456 episodes

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.

Relentless Health Value‪™‬ Stacey Richter

    • Health & Fitness
    • 4.9 • 141 Ratings

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.

    INBW36: Will Healthcare Stakeholders Who Don’t Collaborate Wind Up With a Business Problem?

    INBW36: Will Healthcare Stakeholders Who Don’t Collaborate Wind Up With a Business Problem?

    We got two new reviews this week on the podcast, which I was thrilled to see. The first was from, it turns out, Dave Chase from Health Rosetta, who wrote that “with so many people in healthcare practicing ‘innovation theater’ and bloviating versus driving real change, it’s a breath of fresh air to listen to Relentless Health Value.” Thank you so much for saying that, Dave. We try really hard to get guests who are actually doing great things such as yourself.
    And then there’s another review from mattiw2002, who says, “For anyone trying to stay abreast of developments in the healthcare space, there’s none better than … Relentless Health Value.”
    Thank you so much to the two of you who took the time to write a review—could not appreciate it more.
    There have been two inbetweenisodes this year where I get deep into the why behind the “why collaborate.” And when I say collaborate, what I mean is anybody in the healthcare industry working together with and for the patients that we’re supposed to be serving here. It’s creating alignment amongst stakeholders around what’s best for the patient.
    Here is the nutshell version of the two previous shows. First point: Patients fall into one care gap after another. You hear this from any PCP you talk to who’s working in a care setting when there’s little, if any, collaboration effort on the front end to ensure a non-fragmented patient journey. So then, all these care gaps wind up getting surfaced, which, by the way—let’s not forget this—these care gaps were there all along negatively affecting patient outcomes. It’s just, in the past, we didn’t know about them. But now that we know about them, it becomes the fee-for-service PCPs’ job to mop up all the care gaps while the faucet is still running.
    So, that’s the situation analysis, and if we’re going to put an end to this, it means that payers have to align with providers and give enough incentive for those providers to create a non-fragmented patient journey (ie, making sure that the care gaps don’t happen to begin with). This also means providers need to talk amongst themselves and collaborate.
    Keep in mind that a multi-morbid Medicare patient sees something like 5 to 13 doctors, on average, depending on what study you look at … 13! If anybody thinks that a patient can see 13 doctors not collaborating with each other and coordinating care and not wind up with some polypharmacy adverse event or materially conflicting advice … I don’t know. Call me. I just do not understand how consistent excellence in patient outcomes or patient care even could be achieved. That whole cliché the left hand doesn’t know what the right hand is doing? That’s a cliché for a reason, and I seriously suspect the entire field of medicine isn’t weirdly excluded from it.
    So, first point: Collaboration/alignment is required amongst healthcare stakeholders for patients to get decent outcomes, especially patients with multiple chronic conditions. Payers gotta pay for the right stuff, and providers have to coordinate care. Otherwise, you wind up with all of the care gaps that PCPs currently working in systems with fragmented patient journeys are seeing.
    Here’s the second point from earlier episodes: Financial toxicity is clinical toxicity. Patients are forgoing care they need and not taking drugs they need because they cannot afford them. This is not speculation. Trilliant Health just released a report that showed this. Healthcare utilization, if you subtract COVID care and behavioral health, might be permanently down. Other reports speculated that by 2030, a leading cause of death might be nonadherence due to cost concerns. Wayne Jenkins, MD, in episode 358, talks about a whole constellation of negative effects when patients can’t afford care; and yeah … here we are. Patients cannot afford their care. They cannot afford premiums, deductibles, out-of-pockets. These are insured patients a lot o

    • 19 min
    Encore! EP351: Everybody in the Healthcare Industry Getting Up in Everyone Else’s Business, With Eric Bricker, MD

    Encore! EP351: Everybody in the Healthcare Industry Getting Up in Everyone Else’s Business, With Eric Bricker, MD

