Relentless Health Value

Uncovering the Economics of Paying Cash for Generic Drugs with Ge Bai To read the full article and show notes with links mentioned as well as a full transcript, click here. In this episode, Stacey Richter talks with Dr. Ge Bai, a professor at Johns Hopkins, about the rationale and financial implications of paying cash for generic drugs instead of using insurance. The discussion highlights the inherent inefficiencies and high administrative costs associated with PBMs (Pharmacy Benefit Managers) and insurance systems when it comes to low-cost generics. Key insights from studies are discussed, revealing that for a significant portion of generics, paying cash is often cheaper than using insurance. The conversation also explores alternative solutions such as Health Savings Accounts (HSAs) and the role of policy and market dynamics in improving drug affordability. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned lin

The Financialization of Health Benefits: A Boardroom Imperative To read the full article and show notes with links mentioned as well as a full transcript, click here. In episode 419 of Relentless Health Value, Stacey Richter interviews Andreas Mang from Blackstone on the financialization of healthcare benefits for corporate boards and C-suite executives. The discussion highlights the transformation of healthcare benefits into a significant business aspect, emphasizing the importance of C-suite involvement to combat waste and financial exploitation by vendors. Andreas offers practical steps to save companies up to 10% on healthcare costs while improving employee satisfaction, including self-insurance and careful selection of brokers. The episode underscores the need for enhanced purchasing discipline and strategic alignment among company leadership to manage healthcare expenses effectively. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episod

Encore: Achieving Customer-Centric Transformation in Large Organizations with Karen Root To read the full article and show notes with links mentioned as well as a full transcript, click here. In this encore episode of 'Relentless Health Value', host Stacey Richter speaks with Karen Root, Director of Experience Strategy at BI, about achieving customer-centric transformation and innovation in large organizations. The discussion highlights the importance of change management, systems thinking, and effective leadership with a compelling vision. Key steps include identifying quick wins, leveraging influencer support, storytelling, and focusing on emotional 'moments that matter'. The conversation also delves into the J-curve, emphasizing the necessity for leaders to sustain hope and overcome the initial challenges during the transformation process. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcr

Episode 418: Mark Cuban’s Insights on Reducing Healthcare Costs for Self-Insured Employers To read the full article and show notes with links mentioned as well as a full transcript, click here. In Episode 418 of Relentless Health Value, Mark Cuban, CEO and founder of Mark Cuban Cost Plus Drugs, joins host Stacey Richter, and guest Farron Williams, Chief Pharmacy Officer at Scripta, to provide critical advice for CEOs and CFOs of self-insured employers. The podcast delves into the financial intricacies of the healthcare industry in 2023, emphasizing the importance of direct involvement by company executives in managing healthcare benefits to save substantial costs. Cuban discusses how his company saves money on drug costs through transparency and direct purchasing from manufacturers, offering actionable steps for businesses to replicate these savings. The episode also highlights partnerships, like the one between Scripta and Mark Cuban Cost Plus Drugs, and discusses strategies for simplifying the healthcare be

5 Strategies for Self-Insured Employers to Enhance Employee Health To read the full article and show notes with links mentioned as well as a full transcript, click here. In this encore episode of Relentless Health Value, host Stacey Richter revisits her discussion with Dan Mendelson, CEO of Morgan Health at JPMorgan Chase. They delve into five pivotal actions self-insured employers can take to improve employee health significantly. These actions include expanding accountable care models, investing in data access for health outcomes, aligning health benefits with population health outcomes, prioritizing adaptable care models, and making care navigation central to benefit packages. The episode underscores the critical role of employer engagement in advancing healthcare quality, affordability, and equity within local markets. Mendelson also shares insights into Morgan Health's current initiatives, such as their new accountable care framework in Columbus, and emphasizes the importance of local provider partnershi

