Relentless Health Value™
543 episodes - English - Latest episode: 20 days ago - ★★★★★ - 203 ratingsAmerican Healthcare Entrepreneurs and Execs you might want to know. Talking.
Relentless Health Value is a weekly interview podcast hosted by Stacey Richter, a healthcare entrepreneur celebrating fifteen years in the business side of healthcare.
This show is for leaders in pharma, devices, payers, providers, patient advocacy and healthcare business. It's for health industry innovators, entrepreneurs or wantrepreneurs or intrapreneurs.
Relentless Healthcare Value is the show for you if you want to connect with others trying to manage the triple play: to provide healthcare value while being personally and professionally fulfilled.
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Episodes
How Come There Aren’t More Hospital Antitrust Cases? With Brennan Bilberry—Summer Shorts 1
July 06, 2023 10:30 - 8 minutes - 11.1 MBMay I just take a moment and thank the Healthy economist for leaving a super nice review on iTunes? The title of the review is “Best podcast on the healthcare industry,” and the Healthy economist writes, “There’s no one simple fix [for the healthcare industry], but [Relentless Health Value] contains valuable insights on what actions can be taken to make things better for consumers and patients.” Thank you, Healthy economist. In this summer short, I am talking with Brennan Bilberry; and we’...
INBW38: What I’m Up to Right Now, Big RHV Plans for the Summer—Also Doug Pohl, Justina Lehman, and Dr. Amy Scanlan
June 29, 2023 10:30 - 9 minutes - 13.5 MBThanks for joining me as we kick off the summer season. Here’s what we’re gonna talk about today in our 10-ish-minute conversation. Keeping it short and sweet. First up, we got three super interesting voice messages left by your fellow members of the Relentless Tribe that I wanted to share with you. Next up, I will cover plans for the summer, because this summer, we have plans. And then after that, just wanted to chat a little bit about what I am up to right now. Agenda item #1: Episod...
Encore! EP365: The Real Deal With PBM Contracts and Drug Rebates, With Scott Haas
June 22, 2023 10:30 - 33 minutes - 45.4 MBI hope you enjoy this encore episode of one of the most popular shows in the last 12 months. One of my mentors often said price is irrelevant. He said he would sell anything for any price as long as he could define the terms of the deal. During this conversation today with Scott Haas about PBMs (pharmacy benefit managers), that quote was playing in my head like an earworm. I’m henceforth gonna struggle with the term rebate to define dollars that the PBM gets back from Pharma, because, ac...
EP408: Who’s Suing Who? An Overview of Healthcare Legal Goings-on, With Chris Deacon
June 15, 2023 10:30 - 39 minutes - 54.5 MBI couldn’t resist the “who’s suing who” because, yeah, you can’t go wrong with Aretha Franklin references. Back on the pod we have Chris Deacon, who is going to give us a rundown of the legal goings-on going on right now that impact self-insured employers, carriers, hospitals, and taxing authorities like cities. Chris breaks down the legal activity into three main categories, and then we discuss some examples of lawsuits in each category. So, here’s the outline of our upcoming conversati...
EP407: Considering Comprehensive Primary Care at Humana, With Vivek Garg, MD, MBA
June 08, 2023 10:30 - 35 minutes - 48.7 MBOkay … let me get real here for a sec. For a few reasons, I wanted to chat with Vivek Garg, MD, MBA. Dr. Garg is CMO (chief medical officer) of primary care at Humana. Dr. Garg is an inspiring and incredibly articulate individual, and I like to both learn from and also be kept on my toes by the likes of such folks. But also, yeah, I’m suspicious of vertically consolidated payers. I mean, you listen to this podcast. I don’t need to recap what the financialization of the healthcare industry ...
EP406: The Inertia Show: 5 Excellent Reasons for the “Why” With the Inertia in Benefits Departments, With Lauren Vela
June 01, 2023 10:30 - 32 minutes - 44.2 MBI’m gonna run through the five reasons Lauren Vela talks about in this healthcare podcast for the “why” with the inertia in benefits departments of self-insured employers. But before I do, let me report that, in sum, they add up to … in many cases, benefits folks sit between a rock and a hard place. You really can’t poke fingers at benefits teams who don’t have the bandwidth, the resources, the expertise, or the organizational power to, in essence, run a small insurance company in-house an...
