Relentless Health Value

In this episode of Relentless Health Value, Stacey Richter engages with Mark Newman, CEO and founder of Nomi Health, in a deep dive into the administrative and transactional inefficiencies plaguing the American healthcare system.

The conversation highlights how plan sponsors often spend more than a dollar to purchase healthcare, yet healthcare providers receive only a fraction of that amount due to data fragmentation and varied accounting practices. Mark Newman reveals two main issues: 'data isn't data' and 'a dollar isn't a dollar,' explaining how inconsistencies and misalignments in data and accounting methods lead to significant waste. <...

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.

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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...

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. T...

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 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...

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.

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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.

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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 PBGH, the Purchaser Business Group on Health, from two weeks ago. That was episode 491.

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...

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...

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.

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...

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.

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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 ep...

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...

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...

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 m...

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 c...

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...

In episode 485, Stacey Richter interviews Dr. Cristin Dickerson on the topic of direct contracting for imaging services. They discuss the high costs of imaging, which can account for 6-11% of a plan sponsor's healthcare spend. The episode covers the potential for significant cost savings and improved patient access through direct contracting, bypassing traditional TPAs that may have conflicts of interest or contractual constraints. 

Dr. Dickerson, who is the founding partner of Green Imaging, explains how her organization has successfully implemented direct contracting, providing affordable and high-quality imaging services nationwide. They also address common barriers such as complexity i...

Exploring TPA and Health Plan Inertia with Elizabeth Mitchell: What Plan Sponsors Need to Know.

In this Take 2 of episode 436 of Relentless Health Value, host Stacey Richter speaks with Elizabeth Mitchell, President and CEO of the Purchaser Business Group on Health, about the challenges third-party administrators (TPAs) face, the issues around hidden fees, and the problems with health plan inertia. 

They discuss how self-insured employers can find reliable TPA partners, the impact of anti-competitive contracts, and the importance of transparency in healthcare procurement. Mitchell emphasizes the need for direct contracting between employers and providers to r...

In Episode 484 of Relentless Health Value, host Stacey Richter talks with Dave Chase from Health Rosetta about the three most pressing questions faced by self-insured employers today.

The discussion covers how to verify if a benefits advisor truly protects employer interests, avoiding personal liability when third-party administrator contracts have hidden conflicts, and identifying if employers are being systematically overcharged on pharmacy costs despite PBM guarantees.

The episode emphasizes the importance of accessing comprehensive data to identify conflicts and transparency in reporting, and it highlights open source resources available to create high-performance health plans. The conversation...

In the second part of this conversation with Jonathan Baran, CEO of Self Fund Health, the focus is on reversing the negative cycle of skyrocketing healthcare costs by shifting from buying discounts to investing in primary care and better benefit designs.

The discussion highlights the current issues with the healthcare flywheel, driven by employers buying discounts, and offers solutions such as investing in direct primary care, incentivizing proper healthcare utilization, and improving patient navigation.

The conversation also explores the potential for direct contracting between employers and health systems, aiming for a paradigm shift where employers...

In this episode Stacey Richter speaks with Jonathan Baran, CEO of Self Fund Health in a detailed exploration of what they term the 'Flywheel Downward Spiral' of American healthcare costs. The conversation delves into how electronic health records (EHR) and the incentives driving insurers, brokers, and hospital systems contribute to consistently rising healthcare premiums. 

Key points include how insurers profit from high premiums, the misleading marketing focus on discounts rather than actual costs, and the role of EHR systems in maximizing hospital profits rather than improving patient care. The episode sets the stage for a subsequent discussion o...

In this bonus clip from Episode 483 of Relentless Health Value, host Stacey Richter discusses the efforts of individuals working within large healthcare organizations to improve patient outcomes despite systemic challenges. 

Guest Jonathan Baran, co-founder and CEO of Self Fund Health, highlights how incentives within the healthcare system drive behaviors that often conflict with patient and member interests. 

The discussion emphasizes the importance of not generalizing the intentions of all employees based on organizational actions and encourages a deeper understanding of underlying incentive structures to foster meaningful changes. 

Self Fund Health, I am so ple...

