Relentless Health Value

American Healthcare Entrepreneurs and Execs you might want to know. Talking. Relentless Health Value is a weekly interview podcast hosted by Stacey Richter, a healthcare entrepreneur celebrating fifteen years in the business side of healthcare. This show is for leaders in pharma, devices, payers, providers, patient advocacy and healthcare business. It's for health industry innovators, entrepreneurs or wantrepreneurs or intrapreneurs. Relentless Healthcare Value is the show for you if you want to connect with others trying to manage the triple play: to provide healthcare value while being personally and professionally fulfilled.

Take Two: EP445: What Does It Take for an Indie Primary Care Practice to Survive Right Now? With Tom X. Lee, MD 07/17/2025

Take Two: EP445: What Does It Take for an Indie Primary Care Practice to Survive Right Now? With Tom X. Lee, MD In this second take on episode host Stacey Richter speaks with Dr. Tom Lee, founder of One Medical and Galileo. The discussion centers on the survival of independent primary care practices in the current healthcare economy, the associated challenges, and the paradox of primary care. Topics include reducing ER visits, managing downstream specialty spend, and the imbalance between CMS and commercial carrier payments to primary care practices. Dr. Lee highlights the importance of 'enlightened leadership' and a 'value-focused mindset' in balancing efficient service operations with quality care. He also touches on the complexities of integrating technology and human-centered care, the importance of operational efficiency, and the challenges posed by current reimbursement models. For a bonus sidebar conversation with Dr. Lee, . === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/TakeTwo-EP445 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth10:30 What is the paradox of primary care? 12:47 Why is it hard to run an independent primary care practice? 13:29 What are the barriers to running an independent primary care practice? 14:09 Can you have fee for service and value? 15:53 “Value is more about a mindset.” 16:49 What hidden waste is there in a primary care practice? 18:36 What do you need to have a value-focused mindset? 20:41 Why does access precede quality? 22:40 What are the nuances of a service business that make them challenging for managers? 23:27 How do you find the balance between fee for service and value? 30:07 with John Lee, MD. 31:04 How can you invest in quality without a value-based contract? 33:09 How do you address the trade-off between fee-for-service finances and investing in value-based care? 34:26 Where is the “productive middle”? 35:18 Dr. Tom Lee’s message to payers. 38:45 Dr. Tom Lee’s message for policymakers. /episode/index/show/healthvalue/id/37360075

Bonus Clip: Dr. Tom Lee Talks About Why Retail Clinics Are Not Doing So Well, in His Opinion 07/17/2025

Bonus Clip: Dr. Tom Lee Talks About Why Retail Clinics Are Not Doing So Well, in His Opinion This short bonus episode is a side bar conversation with Dr. Tom Lee discussing why retail clinics are struggling with Dr. Tom Lee. They explore the shortcomings of retail clinics in providing longitudinal primary care, despite their convenience for minor urgent care and vaccinations. Dr. Lee emphasizes that true primary care requires consistent, long-term patient relationships and complex management which many retail clinics fail to deliver. They also discuss the economic challenges of running such clinics and the importance of defining primary care's value proposition correctly. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/Bonus445 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 01:01 Why have retail clinics failed in being longitudinal primary care destinations? 01:32 Why access is an important factor, but not the only one. 02:10 Access vs. longitudinal care. 02:47 The challenges of operating a service operation within primary care. 03:47 What is a longitudinal primary care destination and why does it matter? 04:15 How is primary care not delivering on its promise? 04:27 How is the “promise of primary care” different than an urgent care or MinuteClinic? Recent past interviews: Click a guest’s name for their latest RHV episode! , , , , , , , , , , /episode/index/show/healthvalue/id/37360170

EP481: Seriously, IRL, What Does “No Margin, No Mission” Even Mean? With Benjamin Schwartz, MD, MBA 07/10/2025

EP481: Seriously, IRL, What Does “No Margin, No Mission” Even Mean? With Benjamin Schwartz, MD, MBA Balancing Mission and Margin in Healthcare: A Candid Conversation with Dr. Ben Schwartz In this episode, host Stacey Richter engages in a deep dive with Dr. Ben Schwartz to explore the phrase 'No Margin, No Mission' and its practical implications in the healthcare industry. They discuss the complex relationship between profitability and mission-driven care, the challenges of value-based care, and the role of dyad leadership. The episode emphasizes the importance of transparency, regulatory measures, and trust in fostering a balance between mission and margin. Along the way, Dr. Schwartz shares insights from his new role at Commons Clinic and addresses broader systemic issues like regulatory capture and the subjective nature of defining value in healthcare. === LINKS === 🔗 Show Notes with all mentioned links: https://relentlesshealthvalue.com/episodes ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 08:50 and the origin of no margin, no mission. 10:01 Margin and mission versus profit and profiteering. 12:45 Stacey’s manifesto (). 13:01 What is the broad mission within healthcare? 14:12 What is mission drift within healthcare? 15:54 with Yashaswini Singh, PhD. 17:26 Why do we struggle with balancing margin and mission? 20:47 with Beau Raymond, MD. 20:52 How does value vary? 23:18 with Rishi Wadhera, MD, MPP. 23:53 What needs to happen to balance margin with mission? 28:29 Why does everything come down to trust? 28:33 with Scott Conard, MD. 30:30 with Andreas Mang. 32:21 What are the “vectors of change” to create balance between mission and margin? 32:43 with Peter Hayes. /episode/index/show/healthvalue/id/37238895

Take Two: EP438: Is It Mission and/or Margin? With John Lee, MD 07/03/2025

Take Two: EP438: Is It Mission and/or Margin? With John Lee, MD In this Take Two episode of Relentless Health Value, host Stacey Richter reflects on her conversation with Dr. John Lee to explore the challenging intersection between mission and margin in healthcare. They discuss the nuances of cognitive dissonance faced by healthcare professionals, particularly when organizational priorities conflict with patient care. Dr. Lee shares insights on finding a sense of mission within the constraints of the current healthcare system, emphasizing the importance of incremental improvements, team-based care, and peer support. The conversation also highlights real-world examples of systemic issues and practical advice on how individuals can contribute to meaningful change without feeling demoralized. This episode is part of an ongoing series addressing critical topics in healthcare, and listeners are encouraged to tune in next week for further discussions. === LINKS === 🔗 Show Notes with all mentioned links: https://relentlesshealthvalue.com/episodes ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X 08:05 What is cognitive dissonance relative to the healthcare industry? 09:23 What are the systems that start to bear down on individuals within the healthcare system? 10:15 with Scott Conard, MD. 10:53 with Rob Andrews. 11:50 with Rishi Wadhera, MD, MPP. 12:27 “The system has almost gamed them.” 15:44 How can alignment still be achieved in the face of cognitive dissonance? 17:12 with Kenny Cole, MD. 20:43 Why does it take more than one person to solve the dysfunction in the healthcare system? 23:01 What are some little changes that can help change the cognitive dissonance in healthcare? 24:57 Why is a hierarchical healthcare structure not necessarily beneficial? 27:12 The RaDonda Vaught . 34:30 “Be happy in the small things.” /episode/index/show/healthvalue/id/37119330