Exploring Effective Payer-Provider Collaborations: Insights and Key Strategies To read the full article and show notes with links mentioned as well as a full transcript, click here. In episode 417 of Relentless Health Value, Stacey Richter engages in a detailed discussion with Josh Berlin from Rule of Three consulting firm about the dynamics and strategies behind successful provider and payer collaborations in the healthcare industry. They delve into the historically adversarial relationship between these entities and explore five distinct types of collaborations, ranging from data sharing to risk-bearing partnerships. Berlin outlines five crucial 'must-haves' for these collaborations to succeed, including scalability, sustainability, flexibility, effective collaboration, and compatible risk profiles. They further examine real-world examples of both successful and failed healthcare collaborations, emphasizing the importance of mutual goals and adaptive strategies to enhance patient outcomes and improve market

Now, I’m being pretty careful here because med schools are super sensitive about their curriculums. And I am sensitive to the fact there’s much to teach in four years. So, throwing no shade here, what do I know from the Krebs cycle? Choices of what to teach are tough. With that disclaimer, in this healthcare podcast I am speaking with Adam Brown MD, MBA, about an article he wrote entitled “Dear Medical Schools, Educate Students on the Business of Medicine—Without it, you are doing your students a disservice.” Let me give you Dr. Brown’s list for the “why teach the business of medicine.” He says: 1. The role of physicians in medicine has changed, and we dig into this in the episode. 2. There’s an expectation mismatch. Docs are investing 10 years and, on average, $200K to $300K in real dollars to get that MD or DO. You don’t want those new physicians quitting on the quick because the reality is so different from what they thought it would be. Not being up front about the business of medicine is like hiding the

Improving Healthcare Outcomes and Reducing Costs: Insights from Rob Andrews of HTA To read the full article and show notes with links mentioned as well as a full transcript, click here. In Episode 415, Stacey Richter speaks with Rob Andrews, CEO of the Health Transformation Alliance (HTA), about how jumbo employers are achieving better healthcare outcomes while saving on total care costs. The discussion highlights the significant positive impact of targeted healthcare strategies on reducing readmissions and overall costs, particularly related to maternal health. Andrews elucidates how addressing root causes, negotiating data-driven contracts, and holding intermediaries accountable can create win-win scenarios for both employers and employees. The episode underscores the importance of using data to drive healthcare improvements and the role of self-insured employers in transforming healthcare delivery. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the l

Delivering Better Care and Getting Paid: A Value-Based Healthcare Guide with Justina Lehman To read the full article and show notes with links mentioned as well as a full transcript, click here. In Episode 414 of 'Relentless Health Value,' host Stacey Richter interviews Justina Lehman to explore practical strategies for healthcare practices to provide coordinated, high-value care while achieving financial growth. The discussion covers the detailed steps for developing and implementing value-based care models, including assembling a committed team, defining ideal care pathways, navigating payer relationships, and engaging with self-insured employers. Lehman emphasizes the importance of close collaboration between physicians, clinicians, and payers to enhance patient outcomes and reduce costs. The episode provides actionable insights for healthcare professionals aiming to transition from fee-for-service to value-based care. Love the show? Please consider signing up for our weekly newsletter. We'll send you an a

Reducing Healthcare Waste: Aligning Incentives and Empowering Primary Care Physicians To read the full article and show notes with links mentioned as well as a full transcript, click here. In Episode 413 of 'Relentless Health Value,' Stacey Richter interviews Dr. Will Schrank on the intersection of healthcare waste, value-based care, and the rising influence of primary care physicians (PCPs). Dr. Schrank's extensive background includes roles at CMMI, CVS Health, UPMC, and Humana, and he is currently a venture partner at Andreessen Horowitz. The discussion delves into a study estimating nearly a trillion dollars of annual waste in U.S. healthcare, categorized into administrative failures (fraud, complexity, pricing) and clinical failures (care coordination, delivery, low-value care). Solutions like aligning financial incentives with higher quality care and primary care-driven models are explored. The episode also highlights challenges in shifting away from fee-for-service models, the potential evolving power o