In this episode, Stacey Richter talks with Dr. Stan Schwartz, co-founder of ZERO.health about the tension between mission-driven healthcare and financial incentives within the healthcare system. Highlighting examples like the Comprehensive Primary Care Initiative and other advanced primary care efforts, Schwartz shares insights on how health system economics, particularly the reliance on emergency room admissions, often undermine initiatives aimed at reducing costs and improving patient outcomes.

The discussion delves into the role of employer-sponsored health plans as potential change agents in the healthcare system, given their significant influence over commercially insured patients, who are highly attractive...

In this episode, Stacey Richter discusses 'Three Surprising Ways Carriers Make Lots of Money' with Preston Alexander. The episode highlights how carriers leverage financial strategies—like using premium dollars as float, intracompany eliminations, and upcoding in Medicare Advantage—to enhance their profits. 

The discussion emphasizes the importance for plan sponsors and policymakers to understand these tactics to better manage healthcare costs. Alexander advises collaborating with unbiased consultants who are experts in health plan design to navigate these complex financial dynamics effectively.

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✉️  Enjo...

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 te...

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.

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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...

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 co...

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 t...

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 th...

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 t...

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...

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 s...

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.

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.

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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...

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...

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...

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.

...

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...

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 avoi...

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.

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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 de...

In part 1 of this two part episode, Stacey Richter speaks with James Gelfand, President and CEO of the ERISA Industry Committee (ERIC), about the potential effects of proposed Medicaid cuts on plan sponsors and their members. 

They explore ways plan sponsors can prepare for the changes, including Medicaid's four major areas of possible cuts: reducing waste, fraud, and abuse; implementing work requirements; reeling in provider taxes; and addressing the 'Cornhusker Kickback' from the ACA. 

The conversation also delves into how state governments and hospitals might respond to these cuts and suggests actions for plan sponsors to...

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 ef...

In this solo episode of 'Relentless Health Value,' host Stacey Richter dives into the intricate relationship between increased emergency room (ER) visits and the lack of access to effective primary care. Discussing insights from recent episodes featuring experts like Matt McQuide, Dr. Christine Hale, and others, Stacey explores how inadequate primary care leads to skyrocketing ER costs, which now account for 6% of total healthcare spending.

Key points include the systemic issues driving this trend, the incentives misalignments within hospitals and insurance carriers, and the importance of establishing trust and relationships in primary care. The episode also...

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.

Dr. Ho shares data-backed insights on hospital consolidation, executive incentives, and how health system pricing impacts self-insured employers and plan...

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...

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 ca...

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...

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 p...

This podcast today is with Dr. Scott Conard, founder of Converging Health. You might remember him from the earlier episode (EP391). 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...

In this inbetweenisode Stacey Richter dives into the complexities of benefit design in American healthcare. Highlighting insights from recent episodes with Bill Sarraille (EP459) 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 c...

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 this Relentless Health Value episode, Dr. Rushika Fernandopulle discusses with Stacey Richter his four-prong theory of change for transforming the American healthcare system. Key topics include the necessity of new payment models, process innovation, employing a relational technology infrastructure, shifting the cultural mindset towards team-based care, and emphasizing the importance of long-term partnerships. The conversation underscores the urgent need to move away from the current status quo to ensure better health outcomes and affordable care for all Americans.

This is one of those episodes where we consider top-line strategic imperatives and key drivers. There was no...

In Episode 459, host Stacey Richter speaks with healthcare attorney Bill Sarraille about co-pay maximizers and accumulators, mechanisms designed to extract maximum co-pay support dollars from pharmaceutical companies.

They discuss the financial implications for patients, plan sponsors, and pharmacy benefit managers (PBMs), emphasizing the legal and ethical issues and potential patient harm due to high out-of-pocket costs and surprise expenses.

Sarraille provides five key pieces of advice for plan sponsors and highlights the importance of transparency and proper utilization management to minimize patient access problems and legal risks. Listen or read the show notes on our...

In this Inbetweenisode titled 'End of Year Wrap Up and My Personal Charter Encore,' Stacey Richter extends heartfelt thanks to listeners and healthcare workers for their dedication. 

She reflects on the challenges of maintaining personal integrity in a profit-driven healthcare system and introduces her personal charter. This charter, focused on ensuring net positive outcomes for patients, acknowledges that achieving transformational change in healthcare requires a collective effort. 

Stacey discusses the complexities of balancing ethical decisions, financial constraints, and the broader impact on patient care, urging others to reflect on their own guiding principles.

