Relentless Health Value

When Stacey Richter and Jonathan Baran dig into the incentive structures driving healthcare costs, there is an important caveat: the individuals working inside large health systems, carriers, and benefit consulting firms are not the same as the organizations they work for. A C-suite decision to pursue margin at the expense of mission is not a democratic vote. Most people working inside these organ...

Northeast Oklahoma beat out Colorado, Oregon, and New York to win a landmark federal competition for the Comprehensive Primary Care Initiative. The program worked — emergency room visits dropped, hospitalizations declined, patients loved it, doctors loved it, and primary care physicians earned tens of thousands in quality bonuses. Then a health system executive whispered a question that ended it:...

One carrier reported $4.8 billion in investment income in 2024. In 2025, United Healthcare recorded $151 billion in intercompany eliminations — payments from the insurance arm to subsidiaries it also owns. And as fee-for-service Medicare prices rise, Medicare Advantage capitation rates follow, creating a flywheel that rewards vertically integrated carriers for allowing underlying costs to climb. N...

Here is the central paradox of primary care: if you do it really well — evidence-based prevention, early intervention, curbing specialty volume — you cannibalize the very revenue stream that most consolidated health systems use to subsidize primary care in the first place. So why would a consolidated entity empower primary care to undermine its own major source of revenue? Stacey Richter calls thi...

Retail clinics have been a concept for 20-plus years — and by Dr. Tom X. Lee's assessment, they've largely failed to become what they promised. They're convenient vaccine shops and minor urgent care stops, but very few have become true longitudinal primary care destinations. In this bonus clip, Stacey Richter shares a sidebar conversation with Dr. Tom X. Lee, MD, founder of One Medical and Galileo...

Profit vs. Profiteering: What "No Margin, No Mission" Really Means in Healthcare "No margin, no mission" was coined by Sister Irene Kraus, a nun who ran a health system — and the spirit of the phrase is simple: if you can't sustain a viable business, you can't take care of patients. But somewhere along the way, as Stacey Richter puts it, enough people in healthcare seem to have adopted Jeff Bezos'...

How to Stay Mission-Driven When the System Is Working Against You A third of healthcare waste is someone else's profit. That profit buys a lot of influence — and it's one reason why doing the right thing for patients can get your face smashed against the wall inside a large healthcare organization. That's the real world Dr. John Lee is talking about in this episode, and his question is the one mos...

When a $1.5 Million Hospital Bill Gets Reduced to $290,000, Payment Integrity Is Why A lung transplant billed at $1.5 million. An organ charged at $676,000 when the legal maximum is $56,000. After a payment integrity review removed the ineligible charges, that bill came down to $290,000. That's not an edge case — for one plan with 55,000 members and $600 million in medical spend, a single year's a...

Per-employee rebates paid to employers have increased almost threefold since 2017. Over that same period, total drug costs still rose by nearly 24%. So what exactly are those rebates buying? That's the uncomfortable question at the center of this Summer Short. In this Summer Short Stacey Richter speaks again with Ann Lewandowski — nationally recognized healthcare executive and whistleblower known...

Stop-Loss Reinsurance Pitfalls: What Self-Insured Plan Sponsors Need to Know Stop-loss carriers shoot for 30 to 40% margins on the policies they sell. That figure came from the CEO of a large stop-loss carrier, in what Andreas Mang describes as a moment of weakness. If you're a self-insured employer and you haven't been actively marketing your stop-loss coverage every year, you may be paying hundr...

Five Hidden Fees in Your Claims Wire That May Be Costing Your Plan Millions The weekly claims wire looks like a payment for medical and pharmacy claims. But tucked inside that same wire, invisible to most plan sponsors, are fees that have nothing to do with the care your members received. One multi-employer fund reduced its $13 million in annual spend by $1.5 million just by getting better eyes on...

Stop-Loss Insurance 101: What Every Self-Insured Plan Sponsor Needs to Know Stop-loss is one of the most important buying decisions a self-insured employer makes — and it's almost always the last one, made when everyone is exhausted and ready to just be done. That combination has produced some expensive disasters. This episode is the 101 that makes sure you don't create one. Stacey Richter speaks...

