Relentless Health Value

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, inc...

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, ...

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 emphas...

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 i...

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 heal...

In this second take on episode host Stacey Richter speaks with Dr. Tom Lee, founder of One Medical and Galileo. The discussion centers on the survival of independent primary care practices in the current healthcare economy, the associated challenges, and the paradox of primary care. 

Topics include reducing ER visits, managing downstream specialty spend, and the imbalance between CMS and commercial carrier payments to primary care ...

This short bonus episode is a side bar conversation with Dr. Tom Lee discussing why retail clinics are struggling with Dr. Tom Lee. 

They explore the shortcomings of retail clinics in providing longitudinal primary care, despite their convenience for minor urgent care and vaccinations. 

Dr. Lee emphasizes that true primary care requires consistent, long-term patient relationships and complex management which many retail clinics fai...

Balancing Mission and Margin in Healthcare: A Candid Conversation with Dr. Ben Schwartz

In this episode, host Stacey Richter engages in a deep dive with Dr. Ben Schwartz to explore the phrase 'No Margin, No Mission' and its practical implications in the healthcare industry. 

They discuss the complex relationship between profitability and mission-driven care, the challenges of value-based care, and the role of dyad leadership. The e...

In this Take Two episode of Relentless Health Value, host Stacey Richter reflects on her conversation with Dr. John Lee to explore the challenging intersection between mission and margin in healthcare. 

They discuss the nuances of cognitive dissonance faced by healthcare professionals, particularly when organizational priorities conflict with patient care. Dr. Lee shares insights on finding a sense of mission within the constraints...

Enhancing Payment Integrity in Health Systems: An In-depth Discussion with Kimberly Carleson.

In Episode 481 of Relentless Health Value, host Stacey Richter speaks with Kimberly Carleson, CEO of US Beacon, about payment integrity within health systems. They delve into strategies some hospitals use to maximize revenue without raising rates and discuss the importance of accurate billing. 

Key takeaways include the high prevalence of ...

Exploring the Complexities of Pharma Rebates with Ann Lewandowski

In this Summer Short episode of Relentless Health Value, host Stacey Richter converses again with Ann Lewandowski about the intricate dynamics of pharmaceutical rebates, or as Lewandowski prefers, post-sale concessions. 

The discussion delves into the nuances of these rebates, the impact they have on drug costs, and the hidden consequences for patients and plan spons...

In this second discussion with Andreas Mang and Jon Camire of Blackstone, Stacey Richter has  an advanced discussion on the intricacies of stop-loss reinsurance for high-cost claimants. 

This show today, for sure, it’s for plan sponsors and anyone on or about plan sponsors; but also listen if you are serving high-cost claimants some other way. Because what you’ll learn here today is some insights relative to how plan sponsors go ab...

Stacey Richter has a second take on the original episode 433 since it is so relevant right now. Stacey engages in a compelling conversation with Justin Leader, CEO of BenefitsDNA, about the opaque practices of third-party administrators (TPAs) and their impact on healthcare costs. 

They discuss the hidden fees tucked into weekly claims wires, including shared savings fees, prior authorization fees, prepayment integrity fees, pay an...

Host Stacey Richter discusses the intricacies of stop-loss coverage with Andreas Mang and Jon Camire from Blackstone. The episode focuses on defining stop-loss insurance and exploring its critical role in protecting self-insured employers from catastrophic financial losses. 

The conversation delves into the nuances of individual and aggregate stop-loss policies, laser claims, and the impo...

In this episode, Stacey Richter explores the impact of trust on healthcare outcomes, drawing from listener contributions and prior episodes of Relentless Health Value.

The discussion underscores how trust or the lack thereof affects patients, clinicians, and healthcare systems. Key points include the importance of building trusted relationships, the detrimental effects of antitrust behaviors, and the bro...

In this bonus add-on to episode 477 of Relentless Health Value, host Stacey Richter revisits a decade-old conversation with trust expert Charles Green, founder of Trusted Advisor Associates. Green discusses the intricacies of building and maintaining trust in healthcare, emphasizing four key trust principles: client focus, collaboration, long-term relationships, and transparency.

The discussion highlight...

In this episode, host Stacey Richter speaks with Ann Lewandowski about whistleblowing in the healthcare industry, focusing on a significant case involving a whistleblower at an employee benefit consultant (EBC) firm. This EBC allegedly pocketed their clients' pharma rebates, violating the Consolidated Appropriations Act of 2021. 

The discussion highlights the nuances of being a whistleblower, the ethical dilemmas faced, compliance ...

In this episode of Relentless Health Value, host Stacey Richter sits down with Peter Hayes to discuss the major forces driving change in the healthcare industry. Hayes outlines three critical factors: changing public opinion, heightened transparency, and new regulations such as the Consolidated Appropriations Act. 

He emphasizes the unprecedented convergence of these elements, creating a pivotal moment for healthcare transformation...

In Episode 474 of 'Relentless Health Value', host Stacey Richter interviews Dr. Yashaswini Singh, an economist and assistant professor at Brown University, about the growing influence of private equity (PE) in healthcare. 

The conversation delves into the corporate transformation of medicine, highlighting the potential misalignment between business interests and patient care. Dr. Singh discusses the diverse strategies PE firms use ...