Relentless Health Value

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.

In this discussion, John Quinn, CEO of Wellness City, shares insights on how employer CEOs are waking up to the realities of healthcare spending. He discusses the impact of health benefits on corporate earnings, and why traditional cost-shifting to employees is unsustainable. John advocates for accountability in vendor contracts and the need for real-time data to tackle high-cost claimants effectively. He emphasizes integrating finance and medical expertise in benefits teams to manage healthcare spend more strategically.

Shane Cerone, a health system executive and co-founder at KADA Health, teams up with Dr. Sam Flanders, a chief quality and safety expert, to delve into elevated hospital management models. They discuss creating a model to thrive at 150% of Medicare, highlighting how reducing inefficiencies can enhance care without compromising quality. Their strategies include Toyota-style continuous improvement and empowering clinicians through Kaizen methods. The duo urges employers to reclaim pricing power to foster market competition, envisioning a healthcare landscape that's more affordable and efficient.

In this engaging conversation, Elizabeth Mitchell, CEO of the Purchaser's Business Group on Health, dives into the PBGH Transparency Demonstration Project. She reveals how this initiative aims to empower jumbo employers with critical data on healthcare costs and quality. Elizabeth discusses the surprising lack of correlation between price and quality, the importance of the Consolidated Appropriations Act, and how transparency can reshape market competition. She also shares insights on improving employer strategies and the potential benefits for high-quality providers.

Shane Cerone, a healthcare executive from Kada Health, and Dr. Sam Flanders, a quality improvement physician, tackle three pervasive healthcare myths. They argue that a true healthcare market is non-existent due to lack of price transparency. Both share insights on how hospitals can thrive on Medicare rates, countering the belief that lower prices mean poorer quality. They emphasize that operational improvements can enhance care while reducing costs, setting the stage for future discussions on actionable solutions.