Encore! EP249: The War on Financial Toxicity in North Carolina as a Case Study Everybody Should Be Keeping Their Eye On, With Dale Folwell, North Carolina State Treasurer
May 25, 2023 10:30 - 32 minutes - 44.6 MBIn this episode of Relentless Health Value, we delve into the perplexing state of healthcare legislation in North Carolina. Unlike the proactive measures taken by other states such as Texas, Indiana, and Wisconsin, North Carolina seems to be an outlier with its current legislative actions, despite its Republican majority legislature. Normally, a bit of divergence can be intriguing, but the current direction in North Carolina raises significant concerns for families and businesses strugglin...
EP405: What Else Physicians Trying to Clinically Integrate in the Real World Really Need to Know, With Eric Gallagher
May 18, 2023 10:30 - 31 minutes - 43.7 MBLet’s cut to the chase. You’ve gotten to the point where you have a gang of physicians/clinicians/physician practices who have expressed a desire to work together. What do you need to know right now? Eric Gallagher, CEO of the Ochsner Health Network, is my guest in this healthcare podcast; and I largely asked him the same question that I had asked Amy Scanlan, MD, from the UCHealth/Intermountain clinically integrated network in Colorado in episode 402 a couple of weeks ago. The question I ...
EP404: What Now? Who’s on the Board of Those Big Hospitals? With Suhas Gondi, MD, MBA
May 11, 2023 10:30 - 32 minutes - 45.3 MBSo much of this episode (and this podcast as a whole, really) is about one consistent theme: How do we reset or redesign our healthcare industry, including hospital chains—mostly talking about the big consolidated ones that have a lot of money here—but how do we redesign these leviathans to be more consistent with our values as a country and the values of the doctors and other clinicians and others who work in these places and who went into the healthcare profession for a reason that had, yo...
EP403: The Mix & Match With the How Doctors Get Paid, With Rachel Reid, MD, MS
May 04, 2023 10:30 - 32 minutes - 44.8 MBThis is a conversation about physician compensation, which is often oddly misaligned from the way that the whole physician or provider organization is getting paid. Now, first thing to point out: There are lots of different kinds of physicians doing all kinds of different things. As with most everything in healthcare, lumping everybody together and making general proclamations about what is best is a really cruddy idea. With that disclaimer, if you think about the main models of physicia...
EP402: What Physicians Trying to Clinically Integrate Care in the Real World Need to Know, With Amy Scanlan, MD
April 27, 2023 10:30 - 32 minutes - 45.2 MBSo, let me just cut to the chase here with very little preamble, and all of this is a setup to the interview that follows, although it is not really what the interview that follows is all about. A mentor of mine used to say, you can’t legislate the heart. Let me also suggest you can’t give someone in finance financial incentives and then expect them to not prioritize financial incentives. It stands to reason that if the healthcare industry is found to be quite attractive to those who are m...
EP401: The Most Interesting Questions About the IRA Drug Price Negotiations, With Peter J. Neumann, ScD
April 20, 2023 10:30 - 31 minutes - 43.4 MBSomebody wrote on Twitter the other day that he was gonna give a talk on the use of evidence in drug policy, and Barrett Montgomery replied, “That’ll be a short talk then!” So, let’s talk about the IRA (Inflation Reduction Act) for a moment, specifically the “CMS can negotiate for drugs for Medicare patients” part of the IRA. There’s one topic I don’t hear discussed what I would consider maybe often enough. Will these negotiations result in pricing that is evidence based? Will good drugs...
EP400: My Manifesto, Part 2: Where the Rubber Hits the Road
April 13, 2023 10:30 - 21 minutes - 30 MBI hope you listened to episode 399, which was Part 1 of this two-part exploration of my manifesto, meaning my aims and my path or framework to achieve those aims. Regarding the first part of my manifesto, episode 399 from two weeks ago, here’s the tl;dl (too long, didn’t listen) version; but please go back and listen to that show (Part 1) because it’s about you—and it’s a compliment and a thank you, and you deserve both. Just to quickly recap, Part 1 of my manifesto is that I started ...