The following episode covers my intro to the episode and thoughts on the topic of new innovations used in hospitals as part of procedure including bloodstream infections and dialysis. Oh, hey, some unexpected news. This interview is unavailable at this time. One of these days we may be able to make it available, and if so, this will be announced in our weekly email. So please subscribe by going over to our website at RelentlessHealthValue.com. The episode emphasizes the remarkable progress made by the Relentless Tribe in improving outcomes for chronic kidney disease (CKD) patients and highlights the obstacles hospitals face in adopting expensive new technologies under the DRG payment model. The discussion also covers the significant impact of hospital-acquired infections, particularly those leading to sepsis, and explores the role of Medicare's NTAP (new technology add-on payment) in incentivizing the use of innovative treatments. The episode underscores the complex balance between cost and patient outcomes i

The Reality of Closing Care Gaps: A Conversation with Dr. Carly Eckert To read the full article and show notes with links mentioned as well as a full transcript, click here. In this encore episode titled 'The Gap In Closing Care Gaps,' host Stacey Richter interviews Dr. Carly Eckert, exploring the pervasive issue of care gaps in the U.S. healthcare system.  Care gaps arise from fragmented medical transitions and tend to recurred if root societal causes are left unaddressed. The conversation reveals the shortcomings of reactive care gap mitigation strategies, likening them to a futile game of 'whack-a-mole.' Dr. Eckert highlights the importance of proactive solutions, such as population health models and community-based interventions. The podcast emphasizes the need for a systemic shift towards holistic and continuous patient care, integrating social determinants of health and enhancing provider-patient relationships. Love the show? Please consider signing up for our weekly newsletter. We'll send you an articl

Leadership in Modern Medicine: Balancing Art and Science with Dr. Robert Pearl To read the full article and show notes with links mentioned as well as a full transcript, click here. In Episode 412 of 'Relentless Health Value,' Stacey Richter interviews Dr. Robert Pearl, former CEO of Kaiser Permanente, to discuss the evolution and current state of leadership in medicine. The conversation explores the balance between the art and science of medicine, touching on how advancements in technology and data have transformed healthcare. Dr. Pearl emphasizes the importance of evidence-based practices while maintaining the human element of patient care. He introduces his A to G model for effective healthcare leadership, which includes aspirations, behaviors, context, data, engagement, faculty, governance, and incentives. Throughout the episode, the focus remains on improving patient outcomes and clinician engagement in a rapidly changing medical landscape. Love the show? Please consider signing up for our weekly newslet

Summer Shorts: Knights, Knaves, and Pawns in Healthcare To read the full article and show notes with links mentioned as well as a full transcript, click here. In this episode, Stacey Richter speaks with Larry Bauer about the societal perceptions of physicians as knights, knaves, or pawns, inspired by a 2010 JAMA article by Dr. Sachin Jain and Dr. Christine Kassel. They delve into how these perceptions influence healthcare policies, the moral dilemmas faced by physicians, and the need for greater integration of doctors in policy-making processes. Throughout the episode, they stress the importance of understanding physicians' motivations and the significant impact of involving medical professionals in discussions about healthcare reform. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 07:36 Are physicians knaves or knights? 10:05 “Most of the people … that [I’v

Understanding Actuarial Risk Horizons in Healthcare with Keith Passwater and J.R. Clark To read the full article and show notes with links mentioned, click here. In this episode, Stacey Richter speaks with Keith Passwater and J.R. Clark, healthcare entrepreneurs and executives, about the importance of actuarial risk horizons in improving patient outcomes. They discuss how different risk horizons impact healthcare costs, benefit designs, and plan strategies. Keith and JR explain the key differences in risk management between short-term and long-term healthcare plans, such as individual exchanges and employer group insurance, and emphasize the significance of including the patient as a stakeholder in actuarial models. The episode highlights the complexities and challenges faced by actuaries in the healthcare system and the potential benefits of innovative, patient-focused actuarial practices. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episo