EP480: Payment Integrity Meets Health System Boasts, Such as Our Rates Are 2x Medicare, With Kimberly Carleson 06/26/2025

EP480: Payment Integrity Meets Health System Boasts, Such as Our Rates Are 2x Medicare, With Kimberly Carleson Enhancing Payment Integrity in Health Systems: An In-depth Discussion with Kimberly Carleson. In Episode 481 of Relentless Health Value, host Stacey Richter speaks with Kimberly Carleson, CEO of US Beacon, about payment integrity within health systems. They delve into strategies some hospitals use to maximize revenue without raising rates and discuss the importance of accurate billing. Key takeaways include the high prevalence of billing errors, which can lead to significant overcharges for plan sponsors, often due to documentation gaps and complex coding systems. Kimberly provides actionable advice for both healthcare providers and plan sponsors on how to mitigate billing inaccuracies and enhance transparency. Emphasized points include the necessity of third-party claim audits, understanding legal rights under various acts, and the importance of maintaining clear communication and compliance with legal billing standards. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP480 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 08:36 What’s the magnitude of the lack of payment integrity within healthcare? 12:11 with Dawn Cornelis. 12:46 How is lack of coordination a main culprit of lack of payment integrity? 13:42 How does reading the records reveal whether health plans are being overcharged? 15:43 A real-world example of how reviewing the charges can drastically reduce your healthcare costs. 18:32 Do you have a right to a review of your claim? 19:37 with Erik Davis and Autumn Yongchu. 22:08 How can contracts contradict what can legally be charged? 23:46 with Eric Bricker, MD. 25:04 How can hospitals update their billing to have better payment integrity? 28:44 Advice for hospital executives and their finance teams. 29:03 Advice for plan sponsors. /episode/index/show/healthvalue/id/37040335

Pharma Rebates: A Few Nuances You May Not Have Thought Of, With Ann Lewandowski—Summer Shorts 06/19/2025

Pharma Rebates: A Few Nuances You May Not Have Thought Of, With Ann Lewandowski—Summer Shorts Exploring the Complexities of Pharma Rebates with Ann Lewandowski In this Summer Short episode of Relentless Health Value, host Stacey Richter converses again with Ann Lewandowski about the intricate dynamics of pharmaceutical rebates, or as Lewandowski prefers, post-sale concessions. The discussion delves into the nuances of these rebates, the impact they have on drug costs, and the hidden consequences for patients and plan sponsors. They highlight articles and insights by Austin Chelko and Peter Hayes, touching on how rebates can disadvantage the pursuit of lower-cost generics and biosimilars, and can obstruct pharmacogenetic testing that ensures drug efficacy and safety. The conversation also critiques the opacity of rebates, deemed trade secrets by pharma and PBM companies, and underscores the ethical and financial dilemmas posed by the current rebate-driven system. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP480 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 07:24 What is a pharmaceutical rebate? 08:15 Why are pharma rebates so opaque? 09:52 Texas on insulin pricing. 10:18 Why is focusing on a singular type of concession difficult with current pharma rebate structures? 10:50 with Paul Holmes. 13:55 with Pramod John, PhD. 14:29 How does pharma genomics testing affect pharma rebates? 14:52 with Chris Crawford. 15:52 with Nina Lathia, RPh, MSc, PhD. /episode/index/show/healthvalue/id/36970830

EP479: Part 2. What Could Go Wrong Covering High-Cost Claimants With Stop-Loss Reinsurance? 06/12/2025

EP479: Part 2. What Could Go Wrong Covering High-Cost Claimants With Stop-Loss Reinsurance? In this second discussion with Andreas Mang and Jon Camire of Blackstone, Stacey Richter has an advanced discussion on the intricacies of stop-loss reinsurance for high-cost claimants. This show today, for sure, it’s for plan sponsors and anyone on or about plan sponsors; but also listen if you are serving high-cost claimants some other way. Because what you’ll learn here today is some insights relative to how plan sponsors go about making sure that they can pay you—like if you work for, for example, some clinical organization. There’s a, I don’t know, 101 starting point of this conversation if you need it on stop-loss, which is from a couple of weeks ago. This show is the, let’s say, 201-level conversation that I’m having with Andreas Mang and Jon Camire about, as I said, stop-loss insurance and stop-loss insurance considerations. Emphasizing the importance of eligibility audits and aggregating buying power, the guests highlight best practices to avoid overpaying for coverage and ensuring comprehensive risk management. This episode is sponsored by , which I am so thankful for. The show, Relentless Health Value, actually does cost an unexpectedly large sum of money to create and produce; so I always appreciate when somebody offers to sponsor a show or help sponsor a show. === LINKS === 🔗 Show Notes with all mentioned links: ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X https://twitter.com/relentleshealth/ 07:47 What are the best practices for plan sponsors to use for stop-loss coverage? 10:11 What are the “unknown unknowns” within stop-loss coverage? 15:25 What are some policy provisions that plan sponsors should be aware of? 19:02 Why is it so important to do eligibility audits? 20:41 What are some common mistakes made with stop-loss coverage among the self-insured? 23:21 What’s a panel approach, and why is it important for negotiating stop-loss coverage? /episode/index/show/healthvalue/id/36838895

Take Two: EP433: The Mystery of the Weekly Claims Wire, With Justin Leader 06/05/2025