Encore! EP285: Who Is Auditing These Healthcare Bills? Also, That Cigna Lawsuit, With Dawn Cornelis, Cofounder and Director of Transparency at ClaimInformatics
April 06, 2023 10:30 - 30 minutes - 41.5 MBWell, this episode became extremely relevant again after that Cigna case bubbled up in the news. Here’s the “too long, didn’t read” version: Attorneys filed a class action lawsuit against Cigna, alleging that the carrier is overcharging for lab services or did overcharge for lab services. The plaintiff is an individual member of a Cigna plan. The complaint tells a pretty wild story. On the Explanation of Benefits (EOB) that this member received for lab services, the amount billed w...
EP399: My Manifesto, Part 1: The Relentless Health Value Tribe, I Salute You.
March 30, 2023 10:30 - 11 minutes - 16 MBThis week and in episode 400 of Relentless Health Value, at the encouragement of the Relentless Health Value team, I’m gonna do two shows entitled “My Manifesto,” Part 1 and Part 2. In other words, why did I start Relentless Health Value and what’s the goal around here? I started contemplating this mission to define the mission thinking about how healthcare will ultimately be transformed and my role (if any) in all of this—or, more accurately, your role as a listener of this show and, of...
EP398: Why Is the Commercial Payer Marketplace in California Completely Boring? With Jacob Asher, MD
March 23, 2023 10:30 - 34 minutes - 46.8 MBYeah, so while the commercial payer marketplace is completely boring, the reasons it’s boring are not. Let me walk you through this conversation I have in this healthcare podcast with Jacob Asher, MD. First, we establish that the relative number of each carrier’s commercial members in California don’t seem to change year over year … and this has been true for years. When you rank order carriers by member count, the song remains the same. It’s Groundhog Day. Here’s a link to the 2022 C...
EP397: The Minefield That Is a PBM Contract and Also Some Advice for EBCs Who Are Taking Money Under the Table, With Paul Holmes
March 16, 2023 10:30 - 33 minutes - 46.3 MBIf this were a video show, I would stare into the camera with steely eyeballs right now and say that I have a special message for employer CFOs. If you aren’t a CFO, pretend that you are so that you get the full effect here. So, now that we’re all CFOs, let’s pull up the company P&L (Profit and Loss) statement. This is what keeps us all up at night, right? Making sure that the net profit line at the bottom looks good. We could decide to lay off a few people. Reorg something or other. ...
EP396: How to Answer This Question: Will Humira® Biosimilars Reduce Drug Spend? With Anna Hyde
March 09, 2023 11:30 - 33 minutes - 46.5 MBThere are two facets of the Humira biosimilar market and launch that Anna Hyde, my guest in this healthcare podcast, talks about. One is market dynamics. The second is provider and patient confidence. These two concepts are tangled up together and cannot be separated. But let me back up a sec and explain, although Anna Hyde covers this really well and offers context in the interview that follows. So, first facet: market dynamics. This means fostering competition so the price of someth...
Encore! EP293: Game Theory Gone Wild: Co-pay Cards, Co-pay Accumulators, and Co-pay Maximizers, With Dea Belazi, PharmD, MPH, President and CEO of AscellaHealth
March 02, 2023 11:30 - 33 minutes - 46.6 MBWell, this episode is suddenly incredibly relevant again just with all the stuff going on with co-pay maximizers. If you’re gonna understand maximizers, though, you really have to start here. In a nutshell, this whole thing is a battle royale between co-pay cards and patient assistance programs offered by pharma companies versus co-pay accumulators and co-pay maximizers deployed by health plans and PBMs (pharmacy benefit managers). I just want to start by getting everyone grounded on a f...
EP395: Consolidated Hospital Systems and Cunning Anticompetitive Contracts, With Brennan Bilberry
February 23, 2023 11:30 - 35 minutes - 49 MBThanks, shurx, for this review on iTunes entitled “Prepare to Learn.” Shurx wrote: “[RHV] provides key insight from experts that you won’t find anywhere else. It paints the picture of how our healthcare is tangled, and who benefits because of it. Whether it’s drug pricing, PBM shenanigans, hospital billing, or market trends that are challenging the status quo, this podcast is worth your time. I’ve shared many of the episodes with my pharmacy colleagues who have replied, ‘I didn’t know that...
EP394: Spoiler Alert: It Is Counterintuitive Which Hospitals Offer the Most Charity Care, With Vikas Saini, MD, and Judith Garber
February 16, 2023 11:30 - 34 minutes - 46.9 MBYou would think that hospitals with the most money would offer the most charity care—trickle down and all of that. If my health system is big and I have lots of money and profitable commercial patients, I can stuff more dollar bills into the charitable donation balance sheet bucket, right? Except, in general, it’s a fairly solid no on that. Let’s talk about some of my takeaways from the conversation that I had with Vikas Saini, MD, and Judith Garber from the Lown Institute. During the...
