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.

EP504: A Back-to-Basics Roadmap Through the Perverse Incentives to Advanced Primary Care, With Ryan Jacobs 03/26/2026

EP504: A Back-to-Basics Roadmap Through the Perverse Incentives to Advanced Primary Care, With Ryan Jacobs 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,” where innovators often lose to the status quo because dominant organizations can rationally avoid investing without gaining share. Jacobs offers a three-step roadmap: perform a reality-based assessment by following the money and identifying who is financially harmed by prevention; anticipate stakeholders’ math by framing value as CFOs, benefits leaders, and plan sponsors do; and proceed from strategic conclusions such as direct contracting to bypass misaligned intermediaries. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP504 ✉️ 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/ 00:00 A refresher on advanced primary care (APC). 02:36 Why APC isn’t everywhere. 04:39 The problem of complacency in the healthcare system. 05:27 Ryan Jacobs’ roadmap. 08:59 The pitfalls of advanced primary care. 09:58 What primary fiduciary responsibility means. 10:51 Growth on the payer side. 11:51 with Jacob Asher, MD. 12:36 EP483 ( and ) with Jonathan Baran. 12:48 with Chris Crawford. 13:27 The reality of the healthcare system in the United States. 14:11 The flywheel created by the tension within the healthcare system. 15:25 with Scott Conard, MD. 15:51 The tension between APC’s goals and fiduciary responsibility. 17:52 The black box of complacency. 19:25 with Elizabeth Mitchell. 20:05 What’s driven most of the change in the advanced primary care space. 20:54 with Jacob Asher, MD. 21:01 What would happen if there was a functioning market in healthcare. 21:41 with John Rodis, MD, MBA. 21:52 Why complacency may be a rational move in healthcare. 22:41 with John Lee, MD. 23:22 A roadmap to success in advanced primary care. 23:55 Step 1: Follow the money. 24:50 Step 2: Someone’s gonna do math. 25:17 What strategic thinking looks like as an employer. 28:34 Step 3: Proceed based on strategic conclusions. 30:20 How self-insured employers have created their own market. 31:07 The strategic decision for physicians wanting to create change. 32:25 A reiteration of the episode’s discussion. 33:49 Better payment structures. /episode/index/show/healthvalue/id/40513855

Insights to Outwit the Hot Mess of the Non-Healthcare Market 03/19/2026

Insights to Outwit the Hot Mess of the Non-Healthcare Market 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 using transparency files to compare what peer companies pay, and citing examples of misleading “transparency” through complex contracting and financialization (e.g., CABG pricing and PBM tactics). She also questions what “disruption” means when the status quo already harms access. Stacey highlights direct contracting, Centers of Excellence, and upcoming advanced primary care episodes. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/INBW46 ✉️ 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/ 00:00 Introduction: trying something new with this inbetweenisode. 01:29 “Insight is common. Execution is rare.”: a LinkedIn from Ken Wosczyna. 03:02 with Larry Bauer, MSW, MEd. 03:08 The power of the C-suite versus the decision power of workers. 03:45 with Keith Passwater and JR Clark. 04:00 The power of actuaries to align with values. 04:50 Rate criticals for fixing the nonexistent healthcare market. 05:50 with Ivana Krajcinovic, PhD. 06:56 Why you can’t fix what you don’t understand. 07:46 with Eric Bricker, MD. 09:27 A from Craig Herndon. 10:44 Why avoiding disruption and problems with access can create disruption and problems with access. 12:22 A LinkedIn from Michelle Bernabe. 12:26 with Stacey. 15:56 Looking ahead: topics future episodes will be covering. 16:07 with Ryan Wells; Leo Spector, MD, MBA; and Adam Stavisky. 17:08 A for Relentless Health Value episodes. 18:24 with Kimberly Carleson. 19:22 Check out this episode’s sponsor. /episode/index/show/healthvalue/id/40499740

EP503: Smart Collaboration With Direct-to-Employer Specialty Care, With Ryan Wells; Leo Spector, MD, MBA; and Adam Stavisky 03/12/2026

EP503: Smart Collaboration With Direct-to-Employer Specialty Care, With Ryan Wells; Leo Spector, MD, MBA; and Adam Stavisky 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 programs. The conversation frames the evolution of Centers of Excellence from 1.0 (travel to brand-name hospitals) to 2.0 (more local but administratively manual) to 3.0 (new infrastructure enabling direct, efficient contracting). Health Here is described as a digital bridge to support payment and communication pathways and reduce administrative waste. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP503 ✉️ 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/ 00:00 Introduction. 00:32 Collaboration as the next breakthrough innovation. 02:24 A summary of the upcoming conversation. 05:45 A summary of where we are and what the future looks like. 06:24 A relevant from Jonathan Baran. 08:12 The conversation with Ryan Wells, Dr. Leo Spector, and Adam Stavisky: collaboration from the standpoint of a specialist. 12:22 The pitfalls of data accuracy and defining what quality means from the POV of a self-insured employer. 15:36 Defining quality and data accuracy from the POV of a physician. 15:57 How do you measure outcomes when assessing quality and looking at the available data? 21:45 with Steve Schutzer, MD. 22:06 Scale and operationalization: How do we do it? 27:00 Shout-out to OrthoForum. 29:58 with Jacob Asher, MD. 30:13 with Ivana Krajcinovic, PhD. 30:30 How things could be better. 33:29 One last complication and how to structure benefit design to align incentives. 35:33 What an “anti-cricket” program looks like. 37:24 with Mark Fendrick, MD. 37:34 How do we operationalize benefit design and aligned incentives? 39:39 What we’re seeing today in Centers of Excellence 2.0. 41:47 What Adam wants to make clear in all of this. /episode/index/show/healthvalue/id/40299310

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 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 projected at $3–$3.5B in 2025. The episode also highlights rapidly growing “skin substitute” spending projected at $13–$15B in 2025; CMS did not classify 2024 skin substitute costs as SAHS, leaving them in ACO performance calculations. Machut explains this fraud and missed CMS trend projections can reduce provider earnings, discourage participation in value-based care, and potentially drive cost shifting into higher commercial rates—affecting plan sponsors such as self-insured employers. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP502 ✉️ 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/ 00:00 One way hackers are using medical data to commit Medicare fraud. 01:49 What today’s conversation with Brian Machut entails. 02:16 The downstream impact that this Medicare fraud can have. 03:30 A brief outline of how plan sponsors can be affected by this Medicare fraud. 06:38 What does a value-based actuary do? 08:04 The conversation with Brian Machut: What caused his team to look into DME costs and uncover Medicare fraud? 08:46 How much did this fraud scheme cost organizations in 2023? 09:57 How this data was tracked down and uncovered. 11:13 How fee-for-service ACOs work, and why this Medicare fraud affected the ACOs’ shared savings. 12:46 The two codes that were the target of this fraud. 15:13 Across the U.S., how much money in 2023 did this fraud, waste, and abuse cost, and what was done about it? 16:14 The framework that was created to combat this fraud spend. 17:49 Why the CMS decision to pull those expenditures negatively affected some ACOs. 20:17 Where things stand now with this catheter fraud. 21:33 Why this fraud is still able to happen. 22:19 Is this a use case for prior authorizations? 23:49 How this Medicare fraud affects self-insured employers and what they should keep in mind. 25:12 What is the correlation to employee affordability? 27:08 A cost that dwarfs the catheter Medicare fraud. 28:21 A brief summary of skin substitutes. 29:32 What SAHS means, and how CMS uses it to calculate an ACO’s shared savings. 31:21 Why CMS chose not to classify skin substitutes as SAHS. 33:26 Why this fraud affects ACOs’ prospective trend pricing risk. 36:40 Why these fraud cases make participating in ACO programs less appealing to provider organizations. 38:28 for 2027. /episode/index/show/healthvalue/id/40241725