Take Two: EP433: The Mystery of the Weekly Claims Wire, With Justin Leader Stacey Richter has a second take on the original episode 433 since it is so relevant right now. Stacey engages in a compelling conversation with Justin Leader, CEO of BenefitsDNA, about the opaque practices of third-party administrators (TPAs) and their impact on healthcare costs. They discuss the hidden fees tucked into weekly claims wires, including shared savings fees, prior authorization fees, prepayment integrity fees, pay and chase fees, and TPA adjudication fees. The episode emphasizes the need for transparency, understanding hidden costs, and ensuring fiduciary responsibility for self-funded employers. Additionally, Leader shares insights from a Health Affairs article and mentions ongoing legal cases that highlight the financial discrepancies in TPA practices. === LINKS === 🔗 Show Notes with all mentioned links: https://relentlesshealthvalue.com/episodes ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 06:32 with Cynthia Fisher. 06:56 How is the claims wire typically explained to a plan sponsor? 10:49 What is the whole point of self-funding? 10:58 Why is it so vital to understand what you’re paying for? 11:53 What are the five “buried” items that wind up in these claims wires? 12:12 What is a shared savings fee? 16:14 “Rates are important, but so are your rights.” 20:13 What’s going on with prior auth fees? 22:44 What is prepayment integrity? 27:29 What is pay and chase? 28:46 with Julie Selesnick. 30:58 What is a TPA claim review? 33:21 with Dawn Cornelis. 34:16 with AJ Loiacono. 34:45 Is there medical claim spread pricing? /episode/index/show/healthvalue/id/36770620

EP478: Stop-Loss Coverage, Part 1: How It Goes Right, and How It Can Go Horribly Wrong, With Andreas Mang and Jon Camire 05/29/2025

EP478: Stop-Loss Coverage, Part 1: How It Goes Right, and How It Can Go Horribly Wrong, With Andreas Mang and Jon Camire 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 for sponsoring this weeks episode. empowers healthcare leaders like you to make smarter decisions that increase quality and lower cost of care. https://havarti-risk.com/ === LINKS === 🔗 Show Notes with all mentioned links: ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 07:24 What is stop-loss? 08:27 What is reinsurance? 09:57 with Ge Bai, PhD, CPA. 10:10 Why has stop-loss been a barrier for smaller companies going self-insured? 13:55 Why self-insurance needs to be a joint decision between finance and HR. 15:38 What is aggregate versus individual within stop-loss? 19:51 Why is it important for companies to choose the right level of stop-loss coverage? 21:29 What is a laser claim? 29:28 Why is it important to know what your brokers are getting paid on your stop-loss policies? /episode/index/show/healthvalue/id/36655130

EP477: Through Line Show: What the Tribe Thinks You Need to Know About Trust or It’s Gonna Be a Problem. Also, Why You Are Smart, With Stacey Richter 05/22/2025

EP477: Through Line Show: What the Tribe Thinks You Need to Know About Trust or It’s Gonna Be a Problem. Also, Why You Are Smart, With Stacey Richter In this episode, Stacey Richter explores the impact of trust on healthcare outcomes, drawing from listener contributions and prior episodes of Relentless Health Value. The discussion underscores how trust or the lack thereof affects patients, clinicians, and healthcare systems. Key points include the importance of building trusted relationships, the detrimental effects of antitrust behaviors, and the broader implications for healthcare delivery. Stacey also highlights a bonus show featuring Charles Green on earning and maintaining trust. The episode concludes with an uplifting message about the collaborative and giving nature of the Relentless Health Value community. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP477 🔗 Bonus Show - Show Notes https://cc-lnk.com/Bonus477: ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X 00:47 What is the new, emerging through line becoming apparent in healthcare? 01:54 with Charles Green. 02:52 What is the impact of trust in healthcare? 02:55 with Peter Hayes. 03:11 with Kenny Cole, MD. 05:31 with Rebecca Etz, PhD. 06:07 with Rishi Wadhera, MD, MPP. 07:06 Why does trust grow through proximity, and why do providers need to integrate this into care models? 07:59 Why antitrust is so prevalent in healthcare. 10:00 What are two main contributors to the lack of primary care doctors? 13:27 Why collaboration builds trust. /episode/index/show/healthvalue/id/36554605

Bonus Add-on to EP477: How to Earn Trust, With Charles Green 05/22/2025

Bonus Add-on to EP477: How to Earn Trust, With Charles Green In this bonus add-on to episode 477 of Relentless Health Value, host Stacey Richter revisits a decade-old conversation with trust expert Charles Green, founder of Trusted Advisor Associates. Green discusses the intricacies of building and maintaining trust in healthcare, emphasizing four key trust principles: client focus, collaboration, long-term relationships, and transparency. The discussion highlights the challenges within the healthcare industry, compounded by conflicts of interest and transactional dynamics. Green underscores the importance of individual actions and leadership in fostering trust, advocating for empathetic listening and genuine curiosity about others as foundational behaviors. === LINKS === 🔗 Show Notes with all mentioned links: https://relentlesshealthvalue.com/episodes ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcastshttps://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 01:45 Four trust principles that can help you earn your clients trust and come off as more trustworthy from first impressions onward. 04:31 Charles’s words of wisdom for rebuilding lost trust. 05:46 Where does trusted leadership start? 06:38 Why trust in leadership is about embodying trust in actions, not words. 07:26 Why does personality have an outsized impact in leadership and trust? 08:21 “If we want to improve our trust, we just simply need to work on ourselves.” 08:56 Why listening with a sense of curiosity and respect drives reciprocal behavior and improves trust. 09:14 What is the best technique to immediately improve your trust relationship? /episode/index/show/healthvalue/id/36554655

EP476: Talking Whistleblowing and the Pharma Rebates Whistleblower Case With an Actual Whistleblower, With Ann Lewandowski 05/15/2025

EP476: Talking Whistleblowing and the Pharma Rebates Whistleblower Case With an Actual Whistleblower, With Ann Lewandowski In this episode, host Stacey Richter speaks with Ann Lewandowski about whistleblowing in the healthcare industry, focusing on a significant case involving a whistleblower at an employee benefit consultant (EBC) firm. This EBC allegedly pocketed their clients' pharma rebates, violating the Consolidated Appropriations Act of 2021. The discussion highlights the nuances of being a whistleblower, the ethical dilemmas faced, compliance challenges, and the significant financial implications for companies and individuals involved in illegal activities. Ann Lewandowski provides insights into documenting and protecting oneself legally and discusses the broader context of trust and transparency in the healthcare sector. Click through to the show notes below to access all of the mentioned links and prior episodes mentioned. === LINKS === 🔗 Show Notes with all mentioned links: https://relentlesshealthvalue.com/episodes ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 08:10 What does it mean to be a whistleblower? 09:05 What’s happening in the current whistleblower case about pharma rebates? 14:24 What are the disclosure requirements, and how does this affect contracts in healthcare? 15:05 with AJ Loiacono. 15:11 The . 15:36 with Paul Holmes. 16:46 Why having a “defensive health plan” is important. 17:31 Matt Ohrt’s about healthcare’s soul. 17:42 Michelle Bernabe’s about how healthcare has lost its heart. 18:15 Why “trust and verify” is important when building contracts and relationships in healthcare. 18:42 by W. Edwards Deming. 21:35 How has this case moved from state to federal court? 23:30 Whistleblower case on . 24:01 What is a lawsuit? 28:08 What is an and the issue of corporate Miranda rights? 30:01 What is Ann’s advice to employees who might be whistleblowers? 31:41 with John Lee, MD. 33:31 What are some red flags that employees should look for to understand what kind of company they work for? /episode/index/show/healthvalue/id/36458710

