Here’s the cold hard truth: The whole specialty pharmacy operational model is not built to serve patients, a fact that becomes crystal clear when you’re a patient. Instead, the specialty pharmacy model is, rather, pretty blatantly dedicated to the power struggle for revenue and captive patient populations. It’s war between providers and the whole PBM/insurer/specialty pharmacy vertical consolidations. Employers and pharma manufacturers are, of course, on the battlefield as well. The patient, mea...
Sep 16, 2021•33 min•Ep. 337
I was listening to a panel discussion and heard Brandon Weber use the phrase the “barbarians at the gate” of the healthcare industry. I think I reached out to invite him to come on the podcast before the end of the segment. But at risk of spoiler alerts, let me sum up what I think is so interesting about Brandon’s insights, which he talks about on the show. First of all, it isn’t an “oh, heavens, some companies out there are trying to disrupt the status quo,” like this is some sort of news flash...
Sep 09, 2021•33 min
Here’s a hot take for you. I just learned what a hot take was last week, so, of course, I needed to get me one on the quick. The thing with hot takes, from what I understand, is that they are open for discussion. What I’m talking about today is something I’ve been thinking about for a while, and I would be interested in your thoughts, since probably some finesse is needed here. I want to talk about the imperative of collaborating with organizations across the care continuum, even the ones you ma...
Sep 02, 2021•8 min•Ep. 30
This conversation starts out talking about the RUC, which is a committee run by the AMA, who has the sole source contract with CMS to figure out how many RVUs any given procedure or service is worth. There are roughly four times as many specialists on this RUC committee as PCPs. You might be able to see where this is going, but let me let our guest in this healthcare podcast, Brian Klepper, explain how primary care got trampled by the goings-on. Brian Klepper is a longtime healthcare analyst and...
Aug 31, 2021•10 min•Ep. 16
In this healthcare podcast, I’m talking with Brian Klepper. If you haven’t heard of him, Brian’s a longtime healthcare analyst and former CEO of the National Business Coalition on Health. This interview takes off like a shot, as most of my conversations with Brian Klepper do. We’re talking about primary care and its various iterations. We start out with Exhibit A—the HMO version of primary care from the ’90s. This is a great comparator to really get a handle on what’s going on today. During the ...
Aug 26, 2021•33 min•Ep. 335
In this episode, host Stacey Richter speaks with Sunita Desai, PhD, a health economist and assistant professor at NYU Grossman School of Medicine, about the real-world impact of price transparency in healthcare. They break down the intended progression from transparency to consumerism to lower costs and higher quality care—and why, in practice, that progression often stalls. Sunita shares key research on the barriers consumers face when trying to act on price information, and they discuss what i...
Aug 19, 2021•33 min•Ep. 334
In this episode, host Stacey Richter engages with a panel of experts—including Jeff Hogan, Darrell Moon, Dr. Grace Terrell, Dr. Rich Klasco, Nicole Bradberry, and Kelly Conroy—to discuss the practical implementation of care plans in real-world settings. The conversation delves into the challenges and successes of integrating care plans into healthcare practices, offering insights into effective strategies and common pitfalls. Listeners will gain valuable perspectives on enhancing patient outcome...
Aug 12, 2021•19 min•Ep. 333
In most other industries, it’s the customer who consumes the services and engages with the purveyor of services. In health care, not so much. Legacy health care has evolved to honor the insurance carrier as the customer or, in some cases, the fancy surgeon or other driver of revenue as the customer. Listen to the podcast with Marshall Allen for more on that front, but yeah. And here we are. Health care should be designed so that patients get the best outcomes at a financially not-toxic price poi...
Aug 05, 2021•32 min•Ep. 332
In this episode, host Stacey Richter interviews Al Lewis, founder and “quizmeister-in-chief” of Quizzify, about the misleading tactics wellness and point-solution vendors use to inflate their cost savings claims. They explore statistical tricks like regression to the mean, flawed participant comparisons, trend inflation, and overstated engagement metrics. Al also shares advice for employers on spotting these deceptive practices and ensuring their brokers or benefit consultants are acting in thei...
Jul 29, 2021•32 min•Ep. 331
In this health care podcast, I’m interviewing John Marchica, who is the CEO at Darwin Research Group. Starting last year in the middle of the worst of the COVID pandemic, Darwin Research Group conducted a study about what was going on at health systems or integrated delivery networks (IDNs), and they’ve updated it every quarter since then. The goal was to try to stay on top of the effects of COVID-19 on care management and the business of care delivery. I loved having this opportunity to quiz Jo...
