Relentless Health Value

Stacey Richter
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American Healthcare Entrepreneurs and Execs you might want to know. Talking. Relentless Health Value is a weekly interview podcast hosted by Stacey Richter, a healthcare entrepreneur celebrating fifteen years in the business side of healthcare. This show is for leaders in pharma, devices, payers, providers, patient advocacy and healthcare business. It's for health industry innovators, entrepreneurs or wantrepreneurs or intrapreneurs. Relentless Healthcare Value is the show for you if you want to connect with others trying to manage the triple play: to provide healthcare value while being personally and professionally fulfilled.

  1. EP485: Imaging Costs 6% to 11% of Plan Sponsor Spend: How Direct Contracting Can Save Money and Improve Access, With Cristin Dickerson, MD

    قبل يوم واحد

    EP485: Imaging Costs 6% to 11% of Plan Sponsor Spend: How Direct Contracting Can Save Money and Improve Access, With Cristin Dickerson, MD

    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 in coding and payment processes, the reluctance of TPAs, and the habitual referral to 'down the hall' services. The conversation highlights the importance of price transparency, patient education, and how Green Imaging supports plan sponsors in navigating these challenges. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP486 ✉️  Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙  Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤  Listen on Apple Podcasts  https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤  Listen on Spotify  https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺  Subscribe to our YouTube channel   https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn   https://www.linkedin.com/company/relentless-health-value/ ✭ Threads  https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky   https://bsky.app/profile/relentleshealth.bsky.social ✭ X   https://twitter.com/relentleshealth/ 00:00 Introduction and Episode Overview 00:31 The Case for Direct Contracting in Imaging 01:43 Real-World Examples and Challenges 04:47 The Importance of Data and Transparency 08:49 Interview with Dr. Kristen Dickerson 12:39 Barriers to Direct Contracting 24:05 Overcoming Barriers and Final Thoughts 33:22 Conclusion and Contact Information

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  2. Take Two: EP436: Let’s Talk About TPA and Health Plan Inertia Instead of Jumbo Employer Inertia, With Elizabeth Mitchell

    ٢٨ أغسطس

    Take Two: EP436: Let’s Talk About TPA and Health Plan Inertia Instead of Jumbo Employer Inertia, With Elizabeth Mitchell

    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 reduce costs and improve quality.  The episode covers the implications of the Consolidated Appropriations Act, the role of brokers, and how employers can achieve better value for their healthcare spend. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP436-Take2 ✉️  Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙  Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤  Listen on Apple Podcasts  https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤  Listen on Spotify  https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺  Subscribe to our YouTube channel   https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn   https://www.linkedin.com/company/relentless-health-value/ ✭ Threads  https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky   https://bsky.app/profile/relentleshealth.bsky.social ✭ X   https://twitter.com/relentleshealth/ 08:06 What is the overarching context for health plans in healthcare purchasing? 11:31 Why is it important to reestablish a connection between the people paying for care and people providing care? 13:47 What are the needs of a self-insured employer when managing employee benefits? 19:00 Is it doable for employers to set their own contracts? 21:24 Is transparency presumed? 22:39 Will the new transparency upon us actually expose wasted expense? 24:23 EP408 with Chris Deacon. 25:58 “This is not about individual bad actors. … The systems … that is not aligned.” 27:39 Are there providers who want to work directly with employers? 30:53 Why is it important that incentives need to be aligned? 32:42 EP427 with Rik Renard. 33:51 What’s missing from the conversation on changing health plans?

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  3. EP484: What Are the 3 Most Burning Questions That Plan Sponsors Have Right Now? With Dave Chase

    ٢١ أغسطس

    EP484: What Are the 3 Most Burning Questions That Plan Sponsors Have Right Now? With Dave Chase

    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 also mentions noteworthy related episodes and cases to provide further context and insights. === LINKS === 🔗  Show Notes with all mentioned links:   https://relentlesshealthvalue.com/episodes ✉️  Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙  Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤  Listen on Apple Podcasts  https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤  Listen on Spotify  https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺  Subscribe to our YouTube channel   https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn   https://www.linkedin.com/company/relentless-health-value/ ✭ Threads  https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky   https://bsky.app/profile/relentleshealth.bsky.social ✭ X   https://twitter.com/relentleshealth/ 06:36 What questions does a plan sponsor need to ask their consultant, EBC, or broker to ensure they are protecting the interest of the plan sponsor? 07:59 EP478 with Andreas Mang and Jon Camire. 08:49 EP453 with Claire Brockbank. 09:51 EP433 with Justin Leader. 09:53 EP436 with Elizabeth Mitchell. 11:03 How can plan sponsors avoid personal liability when their TPA has hidden conflicts of interest? 11:40 Tiara Yachts v. Blue Cross Blue Shield of Michigan lawsuit. 13:48 EP483 (Part 1) with Jonathan Baran. 14:18 EP457 with Cynthia Fisher. 16:18 The Marshall-Hickenlooper bill called the Price Tags Act. 16:50 Summer Short with Elizabeth Mitchell. 17:36 How do plan sponsors figure out if they are being overcharged for pharmacy benefits? 18:09 EP365 with Scott Haas. 20:18 EP397 with Paul Holmes. 20:22 EP465 with Chris Crawford. 20:37 EP429 with Luke Slindee, PharmD. 22:56 EP476 with Ann Lewandowski. 28:38 Where to find open-source resources to help guide plan sponsors with making better health plan decisions. 29:47 How the open-source trend is growing for health transparency. 30:48 What to look forward to at RosettaFest.

