's eyes? 34:13 To whom should the task of risk adjustment fall? 38:03 "Better contracts do improve outcomes." | |||
| EP414: An IRL How-To for Delivering Better Care and Getting Paid for It—A Value-Based Case Study, With Justina Lehman | 12 Oct 2023 | 00:39:58 | |
Delivering Better Care and Getting Paid: A Value-Based Healthcare Guide with Justina Lehman To read the full article and show notes with links mentioned as well as a full transcript, click here. In Episode 414 of 'Relentless Health Value,' host Stacey Richter interviews Justina Lehman to explore practical strategies for healthcare practices to provide coordinated, high-value care while achieving financial growth. The discussion covers the detailed steps for developing and implementing value-based care models, including assembling a committed team, defining ideal care pathways, navigating payer relationships, and engaging with self-insured employers. Lehman emphasizes the importance of close collaboration between physicians, clinicians, and payers to enhance patient outcomes and reduce costs. The episode provides actionable insights for healthcare professionals aiming to transition from fee-for-service to value-based care. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 07:35 What has Justina been up to, and why is it relevant to this conversation? 08:23 What is high-value care, and how do we figure out what it is in reality? 08:59 EP412 with Robert Pearl, MD, on the art and science of medicine. 10:08 "What is the clinical design of … high-value care?" 10:21 Care as usual vs ideal care. 11:11 Summer Shorts 8 with Larry Bauer. 12:23 How does Justina figure out what the benchmark is for high-value care? 12:36 Meeting patients where they are at, not where we want them to be. 17:42 EP402 with Amy Scanlan, MD. 18:28 "What is the story as a group to the payer? What is the story as a group to the self-funded employer?" 19:19 How do you align business operations and the financials? 20:16 What are the four avenues for getting paid for high-value care? 21:58 What are highly engaged payers most intrigued by in high-value care? 24:11 What are the different ways a practice can get compensated? 28:52 Are there programs that have advanced without payers leading the way? 29:37 What's the "hook" for payers? 31:12 What's a winning message to payers and employers? 33:04 Summer Shorts 4 with Eric Gallagher. 34:13 "Not everyone needs to participate." 38:24 Can a program be successful even if a physician is a passive participant in the program? | |||
| EP413: The Intersection of Healthcare Waste, Value-Based Care, and the Potential Rising Power of PCPs, With Will Shrank, MD | 05 Oct 2023 | 00:35:24 | |
Reducing Healthcare Waste: Aligning Incentives and Empowering Primary Care Physicians To read the full article and show notes with links mentioned as well as a full transcript, click here. In Episode 413 of 'Relentless Health Value,' Stacey Richter interviews Dr. Will Schrank on the intersection of healthcare waste, value-based care, and the rising influence of primary care physicians (PCPs). Dr. Schrank's extensive background includes roles at CMMI, CVS Health, UPMC, and Humana, and he is currently a venture partner at Andreessen Horowitz. The discussion delves into a study estimating nearly a trillion dollars of annual waste in U.S. healthcare, categorized into administrative failures (fraud, complexity, pricing) and clinical failures (care coordination, delivery, low-value care). Solutions like aligning financial incentives with higher quality care and primary care-driven models are explored. The episode also highlights challenges in shifting away from fee-for-service models, the potential evolving power of banded PCP groups, and the imperative for health systems to adopt value-based approaches. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 05:56 Can we cut healthcare waste while improving patient care? 06:35 What does "healthcare waste" consist of? 06:48 What are the six categories of "healthcare waste"? 09:25 EP363 with David Scheinker, PhD. 09:39 How much money does Dr. Shrank estimate is wasted each year in healthcare? 12:11 Where is that healthcare waste going, and why does it happen? 19:09 Uncaring by Robert Pearl, MD. 20:20 "We've built a backbone of extraordinary waste on a fee-for-service chassis." 21:18 EP409 with Larry Bauer, MSW, MEd. 23:26 EP359 with Dan O'Neill. 25:04 Dr. Shrank's warning to providers out there. 29:04 Summer Shorts 2 with Scott Conard, MD. 30:43 Why there might be a generational shift among younger providers looking to work with different models. | |||
| EP497: What You Don't Know About Healthcare Transactions and Clearinghouses Could Cost You, With Zack Kanter | 15 Jan 2026 | 00:38:27 | |
In Episode 497 of Relentless Health Value, Stacey Richter engages in a detailed conversation with Zack Kanter, CEO of Stedi about the complexities and inefficiencies inherent in healthcare transactions and clearinghouses. They discuss how non-standardized processes and legacy systems result in exorbitant costs and delays in claims processing and eligibility checks, which are significantly higher compared to other industries. Despite HIPAA's standardized rules, the lack of competitive pressure and outdated technology contribute to these issues, ultimately impacting patient care and administrative costs. Zack offers insights on how modernizing the clearinghouse infrastructure can lead to substantial cost savings and better patient outcomes. === LINKS === 🔗 Visit Stedi: ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === 09:47 What things are being paid for that we might not be aware we're paying for in healthcare? 12:09 Why HIPAA actually makes healthcare more standardized than other industries. 15:35 How healthcare is ahead in some ways and behind in others. 18:03 Where do the 4 to 5 days come from in healthcare transaction processing? 20:39 Why these transaction delays affect care delay. 23:14 EP482 with Preston Alexander. 23:18 EP472 with Eric Bricker, MD. 27:10 How should the process work from the time a provider clicks "validate"? 30:19 Why is the clearinghouse the right place to solve all these issues? 31:41 Why are we where we are in terms of these issues? 35:28 Why people should be looking at their clearinghouse costs. 36:59 What to know about Stedi. | |||