    This episode was one of the most popular episodes in the past 12 months. Since it aired, there was a show with Kevin Schulman, MD (EP366), that added some context, which I would recommend, and also one with David Muhlestein, PhD, JD (EP364). Those two shows and this one are a good three-pack.
    And hey, here’s something new that we’re going to try out. Coming up in December, Dr. Bricker and I will host a smallish virtual chat to discuss the topics covered in this episode. It will be a conversation, not a presentation, so therefore the “why” behind the “smallish.” If you are kinda thinking this is something that you’d like to do, go to our Web site and scroll down to the “Join the Relentless Tribe.” When we get our act together, we’ll send out the details for how to sign up in a future email. I’m thinking it will be very cool to get a chance for the great people who support our show enough to actually get a weekly email to talk amongst ourselves!
    In this healthcare podcast, I’m speaking with Eric Bricker, MD, about how so many entities in healthcare are getting up in other people’s business and swimming in other people’s traditional lanes. We kick off the conversation talking about the payer, PBM, and hospital system horizontal consolidation that has transpired over the past decades (that’s plural). Horizontal consolidation is pretty much the easiest way to decimate all competition in your own swim lane so that you can charge more and not worry so much about patient/customer/member experience because the patients/customers/members have no better alternative. They effectively have nowhere, or few other places at best, to go if they leave you.
    So, what’s the impact of horizontal consolidation? Commercial insurance costs have gone up 4x the rate of other benchmark goods and services.
    Let’s spend a moment, shall we, on the human impact of all this extreme consolidation. The impact is your sister, your neighbor, your son, your friend. So many feel so much pressure financially in our country today because of healthcare costs. Even families earning significantly more than median household income are forgoing care because of costs. This was in a recent paper. (The authors are Alyce S. Adams, Raymond Kluender, Neale Mahoney, Jinglin Wang, Francis Wong, and Wesley Yin.)
    But the direct observable financial toxicity resulting from high healthcare patient costs is really only the tip of the iceberg here. As Dave Chase from Health Rosetta has said a million times already, high healthcare costs have a multitude of effects on employers, big and small. One big one is, if healthcare costs more, then there’s less money for salaries. Dave, citing lots of evidence, has long attributed wage stagnation in this country to accelerating healthcare costs, which became even more rampant during periods of industry consolidation. Dave Chase leads Health Rosetta, by the way.
    Here’s another human toxicity: Listen to episode 337 with Oliva Webb on the impact on her life as a result of the undeniably and unquestionably common non-excellent treatment by the PBMs and SPPs that she has to deal with. Because, as Dr. Bricker also says, no competition means basically not a whole lot of concern about patient experience. Why should a for-profit business spend money to improve something when there’s nothing really to be gained for them financially to do so? I mean, the best a patient can do most of the time is hop from the frying pan into the fire. That’s what happens when there’s no competition or no real competition. Also consider the burned-out clinicians who have to get stuck in the middle of this nobody-really-cares-at-the-monopoly customer service paperwork quagmire.
    By the way, here’s a sidebar that might come as a surprise to some people, but please take this in the spirit with which it’s intended. All of us innovators and lifelong learners, we want to update our beliefs when the facts show us an updated co

    • 34 min
    EP386: What You Need to Know About ER Bills Post the No Surprises Act, With Al Lewis

    EP386: What You Need to Know About ER Bills Post the No Surprises Act, With Al Lewis