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  4. EP483 (Part 2): Reversing the Healthcare Flywheel to Contain Skyrocketing Healthcare Costs, With Jonathan Baran

    ١٤ أغسطس

    EP483 (Part 2): Reversing the Healthcare Flywheel to Contain Skyrocketing Healthcare Costs, With Jonathan Baran

    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, brokers, and health plans work collaboratively to improve member health and reduce costs. === LINKS === 🔗  Show Notes with all mentioned links:   https://relentlesshealthvalue.com/episodes ✉️  Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙  Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤  Listen on Apple Podcasts  https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤  Listen on Spotify  https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺  Subscribe to our YouTube channel   https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn   https://www.linkedin.com/company/relentless-health-value/ ✭ Threads  https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky   https://bsky.app/profile/relentleshealth.bsky.social ✭ X   https://twitter.com/relentleshealth/ 05:23 Where to start in reversing the flywheel. 06:57 Why investing in primary care is pivotal to containing healthcare costs. 10:02 EP453 with Claire Brockbank. 10:04 EP452 with Cora Opsahl. 10:07 EP457 with Cynthia Fisher. 10:12 EP365 with Scott Haas. 10:13 EP465 with Chris Crawford. 10:14 EP475 with Peter Hayes. 11:11 EP468 with Matt McQuide. 11:13 EP472 with Eric Bricker, MD. 12:14 “The most expensive thing in healthcare is the pen of the primary care doctor.” 13:04 How the role of the broker has to fundamentally change. 16:16 What will the single most challenging aspect of this restructuring become? 20:20 How self-funded employers can be amazing customers in containing the rising cost flywheel in healthcare. 22:56 How do EHRs and other medical record systems play into reversing the flywheel of rising healthcare costs? 23:57 Ramy Khalil, MD’s post on interoperability. 24:59 Why is it important for employers to drive volume differently? 25:38 How Self Fund Health is helping in this regard.

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  5. EP483 (Part 1): To Contain Skyrocketing Healthcare Costs or Renewals, You Gotta Understand How the Flywheel Works, With Jonathan Baran

    ٧ أغسطس

    EP483 (Part 1): To Contain Skyrocketing Healthcare Costs or Renewals, You Gotta Understand How the Flywheel Works, With Jonathan Baran

    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 on reversing these trends, aiming to align healthcare outcomes with cost reductions. Self Fund Health, I am so pleased to tell you, as I am always so pleased to tell you, did make such a kind offer to help out Relentless Health Value financially. You and the tribe here are really, really great folks who I truly appreciate. Please support Self Fund Health if you are in Wisconsin. This episode is sponsored by Self Fund Health. === LINKS === 🔗  Self Fund Health: https://selffundhealth.com 🔗  Show Notes with all mentioned links:   https://relentlesshealthvalue.com/episodes ✉️  Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙  Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤  Listen on Apple Podcasts  https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤  Listen on Spotify  https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺  Subscribe to our YouTube channel   https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn   https://www.linkedin.com/company/relentless-health-value/ ✭ Threads  https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky   https://bsky.app/profile/relentleshealth.bsky.social ✭ X   https://twitter.com/relentleshealth/ 08:46 Entering the health system “flywheel” at the renewal phase. 09:46 What goes on in the renewal season that contributes to the health system “flywheel”? 12:28 Why is the standard 9% increase in healthcare costs during renewal season actually problematic? 13:22 How does the purchase of discounts contribute to the skyrocketing cost of healthcare and distract from discussing the actually underlying cost of healthcare? 16:07 EP465 with Chris Crawford. 17:01 Why do employers need to learn to buy healthcare and not insurance? 20:32 Rina Tikia’s post on self-funded plans. 23:18 Why are hospital executives incentivized to buy and own all of the primary care in a market? 26:35 How big electronic medical record systems play into this increase in healthcare costs. 28:27 Acquired podcast on one EHR system. 31:09 What needs to happen to reverse this flywheel of increasing healthcare costs?