...

Are you on the board of directors of a company? Or are you a shareholder of a publicly traded company? Or are you a CEO or a CFO or in-house counsel who reports to a board of directors or these shareholders? Well, this show is for you.

And it's about how the healthcare industry has become financialized at the same time that providing health benefits has become the second-biggest line item after payroll for most companies. We talked about that in a recent encore with Mark Cuban (EP418) also, as well as the show with Cora Opsahl...

In Episode 458 of Relentless Health Value, host Stacey Richter speaks with Dr. Komal Bajaj about innovative strategies for addressing staffing shortages in the healthcare sector. They explore the importance of cultural alignment within organizations, emphasizing trust and shared values to retain staff.

Dr. Bajaj shares surprising findings from surveys indicating that healthcare workers are motivated by the goal of providing high-quality, planet-friendly care. The discussion highlights the interconnectedness of environmental sustainability and healthcare quality, presenting tangible ways to engage and empower healthcare workers while addressing both local community health and broader environmental concerns.

The episode...

In this episode of 'Relentlessly Seeking Value,' host Stacey Richter is joined by healthcare entrepreneur Cynthia Fisher to discuss the crucial issue of medical spread pricing and the need for contract transparency.

Fisher explains how hidden fees and spread pricing by middlemen are leading to substantial overcharges for employers and patients in the U.S. healthcare system. The conversation delves into recent lawsuits that highlight these practices, the legislative strides made to enforce price transparency, and how transparency can potentially transform the industry.

Look, this is a thing now, medical spread. And similar to...

In this special Thanksgiving episode of Relentlessly Seeking Value, Stacey Richter discusses the significance of being 'givers' in healthcare, advocating for collaboration over transactional relationships to deliver real value to patients.

She touches on the challenges and necessary shifts in healthcare market dynamics, emphasizing that true value is determined through bi-directional conversations between providers and end-users, like patients and plan sponsors. Stacey concludes with a call to action for listeners to reflect on their support networks and consider supporting valuable media and publications.

I want to drop a thank you right here to those who...

In this encore episode, Mark Cuban discusses his insights and experiences on disrupting the healthcare and pharmacy benefits landscape with Stacey Richter. This show from last year was one of the most popular episodes of the past year. And it's also extremely relevant right now, given all of the PBM (pharmacy benefit manager) goings-on, as well as ongoing litigation like the J&J lawsuit, etc. Listen to the show with Julie Selesnick (EP428) for more on that one.

Joined by Ferrin Williams from Scripta, Cuban stresses the importance for CEOs and CFOs of self-insured companies to get...

In this episode, Stacey Richter speaks with Rob Andrews, CEO of the Health Transformation Alliance (HTA) and former Congressman, about the strategic steps jumbo employers can take to achieve improved health outcomes while reducing cost. They delve into the importance of using data to discern effective practices, negotiate contracts, and hold intermediaries accountable.

The discussion highlights maternal health as a critical area of focus, with successful interventions shown to reduce NICU admissions and overall healthcare costs. Andrews emphasizes the role of self-insured employers in driving systemic changes that align financial incentives with health outcomes.

This...

In this comprehensive episode host Stacey Richter sits down with Brian Reid to discuss pivotal aspects for the pharmaceutical industry. Key topics include understanding product value from the perspectives of plan sponsors, patients, and society, and the significance of benefit design in improving patient affordability.

The discussion delves into the complexities of drug pricing, the roles of Pharmacy Benefit Managers (PBMs) and brokers, and the impact of healthcare consolidation on costs. Reid emphasizes the importance of transparent communication among stakeholders, the detrimental effects of cost containment strategies, and the necessity of considering policy and reputational impacts.

In this conversation, Stacey Richter engages with healthcare leader Dr. Beau Raymond from Ochsner Health Network to explore the blueprint for better patient care through enlightened leadership, data-driven strategies, and localized health initiatives. 

The discussion covers shifting from 'sick care' to preventative healthcare, integrating technology and data tools like glucometers for health coaching, and addressing health equity through accurate data and regional strategies.

The conversation explains the importance of stakeholder engagement, setting clear goals, financial incentives aligned with patient care, and continuous improvement through feedback loops. Practical steps such as weekly huddles for primary care t...