EP475: Is This a Moment or a Movement? With Peter Hayes 05/08/2025

EP475: Is This a Moment or a Movement? With Peter Hayes In this episode of Relentless Health Value, host Stacey Richter sits down with Peter Hayes to discuss the major forces driving change in the healthcare industry. Hayes outlines three critical factors: changing public opinion, heightened transparency, and new regulations such as the Consolidated Appropriations Act. He emphasizes the unprecedented convergence of these elements, creating a pivotal moment for healthcare transformation. The discussion delves into the erosion of trust within the healthcare system and the growing public unrest over high costs and inefficiencies. Hayes also highlights the role of state-level initiatives as experimental laboratories for potential national solutions. The episode concludes with a call to focus on root causes and collaborative approaches to restore trust and improve healthcare affordability and quality. === LINKS === 🔗 Show Notes with all mentioned links: https://relentlesshealthvalue.com/episodes ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 05:28 What things are adding to the urgency in this moment of healthcare? 05:55 The three things that have brought us to a tipping point in healthcare. 07:05 Why is now the real moment for this tipping point? 10:35 with Komal Bajaj, MD. 13:01 by (and tribute to) Uwe Reinhardt. 13:27 Hospital by The Leapfrog Group. 14:08 with Wayne Jenkins, MD. 15:07 with Yashaswini Singh, PhD. 16:29 How is regulation changing in healthcare? 21:48 How the “trifecta” of change is working together to create this movement of change in healthcare. 23:54 What do we need to look at to address the problems pushing this change in healthcare? 25:44 with Chris Crawford. 30:04 Why is federal and state collaboration going to be important to this healthcare change? 31:51 with Beau Raymond, MD. /episode/index/show/healthvalue/id/36345600

EP474: Private Equity in Healthcare—The Big Data Points You Really Need to Know, All Together in One Episode, With Yashaswini Singh, PhD 05/01/2025

EP474: Private Equity in Healthcare—The Big Data Points You Really Need to Know, All Together in One Episode, With Yashaswini Singh, PhD In Episode 474 of 'Relentless Health Value', host Stacey Richter interviews Dr. Yashaswini Singh, an economist and assistant professor at Brown University, about the growing influence of private equity (PE) in healthcare. The conversation delves into the corporate transformation of medicine, highlighting the potential misalignment between business interests and patient care. Dr. Singh discusses the diverse strategies PE firms use to drive profitability, such as increasing negotiated prices, consolidating market share, employing real estate leasebacks, and emphasizing performance metrics that may not align with patient benefits. The episode also examines the significant impacts these strategies have on physicians, including increased turnover and changes in practice patterns, as well as the broader implications for patients and communities. Dr. Singh stresses the importance of informed leadership, education, policy enforcement, and transparency to ensure that private investments ultimately benefit healthcare systems without compromising patient care. === LINKS === 🔗 Show Notes with all mentioned links: ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify 📺 Subscribe to our YouTube channel === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 05:53 What is the tension between business and medicine? 07:05 What is the impact of private equity on healthcare? 08:46 How does healthcare change when private equity invests in medical facilities? 10:54 What are the intuitive impacts of private equity in healthcare? 12:28 What are the less intuitive effects of private equity on healthcare? 13:36 with Eric Bricker, MD. 14:15 What are the misconceptions about private equity investors acquiring healthcare facilities? 16:17 The . 16:24 The death of in Philadelphia. 19:27 Are there any positive outcomes to private equity investment in healthcare? 21:17 with Tom X. Lee, MD. 22:45 with Ge Bai, PhD, CPA. 22:47 with Chris Crawford. 22:49 with Rushika Fernandopulle, MD. 22:55 Is there ever a need for private investment in healthcare? 25:40 How do the changes private equity firms create affect patients? 27:20 in Health Affairs on physician turnover rates following private equity acquisitions. 29:30 How can private equity disrupt physician employment as well? 34:13 What remedies might there be for consolidation in healthcare and private equity investing in medicine? /episode/index/show/healthvalue/id/36266330

EP473: Keeping Patients out of the ER: How Trusted Relationships in Primary Care Should Work. A Take 2 With Kenny Cole, MD 04/24/2025

EP473: Keeping Patients out of the ER: How Trusted Relationships in Primary Care Should Work. A Take 2 With Kenny Cole, MD This episode of Relentless Health Value features Dr. Kenny Cole from Ochsner Health System. The discussion emphasizes the critical role of trusted relationships and excellent primary care teams in keeping patients out of the emergency room, thus reducing healthcare costs. Stacey Richter revisits this conversation to highlight the importance of care teams building trust with patients and the concept of primary care as an investment in health and wellness. The episode outlines four key points for delivering great primary care, including accountability for outcomes, belief in clinical goals, standardized care flows, and building patient trust. Dr. Cole also discusses the real-world challenges and strategies for achieving clinical and financial success in primary care. The episode serves as a guide for plan sponsors, clinicians, and healthcare executives looking to improve primary care delivery and align it with financial viability. The discussion is further enriched with insights on digitizing care pathways and the importance of measuring and sharing best practices to achieve high standards of care.I Stacey revisits, in a take two, this episode with Dr. Kenny Cole because she's listening to it this time with a new focus. That focus is the theme that keeps coming up over and over and over again on Relentless Health Value these past few months. === LINKS === 🔗 Show Notes with all mentioned links: ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify 📺 Subscribe to our YouTube channel === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 07:35 Is there an optimal care pathway where there might be a lot of treatment variability? 10:52 with Robert Pearl, MD. 12:32 Why is it important to start with the end in mind? 15:44 How do you scale clinical excellence? 18:18 with Bob Matthews. 19:12 with Marty Makary, MD. 21:29 Why is it important simply to demonstrate what’s possible for better health outcomes? 22:33 with Rik Renard. 23:18 How do we reinvent the business model of healthcare? 24:51 with Vivian Ho, PhD. 25:06 with Rob Andrews. 26:51 with Scott Conard, MD. 30:14 with Beau Raymond, MD. 34:22 Dr. Cole is published in various healthcare journals; check out his . /episode/index/show/healthvalue/id/36158985

EP472: The Well-Honed, Three-Prong Hospital Playbook to Maximize Revenue From High-Cost Claimants, With Eric Bricker, MD 04/17/2025