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 02/26/2026

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 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 Medicare. The discussion highlights how these prices create major member affordability problems through co-insurance and reduce funds available for wages, with one Monterey analysis showing nearly $1 million in annual savings by moving just two patients to an independent oncology practice. They argue that functioning markets would rationalize prices and that carrier networks often fail as a demand curve, showing apathy and relying on broad “discount” negotiations even when prices differ by hundreds of times, including cases within the same health system. Krajcinovic describes a roadmap to fight back: drill into claims data, push back on providers and networks, use benefit design to steer site of care, carve out utilization management and case management to support member navigation, and pursue direct contracts with independent practices. They also discuss the “whack-a-mole” dynamic of hospital pricing and the value of collective action, media attention and regulatory forums such as California’s Office of Health Care Affordability. === LINKS === 🔗 Show Notes with all mentioned links: https://bit.ly/Episode501 ✉️ 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 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue 🎤 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/ 00:00 $135 vs $13,560: How infusion drug prices play into the “Inches All Around Us” series. 02:02 How infusion drug pricing fits into the “No Market” series. 03:19 A roadmap and more episodes on this topic. 04:36 Introducing this week’s expert, Ivana Krajcinovic, PhD. 05:10 A must-read Bloomberg News article on infusion pricing. 05:33 An overview of what to expect from this episode. 06:54 The first tell of the infusion nonmarket. 07:41 The price variations that Ivana has seen in the infusion nonmarket. 11:39 How hospital spend affects wage increases affects patients and employees twice over. 12:04 with Cora Opsahl. 13:43 The second tell of the infusion nonmarket. 14:33 with Jacob Asher, MD. 14:55 with Jonathan Baran. 16:15 Why networks are apathetic to this pricing discrepancy. 17:55 The factors that play into the nonmarket issue of infusion drug pricing variations. 18:26 with Peter Hayes. 19:18 with Erik Davis and Autumn Yongchu. 19:45 Are pricing discrepancies easy to spot? 22:38 Where we have power in a nonmarket situation. 23:22 A recap of the advice in the show so far. 23:39 with John Quinn. 23:41 with Mark Newman. 25:51 How you place pricing pressure on an entity. 28:47 with Preston Alexander. 29:34 How an improved market creates time for better care coordination. 30:52 with Stan Schwartz, MD. 33:23 The fourth part of the roadmap. 36:41 and with Sam Flanders, MD, and Shane Cerone. 36:49 Why serving the community and being fiscally responsible should go hand in hand. 38:05 with Stacey. /episode/index/show/healthvalue/id/40140485

Take Two: EP398: Why Are Commercial Carrier Marketplaces Completely Boring? Maybe Because There Isn’t a Marketplace, With Jacob Asher, MD 02/19/2026

Take Two: EP398: Why Are Commercial Carrier Marketplaces Completely Boring? Maybe Because There Isn’t a Marketplace, With Jacob Asher, MD 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 inertia, the influence of employee benefit consultants, and the strategic focus of carriers on Medicare Advantage over commercial business. They also explore how carriers' dependence on existing provider networks and contractual negotiations based on member volumes contribute to a lack of meaningful competition. The episode highlights the challenges faced by plans attempting to innovate or differentiate on quality and the systemic issues that perpetuate the current equilibrium. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/Take2-EP398 ✉️ 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/ 00:00 Introduction to the episode. 00:42 The “No Market” series. 01:51 Why is the carrier market boring? 04:26 A breakdown of what follows. 05:48 Six reasons why a marketplace doesn’t actually exist. 10:04 Upcoming episodes in the “No Market” series. 10:41 The conversation with Dr. Jacob Asher. 11:01 What is the competitive picture of California’s health plans? 11:03 Understanding the California health plan market. 12:28 What the competitive landscape looks like to get market share in California. 12:55 Challenges in market competition. 13:14 What are micro markets and market drivers? 15:14 How brokers and consultants shape the marketplace. 15:49 Why is it difficult to take market share? 16:56 Who was Dr. Asher pitching to and why? 18:56 How is Kaiser’s position in the marketplace unique? 19:29 Did employers ever buy plans for quality? 23:23 What does this look like from the payer perspective? 27:42 What improvements have there been to engagement in health plans? 29:47 Have plans gotten better at communicating with employers? 31:19 Why is it hard to compare the Kaiser world to the non-Kaiser world? 31:19 Dr. Asher’s final thoughts and reflections. 33:40 with Gloria Sachdev, PharmD, and Chris Skisak, PhD. /episode/index/show/healthvalue/id/40073935

EP500: This Is Episode 500, and It’s All About You, Tribe 02/12/2026

EP500: This Is Episode 500, and It’s All About You, Tribe In the milestone Episode 500 of the 'Relentless Health Value' podcast, Stacey Richter reflects on the significant influence and community formed around the platform. Initiated by a conversation with Cora Opsahl, the episode transforms into a heartfelt ode to the listeners — healthcare entrepreneurs, executives, and change-makers, whom Stacey refers to as 'the tribe.' Featured contributions from several listeners highlight themes such as moving from theory to practical transformation, the power of collective momentum, and 'unplugging from the Matrix' of opaque healthcare practices. Notable testimonials underline how the podcast has guided real-world decisions, fostered community connections, and provided actionable insights that have tangibly influenced the healthcare sector. The episode concludes with gratitude for the tribe's effort toward transforming the healthcare system and a forward-looking encouragement to remain relentless in their mission. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP500 ✉️ 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/ 00:00 Introduction and episode 500 announcement. 00:22 The origin of episode 500. 01:49 The LinkedIn post and its impact. 02:43 Celebrating the Relentless Health Tribe. 07:55 Clip from Michelle Bernabe and how EP373 gave her a framework to model off of and understand that the failures in healthcare weren’t personal failures. 10:08 Theme 1: Moving From Theory to Practical Transformation. 10:38 Clip from Ken Wosczyna and the episodes that have led to consistently good decisions in his work. 11:27 The Tipping Point by Malcolm Gladwell. 12:55 Examples of tribe members changing and improving their corner of healthcare after being inspired by RHV episodes. 13:54 Clip from Mark Weber. 14:54 Clip from Alex Sommers, MD, and how EP391 and EP462 changed his work 16:13 Clip from John Lee, MD, and how RHV helped him realize that “gaming the system” can also be used for good. 18:42 Theme 2: The Power of the Tribe and Collective Momentum. 19:28 Clip from Justin Leader. 21:45 Why being a “good villager” is so important to the overall outcome of healthcare. 23:22 Clip from Cristin Dickerson, MD, and how she draws inspiration from various RHV episodes. 25:21 Clip from Andrew Gordon. 27:39 Theme 3: Unplugging From the Matrix of Healthcare Opacity. 28:32 Clip from Andrew Tsang. 29:29 RHV episodes that cover better value out of health benefits. 32:15 Clip from Sergei Polevikov. 34:11 What tech needs to do in order for healthcare to succeed and improve. 35:06 Clip from Bryce Platt, PharmD. 36:01 More RHV episodes on unplugging from pricing opacity. /episode/index/show/healthvalue/id/39980375

