Relentless Health Value‪™‬ Stacey Richter

To read the full article with show notes, mentioned links and a full transcript, visit relentlesshealthvalue.com
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.
03:33 Stacey’s journey and mission.
04:16 The story of Scott Conard, MD (EP391).
09:28 Why it’s important not just to drive change but to sustain it.
12:23 Heart Failure: A Case Study in Value.
14:13 EP438 with John Lee, MD.
15:07 Why patient positive value often fails instead of succeeds.
18:07 How financial toxicity has become clinical toxicity in healthcare.
19:44 How cultural norms have evolved into healthcare challenges.
23:38 The story of Mike Tuggy, MD, in Washington.
25:13 Looking at the four tensions in measuring value as continuums.
25:37 Why timeline is important in creative value in healthcare.
27:52 Finding Allies by Michael Leavitt.
28:34 What are the four ways to measure value in healthcare?
29:27 How do payers and providers collaborate to align on value metrics?
31:26 Why will proven versus experimental treatments become more important in the next few years?
34:54 Stacey’s manifesto (EP400) and values for personal integrity in healthcare.
38:55 Stacey’s parting advice.
For more information, go to Radio Advisory or Aventria Health Group.

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 implementing business units or decentralized models to realign with patient care values and efficiencies.
To read the full article and show notes with links mentioned as well as a full transcript, click here.
08:12 From a business and patient/better outcomes standpoint, what does an optimal provider practice look like?
11:48 EP412 with Robert Pearl, MD.
13:06 Why isn’t the current landscape what David considers optimal?
14:53 What leads to the “crisis of autonomy”?
15:13 How do medical practices get to the phase of delegation?
17:39 EP438 with John Lee, MD.
18:55 EP437 with Brian Klepper, PhD.
20:53 EP432 with Kate Wolin, ScD.
20:55 EP421 with Jodilyn Owen.
23:48 Medicare Meet-Up podcast with Mai Pham, MD.
24:45 What metrics should boards of directors also be held accountable for?
28:48 Why is an efficiency-focused business not necessarily the best at managing population care?
31:13 What is the “diversification discount”?
32:49 Pivot podcast with Kara Swisher and Scott Galloway, MBA.
35:53 What can primary care doctors do to optimize their practices?
36:48 Why do we need to shift the mindset from “bigger” and “more”?
 

In Episode 439 of 'Relentlessly Seeking Value,' host Stacey Richter discusses the convoluted issues surrounding generic drug pricing with pharmacy consultant Luke Slindee.
To read the full article and show notes with links mentioned as well as a full transcript, click here.
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 rebalancing the generic drug market to benefit patients, pharmacies, and plan sponsors alike. Additionally, the broader implications of these dysfunctional systems on pharmacy operations and staff conditions are discussed.
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08:12 Where do cash prices fall when pharmacies have contracts with PBMs?
08:39 What is a usual and customary price?
12:14 How is the usual and customary price affected by PBMs?
16:49 Should pharmacies be allowed to have two sets of cash prices?
17:14 Where does GoodRx fit into this because of the pharmacy/PBM dilemma?
19:06 What’s happening with Amazon and the anticompetitive contract lawsuit, and how does it relate back to pharmacy contracts with PBMs?
20:38 EP395 with Brennan Bilberry.
21:05 EP420 with Ge Bai, PhD, CPA.
23:27 Why is there a new wave of cash-only pharmacies?
24:02 EP418 with Mark Cuban and Ferrin Williams, PharmD, MBA, from Scripta.
25:41 What would allow the generic market to return to normal competitive pricing?
26:39 How does this dysfunction create a negative downstream effect?

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. 
To read the full article and show notes with links mentioned as well as a full transcript, click here.
Dr. John Lee is an ER (emergency room) doc by training, who is also an informaticist and chief medical information officer. I can tell you from personal experience that Dr. Lee is one of the most creative and pragmatic problem solvers that I have encountered. He says he’s dedicated to trying to help move the ball forward and changing our healthcare system using information technology and using our ability to be far more transparent with the things that we try to do in a positive way in healthcare.
Join us for an insightful discussion on balancing ideals and realities in modern healthcare.
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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 care physicians—skews the financial incentives in healthcare, affecting the viability of primary care practices and mental health services. The discussion also explores the flawed assumption that the financial value assigned to healthcare services by the RUC equals their true value to patients, highlighting the need for a better understanding of the inner workings of American healthcare to address its shortcomings.
To Read the Full Article with Show Notes Including Links Mentioned, Visit Our Site.
00:00 Introduction
02:29 Unpacking the RUC: The Power Behind Healthcare Economics
04:26 The Financial Impact of the RUC on Primary Care
07:43 Exploring the Value of Healthcare Services
10:29 The Real-World Consequences of RUC Decisions
12:50 Debunking the Equivalence of Value and Money in Healthcare
15:09 Final Thoughts and How to Stay Informed
Brian Klepper, PhD, is principal of Worksite Health Advisors and a nationally prominent healthcare analyst and commentator. He speaks, writes, and advises extensively on the management of clinical and financial risk, on high-performance healthcare, and on realizing the potential of primary care.
His current focus is on high-performing healthcare organizations that consistently deliver better health outcomes at lower cost than usual approaches in high-value niches and how, integrated with advanced primary care, they can be configured into turnkey comprehensive high-value health plans that can disrupt the status quo.
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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 a gap in the market. What is needed are indie TPAs who are effective and efficient and not owned by a health plan because, if history is any predictor of the future, the second the TPA gets owned by a health plan, the TPA sort of ceases to be a TPA and becomes a health plan.
The conversation today with Elizabeth Mitchell pretty quickly gets into the shift toward direct contracting between employers and providers to improve access quality and outcomes. If you can’t beat them, get ruthlessly practical is my takeaway. I have to say, I truly admire some of these HR folks and their leadership willing to do what it takes on behalf of protecting the people that work for them.
There are certainly some health plans at least trying here, so I don’t want to imply otherwise. There are some interesting initiatives that are afoot at, I’m gonna say, usually regional health plans. Elizabeth Mitchell has talked about some of these and made this clear also elsewhere.
Join us for a deep dive into these critical components of the healthcare system and their impact on self-insured employers.
To read the full article and show notes with links mentioned as well as a full transcript, click here. 
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