In this episode, host Stacey Richter and guest Brendan Keeler dive deep into the significant legal clash between Epic and Particle over electronic health record (EHR) data access and market competition.

This episode examines the broader repercussions on healthcare data exchange, including antitrust concerns, data liquidity, and the ethical considerations around secondary use of treatment data. The discussion brings to light how the outcome of such lawsuits could influence data transparency, interoperability, and the rules governing data sharing among plan sponsors, employers, and healthcare providers.

Notable points include the shift to a judicial era impacting...

In this episode, host Stacey Richter delves into the complexities of the Third Party Administrator (TPA) Request for Proposal (RFP) process with guest Claire Brockbank from 32BJUnion.

The discussion highlights the critical role of contracts in managing health plans effectively and the potential pitfalls of accepting contracts crafted by TPAs without thorough review. Drawing from Claire's experience, they explore tactics like starting with your own contract paper in RFP processes to gain negotiation leverage, and the benefits of employer coalitions in navigating health care complexities.

Real-world examples underscore the financial impacts of poorly negotiated contracts...

In this episode I interview Cora Opsahl from the 32BJ Health Fund to examine the intricate dynamics between fiduciary duties and the entrenched status quo in healthcare. The discussion focuses on the challenges employers face when dealing with anti-competitive contracts and their responsibility to ensure plan expenses are reasonable. Cora Opsahl, my guest today, is the director of the 32BJ Health Fund, serving over 200,000 folks. Their ability to kick NewYork-Presbyterian, a big, consolidated, very expensive hospital, out of their network in 2018 enabled them to offer maternity benefits for $40 in total out-of-pocket for members. And also, employees got their biggest raise...

In this Spotlight Episode host Stacey Richter discusses the management of oncology side effects with Dan Nardi, CEO of Reimagine Care. Highlighting the challenges cancer patients face, especially following chemotherapy which often leads to nausea and readmissions, the conversation delves into how Reimagine Care facilitates at-home integrative cancer care.   Their services focus on proactive and reactive support via AI-driven tools like 'Remy' to assist patients outside of clinical environments. This approach aims to reduce emergency visits and improve patient outcomes while easing the workload on healthcare providers. The discussion underscores the role of patient reported outcomes and the integration of t...

In Episode 451 of Relentless Health Value, host Stacey Richter converses with Dr. Spencer Dorn about the implications of AI in healthcare, referencing lessons learned from EHR implementations.

They discuss Kranzberg's first law of technology, which advises against labeling a technology as inherently good, bad, or neutral, emphasizing instead the importance of its application, configuration, and the human decisions surrounding its use. Dorn and Richter explore both the potential benefits and drawbacks of AI, drawing parallels with past experiences in healthcare digitization.

The first takeaway from this short show focused on artificial intelligence is gonna be...

In Episode 450 I speak with Marilyn Bartlett, a renowned CPA in the healthcare field, about her remarkable achievement of transforming the state of Montana's employee health plan from $9 million in debt to a surplus of $112 million within three years.

Marilyn discusses the steps she took, including identifying financial inefficiencies, targeting high-cost areas, and implementing data-driven strategies to produce quick wins and sustainable results. The conversation delves into the importance of having the right team, communicating effectively with stakeholders, and staying focused amidst challenges. Listeners will gain valuable insights into strategic change management and actionable advice for improving...

So, I had a chance to read Dr. Marty Makary's new book, which is called Blind Spots; and here's why I wanted to get him to come back on Relentless Health Value and talk to you, people of the healthcare industry. It's because of something that he said on page 127 and which I've been mulling over for probably years, actually.

It's this idea of what is appropriate care and how good are we at ensuring that patients/members get said appropriate care. Lots of people are of the same minds because appropriate care has come up in...

Maybe you've already caught Part 1 of my conversation with Shawn Gremminger, and if so, you're ahead of the game. But if not, no worries—here's the deal: I decided to split this deep dive into the 340B program with Shawn into two parts. So, feel free to jump into one or both—it's totally up to you.

These episodes don't have to be listened to in order, so you're good to start here with Part 2. Let's get into it!"

Right now, we are going to talk about how 340B impacts employers and commercial plans and othe...