EP499: Self-insured Employers and Other Plan Sponsors Are Paying Millions for MSK (Musculoskeletal) Injuries That Would Have Healed Themselves, With Jay Kimmel, MD 02/05/2026

EP499: Self-insured Employers and Other Plan Sponsors Are Paying Millions for MSK (Musculoskeletal) Injuries That Would Have Healed Themselves, With Jay Kimmel, MD In this episode of Relentless Health Value, host Stacey Richter talks with Dr. Jay Kimmel, an orthopedic surgeon and co-founder of Upswing Health, about the significant costs associated with musculoskeletal (MSK) injuries and conditions for self-insured employers and other plan sponsors. They explore how a large portion of MSK-related expenses are for low-acuity injuries that often heal on their own without the need for emergency room visits or unnecessary treatments. Dr. Kimmel discusses the importance of addressing the 'white space'—the critical initial moments when a patient decides whether or not to seek emergency care. He emphasizes the value of immediate access to knowledgeable professionals to help guide these decisions and prevent avoidable high-cost care. They also touch on historical practices where physicians would consult each other informally, suggesting that modern solutions like Upswing Health can replicate those beneficial spontaneous interactions to improve patient care and reduce costs. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP499 🔗 Visit Upswing Health: https://upswinghealth.com ✉️ 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/ 07:49 with Eric Bricker, MD, on high-cost claimants. 08:01 What is the “white space” in MSK spend? 10:43 on Connecticut’s spending on plan members with low-acuity MSK injuries. 13:30 How back pain also easily transitions from a low-acuity issue to a high-acuity problem. 15:11 How plan sponsors can detect their white space downstream spend. 16:58 with Al Lewis. 17:02 with Nikki King, DHA. 18:15 Why where patients start their journey often dictates where they wind up and how costly that medical pathway is. 20:48 Where PCPs fit into this MSK spend issue. 25:26 with Matt McQuide. 25:34 with Christine Hale, MD, MBA. 25:39 Why access is key. /episode/index/show/healthvalue/id/39899755

EP498: The Payment Integrity Arms Race—RCM (Revenue Cycle Management) and Plan Sponsors, With Mark Noel 01/29/2026

EP498: The Payment Integrity Arms Race—RCM (Revenue Cycle Management) and Plan Sponsors, With Mark Noel 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 meticulous oversight and proactive management in payment processes. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP498 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe ✉️ Visit ClaimInsight https://www.claiminsight.com/ 🫙 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/ 06:03 How millions of dollars can be recovered per year from smaller claims under $500. 07:46 with Stan Schwartz, MD. 09:10 How to get to payment integrity prepayment. 11:20 How payment processing efficiency is necessary to payment integrity. 13:59 How TPAs fit into the claims payment process and how they can add to payment integrity. 15:59 LinkedIn from Chris Deacon. 16:50 with Justin Leader. 17:04 LinkedIn from Justin Leader. 17:10 How shared savings incentives can be perverse incentives. 23:05 How employers are doing retrospective reviews. 24:29 How employers should be negotiating their TPA contracts. 25:41 with Dawn Cornelis. 25:43 with Kimberly Carleson. 27:40 Why it’s imperative that payment integrity vendors are up-to-date on all policies. 30:00 with Zack Kanter. 31:13 What should self-insured employers do to assess their payment integrity? /episode/index/show/healthvalue/id/39801470

Take Two: EP341: The “Just Spend Everything You’re Given” Trap—Lessons in True Provider Fiscal Discipline, With Gary Campbell 01/22/2026

Take Two: EP341: The “Just Spend Everything You’re Given” Trap—Lessons in True Provider Fiscal Discipline, With Gary Campbell 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 of visionary leadership, cultural alignment, and operational efficiency to deliver high-quality patient care and maintain financial health. Gary Campbell emphasizes the necessity of strategic planning, involving clinicians in decision-making, and standardizing processes to create a better work environment and optimize patient care. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/TakeTwo-EP341 ✉️ 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/ 09:03 Why is there no opportunity to cost shift in an FQHC? 09:34 What happens when an FQHC is operating inefficiently? 10:00 “Have you workflowed it out? … You can overstaff yourself in a way that your cost per patient goes way up.” 10:23 Why is taking a lean approach not an excuse to cut staff? 11:27 and with Shane Cerone and Sam Flanders, MD. 11:35 with John Lee, MD. 11:38 with Beau Raymond, MD. 11:40 with Amy Scanlan, MD. 11:42 with Eric Gallagher. 12:48 “The nurses are linchpins to everything.” 13:44 LinkedIn from Eve Cunningham, MD, MBA. 15:10 How does standardizing care lead to personalization of care? 16:34 “Our clinical teams see that we care.” 16:53 “If you don’t have a vision for where you want to be two and three years down the road, you’re struggling.” 17:09 “I want everybody to understand, What is their why?” 19:45 by Roger E. Herman and Joyce L. Gioia. 24:44 “You have to project plan things out that you want.” 25:51 “They don’t teach leadership in most medical schools.”—Dr. Robert Pearl 26:46 by Peter Attia, MD. 27:55 “Get to know these clinicians.” 29:39 “From a core values perspective, you can make every single decision … on core values.” 30:03 “We always start with those values. … They’re embedded in everything we do.” 30:20 How does an FQHC or private practices that are patient-oriented attract talent? 35:24 with Jerry Durham. 35:54 “First and foremost, be visible.” /episode/index/show/healthvalue/id/39719085

EP497: What You Don’t Know About Healthcare Transactions and Clearinghouses Could Cost You, With Zack Kanter 01/15/2026