EP393: How Do You Know if a Practice or a CIN (Clinically Integrated Network) Is Actually Clinically Integrated? With David Muhlestein, PhD, JD
February 09, 2023 11:30 - 31 minutes - 43.6 MBHey, thanks so much to kwebs14 for your super nice review on iTunes the other day. Kwebs wrote: [I have] learned so much, shared so many episodes with colleagues, clients … and gained so much value from regularly listening to [Relentless Health Value]. … Thank you … for providing the platform for so many that believe that we can consistently do better in healthcare. Thanks much for writing this. I think our Relentless Tribe is a unique group, and every day of every week I admire your ...
Encore! EP355: The 5 Business Models for Digital Health Companies, With Nikhil Krishnan
February 02, 2023 11:30 - 35 minutes - 49.3 MBThis week, I am with my Aventria team on-site at one of our clients. We are holding a full-day workshop to help our client figure out who all across the healthcare industry they will need to get aligned with to achieve greater success in the market and how to handle all of these inevitably conflicting interests strategically and also potentially from a messaging standpoint. I’m one of the subject matter experts who gets to pipe up during the part where we talk about all of these market dyn...
EP392: When Patient Journeys Don’t Fit in the EHR System, With Emily Kagan Trenchard From Northwell Health
January 26, 2023 11:30 - 31 minutes - 43.5 MBSo, a few things to remind everybody. First of all, don’t forget EHRs (electronic health records) were purpose built originally for billing. This is no secret. People quite openly have called EHR systems glorified cash registers. If I want to be generous, maybe I would restate this to say that EHRs were designed to document patient interactions. This is what their core architecture was built to achieve. But today, there’s a lot that goes on that isn’t a traditional patient interaction. Fir...
EP391: Lessons for Private Equity and Others Trying to Do Right by PCPs and Their Patients, With Scott Conard, MD
January 19, 2023 11:30 - 35 minutes - 48.5 MBOn Relentless Health Value, I don’t often get into our guests’ personal histories. There are a bunch of reasons for this, which, if you buy me beer, we can talk podcast philosophy and I will tell you all about my personal, very arguable opinion here. Nevertheless, in this healthcare podcast, we are going rogue; and I am talking with Scott Conard, MD, who shares his personal story. You may ask why I decided to go this route for this particular episode, and I will tell you point blank that D...
EP390: What Legislators Need to Know About Hospital Prices, With Gloria Sachdev, PharmD, and Chris Skisak, PhD
January 12, 2023 11:30 - 34 minutes - 47.7 MBIf you go to the Sage Transparency dashboard Web site, you get a really graphical representation of the prices that any given hospital actually needs to charge so that they break even. You can see precisely which hospitals are operating on thin margins and which ones are not. You might be thinking, “Okay, so ... what’s the big deal about this? Why is the Sage Transparency information so meaningful? Aren’t hospitals (most of them) providing their financial statements already?” Well, let’s...
EP389: The Clapback When Hospitals Cannot Constrain Their Own Prices, With Mike Thompson
January 05, 2023 11:30 - 34 minutes - 47.6 MBFor the past few shows and in a few coming up, we are circling our wagons around a theme: In healthcare in this country, there are two teams. One team is employers, taxpayers, patients … those trying to keep healthcare prices down. Then on the other team, we have those looking for healthcare prices to continue to go up, meaning, as just one example, some health systems and some hospitals. There was a New York Times article recently, and Peter Hayes wrote an interesting comment about it on ...
Encore! EP326: The Unfortunate News About HRRP, With Insight Into How to Fix It, With Rishi Wadhera, MD, MPP
December 29, 2022 11:30 - 34 minutes - 47.1 MBHRRP stands for Hospital Readmissions Reduction Program, by the way. I wanted to encore this episode with Dr. Rishi Wadhera because it’s a great representation of a common root cause reason why quality metrics sometimes don’t end well in real life. This root cause is otherwise known as Goodhart’s Law, and we dig into Goodhart’s law later on in this healthcare podcast. But the actual and ultimate impact of HRRP is also a pretty good representation of the consequences, what happens, when y...
