Relentless Health Value

I was on LinkedIn, and someone was saying, "Oh, there's no real money in generic drugs. It's not a huge issue if patients are paying 10 bucks instead of 93 cents for something. It's not like anyone is getting rich off of that, and it's not like patient impact here is super meaningful." This is a pretty common refrain, actually; and from a conventional wisdom perspective, I get it, especially for t...

Most people who have been in the healthcare industry for a while have heard by now the metaphor about the two canoes. Provider organizations or health systems with some of their payments coming from a fee-for-service (FFS) payment model and some of them coming from value-based arrangements have the challenge of one foot in the FFS canoe and one foot in the value-based canoe. They're probably going...

This episode's conversation is about the new Consolidated Appropriations Act (CAA), the fee disclosure part of it, as well as ERISA and the fiduciary responsibility that self-insured employers are responsible to comply with under the law. Don't worry, the first thing my guest in this healthcare podcast, Christin Deacon, does is explain these terms, what they actually mean, and how they can be a to...

First, let's talk about reducing administrative waste in the US healthcare system. There was a pretty famous 2019 study by Shrank et al. that estimated about 25% of the $3.6 trillion the US spends on healthcare annually is potentially wasteful. This is each person spending $2500 unnecessarily. Robert Kocher wrote a really interesting article about getting rid of administrative waste and inefficien...

There's a next generation of digital front doors being created that open up to a patient/member experience that folds in payer, provider, and employer data—plus behavioral data the patient themselves generates when they browse through content in there. Because that's what it takes for a so-called personalized experience or patient journey to ensue. This is what I'm talking about in this healthcare...

Reference-based pricing, the way that most employee benefit consultants use the term anyway, refers to a methodology used by employers to pay providers for services. Usually we're talking within a fee-for-service (FFS) environment here. The way it typically works ... there are different flavors, but how it typically works is this: Reference-based pricing (RBP) means that an employer starts with so...

Let's just start here: As a general construct, insurance carriers have every incentive for health insurance premiums to go up every year. If you're an employer, that is a material fact. Is it counterintuitive? Maybe. Except if you're an employer and your premiums are going up year after year, it begs the question why, every single year, the already-extravagant amount you pay continues to go up way...

My overarching thought throughout a lot of this interview was that improving rural health will take everyone remembering to not let perfect be the enemy of the good. If I live in rural America, there's no subspecialists. Forget about even seeing a garden-variety kind of specialist. I might have to drive hours to even get to a PCP. There are NPs (nurse practitioners) in a lot of these remote commun...

Here's the cold hard truth: The whole specialty pharmacy operational model is not built to serve patients, a fact that becomes crystal clear when you're a patient. Instead, the specialty pharmacy model is, rather, pretty blatantly dedicated to the power struggle for revenue and captive patient populations. It's war between providers and the whole PBM/insurer/specialty pharmacy vertical consolidati...

I was listening to a panel discussion and heard Brandon Weber use the phrase the "barbarians at the gate" of the healthcare industry. I think I reached out to invite him to come on the podcast before the end of the segment. But at risk of spoiler alerts, let me sum up what I think is so interesting about Brandon's insights, which he talks about on the show. First of all, it isn't an "oh, heavens,...

Here's a hot take for you. I just learned what a hot take was last week, so, of course, I needed to get me one on the quick. The thing with hot takes, from what I understand, is that they are open for discussion. What I'm talking about today is something I've been thinking about for a while, and I would be interested in your thoughts, since probably some finesse is needed here. I want to talk abou...

This conversation starts out talking about the RUC, which is a committee run by the AMA, who has the sole source contract with CMS to figure out how many RVUs any given procedure or service is worth. There are roughly four times as many specialists on this RUC committee as PCPs. You might be able to see where this is going, but let me let our guest in this healthcare podcast, Brian Klepper, explai...

In this healthcare podcast, I'm talking with Brian Klepper. If you haven't heard of him, Brian's a longtime healthcare analyst and former CEO of the National Business Coalition on Health. This interview takes off like a shot, as most of my conversations with Brian Klepper do. We're talking about primary care and its various iterations. We start out with Exhibit A—the HMO version of primary care fr...