EP497: What You Don’t Know About Healthcare Transactions and Clearinghouses Could Cost You, With Zack Kanter 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 administrative costs. Zack offers insights on how modernizing the clearinghouse infrastructure can lead to substantial cost savings and better patient outcomes. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP497 🔗 Visit Stedi: https://www.stedi.com ✉️ 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/ 09:47 What things are being paid for that we might not be aware we’re paying for in healthcare? 12:09 Why HIPAA actually makes healthcare more standardized than other industries. 15:35 How healthcare is ahead in some ways and behind in others. 18:03 Where do the 4 to 5 days come from in healthcare transaction processing? 20:39 Why these transaction delays affect care delay. 23:14 with Preston Alexander. 23:18 with Eric Bricker, MD. 27:10 How should the process work from the time a provider clicks “validate”? 30:19 Why is the clearinghouse the right place to solve all these issues? 31:41 Why are we where we are in terms of these issues? 35:28 Why people should be looking at their clearinghouse costs. 36:59 What to know about Stedi. /episode/index/show/healthvalue/id/39627725

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 01/08/2026

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 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 data and accounting methods lead to significant waste. The discussion also explores innovative solutions Nomi Health is piloting to streamline payments, reduce friction, and ultimately lower healthcare costs while improving care. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP496 🔗 Visit our sponsor Nomi Health: https://www.nomihealth.com/ ✉️ 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/ 06:48 What is actionable to know about the life of a claim? 08:14 How data can change as it moves through the claims process. 11:45 Why a dollar isn’t a dollar in healthcare. 18:50 Why employers are actually paying more than a dollar to access a dollar of healthcare (the medical loss ratio). 21:54 Why cutting out the “friction” is actually better for employees and members. 22:48 with Preston Alexander. 22:50 with Eric Bricker, MD. 23:36 and with Sam Flanders, MD, and Shane Cerone. 23:53 by Andrew Tsang showing 27 streams of income. 26:53 How do we fix these issues? 28:05 LinkedIn from Sandra Raup. 28:59 How Nomi Health is experimenting with a no co-payment, no deductible model. 31:29 with Stacey on moral hazard. 32:26 with Stan Schwartz, MD. 32:31 with Cristin Dickerson, MD. 32:56 by Clayton M. Christensen. 34:55 How does Nomi Health work with and help employers? /episode/index/show/healthvalue/id/39589870

INBW45: Extremely Actionable Themes That We Covered Throughout 2025 12/31/2025

INBW45: Extremely Actionable Themes That We Covered Throughout 2025 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 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 00:00 Introduction 03:30 Theme 4: lack of transparency and data access. 04:46 Clip of Elizabeth Mitchell from . 07:07 Is there a tipping point finally coming regarding transparency? 08:58 Why and how siloed data is also part of this transparency issue. 11:37 How opaque pricing leads to more opaque pricing. 13:21 The need for transparency around ownership and what that looks like in healthcare. 14:06 Theme 5: the need to shift purchasing from discounts/volume to value. 14:52 Clip of Mark Cuban from . 16:35 Clip of Sarah Emond from . 17:02 How pricing transparency can eliminate the need for rebates and prior authorizations. 18:30 Why healthcare needs a demand curve. 22:09 Shows covered in 2025 that touched on other timely ideas. /episode/index/show/healthvalue/id/39516750

INBW44: The Relentless Health Value Themes That We Covered Throughout 2025—A Recap, Part 1 12/24/2025

INBW44: The Relentless Health Value Themes That We Covered Throughout 2025—A Recap, Part 1 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 system, the financial implications of underfunded primary care, and the negative effects of misaligned financial incentives and profiteering within the industry. Check out the show notes using the link below for all of the mentioned links and episodes. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/INBW44 ✉️ 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/ 02:06 Theme 1: the critical need for trusted relationships and simplicity. 02:28 The two categories of trust that are needed. 02:43 Clip of Kenny Cole, MD, from . 03:43 Clip of Ann Lewandowski from . 06:07 Why simplicity and trust have to go together. 08:30 Theme 2: primary care as an investment, not a cost. 08:41 Clip of Jonathan Baran from . 09:01 Clip of Nikki King, DHA, from . 09:34 How broken primary care affects self-insured employers. 10:12 Why there are perverse financial incentives to gut primary care. 15:19 Theme 3: the dominance of perverse financial incentives and profiteering. 15:46 Clip of Benjamin Schwartz, MD, MBA, from . 16:18 The actual definition of margin. 16:55 Clip of Mick Connors, MD, from . 18:25 Clip of Yashaswini Singh, PhD, from . /episode/index/show/healthvalue/id/39431425

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 12/18/2025

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 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 staying focused on the ultimate goal of creating real health value. This episode is a must-listen for anyone looking to drive meaningful change in the healthcare industry. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EncoreEP450 ✉️ 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/ 07:09 What gave Marilyn the confidence to fix Montana’s state health plan? 08:35 Why Marilyn knew she would have enough power to make the changes needed in Montana’s state health plan. 09:35 What Marilyn achieved in her time as the administrator of the Montana State Employee Health Plan. 11:03 What were the “quick wins” Marilyn was able to achieve when she first took over as administrator? 17:55 with Claire Brockbank, which covers RFP in detail. 18:12 How Marilyn structured her plan for the Montana State Employee Health Plan. 21:42 What’s the key to setting yourself up for success when doing what Marilyn was able to achieve? 25:23 Why putting together your own team is so important. 28:20 with Paul Homes. 28:24 with Mark Cuban and Ferrin Williams, PharmD, MBA. 29:28 What happened when Marilyn left the Montana State Employee Health Plan? 31:28 Have the costs of the plan gone up since Marilyn’s time working on it? /episode/index/show/healthvalue/id/39361375

EP495: Wait … Flip That—A Crazy Revelation I Had About Trying to Fix U.S. Healthcare, With Mick Connors, MD 12/11/2025

EP495: Wait … Flip That—A Crazy Revelation I Had About Trying to Fix U.S. Healthcare, With Mick Connors, MD 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 aggregation and patient-level outcome measurements. They explore the challenges faced by physicians in the current system, the role of investor mindsets, and the importance of dyad leadership and mission-driven practices to improve overall healthcare value. === LINKS === 🔗 Show Notes with all mentioned links: 🔗 Visit this week's sponsor Payerset: ✉️ 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 06:32 How Dr. Mick Connors defines margin. 08:18 with Steve Schutzer, MD. 08:54 Why nobody wants to do cost accounting in healthcare. 09:20 with Shane Cerone and Sam Flanders, MD. 11:05 by Andrew Tsang showing streams of income. 12:27 What is the value equation? 15:55 with Suhas Gondi, MD, MBA. 15:59 with Vivian Ho, PhD. 16:01 with Preston Alexander. 16:25 with Yashaswini Singh, PhD. 17:44 How business decisions can really undermine the value proposition. 18:58 Classic on incentivizing. 23:07 with Rebecca Etz, PhD. 24:21 Why it comes down to the 80/20 rule. 26:31 with Tom X. Lee, MD. 26:35 with Rushika Fernandopulle, MD. 26:40 Why mission return requires dyad leadership. 27:13 What does dyad leadership mean? 27:33 with Sam Flanders, MD, and Shane Cerone. /episode/index/show/healthvalue/id/39242625

