In this inbetweenisode Stacey Richter dives into the complexities of benefit design in American healthcare. Highlighting insights from recent episodes with Bill Sarraille (EP459) and upcoming episode with Scott Conard, MD, Richter explores the impact of cost containment measures and the moral hazard of insurance, emphasizing the importance of creating balanced and efficient benefit plans that align with plan values and avoid unintended consequences.  She discusses the challenges and implications of high deductible health plans and copay maximizers/accumulators, urging plan sponsors to strive for pareto optimality and practical solutions. This episode is a call to carefully consider patient behavior, healthcare utilization, and the broader impacts of financial incentives in healthcare. Going black and white or over-indexing to prevent outlier kind of stuff is probably not gonna end well. Not seeking a middle way can easily result in a solution that is possibly worse than the problem. Moral hazard is actually a thing. There are lots of implications to patients not being able to distinguish high-value and low-value care. But if we know this, then, philosophically at least, how do we conceptualize a solve? What should we be doing? If we’re not doing black and white, what does the gray in the middle look like? === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/INBW42 ✉️  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 🎤  Follow on Apple Podcasts  https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤  Follow 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/ ✭ X   https://twitter.com/relentleshealth/ ✭ Bluesky   https://bsky.app/profile/relentleshealth.bsky.social 00:00 Introduction to the Rabbit Hole 04:05 Where did Stacey’s rabbit hole spiral start? 05:40 What is the moral hazard of insurance? 09:31 EP358 with Wayne Jenkins, MD. 12:49 Why isn’t moral hazard mitigated in insurance? 18:16 EP459 with Bill Sarraille. 20:51 “How do we conceptualize a solve?” 22:24 Why should we be striving for Pareto optimality? 25:20 What is the theory of second best?

This episode with Chris Crawford, CEO of RxSaveCard, is not about the when, why, or how of GLP-1s for weight loss or best-practice prescribing. This episode very, very specifically is about the how and why of the pickle plan sponsors get themselves into often enough where if they impose formulary restrictions to limit the volume of meds that they are paying for, then unit prices go up, which is a thing for GLP-1s. And this is critical just given how the costs associated with GLP-1s for weight loss contribute to some pretty significant increases in pharmacy trend for plan sponsors who choose to cover the GLP-1s for weight loss. Chris Crawford and Stacey Richter discuss the challenges plan sponsors face with the rising costs of GLP-1 medications for weight loss. They explore how plan sponsors’ efforts to manage pharmacy trends often result in a tradeoff: lowering unit costs by increasing volume or vice versa. Chris also introduces a potential solution leveraging the growing cash marketplace, where employers can bypass traditional PBM contracts to achieve cost savings. Tune in for actionable insights into the perverse incentives in the pharmacy supply chain and innovative ways to navigate them. (Continued below the links) === LINKS === 🔗  Show Notes with all mentioned links:   hhttps://cc-lnk.com/EP461 ✉️  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/ ✭ X   https://twitter.com/relentleshealth/ ✭ Bluesky   https://bsky.app/profile/relentleshealth.bsky.social Bottom line, there are some really impactful and not frequently delved into perverse incentives at play here. And we’re gonna talk about these today. And these are really key for anybody on or about the pharmacy supply chain in the U.S. to know about. This is very actionable insight. So, again, there’s an unfortunate tradeoff, as it stands right now, for many plan sponsors. Lower your volume and raise the unit price or vice versa. This episode is sponsored by RxSaveCard, and a big thanks for that. I really appreciate RxSaveCard for its financial support because this episode covers a really important topic that we probably would have covered anyway over here at Relentless Health Value. And so, RxSaveCard standing up and offering their financial support to cover it was a really nice thing to do. And I thank them for their generosity. 07:57 What are the two pieces going on with GLP-1 PBM prices and rebates for employers? 10:00 Is the cash price for these name brand drugs currently less than the rebated PBM price? 11:49 Why does the rebate for GLP-1s disappear if employers try to put restrictions on who can receive access to these drugs? 15:07 Where does RxSaveCard come in to play here? 19:55 “We exist to save people money.” 20:45 EP456 with Brian Reid. 21:16 EP356 with Ge Bai, PhD, CPA. 21:37 EP439 with Luke Slindee, PharmD.

