There is a land grab going on right now, the likes of which the health care industry hasn’t seen before—at least in our generation. Spoiler alert: There’s a whole episode of Relentless Health Value coming up on the impact of the Teladoc-Livongo hookup. And that is totally relevant to the point I’m about to make. But let me just start with a little bit of background: American patients—let’s get real here—have no more money to spend on health care every year. Really. I mean, you look to employers....
Sep 03, 2020•31 min
Here’s a couple of sentences ripped from the headlines recently: It is free to be tested for COVID-19 in the US, but the cost of treatment can be shocking. Even if you’re insured, the deductible and co-pay can add up to several thousand dollars. And if you’re uninsured, the financial toll is even uglier. That’s what Boston resident Danni Askini learned when she got a $34,927 bill after receiving treatment in a local emergency room for COVID. That’s from Time magazine. Episode 260 of the show was...
Aug 27, 2020•33 min•Ep. 290
You may or may not know (I don’t know why you would, honestly), but I speak Swedish. I mention this because there’s this famous and really culturally emblematic Swedish word which is this: lagom . It means “the exact right amount.” In Swedish culture, the exact right amount deserves its own word. For example, “Did you have enough watermelon?” “Why, yes, I had half a slice. It was lagom.” Lagom has no direct translation in US English because, in the United States, we don’t need a word for “the ex...
Aug 20, 2020•36 min•Ep. 289
Disclaimer before we get started here: This show is probably a 300-level class in pharmaceutical/PBM relations. If you are tuning in for the first time and you aren’t pretty familiar with the role of PBMs, I would go back and listen to, say, episode 241 with Vinay Patel or episode 166 with Tim Thomas from Crystal Clear Rx. OK, now that that’s out of the way, if you’re still with me, this episode is like a ride on a roller coaster. In this health care podcast, I talk with Mike Schneider, who’s a ...
Aug 13, 2020•30 min•Ep. 288
In this health care podcast, I’m speaking with Dan O’Neill, MA, MS. Dan says that, in many ways, this is a fantastic time to be an entrepreneurial physician leader. We are in a place to reinvent the practice model, meaning finding ways to increase value while losing bloated business practices in labor and capital. It’s more possible than ever to make a medical practice more efficient and effective with less overhead and, at the same time, meet the needs of patients in ways that are, you know, we...
Aug 06, 2020•32 min•Ep. 287
John Rodis, MD, MBA, is an OB/GYN specializing in high-risk pregnancies. He’s been a board examiner and a department chairman. He’s been a COO and a CEO of a 600-bed Level 1 trauma center. He’s also an author working on a book to help consumers make better choices. Dr. Rodis has said he feels an inflection point is coming in the transition to value. First, we have the pressure of large employers. Second, we’ve got doctors themselves who are being crushed by the current environment and who may al...
Jul 30, 2020•34 min•Ep. 286
I’m going to summarize some points that Dr. Marty Makary made in his manifesto for why he wrote his most recent book. The Price We Pay is its name. You can hear this manifesto in his own words—in Dr. Makary’s own words—on Relentless Health Value episode 242 , but here’s his point: He said that the 2007 banking crisis, writ large, resulted from complexity that kept onlookers confused. So, when people questioned the banks being overleveraged and selling mortgages to, you know, those who couldn’t a...
Jul 23, 2020•34 min•Ep. 285
There is a transparency zeitgeist kicking off right about now. In June was the biggie, the one where health systems now have to divulge their contracted rates with insurance carriers starting January 1, 2021. But this zeitgeist is flowing into drug prices as well. Surescripts just released their real-time prescription price transparency tool. This price transparency tool allows detailed cost and alternative drug information to be seen in real-time. Surescripts, by the way, is owned by several la...
Jul 16, 2020•35 min•Ep. 284
At the end of the day, health care should be about helping patients find their way to health while doctors, nurses, and other clinicians don’t burn out in the process. It’s becoming increasingly indisputable that the way to get to this North Star efficiently is through human-centered health care. Human-centered health care is a term coined by Dr. Sylvia Romm, and it’s a play on the term customer-centered design . How do we innovate? How do we use technology to intensify the human experience for ...
Jul 09, 2020•33 min•Ep. 283
This past March, I was looking forward to giving a keynote at the Arizona Technology Council. Unfortunately, that didn’t happen. COVID happened. But in the process of figuring out what I was going to talk about during my keynote, I came up with an idea and I wanted to share it. It’s the idea of how to measure value in health care delivery, because might as well go big or go home, right? The metrics that we use to measure value is critical, and not just because what gets measured gets managed. It...