So, after some pondering, I decided to release this conversation with Shawn Gremminger about 340B in two parts. So, listen to one, listen to both, pick your poison. Shawn Gremminger came up with three really important takeaways relative to 340B, which is a feat unto itself, considering how sprawling this conversation can be. So, if you came here for some concise and actionable takeaways, you have come to the right place.

This first part you are listening to right now zeros in on Shawn's first takeaway: whether or not the original intent, or the presumed original intent...

In this Summer Short Episode of Relentlessly Seeking Value, host Stacey Richter discusses the hidden costs and inefficiencies of value-based care with Elizabeth Mitchell, President and CEO of the Purchaser Business Group on Health (PBGH).

They uncover how value-based care, often touted as the ideal system, can be manipulated by middlemen to extract more money from plan sponsors without delivering real value to patients.

Through a critical conversation involving examples and insights from various experts, they explore the disconnect between financial incentives and actual care quality in American healthcare.

Elizabeth argues for for-real...

My conversation today is with Will Shrank, MD. Dr. Shrank led the evaluation group at CMMI (Center for Medicare and Medicaid Innovation). He has spent time in the private sector, first at CVS Health and UPMC (University of Pittsburgh Medical Center) as chief medical officer of the health plan in Pittsburgh, and then as the chief medical officer for Humana. Now he is a venture partner at Andreessen Horowitz and doing some consulting for CMMI.

We start out this conversation talking about waste in healthcare. In fact, Dr. Shrank was on a team who did a study...

In this encore episode, host Stacey Richter speaks with Dr. Amy Scanlon, Chief Medical Officer of the Clinically Integrated Network, a joint venture between Intermountain Health and UC Health in Colorado.

They discuss the complexities of transitioning to value-based care, including the need for infrastructure, data, technology, and team collaboration. Dr. Scanlon emphasizes the importance of listening to practices, fostering medical culture change, and addressing the powerful influence of fee-for-service incentives. They also explore the necessity of strong interpersonal relationships and the critical role of leaders in facilitating effective care integration. Despite the challenges, Dr. Scanlon offers...

In Episode 447, Stacey Richter interviews Ashleigh Gunter, president of Translucent Healthcare Consulting, to discuss the indispensable role of change management in healthcare transformation. They emphasize that creating an effective change strategy involves great leadership, a clear case for change, influential change champions, over-communication, and continuous measurement and celebration of successes.

The conversation highlights the importance of understanding and aligning with the 'why' that drives healthcare professionals and the necessity of a multi-faceted approach beyond just implementing technological solutions like EHR systems.

Before we kick in to the show today, let me remind you, if you...

In Episode 446, "Hey, Let's Not Talk About EHRs," host Stacey Richter engages Dr. Spencer Dorn, vice chair and professor of medicine at the University of North Carolina, in a comprehensive discussion about the implications of healthcare technology, specifically electronic health records (EHRs). 

The conversation emphasizes the necessity of understanding technology as a tool that neither possesses inherent goodness nor badness but delivers results based on its implementation and usage.

They discuss the paradoxical nature of technology in healthcare, highlighting how EHR systems can simultaneously empower and overwhelm healthcare practitioners.

Dr. Dorn and Stacey d...

I wanted to talk with Dr. Lee because so many RHV (Relentless Health Value) listeners are trying to figure out how to sustain primary care as a stand-alone entity when the most obvious and most common way to make enough money in primary care is to drive and maximize the dollars from downstream volume of high-priced service lines, which, if you think about it, undermines the entire point of primary care.

In Episode 445 of Relentless Health Value, Stacey Richter interviews Dr. Tom Lee, founder of One Medical and Galileo, about the sustainability of standalone primary care practices...

In this encore episode of 'Relentlessly Seeking Value,' host Stacey Richter revisits a critically important conversation with ERISA attorney Paul Holmes about the complexities and hidden pitfalls in Pharmacy Benefit Manager (PBM) contracts.

Aimed at CFOs and employer plan sponsors, Holmes highlights how poorly reviewed PBM contracts can lead to companies paying 30-40% over market for pharmacy benefits, discusses the potential legal exposures under the Consolidated Appropriations Act (CAA), and suggests the essential need for independent reviews.

Holmes also delves into issues with Employee Benefit Consultants (EBCs) taking indirect compensation from PBMs and offers...

