Relentless Health Value

Alex Azar, who is the current Health and Human Services (HHS) secretary (until January 21 anyway), came out with a reboot of the proposal that effectively halts the practice of pharma manufacturers paying rebates to Part D plans. This reboot is supposed to go into effect on 1/1/2022. But this podcast is less about this may-or-may-not-actually-happen rule and is more about the actual impact of remo...

In November 2020, there was an Executive Order entitled "Lowering Prices for Patients by Eliminating Kickbacks to Middlemen." And we had HHS (US Department of Health and Human Services) Secretary Alex Azar and the HHS Office of Inspector General finalizing a regulation to eliminate the current system of drug rebates in Med D (Medicare Part D). And what they were trying to do is create incentives t...

I had a vision for this inbetweenisode. I wanted to highlight the wisdom of our amazing guests this year. I really wanted to find some theme that might be a key to our health care transformation. To achieve maximum suspense, here's the very short story of how I got from "Is there a common thread of wisdom throughout all the RHV episodes this year?" to "Why, yes, there is … and it's a good one!" So...

You know back in the olden days when a foot of measurement was actually the measure of your own foot? So, I might measure something and it's, like, 19 feet. And then you measure the same exact thing and it's 38 feet because you have tiny feet. This is the analogy that kept running through my mind as I was talking with Anna Kaltenboeck in this health care podcast about QALYs to measure the value of...

Sometimes when I overhear a conversation/argument about telehealth, it occurs to me that there's a lot of fighting words about some things and very, very little about other things which I'd regard as equally, or maybe even more, important. Some of the sparring tends to jump immediately to tactics and UX (user experience), absent of strategy and CX (customer experience). In my experience, you can't...

There's lots going on these days with transparency. Three cost transparency rules, as a matter of fact, just came out of CMS, for example. These rules demand that hospitals and payers make available cost information so patients can shop and employers can also shop. That last part there, about employers and/or payers being able to shop … that might wind up actually being the part of these transpare...

Three transparency rules have come out of CMS in the past months. My guest in this health care podcast, Jeff Leibach, calls these three rules three steps on a ladder. They build on each other. The first rule was announced last year, and it was for hospitals to post their chargemasters. You could consider this a baseline step. It's not really all that useful in practice as many discovered. The next...

Wow! It's episode 300. That's a milestone. Because of you, we've grown to be one of the largest podcasts for health care executives—so, thank you to every one of you who has recommended the show to your friends and colleagues, which is really the highest compliment. Thanks also to all the listeners of this show who have written reviews, LinkedIn posts, and sent emails. The team over here at Relent...

If you are a forward-thinking specialist right now, alarm bells may be going off, given COVID and/or the prospect of another COVID-style pandemic. Also, all of the capitated and advanced PCP (primary care provider) practices popping up. Also, virtual care models. FFS is a cushy status quo revenue model until it isn't. One underappreciated point might be that FFS is not only a revenue/payment model...

I was really vexed the other day when I read on Twitter—First rule of thumb: Stay away from Twitter—but I read on Twitter someone bashing telehealth because, for many older Americans, going to the doctor is the only thing on their social calendar. Ummm, OK. So, we celebrate the idea of paying a cardiologist or a nephrologist or an orthopedic surgeon or some other specialist how much in FFS (fee-fo...

Here's something I never really understood: how physicians and nurses more often than not get to be responsible for the entire patient journey, including, start to finish, patient satisfaction. But if you just take one look at any random poorly rated physician's reviews, they're usually littered with complaints about the front desk in the practice. Negative reviews, of course, are not limited to f...

My guest in this health care podcast is Vincent Rajkumar, MD. Dr. Rajkumar is a professor of medicine at Mayo Clinic, Rochester. He's also a practicing hematologist at the Mayo Clinic with a focus on multiple myeloma. Dr. Rajkumar does research and conducts clinical trials. He's a well-known thought leader in questions about the cost of drugs in this country versus other countries. So, let me tell...

PCPs (primary care providers) are really important to population health. Primary care is the foundation of any well-functioning health system, I am sure many listening to this podcast know well. For the Triple Aim to happen, patients really need access to robust primary care. This has been affirmed by almost anyone who looks into it. And yet, in this country, our system sort of anemically supports...