Jul 22, 2021•32 min•Ep. 330
In a recent article in STAT news, TJ Parker, the VP of pharmacy at Amazon and the founder of PillPack, explained that Amazon’s plan to stand out in the pharmacy space is simple: “Better selection, better convenience, and better prices.” He added, “It really is the Amazon playbook.” Better selection, better convenience, better price. The playbook of arguably one of the most successful companies ever, Amazon has decimated and bankrupted anybody standing in its way toward total market dominance. Th...
Jul 15, 2021•30 min•Ep. 329
“Scientists Announce Successful Experiment to Bankrupt Mouse That Can’t Afford Cancer Drug.” That’s a recent headline from The Onion , which is, by the way, a funny satire newspaper, if you haven’t heard of it. You could swap out “Cancer Drug” in that headline with “a Trip to the ER”—or pretty much any aspect of health care in this country. No matter what health care service you stick in there as the potential cause for a mouse’s bankruptcy, it’s a pretty LOL headline, right? But the reason why ...
Jul 08, 2021•43 min•Ep. 328
If I had a nickel for every guest on this show who went on to achieve wild success … TJ Parker from PillPack three years before they were bought by Amazon. Anyway, let me introduce this show with a clip from the recent podcast ( EP325 ) with Dr. Mai Pham. We were talking about the rampant and very open secret of excessive upcoding in Medicare Advantage (MA) that is costing American taxpayers a fortune and is very not correlated with actual spend. Here we go with Dr. Mai Pham: Stacey: Do you have...
Jul 01, 2021•32 min•Ep. 263
You can subscribe to this show two ways. One way is through the iTunes podcast app or your podcast app of choice. That’s a cool way to subscribe because then the show just kind of turns up in your podcast app each week and you can decide to listen to it on the fly. The other way is to subscribe on our Web site. This is more like a newsletter subscription. If you subscribe this way, you get an email each week that transcribes the show introduction, plus includes timed show notes. Many people subs...
Jun 24, 2021•32 min•Ep. 327
Here’s the context, friends: As you may have noticed over the past few episodes, we have been digging into value-based care here at Relentless Health Value corporate work-from-home headquarters. Many lessons have been learned, and it’s important that we sit back and think hard every now and then about how we are going to use these learnings to improve. While this show tackles the Hospital Readmissions Reduction Program (HRRP)—and wow, I was glued to my seat during this interview—the show is real...
Jun 17, 2021•37 min•Ep. 326
First of all, a shout-out to all of you listeners who have shared this show with colleagues and LISTSERVs—really appreciate it. It’s because of you and your efforts to share that Relentless Health Value maintains its spot as one of the top podcasts reaching health care executives, executives who take the insights shared by our guests to drive actual change and transformation across our industry. So, thank you. Leaving a rating and/or a review on iTunes is also the bomb and really helps our RHV t...
Jun 10, 2021•37 min•Ep. 325
Recently, the University of Pennsylvania Leonard Davis Institute of Health Economics, or LDI, put out a white paper called “The Future of Value-Based Payment: A Road Map to 2030.” Spoiler alert: Next week’s show is with Dr. Mai Pham, an author of that paper; and it’ll be a great show—so, tune back in next week. But, in the meantime, that paper made some really interesting points about ACOs (accountable care organizations). For example, they say that the average ACO shows a net savings of...
Jun 03, 2021•34 min•Ep. 324
This episode seemed particularly relevant right now because it gives insight into how large self-insured employers are prioritizing their efforts to disrupt health care revenue streams that do not provide adequate health outcomes for dollars spent. This episode’s conversation is with Lee Lewis. This is an encore episode. The original was recorded when Lee was the newly minted chief strategy officer at the Health Transformation Alliance, otherwise known as HTA. The HTA is a group of 50 major corp...
May 27, 2021•31 min
One way to spot a flash point is to notice when people are using different words to describe the same concept. Throughput is one example of this. On one side of the table, you have those who grasp that if a provider organization is concerned about patient outcomes, with few exceptions, building relationships with said patients is essential. It’s not entirely clear to anyone anywhere how you manage to build relationships and trust without spending a certain amount of time with patients. These “we...
May 20, 2021•18 min•Ep. 323
Imagine if innovators in other businesses operated in the way that some health care status quo doomsayers finger wag. So much for failing fast, iterating, and folding learnings into something that might work better. I don’t like to see screeds that seem to advocate an approach of “try it a few times at a minimum half-heartedly, fail, and then just quit, because obviously anything worth doing should be that easy.” Pieces fell into place with me as I was speaking to Monica Lypson, MD, MHPE. Dr. Ly...