In Episode 444 of Relentless Health Value, Stacey Richter speaks with healthcare consultant Ann Kempski about two state healthcare laws with unintended consequences: the Certificate of Need (CON) and the Certificate of Public Advantage (COPA) laws. They delve into the original intentions behind these laws, the ways in which they have often failed, and their impact on the competitive landscape.

The discussion also explores how CON laws have led to increased costs and market consolidation, while COPA laws have allowed potentially monopolistic mergers under state oversight. The episode sheds light on complex regulatory terrain and highlights the importance...

Episode 443 of Relentless Health Value pays tribute to the late Marshall Allen, an investigative journalist dedicated to exposing injustices within the American healthcare system. Hosted by Stacey Richter, the episode features Dave Chase, founder of Health Rosetta, who shares memories and insights into Marshall's tireless work in investigative reporting.

The episode highlights Marshall's impact on healthcare legislation, his significant contributions to ProPublica, and his book 'Never Pay the First Bill,' which empowers patients and employers to fight back against corrupt billing practices.

The episode also includes an earlier interview with Marshall, focusing on his...

In Episode 442 of 'Relentless Health Value,' host Stacey Richter shares an intriguing outtake from a previous episode featuring Andreas Mang, senior managing director at Blackstone, discussing the critical issue of cost management in oncology side effect treatment.

The conversation delves into the inefficiencies and patient harms caused by inadequate side effect management, particularly dehydration due to chemotherapy, and the resulting financial burdens on employers, taxpayers, and patients. 

Stacey explores the importance of a value-based mindset in drug purchasing, integrating oncology care, and the potential financial and health benefits of better side effect management. She h...

In this episode, Abby Burns from Radio Advisory interviews Stacey Richter, host of the Relentless Health Value podcast, during the Raising the Bar Value Summit. They discuss the complexities of defining and creating value in healthcare, focusing on the roles of various stakeholders including patients, providers, and payers.

Stacey shares insights on the challenges and tensions in the healthcare system, such as the fragmentation of care, financial toxicity, and the cultural norms that inhibit progress. The conversation also highlights practical examples and potential strategies to drive value and sustain positive changes within the industry.

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In Episode 440 of 'Relentless Health Value,' host Stacey Richter engages with David Muhlestein to explore the optimal size for a medical practice, concluding that 10 to 20 physicians supported by a capable team provide the best balance of economies of scale and community integration. The conversation transitions into the challenges large healthcare systems face, particularly the Diversification Discount.

This diversification often impedes patient care and operational efficiency by misaligning values with business practices. The episode delves into the paradox of optimizing primary care while still supporting specialty care, reflecting on how organizational values impact healthcare outcomes. Muhlestein suggests...

In Episode 439 of 'Relentlessly Seeking Value,' host Stacey Richter discusses the convoluted issues surrounding generic drug pricing with pharmacy consultant Luke Slindee.

They delve into the ways traditional Pharmacy Benefit Managers (PBMs) exploit the system to make immense profits, often leading patients to pay more even with insurance. The conversation explores various solutions, such as the removal of "Usual and Customary Prices" from PBM contracts, the advantages of bypassing insurance, and giving patients direct payment tools like health savings accounts.

Luke Slindee, with his extensive background in pharmacy and consulting, provides valuable insights into...

In this episode of Relentless Health Value we dive into the concept of Cognitive Dissonance in the healthcare industry with Dr. John Lee, an ER physician and chief medical information officer. We explore how healthcare professionals navigate the conflict between their beliefs and actions, especially in large healthcare organizations. Dr. Lee shares practical advice on celebrating small wins, incremental improvements, and fostering a supportive culture among colleagues.

This conversation sheds light on the challenges and solutions for those striving to deliver better patient care despite systemic obstacles. 

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The Unseen Influence of the RUC on Healthcare

This episode of 'Relentless Health Value' features a discussion with Brian Klepper, a healthcare analyst and former CEO of the National Business Coalition on Health, about the powerful yet obscure RUC (RBRVS Update Committee) and its significant impact on the economics of primary care and the broader healthcare system. The RUC, a committee within the American Medical Association, plays a critical role in determining the relative value of medical procedures, which directly influences Medicare payments.

The episode reveals how the RUC's composition—dominated by specialists over primary ca...

