This episode would not be happening, to be frank, if Cora Opsahl hadn't asked me what my plans were for episode 500. A few weeks ago, we were in the lobby bar at the legendary Hotel Chelsea—Sid Vicious, Patti Smith, you know the place. In our defense, the Hotel Chelsea is, in fact, probably about the halfway point between our two places of business. They are known for their martinis. The show just started, and it's already off the rails. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. Anyway, Cora said (casually, mind you), "Whatcha you gonna do for episode 500?" I said, "Oh, I have that all figured out. I'm gonna do episode 499, and then I'm gonna do episode 501, and then I'm gonna figure out episode 500 when I have a little bit more time to think about it. Because right now I'm really, really busy at my day job." As I've said many times, I used to crastinate, then I went pro. Cora just stared at me, gathering her thoughts maybe. Finally, Cora goes in response to my do episode 499 and then do episode 501 and then do episode 500 sometime later on when I get around to it. Cora goes, "Yeah, well, that is a truly terrible idea." Then she helped me figure out a good plan. So, welcome to episode 500. This podcast is sponsored by Aventria Health Group. While I'm talking about sponsored by, and I know I covered this in the Thanksgiving Show (INBW43), but I really, really wanna thank all of the individuals who have contributed moral and/or financial support. Back to how episode 500 came to be. The plan I concocted with Cora started out as a LinkedIn post. Here's the post: "Ten years ago and 500 episodes ago, I started Relentless Health Value because the healthcare industry felt like a game of pachinko. You drop a program or a policy or a technology in. It bounces around a black box. And sometimes the result is the opposite of what you intended or what you wanted." I keenly felt my lack of not just essential knowledge but just how to actually deploy that knowledge to move the needle and secure a really patient-centric system. But then I met the Relentless Health Tribe. You lot. "You are the alchemists of this industry. You take the words [that] you hear here and turn them into [tangible programs and solutions]," things that actually work in this hot mess that we call the healthcare sector. So, look, the whole reason for Relentless Health Value continuing for all of these years is the impact that you have. Some of this impact I hear about, but a lot of it, frankly, I don't. So, this is what I asked for on that LinkedIn post. I wrote, "I want to hear from you." And then I asked everyone reading to write their own accountings for how Relentless Health Value and its guests may have influenced their own trajectories toward a better way forward. Because here's the thing, and how do I wanna say this? Not everyone listens to the show. We are not everyone's cup of tea. We meaning, for sure, me; but yeah, if you're here listening, you, too. So, don't try to claim otherwise. I'm onto you. We are not only worried about patients/members, but we are also a bunch of deeply knowledgeable wonks who understand—because we need to—how the pipes have been laid and how the dollars flow through them. Because we get that you cannot actually manage to do the right thing by patients and members a lot of times, unless you have a handle on how this deeply opaque and often wildly counterintuitive world actually works that functions, in many ways, the opposite of what the press release says or the first three pages of the contract, as the case may be. So, I'm proud of you, and I'm proud that you are listening because if I added up the number of lives that you lot serve—like when you make decisions, how many are impacted by your choices—it's, I don't know, if I had to add it all up, I'd say back of envelope over 80 million people in this country, 100 million. Not sure how to count, because some of you work upstairs at health systems and provider organizations. Some of you are self-insured employers or TPAs (third-party administrators) or consultancies or solution providers, legislative folks, policymakers. Or maybe you just work with one patient at a time trying to figure out how to do that as best you can. You're here, and I appreciate that from the bottom of my heart, and I would certainly encourage you to look around because there's real power in this village that you are a part of and that can and will matter. So, again, this show, not for everyone by a long stretch. But who gravitates here are those with a strong desire to find their own North Star, their own beacon, as Alex Sommers, MD, put it. And we're all looking for actionable insights so we can manage to succeed doing something. We are not here to stare at our belly buttons. And this is often uncomfortable, right? It's sometimes really, really awkward and cognitively dissonant to gather up a