EP472: The Well-Honed, Three-Prong Hospital Playbook to Maximize Revenue From High-Cost Claimants, With Eric Bricker, MD In Episode 472, Stacey Richter speaks with Dr. Eric Bricker about the impactful strategies hospital systems use to maximize revenue from high-cost patients. They explore the financial complexities and contracting tactics that enable hospitals to profit significantly from a small percentage of high-cost claimants. Key points include the negotiation of provider stop-loss contract provisions, strategic adjustment of charge masters, and the intentional steerage of patients to high-revenue service lines. This episode highlights the intricacies of hospital finance and the hidden mechanisms that drive healthcare costs for self-insured employers and other plan sponsors. We could have 0.5% to 1% of total plan members costing upwards of 40% of total plan dollars. And I bring this up just to highlight the magnitude of the money here. In that show from last week, we take the issue of high-cost claimants from the standpoint of the plan sponsor. Today, however, we’re gonna be looking at this from the standpoint of the hospital system. If we were to come up with a motto for the show today with Dr. Eric Bricker, it’s that all costs are somebody else’s revenue. And when it’s revenue and profit of the magnitude that we’re talking about with many high-cost claimants, it starts to be less of an accidental “Oh, wow! How did that CABG patient wind up in our clinic? What are the odds?” and more of a “Whoever is not steering patients is letting someone else with a big profit incentive lock down that steerage in deeply embedded ways.” === LINKS === 🔗 Show Notes with all mentioned links: 📺 Dr. Bricker's AhealthcareZ Channel ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: 🫙 Support the podcast with a small donation to the Tip Jar: 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify 📺 Subscribe to our YouTube channel === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 05:06 From a hospital revenue perspective, where do high-cost claimants fall? 08:45 How do hospitals structure their stop-loss provisions so that they ensure they’re always maximizing their revenue? 12:15 How hospitals acquire providers to steer as many patients as possible through specific service lines. 20:21 Why do carriers let hospitals get away with these rates and stop-loss negotiations? 21:06 How do Medicare Advantage and Medicare rates play into all of this? 22:00 What should a benefit consultant be doing here? 23:37 What are the keys to direct contracting? 27:21 Why is it important to get trusted relationships set up ahead of time? 28:04 by John Torinus Jr. 29:23 What needs to be the clinical consideration for specialists? 30:46 What is the advantage that employers have in all of this? 33:06 Dr. Bricker’s on 32 examples of healthcare deception. /episode/index/show/healthvalue/id/36065430

EP471: High-Cost Claimants in 2025 and Beyond—What Is Really Expensive Not to Know? With Christine Hale, MD, MBA 04/10/2025

EP471: High-Cost Claimants in 2025 and Beyond—What Is Really Expensive Not to Know? With Christine Hale, MD, MBA Recently on Relentless Health Value, we’ve been tinkering around with a few recurring themes—recurring through lines—that are just true about American healthcare these days. In this episode of Relentless Health Value, host Stacey Richter speaks with Dr. Christine Hale about high cost claimants and the implications for healthcare plans in 2025 and beyond. They discuss the importance of trust in patient care, the financial incentives behind patient steering, and the critical role of timely and comprehensive data analysis. Dr. Hale emphasizes the need for an integrated approach to medical and pharmacy claims data to avoid expensive consequences and improve patient outcomes. She also shares strategies for plan sponsors to effectively manage high cost claimants through evidence-based care, appropriate treatment settings, and creative problem-solving, while underlining the importance of patient engagement and satisfaction. Don't miss next week's episode with Dr. Eric Bricker for a deeper dive into these topics. === LINKS === 🔗 Show Notes with all mentioned links: https://relentlesshealthvalue.com/episodes ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 05:22 What is a high-cost claimant, and how is the definition changing? 07:42 Why buy-and-bill pharmaceuticals can be so costly for plan sponsors. 10:19 What are plan sponsors getting wrong about this situation? 11:28 What do you need as an employer to understand your plan data fully? 13:41 with Scott Conard, MD. 17:35 What are plan sponsors currently doing that they should not being doing? 19:54 Why starting small is important. 23:02 with Matt McQuide. 25:37 What are the steps employers should take to improve their high-cost claimant spend? 31:02 with Erik Davis and Autumn Yongchu. 33:46 with Stacey. Recent past interviews: Click a guest’s name for their latest RHV episode! , , , , , , , , , , /episode/index/show/healthvalue/id/35962595

EP470: Continuing the ER and Primary Care Through Line Over to Rural Hospitals and Healthcare, With Nikki King, DHA 04/03/2025

EP470: Continuing the ER and Primary Care Through Line Over to Rural Hospitals and Healthcare, With Nikki King, DHA In this episode, host Stacey Richter revisits a conversation with Nikki King, CEO of Alliance Health Centers, discussing the critical issues facing rural hospitals and healthcare systems. They delve into the impacts of Medicaid cuts, the financial struggles of rural hospitals reliant on commercial insurance, and potential solutions like freestanding emergency rooms, telehealth, and the expanded roles of nurse practitioners. The conversation also covers the complexities of maternity care and mental health services in rural areas, emphasizing the urgent need for systemic reforms to ensure equitable access to healthcare. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP470 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 08:14 How dire is the rural hospital situation right now? 08:33 How could freestanding ERs be a potential solution for rural hospitals? 09:56 Advice from CHQPR: Rural hospitals should not be forced to eliminate inpatient care. 11:22 Why is broadband a roadblock to telehealth as a solution for rural health access? 14:52 What are other potential rural health access solutions? 15:37 The “hot potato” of nurse practitioners in the healthcare world. 16:34 “The number of residencies for physicians each year is not increasing, but the population … is increasing.” 20:28 with Douglas Eby, MD, MPH, CPE, of the Nuka System of Care. 22:00 What’s the issue with maternity care in rural America? 24:09 “As healthcare becomes more and more specialized, [the] ability to treat high-risk cases is better, but access gets worse.” 27:57 How is mental health care affected in rural communities? 28:29 “Rural communities are trying very hard to hang on to what they have.” 29:52 “When you look at the one market plan that’s available in a rural community, you probably can’t afford it.” 31:37 What’s the single biggest challenge to moving to a model that incentivizes keeping people healthy? 32:32 “The easiest low-hanging fruit … is having national Medicaid and have that put under the same hood as Medicare.” /episode/index/show/healthvalue/id/35874890

EP469 (Part 2): The Impact on Plan Sponsors of Medicare Site-Neutral Payments and HSA Reforms, With James Gelfand, JD 03/27/2025