| EP411: Getting Paid (or Paying) for New Innovations Used in Hospitals as Part of a Procedure or a DRG—Also Bloodstream Infections and Dialysis, With Secretary David Shulkin, MD, and Erin Mistry | 29 Sep 2023 | 00:10:18 | |
The following episode covers my intro to the episode and thoughts on the topic of new innovations used in hospitals as part of procedure including bloodstream infections and dialysis. Oh, hey, some unexpected news. This interview is unavailable at this time. One of these days we may be able to make it available, and if so, this will be announced in our weekly email. So please subscribe by going over to our website at RelentlessHealthValue.com. The episode emphasizes the remarkable progress made by the Relentless Tribe in improving outcomes for chronic kidney disease (CKD) patients and highlights the obstacles hospitals face in adopting expensive new technologies under the DRG payment model. The discussion also covers the significant impact of hospital-acquired infections, particularly those leading to sepsis, and explores the role of Medicare's NTAP (new technology add-on payment) in incentivizing the use of innovative treatments. The episode underscores the complex balance between cost and patient outcomes in healthcare. 00:00 Introduction to Episode 411 00:36 Acknowledging the Relentless Tribe 02:30 Interview with Secretary David Shulkin and Erin Mistry 03:53 The Issue of Bloodstream Infections 04:52 Understanding DRG and Hospital Economics 06:19 Medicare's NTAP and Hospital Payments 07:44 Guest Backgrounds and Acknowledgements 08:43 Acronym Alerts and NTAP Recap 09:54 Conclusion and Subscription Information | |||
| Encore! EP361: The Gap in Closing Care Gaps, With Carly Eckert, MD, PhD(c), MPH | 28 Sep 2023 | 00:30:33 | |
The Reality of Closing Care Gaps: A Conversation with Dr. Carly Eckert To read the full article and show notes with links mentioned as well as a full transcript, click here. In this encore episode titled 'The Gap In Closing Care Gaps,' host Stacey Richter interviews Dr. Carly Eckert, exploring the pervasive issue of care gaps in the U.S. healthcare system. Care gaps arise from fragmented medical transitions and tend to recurred if root societal causes are left unaddressed. The conversation reveals the shortcomings of reactive care gap mitigation strategies, likening them to a futile game of 'whack-a-mole.' Dr. Eckert highlights the importance of proactive solutions, such as population health models and community-based interventions. The podcast emphasizes the need for a systemic shift towards holistic and continuous patient care, integrating social determinants of health and enhancing provider-patient relationships. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 05:31 What is the true goal in making population health successful? 05:58 How does the clinical pathway need to manifest in population health? 06:29 How do we get a nonfragmented state of care? 06:54 What is the best model of care? 08:37 "Identifying and addressing care gaps is an important element of population health." 11:30 Closing care gaps vs creating a nonfragmented system of care. 15:38 "I think you have to take small steps with people." 16:45 "There's a lot of power in peer support." 17:18 Why should provider organizations connect with peer groups? 19:05 "The key is that it's not going to be the same for everybody." 23:09 Why is diversity of the workforce key to closing care gaps? 23:33 EP322 with Monica Lypson, MD, MHPE. 23:37 EP347 with Ian Tong, MD. 28:36 Where can providers improve transparency to help close care gaps?
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| EP412: Leadership of the Art and Science of Medicine, With Robert Pearl, MD | 21 Sep 2023 | 00:32:38 | |
Leadership in Modern Medicine: Balancing Art and Science with Dr. Robert Pearl To read the full article and show notes with links mentioned as well as a full transcript, click here. In Episode 412 of 'Relentless Health Value,' Stacey Richter interviews Dr. Robert Pearl, former CEO of Kaiser Permanente, to discuss the evolution and current state of leadership in medicine. The conversation explores the balance between the art and science of medicine, touching on how advancements in technology and data have transformed healthcare. Dr. Pearl emphasizes the importance of evidence-based practices while maintaining the human element of patient care. He introduces his A to G model for effective healthcare leadership, which includes aspirations, behaviors, context, data, engagement, faculty, governance, and incentives. Throughout the episode, the focus remains on improving patient outcomes and clinician engagement in a rapidly changing medical landscape. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 04:50 What is the idea of the art of medicine? 09:29 EP407 with Vivek Garg, MD, MBA. 09:32 Why has the intrinsic motivation of doctors plummeted? 09:48 Patient perspective versus doctor subjective response. 12:36 Why is there a fundamental change in what doctors and medical professionals can take pride in? 14:38 What did change management look like in the past? 15:24 "What does a patient really want? They'd like not to have a stroke, a heart attack … in the first place." 20:23 "How do leaders achieve evolution?" 23:57 "Incentives always work … the problem in medicine is, they rarely work the way you planned." 24:20 What's the way to make change happen, and why doesn't it involve financial incentives? 28:10 What do leaders in organizations today consistently underestimate? 29:11 What are the three parts of leadership? 29:25 What is the hardest part about leadership? 31:31 Dr. Pearl's two books, Mistreated and Uncaring. | |||