    First of all, let me thank those of you who have left a podcast review in 2022. There was one from Best Healthcare Podcast Around on Apple Podcasts the other day that thanked Relentless Health Value for being singularly responsible for providing a 400-level education in so many complex areas of healthcare, which I personally really appreciated because we aspire to be a master class in healthcare industry strategy, such that those looking to do right by patients understand the dynamics well enough to succeed.
    This also echoed a review from February of this year that said that Relentless Health Value distills complex healthcare issues into a highly intuitive and highly accessible narrative that helped the reviewer’s Fortune 500 company get everybody in the C-suite the understanding needed to confidently make some pretty key healthcare-related decisions.
    Thanks so much to those of you who left a review for taking the time. As I have said on earlier shows, we really have a Relentless Tribe here working hard to make the healthcare industry in this country much more accountable to the patients that we serve.
    And you leaving a rating and a review might be the best thing that you can do if you’re into helping us achieve our mission, because the ratings are so entwined with helping others find the show. If you consider yourself a listener who has gained value from this show and you haven’t yet left a review or a rating, could I ask that you do me a favor and do so? If you don’t know how to do that, there are instructions here for how to do so.
    ***
    In this healthcare podcast, I am talking with Al Lewis. Al has been on the show before. One thing I did not realize about Al is that he went to Harvard Law School. Today we are discussing using the Quizzify Consent Form in the emergency room. This Quizzify Consent Form quite simply gives patients convenient ways to remember the exact and specific words they need to write on any financial forms they are presented with and told to sign in the emergency room. These words negate a hospital system or ER staffing firm’s claims that the patient agreed in a blanket statement to pay whatever they are charged.
    In the past (ie, before the surprise billing legislation that went into effect at the beginning of 2022), this Quizzify Consent Form helped prevent the old $11,000 COVID test somebody got in the emergency room or the million-dollar heart attack. For more on the legislation itself, listen to the show with Loren Adler (EP307).
    While it is far from perfect in a few respects, on the whole, the No Surprises Act is good for patients. It’s been terribly bad news, however, for certain private equity–backed ER staffing organizations who used surprise billing as a business model, meaning specifically—and maybe there’s others, but Team Health and Envision are certainly the big dogs here.
    This wasn’t any sort of cloaked-in-the-shadows secret, by the way, as far as business models for these two entities. I recall one of them saying without equivocation that the No Surprises Act would be very detrimental to their business. And it turns out, they were right. Here’s from Fierce Healthcare, quoting Moody’s: “Envision ‘faces significant social risk’ due to ‘significant negative publicity relating to the patients … receiving surprise medical bills’ and will remain financially challenged by the No Surprises Act.” Moody’s downgraded Envision’s corporate debt, suggesting that they are at risk of going bankrupt over the next 12-18 months.
    To further attenuate my sympathies, both of these companies, Team Health and Envision, cut doctors’ pay during the first COVID-19 wave while simultaneously spending millions on political ads to protect surprise billing practices. Anyway, sad … not sad.
    Getting back on track here, the good news in all of this is that patients don’t have to worry about surprise bills either by private equity–backed entities or just your run-

    • 32 min
    EP385: Morgan Health and the 5 Things Self-insured Employers Should Do Right Now, With Dan Mendelson

    EP385: Morgan Health and the 5 Things Self-insured Employers Should Do Right Now, With Dan Mendelson

    If you listened to the show with Dan O’Neill (EP359), you would know this already. But let me tell you: If you’re a provider, even a provider very confident in your office’s ability to confer better patient health, you will still have a super hard time getting off the fee-for-service (FFS) hamster wheel.
    Why? Because it’s hard to find payer contracts out there which will reward you (the provider) for actually taking care of your patients and to be accountable for the value of healthcare that you deliver. This is a tangled web we weave because, despite some payers offering risk-based contracts, a lot of times there’s some IPA (independent physician association) or other “holder of the actual payer contract” who does not pass along these contract terms. These IPAs or health systems even sometimes just keep paying docs or provider offices FFS even if they themselves have a risk-based or capitated or value-based-of-any-kind agreement.
    If I actually kept track of the issues raised in the emails I receive from docs, there’s one thing that I would likely find amongst the most frequently cited points of consternation: Physicians or practices or CINs (clinically integrated networks) or ACOs (accountable care organizations) want contracts where they can do right by patients. These are the good docs. These are the ones burned out and suffering from moral injury because physicians, PAs (physician assistants), nurses, clinicians who actually follow up and coordinate care and spend time making accurate diagnoses instead of cramming in more procedures … these are the clinicians who want to do the right thing and are also the ones who are getting dinged on performance reports and paid less.
    Bottom line here, for a physician practice to transform itself from an FFS machine cranking out volume but not necessarily health or care, the office has to have a high enough percentage of their patients in value-based arrangements to make it actually feasible to transform. It is only when they hit a tipping point of enough volume, enough patients in risk-based contracts that they can afford to be accountable for their results. At that point, yeah, everybody wins—doctors, patients, actually the entire community wins because when a local practice transforms, all of their patients tend to benefit at some level from the new processes and procedures and standardizations and pop health systems that get put in place.
    So, let’s move forward with this with all haste, shall we? Why aren’t we? What’s the problem here? Well, there are lots of problems, don’t get me wrong. But a big one is self-insured employers on the whole are not offering any sort of accountable care arrangements to the providers in their community. This is 150 million patient lives we’re talking about here—a huge chunk of many providers’ patient panels. Self-insured employers have a really big opportunity to level up the care in their whole community due to the spillover effect when a provider practice transforms itself because it has enough patients to do so.
    But these employers are stuck. They are paralyzed. They are doing the same thing this year that they’ve done last year, and therefore their whole community is equally stuck in a smorgasbord of suboptimal FFS goings-on.
    So, offering accountable care contracts is one thing (a very big consequential thing) that is also one of the five things self-insured employers can do to improve employee health that I talk about in this healthcare podcast with Dan Mendelson. Dan Mendelson, my guest today, also wrote a Forbes article listing out these five things. Here are all five things that Dan mentions in one handy list:
    Expand availability of accountable care models to improve the care experience, quality, and affordability at a local level. For a deep dive on this, listen to the show with Dave Chase (EP374). Invest in the data access needed to assess health outcomes. For a deep dive on this, listen to the

