Relentless Health Value™

In this encore episode of 'Relentlessly Seeking Value,' host Stacey Richter revisits a critically important conversation with ERISA attorney Paul Holmes about the complexities and hidden pitfalls in Pharmacy Benefit Manager (PBM) contracts.

Aimed at CFOs and employer plan sponsors, Holmes highlights how poorly reviewed PBM con...

In Episode 444 of Relentless Health Value, Stacey Richter speaks with healthcare consultant Ann Kempski about two state healthcare laws with unintended consequences: the Certificate of Need (CON) and the Certificate of Public Advantage (COPA) laws. They delve into the original intentions behind these laws, the ways in which they have often failed, and their impact on the competitive landscape.

The discussion also explores how CON l...

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Episode 443 of Relentless Health Value pays tribute to the late Marshall Allen, an investigative journalist dedicated to exposing injustices within the American healthcare system. Hosted by Stacey Richter, the episode features Dave Chase, founder of Health Rosetta, who share...

In Episode 442 of 'Relentless Health Value,' host Stacey Richter shares an intriguing outtake from a previous episode featuring Andreas Mang, senior managing director at Blackstone, discussing the critical issue of cost management in oncology side effect treatment.

The conversation delves into the inefficiencies and patient harms caused by inadequate side effect management, particularly dehydration due to chemotherapy, and the resu...

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 var...

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 ...

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 i...

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 ...

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 ...

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 mark...

For a full transcript of this episode, click here.

I’m gonna encore this episode with David Scheinker, PhD, for several reasons; but here’s a big one: Why are we as an industry not doing what David Scheinker suggests in this episode?

Why are we not doing, I don’t know, k...

Optimizing Pharmacy Benefits in Value-Based Care: A Conversation with Dan Mendelson

In Episode 435 of 'Relentless Health Value,' Stacey Richter hosts Dan Mendelson from Morgan Health to discuss the importance of integrating pharmacy benefits into the broader context of value-based care. The conversation stems from a LinkedIn post by Mendelson outlining five key considerations for optimizing pharmacy benefits. Topics include the tot...

Five Surprising Facts About Bundled Payments in Healthcare

In Episode 434 of 'Relentless Health Value,' host Stacey Richter interviews Dr. Ben Schwartz, an orthopedic surgeon and prolific writer, about bundled payments in the healthcare industry. The discussion focuses on four key surprises related to bundled payments: the all-encompassing nature of the 90-day post-surgery cost coverage; the reluctance of commercial payers to engag...

Unveiling Hidden Fees in Weekly Claims: What Plan Sponsors Need to Know

Episode 433 of Relentless Health Value dives into the complexities of weekly claims wires that self-funded employers receive. Host Stacey Richter speaks with Justin Leader about the hidden fees embedded in these claims, including shared savings fees, prior authorization fees, prepayment integrity fees, pay and chase fees, a...

Mission vs. Margin: Dr. Scott Conard's Journey in Transforming Primary Care

In this encore episode, Stacey Richter discusses the challenges and opportunities in primary care transformation with Dr. Scott Conard. The conversation explores the conflict between mission-driven healthcare and profitability, drawing from Dr. Conard's personal and professional experiences. Key topics include advanced primary care models, perverse incentiv...

Unlocking the Front Desk: The Overlooked Key to Patient and Clinician Success

In this encore episode of Relentless Health Value, host Stacey Richter delves into a crucial yet often ignored aspect of patient engagement and clinical success with Jerry Durham from the Client Experience Company. The discussion emphasizes how the front desk can significantly influence positive patient outcomes and mitigate clinician burnout. Jerry outli...

Balancing Mission and Margin in Healthcare: Lessons from Kate Wolin

In Episode 432 of 'Relentlessly Seeking Value,' host Stacey Richter discusses with behavioral epidemiologist and digital health entrepreneur Kate Wolin about the challenges and opportunities in merging clinical care with efficient business practices. They explore the pitfalls of scaling healthcare services while maintaining patient outcomes and why human-centered a...

For a full transcript of this episode, click here.

There’s this meme that’s going around on the interwebs with the caption, “Sometimes the shortest distance in between two places isn’t a straight line.” What? Yeah, because actually there’s three dimensions in the real world.

So, when we all consider the real world, understanding the contours of reality and aligning with them ...

For a full transcript of this episode, click here.

We have been spending a bunch of time here on Relentless Health Value talking about PBMs (pharmacy benefit managers) lately and pharmacy benefits, but we are moving into a new topic area. It sort of kicked off three weeks ago with the pod with Rik Renard (EP427) on the importance of care flows if you are a digital health vendor trying to get co...