EP469 (Part 2): The Impact on Plan Sponsors of Medicare Site-Neutral Payments and HSA Reforms, With James Gelfand, JD In part 2 of episode 469, host Stacey Richter discusses the implications of Medicare site neutral payments and Health Savings Account (HSA) reforms with James Gelfand, president and CEO of the ERISA Industry Committee (ERIC). The episode details how plan sponsors should adapt to Medicare's site neutral payment policies aimed at curbing hospital consolidation and inflated prices through facility fees and markups. Gelfand provides insights into how HSA reforms currently in Congress could expand the scope of preventive care covered before deductibles are met, benefitting both employers and employees. The conversation also touches on the challenges high deductible health plans pose and the potential benefits of codifying recent IRS guidance to allow greater flexibility in pre-deductible coverage. The discussion underscores the importance of plan sponsors staying ahead of Medicare policies to avoid higher costs. === LINKS === 🔗 Show Notes with all mentioned links: https://relentlesshealthvalue.com/episodes ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 05:42 What does Medicare site-neutral payments mean? 08:59 How do markups play into the dynamics here? 09:52 Upcoming episode with Christine Hale, MD, MBA. 10:36 What does the “narrow” start for these changes mean? 11:42 What action steps should plan sponsors be taking? 13:01 What options do plan sponsors have in highly consolidated markets? 14:27 with Erik Davis and Autumn Yongchu. 14:53 EP448 ( and ) with Shawn Gremminger. 15:46 Will this bill potentially make changes to HSA plans? 17:40 Why has the thinking behind healthcare usage changed since the inception of HSAs? 18:42 with Stacey. 23:24 How are preventive care and first-dollar coverage connected within the context of HSAs? 25:48 Why would it be difficult to completely get rid of a high-deductible health plan and offer HSAs without them? /episode/index/show/healthvalue/id/35733980

EP469 (Part 1): The Impact on Plan Sponsors of Medicaid Cuts, With James Gelfand, JD 03/27/2025

EP468: Very Common Assumptions That Aren’t Actually True About Member Engagement and the Healthcare Industry, With Matt McQuide 03/20/2025

EP468: Very Common Assumptions That Aren’t Actually True About Member Engagement and the Healthcare Industry, With Matt McQuide In Episode 468, host Stacey Richter engages in a conversation with Matt McQuide, CEO of Synergy Healthcare. This episode delves into the critical assumptions surrounding member engagement within the healthcare industry. Key points discussed include the role of employers in steering plan members, the importance of member engagement for navigating the healthcare marketplace, and Matt’s three major misconceptions about health plan membership. Matt also presents real-life examples of how engagement significantly impacts health outcomes, emphasizing that relationships and trust are paramount. The episode concludes with practical strategies for employers to enhance engagement and manage employee health effectively. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP468 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ You can learn more at and by following Matt on . Matt McQuide is the founder and CEO of Synergy Healthcare, a role he has held since launching the company in 2012. Under his leadership, Synergy has made significant strides in improving member health, enhancing the health insurance experience and the financial integrity of health plans. 06:28 What are Matt’s three common assumptions that employers make about member engagement? 07:08 “Health is actually hard.” 08:19 Why is it important to meet people when their need for healthcare sparks their interest in their health? 11:29 “It didn’t take much … it just takes time.” 13:53 Why are relationships and trust more important today for employee health and member engagement? 16:04 Do people actually want optimal health? 17:44 Why is it important to meet people where they are today? 22:38 “Employers don’t want to fix healthcare.” 24:10 Why it’s important to remember that claims are real people. 24:38 from Steve Schutzer, MD, about with Betsy Seals. 26:44 How do you solve the “middle way”? /episode/index/show/healthvalue/id/35637995

EP467: Connecting Sky-High ER Spend to Primary Care Access—Following the Dollar Through Carriers and Hospitals, With Stacey Richter 03/13/2025

EP466: What Is Rising Faster, Insurance Premiums or Hospital Prices? With Vivian Ho, PhD 03/06/2025

EP466: What Is Rising Faster, Insurance Premiums or Hospital Prices? With Vivian Ho, PhD Healthcare costs keep rising, but what’s driving those increases? In this episode, Stacey Richter speaks with Dr. Vivian Ho, a health economist at Rice University and Baylor College of Medicine, to break down the real reasons behind skyrocketing commercial insurance premiums. Are insurance premiums rising faster than wages—and why does it matter? What’s the biggest driver of premium increases? (Spoiler: It’s hospital prices.) Are hospital price hikes justified by rising costs—or is something else at play? Dr. Ho shares data-backed insights on hospital consolidation, executive incentives, and how health system pricing impacts self-insured employers and plan sponsors. If you’re a healthcare executive or a jumbo employer managing benefits, this episode is a must-listen. === LINKS === 🔗 Show Notes with all mentioned links:https://relentlesshealthvalue.com/episodes ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter:https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar:https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcastshttps://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Bluesky ✭ Threads ✭ X 05:12 Are insurance premiums going up?05:59 What is the disparity between cost of insurance and wage increases?06:21 LinkedIn by Byron Hugley.06:25 by Michael Strain.06:46 How much have insurance premiums gone up for employers versus employees?09:06 showing the cost to insure populations of employees and families.10:17 What is causing hospital prices and insurance premiums to go up so exponentially?12:53 by (and tribute to) Uwe Reinhardt.13:49 with Marilyn Bartlett, CPA, CGMA, CMA, CFM.15:28 Are razor-thin operating margins for hospitals causing these rising hospital prices?16:56 Collaboration with Marilyn Bartlett and the .19:47 What is the explanation that hospitals give for justifying these profits?23:16 How do these hospital cost increases actually happen?27:06 by Zack Cooper, PhD.27:50 Who typically makes up a hospital board, and why do these motivations incentivize hospital price increases?30:12 with Mark Cuban and Ferrin Williams, PharmD, MBA.33:17 Why is it vital that change start at the board level? /episode/index/show/healthvalue/id/35427765

EP465: The Not Super Effective Contracting Industry Norm, Where Jumbo Plans and Others Wind Up Paying $10,000 for $50 Drugs, With Chris Crawford 02/27/2025