May 13, 2021•31 min•Ep. 322
If you listen to this show on the regular, you probably have a pretty good bead on a couple of things I’ve been really into lately. One of them is high-value care versus low-value care. These are terms that are really easy to throw around. You also can get pretty much everybody to agree with a plan to deliver only high-value care and quit it with the low-value care … in theory. But the wheels fall right off the bus when it comes to actually doing this. IRL (in real life), what constitutes high-v...
May 06, 2021•30 min•Ep. 321
When I was talking with Dr. David Carmouche from Ochsner in EP316 about the importance of collaboration amongst anybody trying to actually pull off value-based care, we took a little detour, which I wound up cutting out, into the potential and challenges for health systems to collaborate and do value-based contracts with pharmaceutical manufacturers. It’s a really interesting sidebar, though, that I wanted to share with you—especially on the heels of the recent interview with Troy Larsgard from ...
May 04, 2021•6 min
If you want to hear what my mom and dad, both Medicare Advantage patients in their late 70s, have to say about telehealth (or teleconferencing, as my dad puts it), you’ll have to listen to the episode. They are not and have never been health care professionals, but they fully get that the question “What’s better—telehealth or in-person care?” asked like it’s some kind of winner-takes-all cage fight doesn’t serve anybody’s needs. And by anybody, I mean clinicians or the patient. And by patient, I...
Apr 29, 2021•30 min•Ep. 320
I’ll tell you what I wanted to figure out: How does care improve in SNF (skilled nursing) or assisted living facilities? My starting point in contemplating a possible path toward this goal was advanced primary care. There is so much talk and evidence these days about advanced primary team-based care and how much patients like it, the low-value care it could potentially prevent downstream, and the patient outcomes it can create. But in general, these advanced primary care models are talked about ...
Apr 22, 2021•31 min•Ep. 319
I heard someone say the other day, “Practicing medicine without pharmaceuticals is like running to the ten-yard line, putting down the ball, and walking off the field.” So, it’s pretty imperative that providers and Pharma know how to work together to get the best outcomes for patients. In this context and in this podcast, when I say “get the best outcomes for patients,” I kinda mean it. There’s a sweet spot in the middle of “won’t let those [expletive goes here] pharma reps in the building” and ...
Apr 15, 2021•28 min•Ep. 318
Let’s get a fast bead on what’s going on with drug pricing reform, shall we? Every time I wade into these waters, my head about explodes. So, I very much appreciate the opportunity to quiz Josh LaRosa from the always-well-informed Wynne Health Group. Here’s the goings-on in a nutshell: There’s goings-on. This infrastructure bill that’s in all the news all over the place right about now? You know what the plan is to fund all those bridges? Yeah, well, part of it is for Medicare to save money on d...
Apr 08, 2021•27 min•Ep. 317
I don’t know what I thought we were going to talk about during my interview with David Carmouche, MD; but I’m glad it turned out exactly as it did. Lately, we’ve had a number of guests on Relentless Health Value talking from the point of view of the employer: what a self-insured employer wants and needs from the large, and small, providers in their network. In this episode, we’re flipping the script and talking about what a large provider organization wants and needs from the commercial side of ...
Apr 01, 2021•22 min•Ep. 316
Medicine is complex. It’s getting more complex. We double what we know in medicine every 73 days. There’s 800,000 journal articles published every year. It is impossible for any human to keep up. It’s just impossible. There’s a lot of talk about amazing technology to help humans manage the 26,000 variables in heart failure treatment or what have you. And, yeah, I’m a huge fan of technology doing what technology is good at doing. But here’s a point to ponder: Just like meds don’t work if the pati...
Mar 25, 2021•32 min•Ep. 315
Have you never heard of the Nuka System of Care? If that’s the case, it is an award-winning and really remarkable health system in Alaska. In this 5-minute “An Expert Explains,” Dr. Douglas Eby, medical director over at Nuka, gets directly to the point. A key component to making sure that the people/customers in your plan get the best care is to make sure that they have access to a team of providers who know them well enough to have earned their patient consumers’ trust. Both the trust and the a...
Mar 23, 2021•8 min
This episode is for anyone as curious as I have been about pharmaceutical supply chain goings-on in long-term care facilities like skilled nursing facilities, otherwise known as SNFs. There are a lot of players in the mix: You have your PBMs. You have your wholesale pharmacies. You have your LTC (meaning long-term care) pharmacies. You have the facilities themselves. You also have Medicare Part A and Medicare Part D and, in some cases, Medicare Advantage. Let me just lay some groundwork here bef...
Mar 18, 2021•29 min•Ep. 314