Lauren Vela is back on the pod today with a summer short that originally was a section of episode 406 that, unfortunately, I had to cut. It was a little bit tangential to the “why with the employer inertia” theme that the original episode was about. But tangential does not mean unimportant. This clip has some really critical insights on a different topic that may or may not to a greater or lesser degree contribute to inertia. And I’m gonna call this other topic the benefit design that most employees might ultimately be the most satisfied with might not be the one that they are explicitly asking for. Let’s start with three kinds of market research insights that Lauren Vela, my guest in this healthcare podcast, uncovered when interviewing friends and neighbors not in the healthcare industry about their benefits: 1. Nobody reads their benefit information. 2. They are unhappy with their benefits. 3. The most important thing for them is to have choice. They want to avoid the notion of “managed care.” In thinking a

This summer short is about the dynamic between payers and providers. An opening point that Jacob Asher, MD, my guest in this healthcare podcast, makes in the interview that follows is that, for a payer, it’s super hard to competitively differentiate from both a cost and/or a quality perspective when you and all of your payer competition use the exact same PPO (preferred provider organization) networks. I mean, what? Are these same exact doctors gonna somehow do a better job with your members than with the rest of their patients? This is even more true if you think about this from a physician or a practice point of view. Will clinical teams in their clinical workflow figure out who your members are, first of all, which is a thing, and then switch up what they choose to do for your members that is special? Even theoretically, that sounds like an executional fandango, which is exacerbated in markets with lots of payers. I guess I am not shocked when I hear stories like Dr. Asher was talking about: Doctor sits do

Here’s a quote from Rolling Stone magazine: “A supergroup is a very fragile thing. Rock bands are always about balancing huge egos, but when those egos are oversized from the get-go it can lead to huge problems. That’s why supergroups like Blind Faith often fail to go beyond a single album, and why long-lasting ones like CSNY had drama that never seemed to end.” Hmmm … that’s apropos because, turns out, super ACOs (accountable care organizations) may have some similar issues. A super ACO means multiple ACOs or CINs (clinically integrated networks) which are each comprised of multiple practices or provider organizations, and it’s all under different ownership. Said another way, there are multiple levels of competitors—frenemies, if you will—trying to work together or not work together as the case may be. There’s a lot of infrastructure complexity and process complexity and, frankly, inefficiency. There’s trust issues. There’s the problem that rule #1 of change management is to create “quick wins” so that every

In this healthcare podcast, I am talking with Dan Serrano; and we’re talking about payer/provider collaboration—blocking and tackling, I’m gonna say—from primarily a financial and revenue point of view. I’d classify this as, say, a 201-level discussion (ie, not entry level, but it’s also not super deep in the weeds). We mainly cover the ins and outs of why a provider organization should probably be looking to get paid to better take care of patients with chronic disease and drive better patient outcomes at lower downstream costs and, to some degree, also why payers should be helping provider organizations in their local communities to do so by providing some help and shelter on the journey from here to a capitated payment. The focus today is really, I’d have to say, on the messy middle, where a provider organization does not have capitated contracts nor access to any premium dollars, which, by all accounts, is the holy grail here. The premium is where it’s at, and provider organizations might want to be aimin

In this healthcare podcast, we are talking about innovative primary care teams and, by way of Larry Bauer, my guest today, bringing you three inspiring case studies. Much can be inferred from these case studies, as much from how they are alike as how they are different. It is wildly important at the same time that it is wildly underappreciated how different local markets are. I love how Cody Coonradt put it on LinkedIn the other day. He wrote: “Healthcare is not a $4T market—it’s 500 some-odd interconnected markets ranging in size from $1-50B. [It is] not a singular problem … each market [is driven] by unique third party payer incentives with unique patient cohorts. … “Before you figure out the next great idea—seek to understand the underlying health economic, revenue cycle, service provider contracting, and cash conversion processes that undergird it all. [That] is how to truly disrupt healthcare.” Or, said another way, if you’re part of the community, if you are already caring for patients in that community