EP494: Six Tensions of Pharmaceutical Drug Pricing, With Sarah Emond 12/04/2025

EP494: Six Tensions of Pharmaceutical Drug Pricing, With Sarah Emond 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 value-based pricing models free from financial conflicts of interest. They highlight the critical role of payers, PBMs, and drug manufacturers in aligning pricing with value to improve patient access and reduce overall healthcare costs. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP494 🔗 Visit our sponsor Payerset https://payerset.com ✉️ 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/ 08:18 Why list prices are a lie. 10:59 How does the rebate model sometimes get in the way of paying for value? 12:50 with Sarah Emond. 13:14 with Elizabeth Mitchell. 13:20 and with Shane Cerone and Sam Flanders, MD. 14:37 The tension that is created between affordability and adherence. 15:03 When cost sharing makes sense in pharmaceutical drug pricing. 17:26 with Stacey on moral hazard. 18:53 How GLP-1s are “wildly cost effective.” 21:32 Why the sticker shock on cost-effective drugs is a failure in the system for paying for value. 22:38 ICER’s on GLP-1s. 26:59 with Dan Mendelson. 28:57 How employers and payers can have a value assessment approach and a health insurance system that allows access to cost-effective drugs. 29:48 How cost-effective prices are calculated. 31:55 One of the core value underpinnings for value assessment of drugs. 34:54 Why manufacturers and pharmacy benefit managers should work together more by referencing something like an ICER report. 36:55 with Nina Lathia, RPh, MSc, PhD. 38:21 “We can make different choices.” /episode/index/show/healthvalue/id/39179420

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 12/04/2025

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 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 deescalate financial tensions and promote value-based healthcare choices. === LINKS === 🔗 Show Notes with all mentioned links: 🔗 Visit our sponsor Payerset: https://payerset.com ✉️ 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 06:51 (“Game Theory Gone Wild”) with Dea Belazi, PharmD, MPH. 02:38 What is ICER? 02:54 What does the Institute for Clinical and Economic Review do? 05:14 The importance of still showing up, even when others don’t understand or disagree. 09:12 Why it’s important to think about population health and how our choices impact affordability for everyone. /episode/index/show/healthvalue/id/39179425

INBW43: Five Baskets of Thank Yous to Hand Out, Along With a Plug for Big Demand Curve Energy 11/26/2025

INBW43: Five Baskets of Thank Yous to Hand Out, Along With a Plug for Big Demand Curve Energy In this special Thanksgiving episode of Relentless Healthcare Value, the focus is on gratitude and giving thanks to various contributors within the healthcare community. Host Stacey Richter extends her 'baskets of thank yous' to colleagues, mentors, and partners committed to transforming healthcare. These baskets recognize those who maintain respectful dialogues despite small disagreements, those who collaborate and pay it forward within the community, and those who support the concept of a 'demand curve' in healthcare markets. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/INBW43 ✉️ 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/ 01:25 First thank you: to those who do not succumb to healthcare narcissism. 01:36 with Stacey. 02:51 with Stacey. 03:00 and with Stacey. 05:40 Second thank you: to those willing to pay it forward. 05:53 with Dan Greenleaf. 08:12 with Cora Opsahl. 08:38 Third thank you: to those who aid the demand curve in healthcare. 09:14 with Shane Cerone and Sam Flanders, MD. 09:16 with Elizabeth Mitchell. 09:17 with Sam Flanders, MD, and Shane Cerone. 09:49 Why healthcare needs a demand curve. 13:34 Fourth thank you: to those who have contributed financial support to the Relentless Health Value podcast. 15:47 The final thank you: to the listeners. /episode/index/show/healthvalue/id/39093140

Take Two: EP240: A Direct Contracted and Actually High-Value Network That Elizabeth Mitchell From PBGH Talked About, With Olivia Ross 11/20/2025

Take Two: EP240: A Direct Contracted and Actually High-Value Network That Elizabeth Mitchell From PBGH Talked About, With Olivia Ross This OG of directly contracted high-value networks or Centers of Excellence networks came up, name dropped and everything in the episode with Elizabeth Mitchell from , the Purchaser Business Group on Health, from two weeks ago. That was . So, welcome to this deep cut episode with Olivia Ross from way back, pre-pandemic times. This episode of Relentless Health Value revisits the concept of directly contracted high value networks or Centers of Excellence (ECEN) with Olivia Ross. The discussion explores the impact and potential of the ECEN network, emphasizing the importance of quality, price transparency, and multidisciplinary approaches in healthcare. Olivia delves into the reasons why ECEN was significant in past PBGH projects and its current relevance, despite its eventual dismantling due to corporate changes. The episode highlights the benefits for employers in creating their own high-value networks and the positive outcomes from fewer unnecessary surgeries and better quality care. Additionally, it covers the rigorous process of selecting Centers of Excellence and how continuous quality improvement efforts benefit both employers and healthcare providers. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/Take2-EP240 ✉️ 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 🎤 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/ 07:40 Prospective bundles and the cost of care. 08:22 How the largest cost savings come from the improvements in quality. 09:51 What Olivia looks for in choosing centers of excellence. 10:36 Creating market pressure and avoiding consolidation. 11:17 Creating positive disruption in the healthcare system. 12:17 How Olivia chooses the centers and providers she works with in the Purchaser Business Group on Health. 13:12 The quality metrics Purchaser Business Group on Health looks at when assessing providers and centers. 14:04 What a team assessment is, and why it’s important. 15:07 How local PCPs have to factor into this health care model. 17:57 How Purchaser Business Group on Health intervenes in the patient journey to ensure that the patient and the employer are getting the best quality care for the best price. 19:39 Olivia’s suggestions on how to have an intervening conversation with a patient who has already been told he or she needs surgery. 20:18 with Matt McQuide. 20:20 with Christine Hale, MD, MBA. 20:22 with Eric Bricker, MD. 25:27 “Even at a more competitive price point, there’s still an upside to them getting this new business.” 25:52 How choosing specific physicians is part of the COE designation process. 27:35 How COEs and their physicians are also involved in continuous quality improvement. 30:56 Employers Centers of Excellence Network collaboration with . 32:24 How the Employers Centers of Excellence Network program is open to any employer, no matter the size. 32:54 What it takes to join the Employers Centers of Excellence Network. /episode/index/show/healthvalue/id/38994830

EP493: Revelations Mainstream CEOs Are Having About the Healthcare Market Right Now—Also, Some Advice, With John Quinn 11/13/2025