Jul 02, 2020•18 min
In the April issue of Value-Based Cancer Care (that’s a journal), there’s an article talking about a keynote presentation and a study highlighting a big problem for patients with cancer: toxicity. It’s a fact that some chemo agents are pretty toxic, but in this health care podcast I am talking about financial toxicity. The financial burden of cancer care has a seriously negative influence on patients’ quality of life. This keynote speaker quoted in the Value-Based Cancer Care article implored hi...
Jun 25, 2020•35 min•Ep. 282
You know what the second biggest cost line item is on most health systems’ profit and loss report: supplies—buying things like artificial knees, stents, service contracts. It’s estimated that an average hospital can save more than $12 million a year if they manage their supply chain better. And interestingly, oftentimes care actually improves as a result. For context, that wasted $12 million could pay for 165 more nurses or 50 more PCPs. It’s the cost of 3100 knee replacements. (All this, by the...
Jun 18, 2020•35 min•Ep. 281
In this health care podcast, I am talking with Yauheni Solad, MD. Dr. Solad is one of the top minds in data and data exchange. He’s medical director of digital health and telemedicine at Yale New Haven Health, and he has a mission to lead digital transformation toward accessible and affordable high-quality care that’s enabled by technology. Dr. Solad also does a lot of work with NODE—the Network of Digital Evidence. In the conversation we’re about to have, Dr. Solad represents the provider point...
Jun 11, 2020•38 min•Ep. 280
Let me explicitly state an implicit theme that’s been running through a bunch of the latest Relentless Health Value podcasts talking about if and how the COVID-19 pandemic could possibly serve as a flash point in the health care industry—a flash point where egregious and self-interested financial pursuits take such a toll that politicians notice. Why do these legislators notice? Because the patients (also known as voters), the ones that we all serve, begin to break under the weight of a system t...
Jun 04, 2020•38 min•Ep. 279
In this health care podcast, I’m speaking with Maura Calsyn from the Center for American Progress—or CAP—and we’re talking about value-based drug pricing and the impact that COVID-19 may have on its definition, operationalism, and broad adoption. I remember a situation (kind of years ago, actually) where a pharma company decided to lower its price on an infused product. Normal supply and demand would dictate that if you lower your price, you will get more overall business, which will result pote...
May 28, 2020•31 min•Ep. 278
Look, bottom line, value-based care has to be the future of health care delivery in this country. That’s just inarguable at this point. Nobody disagrees except for health care industry stakeholders trying to reap as much reward as possible while the going is good. And they’ve been really successful with their reaping thus far. Here’s the thing, though: There’s speculation that health insurance premiums may go up, like, 4% to 40% next year if the status quo remains the status quo. Is this the mom...
May 21, 2020•32 min•Ep. 277
In this health care podcast, I talk with Brian Scott. Brian has a background which is perfect for the question of “Will employer health care costs go up or will they go down as a result of this pandemic?” First, Brian was an underwriter at United. Then he was in a dedicated complex claims group for Lockton that managed self-funded plans. And now he’s at Point6 Healthcare, where he works to put together the best-value plan for employers, including getting stop-loss. Brian works with TPAs (third-p...
May 14, 2020•26 min•Ep. 276
I have the same burning question that I think many of you have: If I am a self-funded employer, as a result of this pandemic, will my health care costs go up? This question boils down to an equation that has two parts: the additions and then the subtractions. In the Additions column, how much will an employer spend on COVID-19 treatments—you know, both the ICU visits but also employees who haven’t been to the doctor in 15 years, get a cough, go to the doctor, and get diagnosed with some underlyi...
May 12, 2020•31 min•Ep. 275
Everybody’s talking about the surge in telehealth usage. I wanted to talk to someone who has been ramping up their telehealth capabilities for a while to get a sense of what it takes to do it well. And, as has been said by many, doing telehealth isn’t just about technology. It’s about training clinicians, patients, and accounts receivable and other staff. It’s about rearranging workflows and processes. So, I was super pleased to have had the opportunity to speak with Jonathan Thierman, MD, PhD. ...
May 07, 2020•21 min•Ep. 274
Everybody’s been talking about the surge in telehealth usage—how it would have taken, like, ten years to get as far as we’ve gotten in the past ten days. I wanted to talk to somebody who has been ramping up their telehealth capabilities for a while to get a sense of what it takes to do it well. As has been said by many, doing telehealth isn’t just about technology. It’s about training—clinicians and patients and accounts receivable and other staff. It’s about rearranging workflows and processes....