Encore! EP356: PBMs React to GoodRx, Mark Cuban, and Amazon Pharmacy, With Ge Bai, PhD, CPA
December 22, 2022 11:30 - 36 minutes - 49.7 MBThis show was one of the most popular episodes in the past 12 months. So, here it is again for your listening pleasure. Mostly this whole episode is about the so-called “Big Three” PBMs that provide between the three of them pharmacy benefit services for 95% of insured Americans. PBM stands for pharmacy benefit manager, and the Big Three PBMs being ESI, otherwise known as Express Scripts; OptumRx, which is a part (a big profitable part) of UnitedHealth Group; and then also CVS. Yes, CVS is...
INBW37: Harnessing the Miracle of the Commons to Improve the Patient Journey Nationwide, A Conversation With Dave Dierk, Co-President of Aventria Health Group
December 15, 2022 11:30 - 24 minutes - 33.7 MBWe have done three inbetweenisodes so far on healthcare stakeholder collaboration. In sum, there are two major issues that patients have with our healthcare industry, and both can only be solved for if healthcare stakeholder collaboration happens: Patients falling into care gaps and winding up with bad downstream consequences Patients not being able to afford their care This show, we are moving on to talk about an actionable solution here to the care gap problem—the very ubiquitous issue...
EP388: Merrill Goozner on the Future of Healthcare and Glide Paths to Get There
December 08, 2022 11:30 - 34 minutes - 48 MBIn this healthcare podcast, I have Merrill Goozner on the show talking about his prognostications for the future of healthcare in this country and how, realistically, it could be engineered so that the healthcare industry rightsizes itself relative to our GDP. Merrill offers three glide paths to this end. Okay … so, let’s break this down some. First, Merrill talks about the full impact of huge numbers of patients/people in this country who are scared to seek medical attention. They are a...
EP387: Medicare Advantage Trends and How Medicare Advantage Plans Will or Will Not Succeed, With Betsy Seals, CEO and Cofounder of Rebellis Group
December 01, 2022 11:30 - 34 minutes - 47.8 MBHere’s a big thing that Betsy Seals makes clear in this show: Big companies can be successful in Medicare Advantage (MA)—and I mean success in all of its financial glory—because they have experience and the scale and also the specialized departments who keep track of all kinds of intricacies that are rate critical to MA success. Specifically, things Betsy Seals talks about as critical success factors, for example, are having relationships with brokers and health systems and other provider or...
INBW36: Will Healthcare Stakeholders Who Don’t Collaborate Wind Up With a Business Problem?
November 24, 2022 11:30 - 19 minutes - 26.1 MBWe got two new reviews this week on the podcast, which I was thrilled to see. The first was from, it turns out, Dave Chase from Health Rosetta, who wrote that “with so many people in healthcare practicing ‘innovation theater’ and bloviating versus driving real change, it’s a breath of fresh air to listen to Relentless Health Value.” Thank you so much for saying that, Dave. We try really hard to get guests who are actually doing great things such as yourself. And then there’s another review...
Encore! EP351: Everybody in the Healthcare Industry Getting Up in Everyone Else’s Business, With Eric Bricker, MD
November 16, 2022 20:00 - 34 minutes - 47.8 MBThis episode was one of the most popular episodes in the past 12 months. Since it aired, there was a show with Kevin Schulman, MD (EP366), that added some context, which I would recommend, and also one with David Muhlestein, PhD, JD (EP364). Those two shows and this one are a good three-pack. And hey, here’s something new that we’re going to try out. Coming up in December, Dr. Bricker and I will host a smallish virtual chat to discuss the topics covered in this episode. It will be a conver...
EP386: What You Need to Know About ER Bills Post the No Surprises Act, With Al Lewis
November 10, 2022 12:00 - 32 minutes - 44.4 MBFirst of all, let me thank those of you who have left a podcast review in 2022. There was one from Best Healthcare Podcast Around on Apple Podcasts the other day that thanked Relentless Health Value for being singularly responsible for providing a 400-level education in so many complex areas of healthcare, which I personally really appreciated because we aspire to be a master class in healthcare industry strategy, such that those looking to do right by patients understand the dynamics well e...