EP493: Revelations Mainstream CEOs Are Having About the Healthcare Market Right Now—Also, Some Advice, With John Quinn In Episode 493 of Relentless Health Value, host Stacey Richter engages in an enlightening discussion with John Quinn, CEO of Wellnecity, about the current revelations and challenges employer CEOs are facing within the healthcare market. Stacey explores whether average employer C-suites are recognizing the fundamental myth that a functioning healthcare market exists. The conversation dives into how self-insured employers are substantially the demand side of the healthcare market and why their lack of insistence on a true market exacerbates high prices. John Quinn shares insights on why C-suites and boards are now more attuned to healthcare spending, emphasizing the need for real-time, correct data and comprehensive vendor accountability. A significant takeaway is the shift from viewing health benefits management as a one-time annual task to adopting a continuous, year-long strategic approach. Finally, the episode delves into actionable steps for employers to manage healthcare costs more effectively without compromising employee health, urging them to move beyond traditional cost-shifting tactics. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP493 🔗 Visit our Sponsor Wellnicity https://wellnecity.com/: ✉️ 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/ 07:06 Why CEOs are looking more closely at healthcare spend. 08:06 with Paul Holmes. 08:21 How savings and health benefits are directly connected. 10:45 with Elizabeth Mitchell. 11:46 What missed earnings look like in relation to healthcare. 14:27 How costs have been shifting to employees for years, and why this doesn’t work anymore. 17:36 with Peter Hayes. 18:23 What employers need to do instead of cost shift. 19:12 with Lauren Vela. 21:30 Why it’s important to make health benefit changes at the speed of business, not at the speed of the benefits year. 26:17 Why is it important to put a finance function into your benefits? 27:10 with Mark Cuban and Cora Opsahl. 27:33 with Andreas Mang and Jon Camire. 27:35 Why daily data matters. 31:10 with Kevin Lyons. 31:21 Why it’s important to hold vendors accountable. 31:47 Why it’s important to move on from vendors who can’t hold up to your scrutiny and needs. 33:46 with Eric Bricker, MD. 34:46 with Christine Hale, MD, MBA. /episode/index/show/healthvalue/id/38898300

EP492: The Solutions Show: How to Run a High-Quality Hospital at 143% of Medicare, With Sam Flanders, MD, and Shane Cerone 11/06/2025

EP492: The Solutions Show: How to Run a High-Quality Hospital at 143% of Medicare, With Sam Flanders, MD, and Shane Cerone In this episode, host Stacey Richter speaks with Dr. Sam Flanders and Shane Cerone about creating a high-quality hospital management model focused on surviving at 150% of Medicare costs. They discuss the inefficiencies in health systems and practical solutions to improve them without compromising quality. The conversation covers the importance of empowering frontline staff, adopting continuous improvement models like Toyota's, and the critical role of employers in reshaping market dynamics through direct negotiation and price transparency. The episode emphasizes actionable steps for hospital executives, plan sponsors, and employers to drive significant improvements in healthcare efficiency and affordability. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP492 ✉️ 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/ 07:08 What are the many problems that health systems deal with? 08:44 EP483 ( and ) with Jonathan Baran. 09:43 What was the real achievement in building this hospital system? 10:25 EP489 ( and ) with Dan Greenleaf. 10:42 Why productivity and patient access are the top two things to focus on. 11:36 with Mark Cuban and Cora Opsahl. 12:32 with Beau Raymond, MD. 12:58 The lean model versus the Toyota model. 16:06 with John Lee, MD. 16:40 with Benjamin Schwartz, MD, MBA. 17:44 Why small changes accumulated create greater change than big changes. 21:01 How an efficiency mindset can increase improvement faster. 27:42 Why administrators should not be negotiators. 28:11 with Elizabeth Mitchell. 29:06 What are the steps to this multifaceted process? 30:17 with John Rodis, MD, MBA. 30:48 by Suhas Gondi, MD, MBA, on hospital boards. 33:03 Why it’s important to focus on the pricing issue first. 33:49 What Kada Health is all about. /episode/index/show/healthvalue/id/38850570

EP491: Incumbent TPAs and Consultants Getting Called to Jumbo Employer Client HQ to Answer Awkward Questions, With Elizabeth Mitchell 10/30/2025

EP491: Incumbent TPAs and Consultants Getting Called to Jumbo Employer Client HQ to Answer Awkward Questions, With Elizabeth Mitchell In Episode 491, Stacey Richter interviews Elizabeth Mitchell, CEO of the Purchaser's Business Group on Health (PBGH), about the PBGH Transparency Demonstration Project. They discuss the project's aim to provide jumbo self-insured employers with transparency in healthcare costs, quality, and safety data. Collaborating with Milliman and Embold and funded by the Peterson Center on Healthcare, PBGH's project reveals no correlation between higher prices and quality in healthcare services. The episode highlights the impacts on TPAs, consultants, and clinical organizations, and underscores the importance of employers using this new transparency data for strategic advantage and compliance with the Consolidated Appropriations Act. Richter and Mitchell delve into the broader implications for creating high-value networks and fostering market competition based on quality and affordability. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP491 ✉️ 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/ 06:35 How did PBGH’s transparency project start? 07:35 with Julie Selesnick. 07:37 with Chris Deacon. 07:39 Why the changes to the CAA and ERISA meant heightened risk for employers and individuals within companies. 09:09 “You can’t outsource the risk.” 11:10 How PBGH’s transparency project demonstrated some clients being noncompliant. 12:52 Why is it irresponsible not to use the data presented if you’re a self-insured employer? 15:06 How did PBGH use the transparency data and apply it effectively to improve their offerings and business? 18:37 Why TPAs should not negotiate contracts. 19:17 with Cristin Dickerson, MD. 19:22 with Stan Schwartz, MD. 19:24 with Mark Cuban and Cora Opsahl. 20:58 “There is no good price for unsafe care.” 21:36 How PBGH found using the transparency data to be totally feasible. 25:03 with Jonathan Baran. 25:32 Why the market will evolve with this data. 28:04 with Keith Hartman, RPh. 28:06 with Erik Davis and Autumn Yongchu. 28:34 What PBGH discovered about high-value centers and centers of excellence. 28:59 with Olivia Ross. 32:26 Why incentives are another challenge. 33:49 Why this is good news for unconflicted benefits consultants. 36:04 with Kevin Lyons. 39:48 Why transparency is going to become the new normal. 40:22 by Clayton M. Christensen. 42:14 with Elizabeth Mitchell. 44:07 with John Rodis, MD, MBA. 45:22 Why there is a great incentive to be a great clinician right now. 46:18 How this information can motivate competition in the right place. 46:52 with Shane Cerone and Sam Flanders, MD. /episode/index/show/healthvalue/id/38744345

