I wanted to talk with Dr. Lee because so many RHV (Relentless Health Value) listeners are trying to figure out how to sustain primary care as a stand-alone entity when the most obvious and most common way to make enough money in primary care is to drive and maximize the dollars from downstream volume of high-priced service lines, which, if you think about it, undermines the entire point of primary care. To read the full article, show notes as well as the links mentioned visit our episode page . ...
Jul 25, 2024•48 min•Ep. 445
In this encore episode of 'Relentlessly Seeking Value,' host Stacey Richter revisits a critically important conversation with ERISA attorney Paul Holmes about the complexities and hidden pitfalls in Pharmacy Benefit Manager (PBM) contracts. Aimed at CFOs and employer plan sponsors, Holmes highlights how poorly reviewed PBM contracts can lead to companies paying 30-40% over market for pharmacy benefits, discusses the potential legal exposures under the Consolidated Appropriations Act (CAA), and s...
Jul 18, 2024•34 min
In Episode 444 of Relentless Health Value, Stacey Richter speaks with healthcare consultant Ann Kempski about two state healthcare laws with unintended consequences: the Certificate of Need (CON) and the Certificate of Public Advantage (COPA) laws. They delve into the original intentions behind these laws, the ways in which they have often failed, and their impact on the competitive landscape. The discussion also explores how CON laws have led to increased costs and market consolidation, while C...
Jul 11, 2024•35 min•Ep. 444
To read the full show notes with links mentioned, be sure to visit our episode page and consider signing up for our free weekly newsletter . 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. Th...
Jul 04, 2024•36 min•Ep. 443
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. St...
Jun 27, 2024•19 min•Ep. 442
To read the full article with show notes, mentioned links and a full transcript, visit relentlesshealthvalue.com 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 ...
Jun 20, 2024•40 min•Ep. 441
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 va...
Jun 13, 2024•38 min•Ep. 440
In Episode 439 of 'Relentlessly Seeking Value,' host Stacey Richter discusses the convoluted issues surrounding generic drug pricing with pharmacy consultant Luke Slindee. To read the full article and show notes with links mentioned as well as a full transcript, click here . 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 t...
Jun 06, 2024•29 min•Ep. 439
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 li...
May 30, 2024•39 min•Ep. 438
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 proc...
May 23, 2024•16 min•Ep. 437
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 contra...
May 16, 2024•42 min•Ep. 436
For a full transcript of this episode, click here . I’m gonna encore this episode with David Scheinker, PhD, for several reasons; but here’s a big one: Why are we as an industry not doing what David Scheinker suggests in this episode? Why are we not doing, I don’t know, kinds of logical things to reduce admin burden in this country when everyone agrees admin burden is a problem? But let me back up for a moment for context. Two things happened since this show originally aired. One is that I was i...
May 09, 2024•34 min
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 phar...
May 02, 2024•35 min•Ep. 435
Five Surprising Facts About Bundled Payments in Healthcare 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...
Apr 25, 2024•40 min•Ep. 434
Unveiling Hidden Fees in Weekly Claims: What Plan Sponsors Need to Know 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 transparenc...
Apr 18, 2024•40 min•Ep. 433
Mission vs. Margin: Dr. Scott Conard's Journey in Transforming Primary Care 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 o...
Apr 11, 2024•37 min
Unlocking the Front Desk: The Overlooked Key to Patient and Clinician Success 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...
Apr 04, 2024•35 min
Balancing Mission and Margin in Healthcare: Lessons from Kate Wolin 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 inves...
Mar 28, 2024•38 min•Ep. 432
For a full transcript of this episode, click here . There’s this meme that’s going around on the interwebs with the caption, “Sometimes the shortest distance in between two places isn’t a straight line.” What? Yeah, because actually there’s three dimensions in the real world. So, when we all consider the real world, understanding the contours of reality and aligning with them is the only way to devise a winning strategy—not only if you’re timing rubber balls getting dropped off straight or curve...
Mar 21, 2024•39 min•Ep. 431
For a full transcript of this episode, click here . We have been spending a bunch of time here on Relentless Health Value talking about PBMs (pharmacy benefit managers) lately and pharmacy benefits, but we are moving into a new topic area. It sort of kicked off three weeks ago with the pod with Rik Renard ( EP427 ) on the importance of care flows if you are a digital health vendor trying to get consistent outcomes. But then I actually went back to the PBM/pharmacy benefits topic to talk with Luk...
Mar 14, 2024•39 min•Ep. 430
For a full transcript of this episode, click here . In this healthcare podcast we’re talking about pharmacy acronyms or terms like AWP and WAC, and, not really an acronym, but we’ll also talk pharmacy list prices, rebates, discounts. We also have NADAC, but that’s slightly off to the side for reasons we’ll get to in a sec. Most of these acronyms refer to a number with a dollar sign in front of it, and it’s hell on wheels to figure out if and/or to what extent that number reflects what is going o...
Mar 07, 2024•38 min•Ep. 429
Practical Steps for Plan Sponsors Post-J&J and DOL vs. BCBS Lawsuits 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. ...
Feb 29, 2024•42 min•Ep. 428
The Importance of Standardized Care Flows in Digital Health: An Interview with Rik Renard To read the full article and show notes with links mentioned as well as a full transcript, click here . 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 p...
Feb 22, 2024•36 min•Ep. 427
Unveiling Hidden Compensation: How Employee Benefit Consultants and Brokers Profit from Plan Sponsors To read the full article and show notes with links mentioned as well as a full transcript, click here . 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...
Feb 15, 2024•35 min
Cost Containment vs Value-Based Drug Purchasing with Nina Lathia To read the full article and show notes with links mentioned as well as a full transcript, click here . 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 satisfa...
Feb 08, 2024•33 min•Ep. 426
Episode 425: Operationalizing Cash Payments in Clinical Practices with Marshall Allen To read the full article and show notes with links mentioned as well as a full transcript, click here . 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 conside...
Feb 01, 2024•39 min•Ep. 425
The Narcissism of Small Differences in Healthcare: Building a Unified Village for Patient-Centric Solutions To read the full article and show notes with links mentioned as well as a full transcript, click here . 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 professiona...
Jan 25, 2024•19 min
Five Realities Hospital Execs Need to Face in 2024 with Peter Hayes To read the full article and show notes with links mentioned as well as a full transcript, click here . 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 ...
Jan 18, 2024•45 min•Ep. 424
Unpacking Pharmacy Benefit Management: Maximizer Programs and Patient Impacts with Joey Dizenhouse To read the full article and show notes with links mentioned as well as a full transcript, click here . 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 transpa...
Jan 11, 2024•44 min•Ep. 423
Episode 422: The Financial Struggles and Unexpected Insights of Independent Pharmacies with Benjamin Jolley To read the full article and show notes with links mentioned as well as a full transcript, click here . 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 prescription...
Jan 04, 2024•37 min•Ep. 422
