Libsyn Directory

EP478: Stop-Loss Coverage, Part 1: How It Goes Right, and How It Can Go Horribly Wrong, With Andreas Mang and Jon Camire

Relentless Health Value

Release Date: 05/29/2025

EP508: Why Don’t More Self-insured CEOs Take Bold Action in Health Benefits Strategy? With Lee Lewis

Relentless Health Value

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...

EP507: 4 Core Concepts to Buy or Deliver the Highest-Value Healthcare—A Review

Relentless Health Value

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...

EP506: How Other Employers, Shareholders, and Clinics Are Using Price Transparency Data—And It’s an Arms Race, With Jerry DiMaso

Relentless Health Value

Stacey Richter interviews Jerry DiMaso, CEO of Payerset, about how hospital and carrier price transparency data (mandates beginning with hospitals in 2019 and carriers in 2022) is being used by plan sponsors and providers. For self-insured employers and unions, DiMaso highlights three key uses: benchmarking against competitors via EIN to compare negotiated rates and carve-outs, identifying high-cost billing codes, and exposing “discount shell games” by validating whether claimed discounts reflect real savings. Employers can use the insights to guide TPA negotiations, implement...

EP505: The Death of the “What Is Value” Guessing Game for Clinical and Plan Decision-Makers Ready to Move On, With Ahilan Sivaganesan, MD

Relentless Health Value

Stacey Richter interviews neurosurgeon Dr. Ahilan Sivaganesan (Dr. Siva) about replacing vague healthcare “value” claims with quantified outcomes and unit-level costs, introducing his Operative Value Index (OVI). They discuss how hospitals often lack true internal episode costs and how common quality metrics miss patient-reported outcomes and appropriateness across the full care journey. Using time-driven activity-based costing (TDABC) and condition- or procedure-specific patient-reported outcomes, OVI creates a common mathematical language to compare surgeons, practices, or health...

EP504: A Back-to-Basics Roadmap Through the Perverse Incentives to Advanced Primary Care, With Ryan Jacobs

Relentless Health Value

Why Advanced Primary Care Doesn’t Scale: Conflicting Incentives, Complacency, and a 3-Step Roadmap Stacey Richter interviews Ryan Jacobs (SVP Strategy and Partnerships, Marathon Health) on why evidence-backed advanced primary care (APC)—focused on managing risk, improving outcomes, and lowering costs—still isn’t widespread. They argue APC struggles to scale due to two root barriers: conflicting fiduciary duties (health systems and payers driven by volume, “heads in beds,” and market-power growth, while APC keeps patients out of hospitals) and a “black box of complacency,”...

Insights to Outwit the Hot Mess of the Non-Healthcare Market

Relentless Health Value

In this Inbetweenisode, Stacey shares listener feedback and reflects on making better decisions in employer-sponsored healthcare, spotlighting LinkedIn posts by Ken Wosczyna and Michelle Bernabe. Ken argues Relentless Health Value moves from theory to practical transformation by sharpening judgment, which Stacey ties to how millions of workplace decisions shape the healthcare system and how actuaries and executives can align choices with values. Stacey emphasizes that good decisions require both transparency and understanding, previewing an upcoming episode with Jerry DiMaso about...

EP503: Smart Collaboration With Direct-to-Employer Specialty Care, With Ryan Wells; Leo Spector, MD, MBA; and Adam Stavisky

Relentless Health Value

Episode 503 of Relentless Health Value features Stacey Richter with Adam Stavisky, Dr. Leo Spector (OrthoCarolina), and Ryan Wells (Health Here) discussing how self-insured employers and specialists rarely connect directly due to intermediaries and fee-for-service “rails.” They outline three common pitfalls when bridging this gap: defining and measuring quality and appropriateness (limits of claims data and missing patient-reported outcomes), achieving scale across geographies and specialties, and ensuring benefit design and incentives so members actually use direct-contracting...

EP502: How Some Pretty Wild Medicare Fraud Sabotages ACOs and Also Independent Practices and Could Cost Plan Sponsors Such as Self-insured Employers a Lot of Zeros Downstream, With Brian Machut

Relentless Health Value

Episode 502 features Stacey’s conversation with Brian Machut (Alliant Health) on how widespread Medicare fee-for-service fraud is inflating costs and undermining ACO shared savings in MSSP and ACO REACH. ACOs uncovered major urinary catheter fraud in 2023 tied to codes A4352/A4353, totaling about $3.5B, with some beneficiaries billed for items never received (including a case shared by Dr. Tara Lagu). CMS created a “SAHS” (significant, anomalous, highly suspect) process to remove certain suspect costs, but benchmark effects can unevenly impact ACOs; catheter fraud is still...

EP501: Speaking of Infusions, Do You Want to Pay $135 or Do You Want to Pay $13,560 for the Exact Same Drug? With Ivana Krajcinovic, PhD

Relentless Health Value

Episode 501 of Relentless Health Value features Stacey Richter interviewing Ivana Krajcinovic, outgoing Vice President of Healthcare Delivery at Unite Here Health, about extreme and persistent price variation for medical infusions as evidence of a “no market” in healthcare. They cite examples where the same chemotherapy drug (Oxaliplatin), long off patent, cost Medicare about $35 (or $185 for a series), an independent practice about $135, but a hospital in Chicago charged $13,560 and a hospital in Monterey billed $90,000 for a series—markups described as up to nearly 500x and far beyond...

Take Two: EP398: Why Are Commercial Carrier Marketplaces Completely Boring? Maybe Because There Isn’t a Marketplace, With Jacob Asher, MD

Relentless Health Value

The Non-Market Reality of Healthcare Carrier Marketplaces with Dr. Jacob Asher. In this episode of Relentlessly Seeking Value, host Stacey Richter introduces the 'No Market' series focused on the healthcare sector's lack of competitive market dynamics, which affects cost and quality. The episode features a conversation with Dr. Jacob Asher, who has extensive experience as a Chief Medical Officer at major healthcare plans. They discuss the stagnant nature of commercial carrier marketplaces, particularly in California, and the various factors contributing to this stasis, including employer...

More Episodes

Host Stacey Richter discusses the intricacies of stop-loss coverage with Andreas Mang and Jon Camire from Blackstone. The episode focuses on defining stop-loss insurance and exploring its critical role in protecting self-insured employers from catastrophic financial losses.

The conversation delves into the nuances of individual and aggregate stop-loss policies, laser claims, and the importance of selecting an experienced consultant to navigate this complex landscape. The episode is essential listening for those managing high-cost claimants and exploring self-insurance options.

This is a two part show. The second show will cover major fails, mistakes that happen with stop-loss when somebody doesn’t understand or do everything that we talk about. So, tune back in for the next part of this conversation, in two weeks.

Thank you to Havarti Risk for sponsoring this weeks episode.
Havarti Risk empowers healthcare leaders like you to make smarter
decisions that increase quality and lower cost of care.
https://havarti-risk.com/

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