In this episode, host Stacey Richter speaks with Sunita Desai, PhD, a health economist and assistant professor at NYU Grossman School of Medicine, about the real-world impact of price transparency in healthcare. They break down the intended progression from transparency to consumerism to lower costs and higher quality care—and why, in practice, that progression often stalls. Sunita shares key rese...

In this episode, host Stacey Richter engages with a panel of experts—including Jeff Hogan, Darrell Moon, Dr. Grace Terrell, Dr. Rich Klasco, Nicole Bradberry, and Kelly Conroy—to discuss the practical implementation of care plans in real-world settings. The conversation delves into the challenges and successes of integrating care plans into healthcare practices, offering insights into effective st...

In most other industries, it's the customer who consumes the services and engages with the purveyor of services. In health care, not so much. Legacy health care has evolved to honor the insurance carrier as the customer or, in some cases, the fancy surgeon or other driver of revenue as the customer. Listen to the podcast with Marshall Allen for more on that front, but yeah. And here we are.   Heal...

  In this episode, host Stacey Richter interviews Al Lewis, founder and "quizmeister-in-chief" of Quizzify, about the misleading tactics wellness and point-solution vendors use to inflate their cost savings claims. They explore statistical tricks like regression to the mean, flawed participant comparisons, trend inflation, and overstated engagement metrics.  Al also shares advice for employers on...

In this health care podcast, I'm interviewing John Marchica, who is the CEO at Darwin Research Group. Starting last year in the middle of the worst of the COVID pandemic, Darwin Research Group conducted a study about what was going on at health systems or integrated delivery networks (IDNs), and they've updated it every quarter since then. The goal was to try to stay on top of the effects of COVID...

In a recent article in STAT news, TJ Parker, the VP of pharmacy at Amazon and the founder of PillPack, explained that Amazon's plan to stand out in the pharmacy space is simple: "Better selection, better convenience, and better prices." He added, "It really is the Amazon playbook."   Better selection, better convenience, better price. The playbook of arguably one of the most successful companies e...

"Scientists Announce Successful Experiment to Bankrupt Mouse That Can't Afford Cancer Drug." That's a recent headline from The Onion , which is, by the way, a funny satire newspaper, if you haven't heard of it. You could swap out "Cancer Drug" in that headline with "a Trip to the ER"—or pretty much any aspect of health care in this country. No matter what health care service you stick in there as...

If I had a nickel for every guest on this show who went on to achieve wild success … TJ Parker from PillPack three years before they were bought by Amazon. Anyway, let me introduce this show with a clip from the recent podcast ( EP325 ) with Dr. Mai Pham. We were talking about the rampant and very open secret of excessive upcoding in Medicare Advantage (MA) that is costing American taxpayers a for...

You can subscribe to this show two ways. One way is through the iTunes podcast app or your podcast app of choice. That's a cool way to subscribe because then the show just kind of turns up in your podcast app each week and you can decide to listen to it on the fly. The other way is to subscribe on our Web site. This is more like a newsletter subscription. If you subscribe this way, you get an emai...

Here's the context, friends: As you may have noticed over the past few episodes, we have been digging into value-based care here at Relentless Health Value corporate work-from-home headquarters. Many lessons have been learned, and it's important that we sit back and think hard every now and then about how we are going to use these learnings to improve. While this show tackles the Hospital Readmiss...

First of all, a shout-out to all of you listeners who have shared this show with colleagues and LISTSERVs—really appreciate it. It's because of you and your efforts to share that Relentless Health Value maintains its spot as one of the top podcasts reaching health care executives, executives who take the insights shared by our guests to drive actual change and transformation across our industry. S...

Recently, the University of Pennsylvania Leonard Davis Institute of Health Economics, or LDI, put out a white paper called "The Future of Value-Based Payment: A Road Map to 2030." Spoiler alert: Next week's show is with Dr. Mai Pham, an author of that paper; and it'll be a great show—so, tune back in next week. But, in the meantime, that paper made some really interesting points about ACOs (accoun...