Apr 30, 2020•29 min•Ep. 273
A lot of people are wondering why independent PCPs are furloughing nurses and talking about shuttering their practices in the middle of a pandemic. Conventional wisdom would assume that PCPs would be just fine if they stand up telehealth and can take some sort of majority of their patient visits virtually. After all, it would make a lot of sense that a lot of patients are calling their doctor right now. In this health care podcast, I interview Guy Culpepper, MD. Dr. Culpepper sets us straight ab...
Apr 28, 2020•35 min•Ep. 272
In this health care podcast, I’m talking to Al Lewis from Quizzify. This episode also guest stars Rachel Miner from Thrive Benefits, David Contorno from E Powered Benefits, and Doug Aldeen, a health care attorney in Texas. This episode started out being about surprise billing in the emergency room (ER) and a potential defense strategy that patients and employees can use to protect themselves from egregious billing practices. Surprise bills are when a patient gets “balance billed” for a sum above...
Apr 23, 2020•41 min•Ep. 271
Let’s talk today specifically about primary care physicians (PCPs) and family medicine doctors. Data was reported in USA Today , saying that an estimated 60,000 family practices will close and 800,000 of their employees will lose their jobs by the end of June. It’s hard for any practice to just snap its fingers and transfer patients over to telemedicine regardless of the reimbursement rate and/or how many payers are actually paying any reimbursement for telemedicine or remote patient monitoring....
Apr 16, 2020•26 min•Ep. 270
The first wave of this COVID-19 pandemic has been totally reactionary. Don’t get me wrong: That does not detract from the Herculean effort made by hospitals and clinicians who have thrown everything they have at this—and more. But I don’t think that anyone would disagree that if we had enough PPE (personal protective equipment) and ventilators—you know, like, proactively—we’d be in better shape. So let’s stay ahead of the second wave of this pandemic, which is going to happen when, as Marty Maka...
Apr 09, 2020•34 min•Ep. 269
On Friday, March 27, President Trump signed into law the Coronavirus Aid, Relief, and Economic Security Act—otherwise known as CARES. This CARES Act covers the whole $2 trillion megillah stimulus package, but in this health care podcast episode, we’re talking quickly about a provision in that Act. I speak first with Doug Aldeen, an attorney specializing in helping employers settle hospital bills. Doug works with clients across the country. And then at the end of the episode, you will also hear f...
Apr 07, 2020•18 min
The reaction of some hospitals and health care systems to the COVID-19 pandemic has been truly breathtaking. Doctors, nurses, first responders, other staff at hospitals and elsewhere have worked hard—so hard—to support the national effort. The same can be said to some tech entrepreneurs and other businesses who have snapped into action in order to provide PPE (personal protective equipment) and artificial intelligence to the frontline health care workers. In this health care podcast, I’m talking...
Apr 02, 2020•27 min•Ep. 268
Marty Makary, MD, MPH, is a surgeon at Johns Hopkins. He’s a professor of surgery and health policy and management at Johns Hopkins University. And he’s also the author of The Price We Pay and Unaccountable . I had the honor of speaking with Dr. Makary last week, and I learned a lot. For one, the worst is between now and June. For two, it’s all about ramping up capacity as fast as possible in our hospitals. We talk a lot, Dr. Makary and I, about what that looks like and what other stakeholders l...
Mar 30, 2020•32 min•Ep. 267
This episode was recorded prior to COVID-19 hitting our shores. Irrespectively, it is incredibly relevant. Right now, more than ever, we need physician leadership and we need partnership across organizations and within organizations so that good decisions can be made as fast as possible. Look, we don’t have time to mess around right now. We need to be making good decisions—and fast. And these decisions on digital health solutions and other technologies and processes and workflows need to really ...
Mar 26, 2020•31 min•Ep. 266
There is a lot going on with digital health tools these days. Which ones are the good ones and which ones are nothing burgers packaged up in beautiful marketing? That’s a good question, and it would be nice to have a go-to source for such information. Some parties — mainly PBMs [pharmacy benefit managers] and to some extent payers and providers — recognize that this actually would be nice, and they see that creating digital formularies could be an opportunity to grow revenue for their shareholde...
Mar 19, 2020•29 min•Ep. 265
It’s kind of a vicious cycle. Payers don’t trust providers to do the right thing and provide appropriate care. And OK, there’s some logic there considering that 25-ish% of health care delivered is low-value or unnecessary. On the other hand, some patients actually need the care and now it’s painstaking for them to get it—and that painstaking part of the sentence is borne by providers, at least logistically. So then the providers learn how to expedite getting their patients care by copying and pa...
Mar 12, 2020•34 min•Ep. 264