EP465: The Not Super Effective Contracting Industry Norm, Where Jumbo Plans and Others Wind Up Paying $10,000 for $50 Drugs, With Chris Crawford The Hidden Costs of PBMs: How Aggregate Discount Guarantees Inflate Drug Prices. In episode 465 of Relentlessly Seeking Value, host Stacey Richter interviews Chris Crawford, CEO of RxSaveCard, about the inflated costs within the pharmacy benefits industry. The discussion centers around a lawsuit involving J&J, highlighting how large PBMs can significantly overcharge for drugs that are available much cheaper through cash-pay options like Mark Cuban's Cost Plus Drugs. Crawford explains how Aggregate Discount Guarantees, a common contracting mechanism, often fail to control spread pricing effectively and instead may lead to higher costs for plan sponsors and employees. The episode also covers how RxSaveCard can help employers and employees access these lower cash prices, circumventing the inflated costs from traditional PBMs. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP465 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Bluesky ✭ Threads ✭ X 07:12 with Scott Haas. 07:17 with Paul Holmes. 07:19 with Luke Slindee, PharmD. 07:20 with AJ Loiacono. 07:44 What is the Aggregate Discount Guarantee? 13:49 Why do the divergent list prices and the perverse incentives prevent the Aggregate Discount Guarantee from really limiting cost spread? 17:55 Why is it important for plan sponsors to check these drug cost prices, and how can employers check them? 23:56 What drives cost lower, and why does it change everything? 25:09 How does RxSaveCard work? 25:44 with Chris Crawford. 30:01 Do you need a PBM’s permission to use RxSaveCard? 30:37 How does it look for employers/employees to use the RxSaveCard? 32:39 with Ge Bai, PhD, CPA. /episode/index/show/healthvalue/id/35335240

EP464: ER Visits Now 6% of Total Plan Spend. Is It Upcoding or What? With Al Lewis 02/20/2025

EP464: ER Visits Now 6% of Total Plan Spend. Is It Upcoding or What? With Al Lewis Emergency room costs now make up 6% of total healthcare plan spending—why? In this episode, host Stacey Richter welcomes Al Lewis to break down the data behind rising ER expenses, separating fact from fiction. They discuss whether increased patient acuity or widespread upcoding is driving costs, the impact of the No Surprises Act, and why plan sponsors struggle to negotiate fair ER rates. Plus, Al shares actionable strategies for employers to push back against inflated charges. If you want to understand the hidden forces behind escalating ER bills, this is a must-listen. You can find the charts and links mentioned in the show notes in the link below. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP464 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Bluesky ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ X 00:00 Introduction 08:32 What is going on in ER visits, and how big of a deal is the total spend? 10:16 Why is the price of ER visits going up when it should be going down? 11:59 What is the major source of unexpected medical debt? 13:27 What is code creep, and why is it happening? 16:26 Why are plan sponsors unable to negotiate emergency room services? 19:22 with Rob Andrews. 25:53 Why is it important not to agree to consent when you go in to visit the ER? 27:47 with Al Lewis. 31:28 What steps can plan sponsors take to be proactive about limiting ER spending for their employees? You can learn more at and by emailing . You can also follow Al on . Recent past interviews: Click a guest’s name for their latest RHV episode! , , , , , , , , , /episode/index/show/healthvalue/id/35228235

EP463: Medicare Advantage Policies—Which Will Stay and Which Will Go Now? With Betsy Seals 02/13/2025

EP463: Medicare Advantage Policies—Which Will Stay and Which Will Go Now? With Betsy Seals In this episode of Relentless Health Value, host Stacey Richter engages with Betsy Seals, CEO and co-founder of Rebellis Group, to analyze the future of key Medicare Advantage policies amidst a changing political landscape. They delve into four critical areas: 1. Medicare Advantage Stars Program: Examining potential changes due to recent lawsuits and the new administration’s stance on quality measures. 2. Risk Adjustment and Government Oversight: Discussing the focus on recouping improper payments and how oversight might evolve. 3. Use of Artificial Intelligence: Considering appropriate oversight for AI applications in prior authorization processes and ensuring they benefit patient care. 4. Agent and Broker Oversight: Exploring increased scrutiny over marketing practices and the dissemination of accurate information to beneficiaries. Betsy emphasizes the importance for Medicare Advantage plans to prioritize patient value, maintain compliance, and proactively utilize data to navigate these evolving policies. This discussion provides valuable insights for stakeholders aiming to understand the future of Medicare Advantage. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP463 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Bluesky ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ X https://twitter.com/relentleshealth/ 05:09 Will the Star Ratings program stay in this new administration? 08:08 How will the lawsuits against CMS policies play out with this new administration? 10:24 Why is it hard for Medicare Advantage plans to survive, let alone thrive? 16:22 How does AI directly impact beneficiary lives? 21:38 What’s going on now with the override payments? 27:08 How is non-collaboration going to impact Medicare beneficiaries moving forward? 31:45 Why is it important to become more technologically savvy in compliance? /episode/index/show/healthvalue/id/35136530

Encore! EP384: How Shareholders Impact Carrier Behavior, Exactly and Specifically, With Wendell Potter 02/06/2025

Encore! EP384: How Shareholders Impact Carrier Behavior, Exactly and Specifically, With Wendell Potter In this episode, Stacey Richter explores how the demands of shareholders influence the actions of publicly traded health insurance companies with guest Wendell Potter. Drawing from Milton Friedman’s assertion that a business’s primary responsibility is to its shareholders, we examine the implications of this philosophy in the healthcare sector. The discussion highlights concerns about fraud allegations among major insurers and the lack of open competition due to market consolidation. We delve into the concept of the “medical loss ratio,” a key metric for investors, and how it pressures insurers to prioritize profits, often at the expense of patient care. Our guest, Wendell Potter, a former health insurance executive turned advocate for healthcare reform, provides insider insights into these dynamics. He discusses the challenges insurers face in controlling costs, the impact of rising premiums, and the broader consequences for patients and the healthcare system. This episode offers a critical look at the intersection of corporate interests and patient care, shedding light on the systemic issues that arise when profit motives drive healthcare decisions. All mentioned links can be found in the show notes. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/Encore384 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Bluesky ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ X 08:31 What is the medical loss metric? 11:33 “The reality is, insurers have been jacking up premiums … for a long time.” 12:48 “It’s a short-term game.” 15:39 “You’re seeing that these companies are not doing a very good job … of controlling costs because they don’t have the incentive.” 20:19 with Kevin Schulman, MD. 22:45 How do payers ensure that they’re controlling utilization? 25:53 “It’s death by a thousand cuts.” 31:51 “Just like independent practice physicians are endangered, so are community pharmacists.” 33:17 Who runs our healthcare system? /episode/index/show/healthvalue/id/35053460

EP462: Managing Populations of Whole, Actual People Who Are Not the Sum of a Bunch of Different Body Parts, With Scott Conard, MD 01/30/2025