Lately, several of the Relentless Health Value episodes have focused on digital health companies and their disruptive potential on referral flows of traditional provider organizations. We also talked about other goings-on with the potential to encroach on hospital systems and independent docs alike. For example, we've got Walmart getting, in a big way, into the health clinic business. We've got Vi...

Let's cut to the chase here for our conversation about co-pay cards offered by pharma companies versus co-pay accumulators and co-pay maximizers deployed by health plans. This whole war of the co-pays started back in the day when PBMs (pharmacy benefit managers) began to shake down Pharma for higher discounts. The prize that PBMs offered Pharma was lower co-pays for patients. It's a well-known fac...

Welcome to Episode 292, Part 2. This is the second part of a two-part episode, but, in a way, you can listen to whichever part you want first. So, if you wound up here first, no worries. Just go back when you have a sec and listen to Part 1 . There's some good stuff there you don't want to miss, including some background information that might be good to have.   This episode, as well as the last o...

This is episode 1 of a two-part show about the potential impact of the Teladoc acquisition of Livongo. To get started here, in deference to the fact that we're all in the health care industry, let's agree on an acronym, shall we—because I can't keep saying Teladoc-Livongo. So, I'm going to go with T&L heretofore that will refer to the Teladoc acquisition of Livongo. What is the general merged T&L...

Medicare Advantage (MA) enrollment has nearly doubled over the past decade. It grew 37% from 2016 to 2020. Right now, MA comprises nearly 40% of the Medicare population—and that number is only expected to grow. So, in case you've been out of the loop, at the beginning of 2020, CMS (Centers for Medicare & Medicaid Services) rolled out a third category of these "chronic supplemental benefits." And t...

There is a land grab going on right now, the likes of which the health care industry hasn't seen before—at least in our generation. Spoiler alert: There's a whole episode of Relentless Health Value coming up on the impact of the Teladoc-Livongo hookup. And that is totally relevant to the point I'm about to make. But let me just start with a little bit of background: American patients—let's get rea...

Here's a couple of sentences ripped from the headlines recently: It is free to be tested for COVID-19 in the US, but the cost of treatment can be shocking. Even if you're insured, the deductible and co-pay can add up to several thousand dollars. And if you're uninsured, the financial toll is even uglier. That's what Boston resident Danni Askini learned when she got a $34,927 bill after receiving t...

You may or may not know (I don't know why you would, honestly), but I speak Swedish. I mention this because there's this famous and really culturally emblematic Swedish word which is this: lagom . It means "the exact right amount." In Swedish culture, the exact right amount deserves its own word. For example, "Did you have enough watermelon?" "Why, yes, I had half a slice. It was lagom." Lagom has...

Disclaimer before we get started here: This show is probably a 300-level class in pharmaceutical/PBM relations. If you are tuning in for the first time and you aren't pretty familiar with the role of PBMs, I would go back and listen to, say, episode 241 with Vinay Patel or episode 166 with Tim Thomas from Crystal Clear Rx.   OK, now that that's out of the way, if you're still with me, this episode...

In this health care podcast, I'm speaking with Dan O'Neill, MA, MS. Dan says that, in many ways, this is a fantastic time to be an entrepreneurial physician leader. We are in a place to reinvent the practice model, meaning finding ways to increase value while losing bloated business practices in labor and capital. It's more possible than ever to make a medical practice more efficient and effective...

John Rodis, MD, MBA, is an OB/GYN specializing in high-risk pregnancies. He's been a board examiner and a department chairman. He's been a COO and a CEO of a 600-bed Level 1 trauma center. He's also an author working on a book to help consumers make better choices. Dr. Rodis has said he feels an inflection point is coming in the transition to value. First, we have the pressure of large employers....

I'm going to summarize some points that Dr. Marty Makary made in his manifesto for why he wrote his most recent book. The Price We Pay is its name. You can hear this manifesto in his own words—in Dr. Makary's own words—on Relentless Health Value episode 242 , but here's his point: He said that the 2007 banking crisis, writ large, resulted from complexity that kept onlookers confused. So, when peop...