Relentless Health Value

Healthcare Transactions Cost 1,000 Times More Than They Should — Here's Why Clearinghouses Are Part of the Problem Sending a claim through a healthcare clearinghouse costs 10 to 15 cents per transaction. Sending a thousand business emails at scale costs about 15 cents total. That is a thousand-to-one cost differential for something that healthcare has actually standardized more rigorously than mos...

Plan Sponsors Pay $1.20 to Buy $1 of Healthcare — and Providers Collect 80 Cents of That A self-insured employer pays $1.20–$1.30 to access a dollar of negotiated healthcare. Providers budget their business around collecting 70 to 80 cents of what they are contractually owed — because denial rates, unpaid patient balances, and collection timelines of 2 to 9 months are the operating reality. The ga...

This is Part 2 of Stacey's year-end synthesis of the most actionable themes from 2025. Last week covered Themes 1–3. This week covers 4 and 5 — which are, if you squint, really two sides of the same problem: plan sponsors can't buy value when they can't see what they're buying, and they can't see what they're buying because the vendors who benefit from opacity are the ones controlling the data. WH...

As Stacey Richter reflects on a year of Relentless Health Value episodes, three themes kept surfacing in nearly every conversation: the foundational role of trusted relationships, the cost of underinvesting in primary care, and the dominance of perverse financial incentives and profiteering. This is Part 1 of a two-part year-end Inbetweenisode hosted by Stacey Richter, drawing on episodes featurin...

From $9 Million in the Hole to $112 Million in the Black: How Marilyn Bartlett Turned Around Montana's State Employee Health Plan. What happens when a self-funded health plan is headed for bankruptcy and a CPA with a spreadsheet and her eye on the target gets to work? In roughly three years, Marilyn Bartlett, CPA, CMA, CFM, CGMA took the State of Montana's employee health plan from a $9 million de...

The value equation in healthcare is outcomes divided by cost — but here's the revelation Stacey Richter had in this conversation: we've been measuring it exactly backwards. In American healthcare, costs are tracked at the macro aggregate level while outcomes are measured at the narrow individual service level. Flip that — measure costs at the unit level and outcomes at the whole person and whole c...

If a drug keeps a patient out of the hospital — and hospital spend is 50% of most plan sponsors' total costs — why do we design benefits that make patients less able to afford that drug? That's the martini-fueled question Stacey Richter started with, and it threads through this entire conversation about why pharmaceutical pricing in America is so persistently broken. In this episode, Stacey Richte...

Pharma raises list prices to maximize rebates. Higher list prices blow up patient coinsurance. Pharma responds with copay cards. PBMs fight back with maximizers and accumulators. Prior auths ramp up. Premiums rise. Deductibles climb. And at no point in this cycle does anyone stop to ask: is this drug actually worth its price? That is the pharmaceutical pricing arms race Stacey Richter lays out in...

It will take a village to transform healthcare. Stacey Richter says this so often it is taped to her wall on a Post-It. This Thanksgiving Inbetweenisode is her chance to say thank you to the people actually building that village — and to make the case, with a detour through a drunk blacksmith charity auction, that the demand curve is the most underappreciated concept in healthcare reform. This is...

Direct contracts between employers and clinical organizations perform way better than what most third parties negotiate — and the Employers Centers of Excellence Network (ECEN), built by the Purchaser Business Group on Health (PBGH), proved exactly that. This Take Two episode revisits that work in light of a key finding from a recent PBGH data demonstration project: plan sponsors can now use publi...

Employer C-suites have been largely absent from healthcare purchasing decisions for decades — dipping in once a year at renewal, then handing the whole thing back to HR. That era is ending. Boards are noticing missed earnings numbers. CEOs are confronted with 10 to 12% trend forecasts on top of already strained budgets. And cost-shifting to employees — the go-to move for 20 years — has finally hit...

Beaumont Hospital Royal Oak was nationally recognized in nine medical specialties, received top hospital awards for seven consecutive years, and charged 143% of Medicare. That combination — genuinely high quality and genuinely low price — is supposed to be impossible. Shane Cerone and Dr. Sam Flanders built the management model that made it happen, and in this solutions-focused episode they explai...