EP385: Morgan Health and the 5 Things Self-insured Employers Should Do Right Now, With Dan Mendelson
November 03, 2022 11:00 - 34 minutes - 48 MBIf you listened to the show with Dan O’Neill (EP359), you would know this already. But let me tell you: If you’re a provider, even a provider very confident in your office’s ability to confer better patient health, you will still have a super hard time getting off the fee-for-service (FFS) hamster wheel. Why? Because it’s hard to find payer contracts out there which will reward you (the provider) for actually taking care of your patients and to be accountable for the value of healthcare th...
EP384: How Shareholders Impact Payer Behavior, Exactly and Specifically, With Wendell Potter
October 27, 2022 11:00 - 36 minutes - 49.6 MBHere’s a Milton Friedman quote: “There is one and only one social responsibility of business—to use its resources and engage in activities designed to increase its profits so long as it [that entity] stays within the rules of the game, which is to say, engages in open and free competition without deception or fraud.” Okay, so this is Friedman, Milton Friedman, pretty much the most influential advocate of free market capitalism, stating quite clearly that an entity’s greatest responsibility...
EP383: Direct Contracting as a Health System Business Strategy, With Nick Stefanizzi
October 20, 2022 13:04 - 32 minutes - 45.2 MBThe show on direct contracting with Doug Hetherington (EP367) and also the one with Katy Talento (EP350), both of these experts have said that if an employer direct contracts with a provider organization, in general, the employer gets about 20% savings over the status quo. This makes sense—just cut out the middleman with an MLR (medical loss ratio) of plus or minus about 15% and you’re at three-quarters of the way there. You might be thinking, “Well, maybe not so fast here, because then wo...
Encore! EP335: Why Private Equity Is Willing to Pay $55,000 per Patient to Primary Care Start-ups, With Brian Klepper, PhD
October 13, 2022 11:30 - 33 minutes - 45.6 MBThis show was one of the most popular episodes in the past 12 months, so enjoy this encore while I am in Chicago moderating a panel on pharmacy benefit management at the WTW Conference Board. But while I have you, I just wanted to thank everyone for listening. You really are a part of our Relentless Tribe, and I could not thank you enough for your commitment to doing the right thing for patients and for this country—and that dedication is evidenced by you listening as often as you do to Re...
EP382: Pharma Conflicts of Interest and the Anti-Kickback Statute, With Aaron Mitchell, MD, MPH
October 06, 2022 11:30 - 32 minutes - 45 MBI saw a Tweet from Farzad Mostashari, MD, the other day; and I’m gonna rewrite it in the context of today’s show: This is why we can’t have nice things! As soon as someone comes up with something that might accomplish some good things when done in moderation and with good intent, it gets exploited for revenue maximization. I have to admit, this conversation with Aaron Mitchell, MD, MPH, and actually the one with Mark Miller, PhD (EP380), from two episodes ago were both kind of painful fo...
EP381: For Reals, Becoming Customer-centric, Transforming, or Innovating at a Very Large Organization, With Karen Root
September 29, 2022 11:30 - 32 minutes - 44.7 MBI was at the PanAgora Pharma Customer Experience (CX) Summit earlier this summer. Let me tell you one of my big takeaways. Many at pharma companies who are trying to convince their organizations of the need to be provider- and/or patient-centric are having a tough go of it. Heard that coming from every direction. Seems there are quite a few pharma organizations out there who are not actually customer/patient-centric. Say it isn’t so. Turns out, they continue to be pretty darn brand-centric w...
EP380: 7 Big Reasons Medicare Drug Price Negotiation Actually Happened This Time Around—What Changed? With Mark Miller, PhD
September 22, 2022 11:30 - 33 minutes - 45.7 MBIt’s been said that healthcare in this country will not be transformed because of some incremental government policy, nor will this industry transform because of some tech company who techs the crap out of healthcare. It’s been said that the only way the healthcare industry in this country is going to fundamentally change is vis-à-vis a seismic shift in the way Americans view the healthcare industry in their understanding of what is going on and the extent to which it directly impacts live...
EP379: How Much Money, Really, Are Employee Benefit Consultants and/or Brokers Making From Plan Sponsors? With AJ Loiacono
September 15, 2022 11:30 - 35 minutes - 48.5 MBThis show with AJ Loiacono is different than others you may have heard with him because in this healthcare podcast, we are not talking about PBMs (pharmacy benefit managers). We’re talking about brokers and EBCs (employee benefit consultants). So, say I’m a self-insured employer. Here’s the big question: Is my broker or EBC helping me make the right decisions, or is he or she helping me make decisions that will make them the most money? While there are some amazing and totally above-boar...
