EP483 (Part 1): To Contain Skyrocketing Healthcare Costs or Renewals, You Gotta Understand How the Flywheel Works, With Jonathan Baran
Release Date: 08/07/2025
EP498: The Payment Integrity Arms Race—RCM (Revenue Cycle Management) and Plan Sponsors, With Mark Noel
Relentless Health Value
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...
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Take Two: EP341: The “Just Spend Everything You’re Given” Trap—Lessons in True Provider Fiscal Discipline, With Gary Campbell
Relentless Health Value
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...
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EP497: What You Don’t Know About Healthcare Transactions and Clearinghouses Could Cost You, With Zack Kanter
Relentless Health Value
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 Despite HIPAA's standardized rules, the lack of competitive pressure and outdated technology contribute to these issues, ultimately impacting patient care and...
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EP496: Plan Sponsors Spend About $1.20 to Buy $1 of Healthcare, and Clinical Organizations Receive 80¢ for Every $1.20 Spent, With Mark Newman
Relentless Health Value
In this episode of Relentless Health Value, Stacey Richter engages with Mark Newman, CEO and founder of Nomi Health, in a deep dive into the administrative and transactional inefficiencies plaguing the American healthcare system. The conversation highlights how plan sponsors often spend more than a dollar to purchase healthcare, yet healthcare providers receive only a fraction of that amount due to data fragmentation and varied accounting practices. Mark Newman reveals two main issues: 'data isn't data' and 'a dollar isn't a dollar,' explaining how inconsistencies and misalignments in...
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INBW45: Extremely Actionable Themes That We Covered Throughout 2025
Relentless Health Value
In this Part 2 episode of 'Relentlessly Seeking Value,' host Stacey Richter recaps the prominent themes 4 and 5 from 2025. The focus is on two major themes: the lack of transparency in data access leading to overspending and the necessity of shifting from volume-based to value-based purchasing in healthcare. The discussion includes insights from numerous healthcare professionals and case examples to underscore these vital themes affecting both patients and providers. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/INBW45 ✉️ Enjoy this...
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INBW44: The Relentless Health Value Themes That We Covered Throughout 2025—A Recap, Part 1
Relentless Health Value
In this 'Inbetweenisode' of the Relentless Health Value podcast, Stacey Richter recaps the major themes covered throughout 2025 in healthcare. In this Part 1, Stacey dives into three critical themes: the necessity of trusted relationships and simplicity, treating primary care as an investment rather than a cost, and the impact of perverse financial incentives and profiteering. Various experts, including Dr. Kenny Cole, Ann Lewandowski, Jonathan Baran, and Yashaswini Singh, share insights on these subjects. The discussion highlights the pervasive lack of trust in the healthcare...
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Encore! EP450: When Your Health Plan Is $9 Million in the Hole, Who Are You Going to Call? A CPA. And Tell Them to Bring Their Spreadsheets, With Marilyn Bartlett, CPA, CMA, CFM, CGMA
Relentless Health Value
In this encore episode of 'Relentlessly Seeking Value,' host Stacey Richter revisits an inspiring conversation with Marilyn Bartlett, a CPA who transformed the State of Montana's employee health plan from a $9 million deficit to a $112 million surplus within three years. Known for her fiscal discipline and patient-first approach, Marilyn shares her strategic steps, from identifying waste in the system and securing quick wins to negotiating better deals with hospitals and ensuring long-term success. She emphasizes the importance of assembling a strong team, maintaining transparency, and...
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EP495: Wait … Flip That—A Crazy Revelation I Had About Trying to Fix U.S. Healthcare, With Mick Connors, MD
Relentless Health Value
In episode 495 titled 'Wait. Flip that. A Crazy Revelation I Had About Trying to Fix US Healthcare,' host Stacey Richter speaks with Dr. Mick Connors, an emergency room pediatrician and healthcare entrepreneur, about a groundbreaking insight into the US healthcare system. They discuss the paramount need to flip the way healthcare costs and outcomes are measured: moving towards unit-level cost accounting and whole-patient or whole-community outcomes assessment. The episode delves into the fundamental pitfalls of the current healthcare structure, emphasizing the misalignment between cost...
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EP494: Six Tensions of Pharmaceutical Drug Pricing, With Sarah Emond
Relentless Health Value
In Episode 494 of Relentless Health Value, host Stacey Richter engages in a detailed discussion with Sarah Emond, CEO of ICER, about the intricate dynamics of pharmaceutical drug pricing. They explore six primary tensions within the current system, including the fair valuation of drugs, the misalignment between drug prices and patient affordability, the disconnect between lifetime drug value and short-term insurance assessments, and the challenge of integrating societal and individual perceptions of value. Emond and Richter also discuss potential solutions, emphasizing the need for...
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Bonus Add-on for EP494: Who Is ICER and What Is the Arms Race of Pharmaceutical Pricing That the Status Quo Has Created? With Sarah Emond
Relentless Health Value
In this bonus episode of 'Relentlessly Seeking Value,' host Stacey Richter engages in a conversation with Sarah Emond, CEO of the Institute for Clinical and Economic Review (ICER). They discuss the complex 'arms race' of pharmaceutical pricing in the current healthcare system, emphasizing issues like inflated drug list prices, patient affordability, and cost-effectiveness. They highlight ICER's role in conducting value assessments of prescription drugs to ensure fair pricing and improve affordability and access. The episode underscores the need for multi-stakeholder dialogues to...
info_outlineIn this episode Stacey Richter speaks with Jonathan Baran, CEO of Self Fund Health in a detailed exploration of what they term the 'Flywheel Downward Spiral' of American healthcare costs. The conversation delves into how electronic health records (EHR) and the incentives driving insurers, brokers, and hospital systems contribute to consistently rising healthcare premiums.
Key points include how insurers profit from high premiums, the misleading marketing focus on discounts rather than actual costs, and the role of EHR systems in maximizing hospital profits rather than improving patient care. The episode sets the stage for a subsequent discussion on reversing these trends, aiming to align healthcare outcomes with cost reductions.
Self Fund Health, I am so pleased to tell you, as I am always so pleased to tell you, did make such a kind offer to help out Relentless Health Value financially. You and the tribe here are really, really great folks who I truly appreciate. Please support Self Fund Health if you are in Wisconsin.
This episode is sponsored by Self Fund Health.
=== LINKS ===
đź”— Self Fund Health:
https://selffundhealth.com
đź”— Show Notes with all mentioned links:
https://relentlesshealthvalue.com/episodes
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08:46 Entering the health system “flywheel” at the renewal phase.
09:46 What goes on in the renewal season that contributes to the health system “flywheel”?
12:28 Why is the standard 9% increase in healthcare costs during renewal season actually problematic?
13:22 How does the purchase of discounts contribute to the skyrocketing cost of healthcare and distract from discussing the actually underlying cost of healthcare?
16:07 EP465 with Chris Crawford.
17:01 Why do employers need to learn to buy healthcare and not insurance?
20:32 Rina Tikia’s post on self-funded plans.
23:18 Why are hospital executives incentivized to buy and own all of the primary care in a market?
26:35 How big electronic medical record systems play into this increase in healthcare costs.
28:27 Acquired podcast on one EHR system.
31:09 What needs to happen to reverse this flywheel of increasing healthcare costs?