Relentless Health Value

Zack Kanter, Founder and CEO of Steady, dives into the world of healthcare transactions. He reveals that transaction costs in healthcare reach $5–7 billion annually, highlighting a stark contrast to lower costs in other sectors, like email. Zack discusses how legacy processes lead to frustrating delays, harming patient experiences. He emphasizes that many validations should occur in real-time but often don’t, resulting in inefficiencies. By modernizing clearinghouses, organizations can cut waste and improve care, urging stakeholders to reevaluate their current systems.

Mark Newman, Founder and CEO of Nomi Health, shares insights on simplifying healthcare purchasing for self-insured employers. He highlights the shocking statistic that employers spend $1.20 to buy $1 of care, pointing out the administrative waste in the system. Mark discusses the misalignment of data between providers and employers, which complicates collaboration. His company’s innovative pilot program, which eliminates copays and reduces costs by 38%, showcases a new model to enhance care accessibility while lowering expenses.

In this Part 2 episode of 'Relentlessly Seeking Value,' host Stacey Richter recaps the prominent themes 4 and 5 from 2025. The focus is on two major themes: the lack of transparency in data access leading to overspending and the necessity of shifting from volume-based to value-based purchasing in healthcare. The discussion includes insights from numerous healthcare professionals and case examples to underscore these vital themes affecting both patients and providers. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/INBW45 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 03:30 Theme 4: lack of transparency and data access. 04:46 Clip of Elizabeth Mitchell from EP436. 07:07 Is there a tipping point finally coming regarding transparency? 08:58 Why and how siloed data is also part of this transparency issue. 11:37 How opaque pricing leads to more opaque pricing. 13:21 The need for transparency around ownership and what that looks like in healthcare. 14:06 Theme 5: the need to shift purchasing from discounts/volume to value. 14:52 Clip of Mark Cuban from EP488. 16:35 Clip of Sarah Emond from EP494. 17:02 How pricing transparency can eliminate the need for rebates and prior authorizations. 18:30 Why healthcare needs a demand curve. 22:09 Shows covered in 2025 that touched on other timely ideas.

Explore the critical need for trust in healthcare relationships and how simplicity can enhance that trust. Discover why primary care should be viewed as an investment rather than just a cost, and the consequences of underfunding this essential service. Delve into the issues of financial incentives that can lead to profiteering and the challenges they pose to patient care. Insights from various experts highlight the pressing need for transparency and relational care models to improve outcomes in the healthcare system.

Join Marilyn Bartlett, an accomplished CPA and healthcare plan administrator, as she shares her journey in transforming Montana's state employee health plan. She reveals how she identified financial red flags and turned a $9 million deficit into a $112 million surplus by cutting wasteful vendors and implementing innovative pricing strategies. Marilyn discusses the importance of transparency, reference-based pricing, and building strong stakeholder alliances to achieve lasting healthcare reforms. Her inspiring insights prove that change is not only possible but necessary.

Dr. Mick Connors, an emergency pediatrician and healthcare entrepreneur, shares a groundbreaking revelation about U.S. healthcare. He highlights the critical importance of cost accounting that clinicians often overlook and exposes how focusing on revenue can lead to poor decision-making in patient care. Connors argues for prioritizing outcomes over mere margins, critiquing private equity's impact on pediatric care. He emphasizes the need to target the sickest patients to lower costs and advocates for restoring mission-driven leadership in healthcare.

In this conversation, Sarah Emond, CEO of ICER, dives into the complexities of pharmaceutical drug pricing. She highlights six major tensions, such as the disconnect between drug prices and patient affordability. Sarah discusses the issues with rebates, emphasizing how they can distort value. The talk also covers the long-term versus short-term cost perspectives employers face. She advocates for transparent, value-based pricing models to enhance patient access and reduce healthcare costs, underscoring the need for conflict-free assessments.

In this bonus episode of 'Relentlessly Seeking Value,' host Stacey Richter engages in a conversation with Sarah Emond, CEO of the Institute for Clinical and Economic Review (ICER). They discuss the complex 'arms race' of pharmaceutical pricing in the current healthcare system, emphasizing issues like inflated drug list prices, patient affordability, and cost-effectiveness. They highlight ICER's role in conducting value assessments of prescription drugs to ensure fair pricing and improve affordability and access. The episode underscores the need for multi-stakeholder dialogues to deescalate financial tensions and promote value-based healthcare choices. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP494-BonusClip 🔗 Visit our sponsor Payerset: https://payerset.com ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 06:51 EP293 ("Game Theory Gone Wild") with Dea Belazi, PharmD, MPH. 02:38 What is ICER? 02:54 What does the Institute for Clinical and Economic Review do? 05:14 The importance of still showing up, even when others don't understand or disagree. 09:12 Why it's important to think about population health and how our choices impact affordability for everyone.

In a special Thanksgiving edition, the host reflects on gratitude and collaboration in healthcare. She expresses thanks to those who maintain respectful dialogue even amid disagreements. Listeners are celebrated for their mentorship and community spirit, with a focus on the importance of paying it forward. The discussion includes the need for a 'demand curve' in healthcare markets and appreciation for various contributors, including donors and volunteers who help sustain the podcast's mission.

Olivia Ross, an experienced leader in employer-centered healthcare programs, dives into the world of high-value networks and Centers of Excellence. She explains how these networks allow self-insured employers to deliver predictable pricing while improving care quality. Olivia highlights the benefits of coordinated care with local providers and the importance of rigorous quality metrics when selecting surgeons. With innovative strategies for engaging patients, she demonstrates how employers can leverage their buying power to drive competition and enhance healthcare outcomes.