In this Relentless Health Value episode, Dr. Rushika Fernandopulle discusses with Stacey Richter his four-prong theory of change for transforming the American healthcare system. Key topics include the necessity of new payment models, process innovation, employing a relational technology infrastructure, shifting the cultural mindset towards team-based care, and emphasizing the importance of long-term partnerships. The conversation underscores the urgent need to move away from the current status quo to ensure better health outcomes and affordable care for all Americans. This is one of those episodes where we consider top-line strategic imperatives and key drivers. There was no better person to do this with than Rushika Fernandopulle, MD, who, in case you were unaware, was the founder of Iora Health, an advanced primary care group that was sold to One Medical and then to Amazon.  They discusses his four-prong theory and as Stacey says, "I can’t leave well enough alone, so I plucked one more prong from our conversation and stuck it on the end." For a summary of this 5 prong approach, visit the show notes page where we also list all of the links mentioned in the episode. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP460 ✉️  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/ ✭ X   https://twitter.com/relentleshealth/ ✭ Bluesky   https://bsky.app/profile/relentleshealth.bsky.social   06:39 How Dr. Rushika Fernandopulle found himself where he is now. 08:06 Dr. Fernandopulle’s conversation with Kenny Cole, MD. 10:33 Why is it important to have new payment models? 12:21 EP453 with Claire Brockbank. 14:50 EP455 with Beau Raymond, MD. 16:19 Why it makes sense to change as quickly as possible. 19:55 How to be proactive and not be reactive and achieve value-based reimbursement for good care. 21:41 Why team-based care is so important for change. 23:37 Why is it important to have a different set of technology tools? 24:38 EP391 with Scott Conard, MD. 25:24 Why changing the culture is important. 27:01 “Getting doctors to do things they don’t like is a waste of time.” 33:22 “Healthcare is local.” 35:31 EP364 with David Muhlestein, PhD, JD. 35:43 Study by Zack Cooper, PhD. 36:53 EP404 with Suhas Gondi, MD, MBA. 39:04 Why long-term partnerships are the only way to make things better.

Bill Sarraille, a Professor of Law and nationally recognized healthcare expert, dives into the complex world of co-pay maximizers and accumulators. He explains how these programs challenge patient affordability and access to medications. The discussion highlights the importance of pricing transparency and the role of Pharmacy Benefit Managers in navigating healthcare costs. Sarraille also raises critical questions about fairness, legality, and the ethical responsibilities within the healthcare system, advocating for clearer communication to protect patients.

In this Inbetweenisode titled 'End of Year Wrap Up and My Personal Charter Encore,' Stacey Richter extends heartfelt thanks to listeners and healthcare workers for their dedication.  She reflects on the challenges of maintaining personal integrity in a profit-driven healthcare system and introduces her personal charter. This charter, focused on ensuring net positive outcomes for patients, acknowledges that achieving transformational change in healthcare requires a collective effort.  Stacey discusses the complexities of balancing ethical decisions, financial constraints, and the broader impact on patient care, urging others to reflect on their own guiding principles. Here's her manifesto which she is now calling her Personal Charter below which she breaks down in this podcast episode: "If the thing results in a net positive for patients, then I will do it. The timeframe is short-term or medium-term. And the assumption is that it will take a village and I am not alone in my efforts to transform healthcare or do right by patients." === LINKS === 🔗  Show Notes with all mentioned links:  https://cc-lnk.com/INBW41 ✉️  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 === CONNECT WITH THE RHV TEAM === ✭ LinkedIn   https://www.linkedin.com/company/relentless-health-value/ ✭ Threads  https://www.threads.net/@relentlesshealthvalue/ ✭ X   https://twitter.com/relentleshealth/ ✭ Bluesky   https://bsky.app/profile/relentleshealth.bsky.social 06:52 “It’s a zero-sum game.” 07:02 Is the amount of profit fair? 07:13 What is an inescapable fact of the healthcare industry? 07:30 What does the financialization of healthcare mean? 07:55 Why does the self-interest in healthcare matter? 09:54 “It’s basically up to us as individuals to do the right thing.” 13:39 What is the first part of Stacey’s personal charter? 13:54 How does Stacey calculate the net positive of an impact? 14:17 What are two major upsides/downsides that Stacey contemplates? 17:08 Why are incremental change and disruptive change not mutually exclusive? 21:16 “I always try to keep in mind that it will take a village.” 22:55 Why finger pointing is killing innovation in healthcare.

In this insightful discussion, Andreas Mang, Senior Managing Director at Blackstone, shares his expertise in managing healthcare benefits for self-insured employers. He explores how health benefits have morphed into substantial financial considerations for companies, requiring active involvement from C-suites. Topics include the importance of selecting the right brokers, conducting dependent eligibility audits, and fostering transparency in health plans. Mang emphasizes a collaborative approach to navigate the complexities of healthcare costs, ensuring employers are not left at a disadvantage.