EP462: Managing Populations of Whole, Actual People Who Are Not the Sum of a Bunch of Different Body Parts, With Scott Conard, MD This podcast today is with Dr. Scott Conard, founder of Converging Health. You might remember him from the earlier episode (). First of all, I enjoyed how it came to be. Brian Uhlig, an employee benefit consultant of some acclaim, came to me and offered to sponsor a show for someone else. Not himself. I gotta say, it’s stuff like this that warms my heart. It’s this village that we have here, this tribe of Relentless folks trying so hard to stand up for and help patients. So, thanks again to Brian Uhlig. Right now, Dr. Conard is doing a bunch of work with Mike Adams from 7-Eleven, helping their plan members. A lot of this work is centered on and about a few pretty striking but very common insights that many plan sponsors will find in their own data. It turns out about 70%, give or take, of people who wind up costing the plan whatever the high-cost threshold is in any given plan year. These higher-cost claimants didn’t fall out of the sky unexpectedly, 70% of them. They were actually high risk but low cost in prior years. So, the trick is to find these individuals and help them not fall into the high-risk and high-cost part of the graph. If the goal is how to best manage a population of members, a lot of that is, again, identifying high-risk patients who are currently in the low-cost zone, who, any given plan year, are gonna go out of that zone and get into the high-cost area. So, if we’re thinking about best practices to avoid this, I’m gonna run through Dr. Conard’s list that we mostly run through in the show that follows. Lastly, we touch a little bit in the show today on community-run primary care. This is a community paying for primary care for community members, just like they pay the fire department and the police department. There’s a town in Rhode Island doing this that Dr. Conard talks about today. In fact, Michael Fine, MD, is part of this effort in Rhode Island. === LINKS === 🔗 Show Notes with all mentioned links and articles: https://cc-lnk.com/EP462 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Bluesky ✭ Threads ✭ X 07:10 How do we think about data wrongly, and how does that affect our healthcare spend in regard to population health? 09:43 What needs to be done with population health data once it’s collected. 14:48 in Rhode Island doing effective proactive care. 16:09 with Marty Makary, MD, MPH. 16:44 A real, successful case study. 24:08 How do we define high-cost patients? 24:14 What do we know about high-cost patients in regard to population health spend? 29:02 Why avoiding prevention in primary care only harms yourself in the future. /episode/index/show/healthvalue/id/34943260

INBW42: A Philosophical Rabbit Hole of Considerations for Plan Sponsors and Others 01/23/2025

INBW42: A Philosophical Rabbit Hole of Considerations for Plan Sponsors and Others In this inbetweenisode Stacey Richter dives into the complexities of benefit design in American healthcare. Highlighting insights from recent episodes with Bill Sarraille () and upcoming episode with Scott Conard, MD, Richter explores the impact of cost containment measures and the moral hazard of insurance, emphasizing the importance of creating balanced and efficient benefit plans that align with plan values and avoid unintended consequences. She discusses the challenges and implications of high deductible health plans and copay maximizers/accumulators, urging plan sponsors to strive for pareto optimality and practical solutions. This episode is a call to carefully consider patient behavior, healthcare utilization, and the broader impacts of financial incentives in healthcare. Going black and white or over-indexing to prevent outlier kind of stuff is probably not gonna end well. Not seeking a middle way can easily result in a solution that is possibly worse than the problem. Moral hazard is actually a thing. There are lots of implications to patients not being able to distinguish high-value and low-value care. But if we know this, then, philosophically at least, how do we conceptualize a solve? What should we be doing? If we’re not doing black and white, what does the gray in the middle look like? === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/INBW42 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Follow on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Follow on Spotify 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ X https://twitter.com/relentleshealth/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social 00:00 Introduction to the Rabbit Hole 04:05 Where did Stacey’s rabbit hole spiral start? 05:40 What is the moral hazard of insurance? 09:31 with Wayne Jenkins, MD. 12:49 Why isn’t moral hazard mitigated in insurance? 18:16 with Bill Sarraille. 20:51 “How do we conceptualize a solve?” 22:24 Why should we be striving for Pareto optimality? 25:20 What is the theory of second best? /episode/index/show/healthvalue/id/34840500

EP461: Pick Only One, Plan Sponsors: Do You Want to Control GLP-1 Volume or Control GLP-1 Unit Cost? With Chris Crawford 01/16/2025

EP461: Pick Only One, Plan Sponsors: Do You Want to Control GLP-1 Volume or Control GLP-1 Unit Cost? With Chris Crawford This episode with Chris Crawford, CEO of RxSaveCard, is not about the when, why, or how of GLP-1s for weight loss or best-practice prescribing. This episode very, very specifically is about the how and why of the pickle plan sponsors get themselves into often enough where if they impose formulary restrictions to limit the volume of meds that they are paying for, then unit prices go up, which is a thing for GLP-1s. And this is critical just given how the costs associated with GLP-1s for weight loss contribute to some pretty significant increases in pharmacy trend for plan sponsors who choose to cover the GLP-1s for weight loss. Chris Crawford and Stacey Richter discuss the challenges plan sponsors face with the rising costs of GLP-1 medications for weight loss. They explore how plan sponsors’ efforts to manage pharmacy trends often result in a tradeoff: lowering unit costs by increasing volume or vice versa. Chris also introduces a potential solution leveraging the growing cash marketplace, where employers can bypass traditional PBM contracts to achieve cost savings. Tune in for actionable insights into the perverse incentives in the pharmacy supply chain and innovative ways to navigate them. (Continued below the links) === LINKS === 🔗 Show Notes with all mentioned links: hhttps://cc-lnk.com/EP461 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ X https://twitter.com/relentleshealth/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social Bottom line, there are some really impactful and not frequently delved into perverse incentives at play here. And we’re gonna talk about these today. And these are really key for anybody on or about the pharmacy supply chain in the U.S. to know about. This is very actionable insight. So, again, there’s an unfortunate tradeoff, as it stands right now, for many plan sponsors. Lower your volume and raise the unit price or vice versa. This episode is sponsored by , and a big thanks for that. I really appreciate RxSaveCard for its financial support because this episode covers a really important topic that we probably would have covered anyway over here at Relentless Health Value. And so, RxSaveCard standing up and offering their financial support to cover it was a really nice thing to do. And I thank them for their generosity. 07:57 What are the two pieces going on with GLP-1 PBM prices and rebates for employers? 10:00 Is the cash price for these name brand drugs currently less than the rebated PBM price? 11:49 Why does the rebate for GLP-1s disappear if employers try to put restrictions on who can receive access to these drugs? 15:07 Where does RxSaveCard come in to play here? 19:55 “We exist to save people money.” 20:45 with Brian Reid. 21:16 with Ge Bai, PhD, CPA. 21:37 with Luke Slindee, PharmD. /episode/index/show/healthvalue/id/34759110

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