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  6. Bonus Add-on to EP483 (Part 1): Honoring Those in Healthcare Who Are Trying Every Day to Do the Right Thing, With Jonathan Baran

    ٧ أغسطس

    Bonus Add-on to EP483 (Part 1): Honoring Those in Healthcare Who Are Trying Every Day to Do the Right Thing, With Jonathan Baran

    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 pleased to tell you, as I am always so pleased to tell you, did make such a kind offer to help out Relentless Health Value financially. You and the tribe here are really, really great folks who I truly appreciate. Please support Self Fund Health if you are in Wisconsin. This episode is sponsored by Self Fund Health. === LINKS === 🔗  Self Fund Health:   https://selffundhealth.com 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP483-BONUS ✉️  Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙  Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤  Listen on Apple Podcasts  https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤  Listen on Spotify  https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺  Subscribe to our YouTube channel   https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn   https://www.linkedin.com/company/relentless-health-value/ ✭ Threads  https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky   https://bsky.app/profile/relentleshealth.bsky.social ✭ X   https://twitter.com/relentleshealth/ 03:11 A brief background on Jonathan and Self Fund Health. 04:24 Why is it imperative that individuals stop identifying wholly with the organization that they work with? 05:48 Why is it important to be direct and call out the behavior without calling out the individual? 07:14 EP483 (Part 1) with Jonathan Baran.

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  7. How Margin Shoves Mission Off of the Bus: A Primary Care Case Study, With Stan Schwartz, MD—Summer Shorts

    ٣١ يوليو

    How Margin Shoves Mission Off of the Bus: A Primary Care Case Study, With Stan Schwartz, MD—Summer Shorts

    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 to providers. Dr. Schwartz underscores the importance of aligned financial incentives and collective action among employers to drive meaningful change in healthcare. If you would like to get a copy of the mentinoed personal integrity and “are you in healthcare for the right reasons” policy called the Guiding Principles Policy that Doug Geinzer and Amy Mecham from High Performance Providers put together.please either check your inbox for the newsletter this week that you just got when this show went live and find the link to download or sign up for the newsletter and I will include it again next week on Thursday. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/SUMS11 ✉️  Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙  Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤  Listen on Apple Podcasts  https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤  Listen on Spotify  https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺  Subscribe to our YouTube channel   https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn   https://www.linkedin.com/company/relentless-health-value/ ✭ Threads  https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky   https://bsky.app/profile/relentleshealth.bsky.social ✭ X   https://twitter.com/relentleshealth/ 08:11 What was Dr. Schwartz’s “Pelican Brief” moment? 09:09 How Dr. Schwartz’s advanced primary care structure and health information exchange beat out competing states for CMMI funding. 12:53 What did “good” look like with this advanced primary care program? 15:06 EP391 with Scott Conard, MD. 15:42 EP438 with John Lee, MD. 16:57 What got Dr. Schwartz interested in employer-sponsored healthcare? 18:46 EP419 with Andreas Mang. 18:48 EP453 with Claire Brockbank. 18:50 EP452 with Cora Opsahl.

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  8. EP482: 3 Surprising Ways Carriers Make Lots of Money—What Do Plan Sponsors and Clinical Organizations Really Need to Know? With Preston Alexander

    ٢٤ يوليو

    EP482: 3 Surprising Ways Carriers Make Lots of Money—What Do Plan Sponsors and Clinical Organizations Really Need to Know? With Preston Alexander

    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. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP482 ✉️  Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙  Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤  Listen on Apple Podcasts  https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤  Listen on Spotify  https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺  Subscribe to our YouTube channel   https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn   https://www.linkedin.com/company/relentless-health-value/ ✭ Threads  https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky   https://bsky.app/profile/relentleshealth.bsky.social ✭ X   https://twitter.com/relentleshealth/ 08:29 What is float, and why is it a surprising way that carriers make money? 14:01 Summer Shorts on pharma rebates with Ann Lewandowski. 14:41 Why carriers really do denials and delays of payouts. 17:34 What are intercompany eliminations, and how do they make carriers more money? 22:21 How do carrier-owned pharmacies play into this? 23:19 How are carriers creating profit off of Medicare Advantage and Medicaid Advantage markets? 27:18 How the fee-for-service price increases affect Medicare prices. 28:12 Why aren’t large insurance carriers motivated to make costs go down? 32:42 What is a potential way forward to fix the rising cost of healthcare? 33:36 As a plan sponsor, how do you address carriers making profit on your float? 35:07 EP478 with Andreas Mang and Jon Camire. 36:34 “Our economy’s not gonna survive healthcare.”

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American Healthcare Entrepreneurs and Execs you might want to know. Talking. Relentless Health Value is a weekly interview podcast hosted by Stacey Richter, a healthcare entrepreneur celebrating fifteen years in the business side of healthcare. This show is for leaders in pharma, devices, payers, providers, patient advocacy and healthcare business. It's for health industry innovators, entrepreneurs or wantrepreneurs or intrapreneurs. Relentless Healthcare Value is the show for you if you want to connect with others trying to manage the triple play: to provide healthcare value while being personally and professionally fulfilled.

المعلومات

  • صناع العمل
    Stacey Richter
  • سنوات النشاط
    ٢٠١٤ - ٢٠٢٥
  • الحلقات
    ٦٠٦
  • التقييم
    ملائم
  • حقوق النشر
    ©BD Bridges LLC, All Rights Reserved.
  • موقع البرنامج على الويب
    Relentless Health Value

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