Dr. Komal Bajaj, an OB-GYN and chief quality officer for Bronx hospitals, shares groundbreaking insights into addressing healthcare staffing shortages. She discusses the surprising link between cultural alignment and staff retention, emphasizing that healthcare workers are motivated by delivering sustainable, high-quality care. Dr. Bajaj highlights eco-friendly practices and their financial benefits, while also connecting environmental sustainability to improved patient outcomes. The conversation stresses the importance of trust in leadership to reduce burnout and foster a supportive healthcare culture.

Cynthia Fisher, the founder of PatientRightsAdvocate.org, dives into the pressing issue of medical spread pricing, revealing how hidden fees inflate costs for employers and patients alike. She highlights shocking disparities in healthcare claim payments, emphasizing the need for transparency. The discussion also covers recent lawsuits against major players like Cigna, advocating for accountability in healthcare contracts. Fisher argues that price transparency could revolutionize the industry, promoting fairness and potentially lowering costs significantly for all involved.

In this special Thanksgiving episode of Relentlessly Seeking Value, Stacey Richter discusses the significance of being 'givers' in healthcare, advocating for collaboration over transactional relationships to deliver real value to patients. She touches on the challenges and necessary shifts in healthcare market dynamics, emphasizing that true value is determined through bi-directional conversations between providers and end-users, like patients and plan sponsors. Stacey concludes with a call to action for listeners to reflect on their support networks and consider supporting valuable media and publications. To read the show notes with the mentioned links visit the epsiode page. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. I want to drop a thank you right here to those who have left a tip in our tip jar and/or offer up a monthly contribution. From the bottom of my heart, thanks for the support. Thank you to Dr. Scott Tromanhauser, Marilyn Bartlett, Ann Kempski, Dr. Matthew Bunte. Also, thank you to Brian Uhlig, Dr. William Gailmard, Dr. John Lee, Dr. Paula Muto, and Linda Krebs. Plus everyone else who left a lesser amount. You guys are my village, and this matters because, as it’s been said by me and others a million times, it will take a village to transform healthcare. So, if you haven’t already done so, because … yeah, Thanksgiving, consider who is on your own list of villagers to thank right about now in your world. So, yeah, long story long, all the more thanks to everyone who has donated to our tip jar, who has written a nice review on Apple Podcasts or Spotify, or who interacts with our posts on LinkedIn. Thank you. This is how pods like this and any of the publications that you like are able to continue. It’s also, if you want to get really “why do givers succeed” about it, it’s through these interactions that like 99% of guests I’d estimate who get invited on a podcast, probably any podcasts, come from, or who likely get their name in any publication come from. As I said, this is true for this pod at least. But I would say that who are most hosts or most reporters going to reach out to when they need information or insight and are looking to quote somebody? It’s gonna be somebody that they know. It’s gonna be somebody that they like. So, giving, the healthcare industry. This is the actual point I wanted to make before I completely distracted myself. And I talked about this at length actually at a recent thINc360 panel about delivering better patient outcomes. So, collaborate, give. And thank you to all of you who do both of these things every day, despite the cognitive dissonance and corporate forces and the lack of time and resources that may plague your efforts. I appreciate you very, very much. And it is this gang—the Relentless Tribe, that listens to this show—it is you who will transform healthcare. It’s really you. And again, from the bottom of my heart, I thank you. 01:33 How do you calculate the number of people you’ve helped? 02:46 Why is giving so important within healthcare? 03:16 Interview with Adam Grant. 05:47 How can you be a better giver? 07:50 Who is in charge of the bidirectional conversation of value? 11:35 Why is collaboration so important to value and being a giver? 12:58 Why is it important that plan sponsors are a part of all this giving and collaboration? 13:22 Encore! EP415 with Rob Andrews. 14:34 Summer Shorts 8 with Larry Bauer, MSW, MEd. 15:08 INBW39 with Stacey on the narcissism of small differences. 15:12 EP399 and EP400 with Stacey.

Mark Cuban, a renowned entrepreneur behind Cost Plus Drugs and the Dallas Mavericks, joins Ferrin Williams, PharmD, MBA. They delve into the complexities of the healthcare landscape, urging self-insured CEOs and CFOs to engage actively to prevent overpayment. Cuban emphasizes the need for transparency in drug pricing and critiques the opaque practices of pharmacy benefit managers. The conversation not only reveals real savings for employers but also advocates for ethical decision-making, ultimately transforming how companies manage healthcare costs.