EP490: The Problem Show: 3 Problematic Hospital Myths, Including “There Is a Healthcare Market,” With Shane Cerone and Sam Flanders, MD 10/23/2025

EP490: The Problem Show: 3 Problematic Hospital Myths, Including “There Is a Healthcare Market,” With Shane Cerone and Sam Flanders, MD In this episode of Relentless Health Value, host Stacey Richter speaks with Shane Cerone and Dr. Sam Flanders of Kada Health about three pervasive myths in the healthcare industry. They discuss the belief in a functioning healthcare market, the necessity of high prices for hospital survival, and the notion that reducing prices means lower quality care. Highlighting the inefficiencies and lack of competition in the current system, they address the importance of transparency and competition. This episode sets the stage for a follow-up discussion focusing on tangible solutions and improvements for the healthcare system. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP490-Part1 ✉️ 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/ 09:28 with Vivian Ho, PhD. 09:31 with Stan Schwartz, MD. 09:42 with Mark Cuban and Cora Opsahl. 10:08 Why we need to focus on prices in healthcare. 11:50 The first myth that holds change back: the healthcare “market.” 15:04 with John Rodis, MD, MBA. 15:51 The reality behind why there is no functional market in healthcare. 17:11 Why price simplicity is so important. 19:15 with Eric Bricker, MD. 19:31 How there is pricing failure while hospitals are still facing razor-thin margins. 22:11 The second myth: Can a hospital survive on Medicare rates alone? 25:21 What is the best hospitals can achieve? 26:01 List of recognized as national leaders for care quality and affordability. 29:23 The third myth: When you lower prices, do you get lower quality? 33:11 Why a decentralized approach at improvement is the way to lower cost and raise quality. /episode/index/show/healthvalue/id/38593325

EP489: MARGIN! Margin That Creates a Path to Mission at a Multispecialty Group, With Dan Greenleaf 10/16/2025

EP489: MARGIN! Margin That Creates a Path to Mission at a Multispecialty Group, With Dan Greenleaf In Episode 489 Part 2 of 'Relentlessly Seeking Value,' Stacey Richter continues the series on 'Mission Margin' by focusing on the financial sustainability aspect with guest Dan Greenleaf, CEO of Duly, a multi-specialty group. The episode dives into the balance between maintaining mission-driven healthcare, which includes affordability, accessibility, and quality, and achieving financial margins. Dan discusses practical strategies like reducing network leakage, negotiating effectively with payers, and leveraging technologies to lower operational costs. The conversation also highlights the significance of clinician involvement in leadership and the value of having aligned incentives across the organization. Additionally, the episode addresses the role of capital partners in sustaining such healthcare models and ensuring they are effective and sustainable. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP489-Part2 ✉️ 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/. 09:56 How does Dan achieve his mission given the realities of margin? 14:49 How Duly Health’s approach and incentives differ from other health systems. 16:04 with Vivian Ho, PhD. 16:28 with Scott Conard, MD. 16:31 with Stan Schwartz, MD. 17:27 with Rushika Fernandopulle, MD. 17:29 with Tom X. Lee, MD. 17:30 with Vivek Garg, MD, MBA. 18:50 How having physicians on the hospital board greatly improves margin and mission. 20:04 How Dan explains his approach to his capital partners. 22:23 Fee for service vs. institutional care. /episode/index/show/healthvalue/id/38495365

EP489: Achieving Mission That Is a Path to Margin at a Multispecialty Practice, With Dan Greenleaf 10/09/2025

EP489: Achieving Mission That Is a Path to Margin at a Multispecialty Practice, With Dan Greenleaf In this episode of Relentless Health Value, Stacey Richter talks mission with Dan Greenleaf, CEO of Duly Health and Care. Next week we cover margin. The discussion delves into the crucial balance between mission and margin in healthcare, highlighting how focusing on mission can drive financial stability. The interview centers around four key quadrants of Duly's mission: affordability, access, consumer experience, and quality. Greenleaf emphasizes how these elements are interconnected and essential for providing better healthcare outcomes and financial viability. The episode is part of a series exploring the mission/margin dynamic in the healthcare industry, and sets the stage for a deeper dive into how mission-focused strategies can result in decent margins in next week's episode. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP489-Part1 ✉️ 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/ 08:32 What should mission be in multispecialty? 08:54 Are mission and margin mutually exclusive? 10:47 What are the four “vectors” of Dan’s mission? 11:32 Why does affordability matter? 12:11 with Vivian Ho, PhD. 12:40 with Mark Cuban and Cora Opsahl. 13:32 Who are the three payers in the marketplace? 17:31 with Merrill Goozner. 19:19 How does access play into mission? 20:28 with Al Lewis. 21:07 with Stacey. 22:56 Why price transparency is important to consumer experience. 24:16 LinkedIn from Patrick Moore. 29:06 with Benjamin Schwartz, MD, MBA. /episode/index/show/healthvalue/id/38427920

EP488: Mark Cuban, Cora Opsahl, Trust, Simplicity, and a Chicken—Today We Talk Healthcare 10/02/2025

EP488: Mark Cuban, Cora Opsahl, Trust, Simplicity, and a Chicken—Today We Talk Healthcare Stacey Richter is joined by Mark Cuban, CEO and founder of Mark Cuban Cost Plus Drugs, and Cora Opsahl, Health Fund Director of the 32BJ Health Fund, to discuss pressing issues in American healthcare. The conversation centers on the inefficiencies and complexities created by high deductible health plans and the layers of vendors self-insured employers hire to manage healthcare claims. Mark Cuban and Cora Opsahl advocate for direct contracting and increased transparency as solutions to reduce costs and improve outcomes. They also explore the potential of simplifying the system back to a more straightforward model where healthcare prices are transparent, and patients and providers can establish trust. This episode emphasizes the importance of leadership and a proactive approach in managing healthcare costs. If you are listening to this prior to October 9, 2025, go to the 32BJ Changing the Playbook on Hospital Prices event, where Mark Cuban will be keynoting. Cora Opsahl will also be speaking, and I will be there listening. https://32bjhealthinsights.org/2025-events/ === LINKS === 🔗 Show Notes with all mentioned links: 🔗 Healthcare Industry Acronyms and Terms https://relentlesshealthvalue.com/healthcare-acronymns ✉️ 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/ 06:25 What was the original rationale behind high deductibles? 07:38 How high deductibles are creating a class of functionally uninsured people. 09:29 with Preston Alexander. 10:20 “We’re using health insurance as a proxy for healthcare.” —Mark 12:30 How providers are now in the debt collecting business rather than the healthcare business. 12:55 with Stan Schwartz, MD. 15:16 “We have a fundamental reasonability problem.” —Cora 16:07 with Marshall Allen. 18:25 Direct contracting versus self-funded employers. 19:27 with Elizabeth Mitchell. 19:30 with Kimberly Carleson. 19:33 with Cora Opsahl. 23:53 Why the current system doesn’t allow the accountability that is needed. 24:39 with Cora Opsahl. 26:34 How direct contracting gives strength back to independent practices that high deductible plans take away. 27:46 Who pays, what’s the price, and where does the power lie? 31:24 with Andreas Mang. 34:45 How it comes down to power and leverage when controlling healthcare costs. 38:13 EP483 ( and ) with Jonathan Baran. 38:35 Why putting together a network and just buying healthcare—not discounts—is not as difficult as it seems. 40:10 Why we need to stop talking about disruption and start talking about change. 40:56 with Claire Brockbank. 41:02 with Dave Chase. 43:07 with Cristin Dickerson, MD. 44:32 with Kevin Lyons. 46:34 with Vivian Ho, PhD. 47:40 Why it’s the incentives that are different between American hospitals and hospitals in a single-payer program. 50:25 The main takeaways from the conversation. 51:08 Why you can’t fix the problems in healthcare without transparency. /episode/index/show/healthvalue/id/38331190

