Take Two: EP436: Let’s Talk About TPA and Health Plan Inertia Instead of Jumbo Employer Inertia, With Elizabeth Mitchell
Release Date: 08/28/2025
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...
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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...
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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...
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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...
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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,”...
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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...
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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...
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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...
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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...
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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...
info_outlineExploring TPA and Health Plan Inertia with Elizabeth Mitchell: What Plan Sponsors Need to Know.
In this Take 2 of episode 436 of Relentless Health Value, host Stacey Richter speaks with Elizabeth Mitchell, President and CEO of the Purchaser Business Group on Health, about the challenges third-party administrators (TPAs) face, the issues around hidden fees, and the problems with health plan inertia.
They discuss how self-insured employers can find reliable TPA partners, the impact of anti-competitive contracts, and the importance of transparency in healthcare procurement. Mitchell emphasizes the need for direct contracting between employers and providers to reduce costs and improve quality.
The episode covers the implications of the Consolidated Appropriations Act, the role of brokers, and how employers can achieve better value for their healthcare spend.
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08:06 What is the overarching context for health plans in healthcare purchasing?
11:31 Why is it important to reestablish a connection between the people paying for care and people providing care?
13:47 What are the needs of a self-insured employer when managing employee benefits?
19:00 Is it doable for employers to set their own contracts?
21:24 Is transparency presumed?
22:39 Will the new transparency upon us actually expose wasted expense?
24:23 EP408 with Chris Deacon.
25:58 “This is not about individual bad actors. … The systems … that is not aligned.”
27:39 Are there providers who want to work directly with employers?
30:53 Why is it important that incentives need to be aligned?
32:42 EP427 with Rik Renard.
33:51 What’s missing from the conversation on changing health plans?