clear-eyed sense that maybe our companies, our boss's boss, or colleagues around us are doing things that are, in fact, less aligned with our own values. And at that point, it is super challenging to figure out a path forward that works at the job and also isn't some kind of personal betrayal of values. The real world is not a sterile, theoretical place. It's full of nasty choices and life that gets really life-y. What's that Mike Tyson quote? "Everybody has a plan until you get punched in the face." So, yeah, the team over here at Relentless Health Value can and will pat ourselves on the back for hitting this 500-episode milestone. But you are the ones who are turning this oil tanker of a healthcare system around and all of what that entails. So, that is why I wanted episode 500 to be a celebration of your impact. You are changing healthcare. That whole thing is the gist of the plan that I concocted with Cora Opsahl at the Hotel Chelsea, like, 2.5 hours before I posted that LinkedIn post and kicked this whole thing off. Fast forward to right now, the post got, like, 100+ beautiful responses and however many reposts with more comments. Plus, I got a whole pile of direct messages, emails, voicemails on the Web site. And all of these, as I would have suspected, honestly, I was completely not surprised. These recountings of impact were the really, really good sort of impact recountings—the kind that matter, the kind written by people who not only know a lot but also care about each other and the patients and the members, the kind who fully understand the stakes here are higher than all of us. We are all or will be patients, and so will our families and our friends and everyone we know. This is the purpose and the burden that we all choose to bear despite the complexity, the steep learning curve, despite the number of powerful entities flying around way more interested in profiteering than I, frankly, find acceptable at most any level. So, right. I've said this before, and I'll probably say it 10 more times. Thanks for being here throughout these past 500 shows. Let's live in the solution. Today is always the first day of what we can build together through the decisions we all make that will coalesce and come together into something really, really meaningful. To this end, I wanna kick this off by playing this beautiful and really inspiring message that sort of universally summarizes so much of our why around here. It's from Michelle Bernabe. Michelle Bernabe: Hi, this is Michelle Bernabe; and I write the Substack Moral Health. Episode 373 changed the course of my life. Stacey: This is the very first episode with Cora Opsahl, and she's talking about how the 32BJ Union Health Fund had a little issue with a very big hospital and what they did about it. Michelle Bernabe: To really understand it, I have to take you to this kind of ludicrous moment I experienced as a nursing student when I saw this nursing aide in dialogue with this giant red banner that this hospital had up that said "Amazing Things Are Happening Here." And she just clapped back at the banner, and she was like, "Amazing things are happening here? You are damn right! It's amazing we don't have any clean linens. It's amazing we're out of water pitchers. It's amazing still nobody's around to cover my break." And she just kinda laughed and strolled on into the distance, and I was like, "Did anyone see that moment?" It kind of haunted me, and unfortunately, it would define my whole career as a New York City nurse—in particular, the distance between the story we tell and the conditions people work and heal inside. And nobody was really talking about that distance. That is, until years later when I found Relentless Health Value episode 373. And I heard Stacey and Cora talking about that distance and saying the data, the contracts, the incentives are what shaped the healthcare reality we all experience. It changed my life. Stacey, congratulations on episode 500. I watched amazing things get used as a banner while the basics fell apart, and your show helped me name it as a design problem, not as a personal failure. And it didn't just validate me; it gave me a blueprint and role models and real people to pattern off of for how to build and fight for something better. So much tribe love. Stacey: Right back at you, Michelle, and please subscribe to Michelle Bernabe's Substack called Moral Health. As you may be able to easily tell, Michelle is so eloquent and able to encapsulate some really big truths from many micro moments such as this one. Okay … if we drill one level down here, I'm seeing three major themes jump out for how Relentless Health Value has aided and abetted in some pretty fantastic results and outcomes. Here's Theme 1: Moving From Theory to Practical Transformation. That's what many of you have said that Relentless Health Value has helped with. We aren't here jus