EP378: The Status of Telehealth Reimbursement and Other Telehealth Policy Updates, With Josh LaRosa, MPP
September 08, 2022 11:30 - 33 minutes - 45.7 MBOkay, so … telehealth for Medicare patients. Currently, there’s payment parity, meaning a clinician gets paid the same amount for a Medicare patient visit regardless of whether that patient comes in the office or has a telehealth encounter. Right? Or did that end already? And if it didn’t end, how much longer will payment parity continue? Also, is it the same for commercial and Medicaid patients? Congress makes rules for Medicare patients, but is it Congress that makes the rules for commerci...
INBW35: Collaboration Between Healthcare Providers, Payers, and Others Is Required to Improve Chronic Care Patient Outcomes
September 01, 2022 11:30 - 13 minutes - 18.6 MBLate in May of this year, three-ish months ago, I did an inbetweenisode that explores the “why with the no collaboration” amongst healthcare stakeholders and what the lack of collaboration signifies. That episode got a lot of traction and engagement. This episode that follows is a pretty good approximation of a presentation that I made at the MTVA (Moving to Value Alliance) symposium that happened in Connecticut this past June. If you listened to the earlier show about collaboration, thi...
Encore! EP295: The Not Entirely New but Definitely Improved Way to Measure Primary Care, With Rebecca Etz, PhD
August 25, 2022 11:30 - 31 minutes - 43 MBI wanted to resurface this episode because when it originally aired over a year ago, the topic may have been ever so slightly ahead of its time. Look, here we are right now with everybody trying to do three big things relative to measuring PCP (primary care provider) performance: Come up with a fair measure for PCP performance. Account for diverse populations with diverse risks so that some docs don’t get dinged because their patient populations have lots of comorbidities or behavioral he...
Encore! EP337: A Patient-First Specialty Pharmacy, Not a Money-First Specialty Pharmacy, With Olivia Webb
August 18, 2022 11:30 - 32 minutes - 45 MBThis encore episode seemed really apropos at this moment in time, since we’ve just basically published a course in the specialty pharmacy ecosystem, including who all of the various stakeholders are and what their vested interests are. Weirdly, in many of the episodes in the series/course, you’ll find the word patient in short supply. And that’s not a weird oversight in our podcast production. It is actually an egregious oversight in the specialty pharmacy market, an oversight with real huma...
EP377: Specialty Pharmacy, PBM, Hospital, Employer, and Pharma Strategic Maneuvering, With Mike Baldzicki, CRCM
August 11, 2022 11:30 - 32 minutes - 44.5 MBMembers taking specialty drugs represent about 2% of any given employer’s population but often consume as much as 30% of an employer’s total cost of care. As Pramod John, PhD, in EP353 has said, this isn’t just small companies we’re talking about here. Some of the largest employers in the US are dropping big bucks on specialty drugs, and they are obviously overpaying and don’t need to. No employer or plan really need pay any more than the pharmacy’s acquisition price plus a reasonable pro...
EP376: Interoperability—Who’s Who and Doing What? With Lisa Bari, MBA, MPH
August 04, 2022 11:30 - 34 minutes - 47 MBInteroperability. Let’s just review a few key points that probably everybody listening knows but certainly bear repeating because they matter. I don’t want to dig into the technical or regulatory details of interoperability. That is above my pay grade. But I want to talk about the really important stuff that maybe doesn’t get talked about a whole lot because you say the word interoperability and it’s like the magic word that transports the unwary into the land of shadow and smoke and mist....
EP375: Medicare Advantage Plans in the Hot Seat, With Betsy Seals, CEO and Cofounder of Rebellis Group
July 28, 2022 11:30 - 32 minutes - 44 MBMedicare Advantage (MA), otherwise known as the “money machine,” is often the most profitable parts of many payers’ business lines. Medicare Advantage plans can make a lot of cash if they are good at what they do. Look at any of these large, consolidated carriers’ financial statements to get the magnitude of that statement. Also, in 2022, Medicare Advantage plans have enrolled 28 million participants between them, which represents 45% of all Medicare beneficiaries. This marks a three-point...