    • 34 min
    EP384: How Shareholders Impact Payer Behavior, Exactly and Specifically, With Wendell Potter

    EP384: How Shareholders Impact Payer Behavior, Exactly and Specifically, With Wendell Potter

    Here’s a Milton Friedman quote: “There is one and only one social responsibility of business—to use its resources and engage in activities designed to increase its profits so long as it [that entity] stays within the rules of the game, which is to say, engages in open and free competition without deception or fraud.”
    Okay, so this is Friedman, Milton Friedman, pretty much the most influential advocate of free market capitalism, stating quite clearly that an entity’s greatest responsibility lies in the satisfaction of its shareholders. His nod to social responsibility or ethics of any kind comes at the end there, where he says that for free market capitalism to function, there must be open and free competition and no fraud.
    So, let’s compare this to what’s going on in the payer space in the healthcare industry. First off, there was just a chart in the New York Times the other day where pretty much every major payer except one got a check in a box for being accused of fraud. Interestingly, if you look in the comments section of that article, people posted links where that one outlier was being accused of fraud. So, I’m not sure what’s up with that, but yeah, let’s just conclude that there’s fraud in the payer space.
    On to Friedman’s requirement for open and free competition. As we all know, there are a few very powerful, very big, consolidated entities who control the vast majority of the market with both regulatory capture as well as the capital to continue to buy more and more adjacent businesses, as well as any threatening upstarts and just close them down.
    As I often hear said, we’re gonna wind up with single-payer healthcare but maybe not the single payer most people are thinking of. If anyone thinks that in the highly consolidated payer space there is open and free competition, send me a note. I’d love to hear from you. I mean, even if what I’ve just said is 50% or 75% true, we’re still outside of Friedman’s definition of functional free market capitalism in the payer space.
    I wanna shift gears now to discuss the rules of the game, and this is really the topic of today’s podcast. Friedman said in that quote above that there are rules of the game that entities abide by. Therefore, these rules of the game are inarguably consequential. And in this healthcare podcast we’re talking about how these rules of the game echo when it comes to payers—companies that are publicly traded on Wall Street with shareholders.
    So, that’s your spoiler for where this episode is headed. But before we go there, let me just say one or two things to the many listeners who I would consider certainly part of our Relentless Tribe who also work for payers. If you work for a payer, you have a few options. One of them is to do as much social good as you can to offset even a little piece of the not so good going on.
    The other is to help those working elsewhere in the organization to understand the full impact of their actions and the hope that they figure out a way to be less financially toxic to members. You have already taken the first step, because simply by listening to the show, you see the problems with clear eyes.
    The larger question, though, is this: Is it possible to do well by doing good vis-à-vis leveraging the power of market forces to efficiently help patients, even if shareholders are demanding otherwise? Well, it ain’t working out so great so far, just comparing us to the rest of the world. But the more white hats we have, the better.
    So, keep advocating for patients in the belly of the beast, and there’s always a whistle around to blow should it come to that. Meanwhile, let’s focus our clear eyes on where we are from a patient’s eye view—just briefly here, because we’ve discussed this all before in great depth.
    Here’s some stats to a Commonwealth Fund issue brief. In the first half of 2020, first quarter, one out of four adults in employer plans were functionally uninsure

    • 36 min
    EP383: Direct Contracting as a Health System Business Strategy, With Nick Stefanizzi

    EP383: Direct Contracting as a Health System Business Strategy, With Nick Stefanizzi