The Very Real Impact of Trust — or the Lack of It — on Healthcare Outcomes "The very real impact of trust, or lack of trust, which may come from too little antitrust." That line, from Dr. Mick Connors, is the through line of this episode — and it connects patients who don't take prescribed medications because they trust their neighbor more than their doctor, to clinicians who are leaving the workf...

Healthcare is one of the hardest industries in which to build trust — conflicts of interest are baked into the economics, relationships have become transactional, and transparency is the exception rather than the default. So what does it actually take to earn it? This bonus add-on to EP477 revisits a conversation Stacey Richter recorded ten years ago with Charles Green, founder of Trusted Advisor...

An EBC Allegedly Pocketed $27 Million of Client Pharma Rebates. Here's What Happened Next. An employee benefit consultant where 61% of revenue allegedly came from keeping clients' pharma rebates — undisclosed, in violation of the Consolidated Appropriations Act of 2021, funneled into the executive bonus pool. When the compliance officer raised the alarm and eventually disclosed to a plan sponsor,...

Something shifted after the assassination of UnitedHealthcare CEO Brian Thompson. As Peter Hayes puts it, we've reached a "force majeure of bridges too far" — obvious, over-the-line activities that offend normal people's sense of justice. In this episode, Stacey Richter speaks with Peter Hayes, retired president and CEO of the Healthcare Purchaser Alliance of Maine and former director of associate...

What Private Equity Actually Does to Your Healthcare Costs, Doctors, and Community Private equity has invested over $1 trillion in U.S. healthcare in the past decade — from neonatal services to nursing homes — and most plan sponsors and patients don't know it's happened until the downstream effects are already deeply pervasive. In this episode, Stacey Richter speaks with Yashaswini Singh, PhD, MPA...

ER spend is now about 6% of average plan spend, and it doesn't have to be. In this Take Two episode, Stacey Richter revisits her conversation with Kenny Cole, MD, primary care internist and system vice president at Ochsner Health System, through a focused lens: what does it actually take for primary care to function as an investment in health rather than a cost center — and what happens when it do...

A single coronary artery bypass graft — no complications, went perfectly normally — billed at $800,000. Not a hypothetical. Eric Bricker, MD, heard it directly from the head of benefits at a major self-funded employer. In this episode, Stacey Richter speaks with Dr. Eric Bricker, internist, former hospital finance professional, co-founder of Compass Professional Health Services, and creator of the...

Recently on Relentless Health Value, we've been tinkering around with a few recurring themes—recurring through lines—that are just true about American healthcare these days. In this episode of Relentless Health Value, host Stacey Richter speaks with Dr. Christine Hale about high cost claimants and the implications for healthcare plans in 2025 and beyond. They discuss the importance of trust in pat...

In this episode, host Stacey Richter revisits a conversation with Nikki King, CEO of Alliance Health Centers, discussing the critical issues facing rural hospitals and healthcare systems. They delve into the impacts of Medicaid cuts, the financial struggles of rural hospitals reliant on commercial insurance, and potential solutions like freestanding emergency rooms, telehealth, and the expanded ro...

In part 2 of episode 469, host Stacey Richter discusses the implications of Medicare site neutral payments and Health Savings Account (HSA) reforms with James Gelfand, president and CEO of the ERISA Industry Committee (ERIC).   The episode details how plan sponsors should adapt to Medicare's site neutral payment policies aimed at curbing hospital consolidation and inflated prices through facility...

In part 1 of this two part episode, Stacey Richter speaks with James Gelfand, President and CEO of the ERISA Industry Committee (ERIC), about the potential effects of proposed Medicaid cuts on plan sponsors and their members.   They explore ways plan sponsors can prepare for the changes, including Medicaid's four major areas of possible cuts: reducing waste, fraud, and abuse; implementing work req...

In Episode 468, host Stacey Richter engages in a conversation with Matt McQuide, CEO of Synergy Healthcare. This episode delves into the critical assumptions surrounding member engagement within the healthcare industry.   Key points discussed include the role of employers in steering plan members, the importance of member engagement for navigating the healthcare marketplace, and Matt's three major...

In this solo episode of 'Relentless Health Value,' host Stacey Richter dives into the intricate relationship between increased emergency room (ER) visits and the lack of access to effective primary care. Discussing insights from recent episodes featuring experts like Matt McQuide, Dr. Christine Hale, and others, Stacey explores how inadequate primary care leads to skyrocketing ER costs, which now...