There is zero correlation between price and quality in hospital care. That is not speculation — it is in the data. The PBGH Transparency Demonstration Project, conducted by the Purchaser Business Group on Health with Milliman and Embold and funded by the Peterson Center on Healthcare, combined price transparency data, claims data, and quality and safety scores from Leapfrog down to the individual...

The myth is that we have a functioning marketplace. We don't. We don't have a broken market — it's closer to a nonexistent market. That's Shane Cerone speaking, a former CEO of multiple hospital systems, and it is the central argument of this episode: the pricing crisis in American healthcare isn't being solved because the foundational premise — that market forces are constraining hospital prices...

One third of adults in this country are delaying or forgoing care due to cost. Financial toxicity is clinical toxicity. And yet the standard assumption in healthcare is that affordable prices and financial sustainability are in fundamental tension with each other. Dan Greenleaf's argument — backed by the operating results of Duly, a 1,800-clinician multispecialty group in Chicago — is that they ar...

Hospitals have increased their prices 256% over the last 20 years while physician compensation adjusted for inflation is down 36%. The average American family of four now spends $24,000 a year on healthcare — up from $6,000 in 2000 — while wages have risen far more slowly. Dan Greenleaf's argument is that in this environment, focusing on mission is not a financial sacrifice. It is a competitive ad...

High deductible health plans were supposed to give patients skin in the game. What they actually did was create a class of functionally uninsured Americans — because if your deductible is more than you have in your bank account, your insurance is worthless. And then there's the second layer: self-insured employers hired armies of consultants and middlemen to navigate the complexity, which made the...

The New Jersey state employee health plan is projected to cost $3.5 billion in 2026 — with no medical director employed by the state and no unconflicted experts at the negotiating table. Kevin Lyons, a former police detective and executive director of labor employee benefits at the New Jersey State Policemen's Benevolent Association, which represents 33,000 members, is trying to change that. In Pa...

The New Jersey PPO family plan cost $67,000 in 2026 — having almost doubled in five years, with a 37% rate increase proposal for that year alone, cumulating to 115% over five years. State workers including teachers, police officers, and public employees are paying roughly $25,000 of that themselves. And the state has no medical director, no unconflicted experts at the table, and a legislature whos...

A 23-year-old roofing laborer paid $125 for a comprehensive metabolic panel — a test available directly for $6.52. That is not a healthcare problem. That is a pricing failure. And it is the origin story of ZERO.health, a direct contracting platform that gets plan members access to high-quality providers for $0 out of pocket using bundled payments. In this episode, Stacey Richter speaks with Dr. St...

Imaging costs 6 to 11% of total plan sponsor spend — and that figure requires aggregating CPT codes, contrast charges, professional services, and facility fees, many of which are split across different code categories in ways that make the true total hard to see. The same MRI that costs $5,000 at a hospital system might cost $300 to $500 at a freestanding imaging center of equivalent quality. And...

PBGH member employers collectively spend over $350 billion a year on healthcare. And per Elizabeth Mitchell, 30% of that spend disappears in the middle — not reaching providers, not improving health — just gone into administrative spread, misaligned fee structures, and the cost of a system that was never designed to pass money through efficiently. That number is not speculation. It is what she obs...

Across the country, self-insured employer teams are waking up to the fact that "I trusted my consultant" is not a legal defense. Not under ERISA. Not under the Consolidated Appropriations Act. And the lawsuits — J&J, Wells Fargo, Tiara Yachts versus Blue Cross Blue Shield of Michigan, Osceola County — are making it impossible to ignore. In this episode, Stacey Richter asks Dave Chase, co-founder a...

The negative healthcare flywheel spins on one axle: employers buying discounts. Discounts create no incentive for health systems to control prices, no incentive to invest in primary care, and no way to know what anything actually costs. The flywheel just keeps spinning. In Part 2 of this conversation, Jonathan Baran turns it around — and the fix starts with employers refusing to buy discounts at a...

A 9% healthcare renewal is celebrated as a good year. But 9% is three times the rate of inflation, and it's not going to doctors or nurses — physician compensation has been flat or declining, and nursing strikes are evidence enough of what's happening there. So where does the money go? Jonathan Baran has a very clear answer: it goes to the flywheel. And the flywheel starts with discounts. In this...