EP487 (Part 2): Kevin Lyons Shares What He Learned in Detective Training That He Uses to Follow the Healthcare Dollar 09/25/2025

EP487 (Part 2): Kevin Lyons Shares What He Learned in Detective Training That He Uses to Follow the Healthcare Dollar In episode 487, part two, host Stacey Richter interviews Kevin Lyons, a former police detective and current Executive Director of the New Jersey State Police Benevolence Association about the application of detective skills to analyze healthcare spending. Following a discussion on the barriers driving up healthcare costs in part one, Lyons delves into techniques such as statement analysis and facial recognition to identify deceit and uncover where healthcare dollars are going. Lyons emphasizes the need for preparation, persistent questioning, and the importance of following the money, thereby encouraging a fearless approach to advocating for transparency and better healthcare management. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP487Part2 ✉️ 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/ 00:00 Introduction and Episode Overview 00:25 Recap of Part One: Barriers to Reducing Healthcare Costs 03:01 Introducing Kevin Lyons: Detective Skills in Healthcare 03:52 Detective Techniques Applied to Healthcare 06:41 Challenges and Solutions in Healthcare Transparency 12:15 Final Thoughts and Acknowledgements 13:10 Closing Remarks and Podcast Information /episode/index/show/healthvalue/id/38265065

EP487 (Part 1): A Former Police Detective Investigates the 3 Big Barriers to the Public Sector Getting Better Affordable Health Benefits, With Kevin Lyons 09/18/2025

EP487 (Part 1): A Former Police Detective Investigates the 3 Big Barriers to the Public Sector Getting Better Affordable Health Benefits, With Kevin Lyons In Episode 487 of Relentless Health Value, host Stacey Richter speaks with Kevin Lyons, a former police detective and current executive director at the New Jersey State Police Benevolence Association. They explore, in this two part episode, the significant challenges public sector employees face in obtaining cost-effective health benefits. The discussion highlights key issues, including the influence of industry profit motives, governmental hiring practices, and media sponsorship biases. Lyons shares insights on the rapidly escalating costs of healthcare for state workers, with specific examples from New Jersey, emphasizing the need for innovative solutions and improved legislative action. The conversation sets the stage for a subsequent episode where Lyons will delve deeper into applying detective skills to uncover financial trails and propose effective changes. Tune in next week for part 2 when Kevin talks about how he pulls out his notebook and uses what he learned as a detective to, first of all, figure out everything probably that we just talked about in this part one. But also, you can't solve for something unless you do what most investigators do, which is follow the money. === 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 00:00 Introduction to Episode 487 00:33 Viral Video and Metaphor for Healthcare 04:48 Healthcare Costs and Union Challenges 07:32 Interview with Kevin Lyons Begins 08:17 Why is it important to “dig in” right now on health benefit cost increases? 08:39 Barriers to Affordable Healthcare 10:16 The first barrier to better health benefits: profit defending profit. 10:54 Profit Defense and Political Influence 16:38 Why “throw money at the problem” isn’t a real solution. 18:31 The second barrier: why a lack of employed experts costs more money. 18:59 Government Inefficiencies and Conflicts of Interest 25:58 The third barrier: media sponsorship from incumbents prevents change. 26:19 Media Influence and Public Perception 28:55 EP483 ( and ) with Jonathan Baran. 30:23 Conclusion and Teaser for Part Two /episode/index/show/healthvalue/id/38163415

EP486: The Secrets to Operationalizing Direct Contracting From an OG, With Stan Schwartz, MD 09/11/2025

EP486: The Secrets to Operationalizing Direct Contracting From an OG, With Stan Schwartz, MD In this episode of Relentless Health Value, host Stacey Richter sits down with Dr. Stan Schwartz, co-founder of ZERO.health, to explore the practical realities and benefits of direct contracting in healthcare. Dr. Schwartz shares his journey from traditional healthcare to pioneering bundled payments and direct contracts, offering actionable insights for employers, providers, and anyone interested in making healthcare more affordable and predictable. The conversation covers the challenges of claims, cost variability, operationalizing direct contracts, and the impact on both patients and providers. Discover how employers and providers can use bundled payments to cut costs, simplify administration, and deliver $0 out-of-pocket care for patients. It was an honor to get Dr. Schwartz on the pod, and we are doubly thankful because he stepped up and offered to help support Relentless Health Value financially as well as spending his time with me and you. So, thanks to everyone over at ZERO.health for being part of the kind of folks who support shows like this one. Dr. Stan Schwartz is co-founder over at ZERO.health. ZERO gets members access to high-quality providers for $0 out of pocket, leveraging bundled payments and direct contracting. This episode, as I just said, is sponsored by ZERO.health, with an assist from Aventria Health Group. === LINKS === 🔗 Show Notes with all mentioned links: 🔗 Zero.Health https://zero.health.com ✉️ 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/ 07:59 How did ZERO.health start? 10:38 with Kimberly Carleson. 11:04 Why does the emotional energy behind understanding how the problem of healthcare affects individuals matter in changing healthcare? 12:45 “If you can schedule it, you can put a price on it.” 15:32 with Ge Bai, PhD, CPA. 16:38 with Elizabeth Mitchell. 18:21 How do employers ensure that patients and clinicians are coordinated and on board with direct contracting within their health plans? 20:26 with Peter Hayes. 22:52 Why is it important that this direct contracting system isn’t mandatory for health plan members? 24:50 How does direct contracting affect excessive utilization? 26:41 (Through Line Show) with Stacey. 27:29 Why is it important that your plan benefits benefit health? 29:39 Why is it important to educate not only members but also providers who agree to participate in the program? 31:06 “It’s all about simplicity.” 33:11 How do you ensure plan members use the service after it is installed? Recent past interviews: Click a guest’s name for their latest RHV episode! , , , , , , , , , , , /episode/index/show/healthvalue/id/38084595

Relentless Health Value

TOPICS