In this episode of Relentless Health Value we follow up on the topic of employer inertia discussed with Lauren Vela in episode 406, turning our focus to third-party administrators (TPAs), administrative services only (ASOs), and health plans.

Elizabeth Mitchell from the Purchaser Business Group on Health (PBGH) joins us to discuss the roles of TPAs and ASOs, highlighting the gap in the market for independent, efficient TPAs not owned by health plans. We also delve into the trend of direct contracting between employers and providers to enhance access, quality, and outcomes.

Bottom line, right now, there's...

Stacey Richter speaks with David Scheinker, PhD, to explore practical strategies for halving the administrative burden in healthcare. The discussion delves into the significant costs of healthcare transactions, the inefficiencies within the system, and actionable steps to reduce these costs. Key highlights include the potential of standardizing healthcare contracts, the role of telemedicine in building efficient systems, and the importance of competitive pressure in driving sector-wide improvements. 

The episode emphasizes real-world examples and research-backed recommendations to illustrate the financial and operational benefits of reducing administrative waste in the healthcare industry.

If you'd like to read t...

Optimizing Pharmacy Benefits in Value-Based Care: A Conversation with Dan Mendelson

In Episode 435 of 'Relentless Health Value,' Stacey Richter hosts Dan Mendelson from Morgan Health to discuss the importance of integrating pharmacy benefits into the broader context of value-based care. The conversation stems from a LinkedIn post by Mendelson outlining five key considerations for optimizing pharmacy benefits.

Topics include the total cost of care, the need for value-based decision-making in pharmacy benefits, the integration of clinical teams in formulary development, and the critical role of patient engagement. The episode also explores how employers can...

In Episode 434 of 'Relentless Health Value,' host Stacey Richter interviews Dr. Ben Schwartz, an orthopedic surgeon and prolific writer, about bundled payments in the healthcare industry. The discussion focuses on four key surprises related to bundled payments: the all-encompassing nature of the 90-day post-surgery cost coverage; the reluctance of commercial payers to engage with bundled payment models; the shifting dynamics towards more integrated care between primary care physicians and specialists; and the complex realities of Centers of Excellence (COE) programs.

The episode also highlights lessons learned from existing bundled payment models and potential future directions for...

Episode 433 of Relentless Health Value dives into the complexities of weekly claims wires that self-funded employers receive. Host Stacey Richter speaks with Justin Leader about the hidden fees embedded in these claims, including shared savings fees, prior authorization fees, prepayment integrity fees, pay and chase fees, and TPA claims review fees.

Learn how these undisclosed charges impact plan sponsors and why transparency is crucial for fiduciary responsibility. This episode is a must-listen for plan sponsors, HR executives, and healthcare entrepreneurs seeking to understand and manage their healthcare costs better.

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In this encore episode, Stacey Richter discusses the challenges and opportunities in primary care transformation with Dr. Scott Conard. The conversation explores the conflict between mission-driven healthcare and profitability, drawing from Dr. Conard's personal and professional experiences.

Key topics include advanced primary care models, perverse incentives in the healthcare system, the impact of large health systems on local communities, and the complex dynamics of healthcare management. The episode illustrates the importance of leadership, systemic change, and balancing patient care with business imperatives.

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https://cc-lnk.com/Encore391

In this encore episode of Relentless Health Value, host Stacey Richter delves into a crucial yet often ignored aspect of patient engagement and clinical success with Jerry Durham from the Client Experience Company. The discussion emphasizes how the front desk can significantly influence positive patient outcomes and mitigate clinician burnout.

Jerry outlines the 'patient life cycle' and the vital role of the front desk in establishing trust and setting up provider success. Highlighting real-world examples and research, the conversation explores how proper front desk management can enhance patient satisfaction, retain patients, and contribute to the overall efficiency...

In Episode 432 of 'Relentlessly Seeking Value,' host Stacey Richter discusses with behavioral epidemiologist and digital health entrepreneur Kate Wolin about the challenges and opportunities in merging clinical care with efficient business practices.

They explore the pitfalls of scaling healthcare services while maintaining patient outcomes and why human-centered approaches are vital. They stress the importance of aligning investors, founders, and clinical leaders, measuring meaningful outcomes, and fostering a mission-driven culture to ensure both financial sustainability and high-quality patient care. The episode also highlights relevant episodes and resources for further exploration.

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