    The show on direct contracting with Doug Hetherington (EP367) and also the one with Katy Talento (EP350), both of these experts have said that if an employer direct contracts with a provider organization, in general, the employer gets about 20% savings over the status quo. This makes sense—just cut out the middleman with an MLR (medical loss ratio) of plus or minus about 15% and you’re at three-quarters of the way there.
    You might be thinking, “Well, maybe not so fast here, because then wouldn’t FFS (fee-for-service) rates go up? Is it not Slide 1 on most carriers’ sales decks how great they are at leveraging their vast buying power to negotiate discounts with hospitals?” Hmmm … if you think this, you’re about to be shook.
    Turns out, carriers are not so good at negotiating rates with hospitals. For more on this topic, follow Leon Wisniewski on LinkedIn. Or check out an article entitled “Hospital prices vary widely, often higher with insurance than cash, The New York Times finds.”
    The big concerns for employers looking to direct contract, I think, are going to be threefold. And right now, I’m just speaking in general. This has nothing to do with the conversation that follows. But I think the three big concerns are this:
    Let’s say the employer gets actual fee-for-service rates that are 20% less than average carrier negotiated rates. So, great … but will utilization go up if the wolf is watching the henhouse, so to speak? Especially if PCPs are owned by the hospital system and incented, as many are, to drive downstream utilization. It’s been estimated that PCPs can drive $1,000,000+ of revenue when they refer in network to profitable service lines. What happens when this is unfettered, meaning no third party to do prior auth stuff for utilization management, for example? Some employers, for sure, could and certainly do hire a third party to do utilization management; but sometimes one of the contractual requirements of a health system direct contract is an easing of, let’s just say, at least the most aggressive PA (prior auth) requirements. So now, all of a sudden, are more plan members getting more services that, even at a 20% discount, add up to a greater total spend?
    A counterpoint: I’ve heard more than one person who would know say that most PA programs don’t actually do a whole lot except defer spend at best. Here’s a quote from Scott Haas. He said, “The only value I have observed of the prior authorization process is the accumulation of data that is required of the stop-loss industry to establish known risk for them to laser risk. Cost shifting at its best. Other than that, I have rarely observed value to the patient, provider, or the plan sponsor.”
    One thing I am noticing is that those providers offering direct contracts are aware of this whole line of questioning and fear of the health system driving overutilization because incentives and might be doing things (the health system looking to direct contract) to mitigate those fears. Some are discussed later in this podcast.
    So, I don’t know about whether plan sponsor spend would net-net go up if you get rid of PAs and profit-driven utilization management or go up enough to offset all of the admin costs and care gaps that crappy prior auths or prior auth processes slam patients and providers with.
    Big concern for employers (besides even if the price goes down will utilization go up—and then what’s the net effect of that?): Will the provider’s PPO (preferred provider organization) network be too narrow if I go with a direct contract with a health system, either legally running afoul of network adequacy rules or run afoul of employees just getting pissed off because their doctors are no longer in network? I guess there’s a bunch of ways you can do things if you are a plan sponsor that might mitigate this, but I could still see it certainly being a concern.

    By aligning the plan sponsor with the provider, includi

    • 32 min

Customer Reviews

4.9 out of 5
141 Ratings

141 Ratings

BoneDoc66 ,

Must listen

Excellent guests, engaging and educational discussions presented without fluff. A must listen for anyone interested in affecting change in healthcare delivery.

Guru CAM ,

Favorite healthcare podcast

As a benefits professional at a large company I think Stacey’s podcast is the most forward leaning, informative and thoughtful podcasts out there. Any fellow benefits professional should check this out to learn that is really happening with our collective healthcare benefits dollars.

PetShopDancer ,

Healthcare’s best interviewer with guests who are “walkers” vs. “talkers”

I’ve been subscribed to this must-listen podcast for years. It just keeps getting better. With so many people in healthcare practicing “innovation theater” and bloviating versus driving real change, it’s a breath of fresh air to listen to Relentless Health Value. Stacey is a great interviewer and gets a wide array of guests from the key areas of healthcare who have actually driving the quadruple aim.

If you are new to the topic, her show notes link to past episodes that can give the 101 when she’s tackling a topic at the 401 level.

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