Relentless Health Value

In this second take on episode host Stacey Richter speaks with Dr. Tom Lee, founder of One Medical and Galileo. The discussion centers on the survival of independent primary care practices in the current healthcare economy, the associated challenges, and the paradox of primary care.  Topics include reducing ER visits, managing downstream specialty spend, and the imbalance between CMS and commercial carrier payments to primary care practices.  Dr. Lee highlights the importance of 'enlightened leadership' and a 'value-focused mindset' in balancing efficient service operations with quality care. He also touches on the complexities of integrating technology and human-centered care, the importance of operational efficiency, and the challenges posed by current reimbursement models. For a bonus sidebar conversation with Dr. Lee, click here. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/TakeTwo-EP445 ✉️  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/relentleshealth10:30 What is the paradox of primary care? 12:47 Why is it hard to run an independent primary care practice? 13:29 What are the barriers to running an independent primary care practice? 14:09 Can you have fee for service and value? 15:53 “Value is more about a mindset.” 16:49 What hidden waste is there in a primary care practice? 18:36 What do you need to have a value-focused mindset? 20:41 Why does access precede quality? 22:40 What are the nuances of a service business that make them challenging for managers? 23:27 How do you find the balance between fee for service and value? 30:07 EP438 with John Lee, MD. 31:04 How can you invest in quality without a value-based contract? 33:09 How do you address the trade-off between fee-for-service finances and investing in value-based care? 34:26 Where is the “productive middle”? 35:18 Dr. Tom Lee’s message to payers. 38:45 Dr. Tom Lee’s message for policymakers.

This short bonus episode is a side bar conversation with Dr. Tom Lee discussing why retail clinics are struggling with Dr. Tom Lee.  They explore the shortcomings of retail clinics in providing longitudinal primary care, despite their convenience for minor urgent care and vaccinations.  Dr. Lee emphasizes that true primary care requires consistent, long-term patient relationships and complex management which many retail clinics fail to deliver. They also discuss the economic challenges of running such clinics and the importance of defining primary care's value proposition correctly. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/Bonus445 ✉️  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/ 01:01 Why have retail clinics failed in being longitudinal primary care destinations? 01:32 Why access is an important factor, but not the only one. 02:10 Access vs. longitudinal care. 02:47 The challenges of operating a service operation within primary care. 03:47 What is a longitudinal primary care destination and why does it matter? 04:15 How is primary care not delivering on its promise? 04:27 How is the “promise of primary care” different than an urgent care or MinuteClinic? Recent past interviews: Click a guest’s name for their latest RHV episode! Dr Benjamin Schwartz, Dr John Lee (Take Two: EP438), Kimberly Carleson, Ann Lewandowski (Summer Shorts), Andreas Mang and Jon Camire (EP479), Justin Leader (Take Two: EP433), Andreas Mang and Jon Camire (EP478), Stacey Richter (EP477), Charles Green (Bonus Episode), Ann Lewandowski, Peter Hayes

Balancing Mission and Margin in Healthcare: A Candid Conversation with Dr. Ben Schwartz In this episode, host Stacey Richter engages in a deep dive with Dr. Ben Schwartz to explore the phrase 'No Margin, No Mission' and its practical implications in the healthcare industry.  They discuss the complex relationship between profitability and mission-driven care, the challenges of value-based care, and the role of dyad leadership. The episode emphasizes the importance of transparency, regulatory measures, and trust in fostering a balance between mission and margin. Along the way, Dr. Schwartz shares insights from his new role at Commons Clinic and addresses broader systemic issues like regulatory capture and the subjective nature of defining value in healthcare. === LINKS === 🔗  Show Notes with all mentioned links:   https://relentlesshealthvalue.com/episodes ✉️  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/ 08:50 Sister Irene Kraus and the origin of no margin, no mission. 10:01 Margin and mission versus profit and profiteering. 12:45 Stacey’s manifesto (EP400). 13:01 What is the broad mission within healthcare? 14:12 What is mission drift within healthcare? 15:54 EP474 with Yashaswini Singh, PhD. 17:26 Why do we struggle with balancing margin and mission? 20:47 EP455 with Beau Raymond, MD. 20:52 How does value vary? 23:18 EP326 with Rishi Wadhera, MD, MPP. 23:53 What needs to happen to balance margin with mission? 28:29 Why does everything come down to trust? 28:33 EP391 with Scott Conard, MD. 30:30 EP419 with Andreas Mang. 32:21 What are the “vectors of change” to create balance between mission and margin? 32:43 EP475 with Peter Hayes.

In this Take Two episode of Relentless Health Value, host Stacey Richter reflects on her conversation with Dr. John Lee to explore the challenging intersection between mission and margin in healthcare.  They discuss the nuances of cognitive dissonance faced by healthcare professionals, particularly when organizational priorities conflict with patient care. Dr. Lee shares insights on finding a sense of mission within the constraints of the current healthcare system, emphasizing the importance of incremental improvements, team-based care, and peer support.  The conversation also highlights real-world examples of systemic issues and practical advice on how individuals can contribute to meaningful change without feeling demoralized. This episode is part of an ongoing series addressing critical topics in healthcare, and listeners are encouraged to tune in next week for further discussions. === LINKS === 🔗  Show Notes with all mentioned links:   https://relentlesshealthvalue.com/episodes ✉️  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/   08:05 What is cognitive dissonance relative to the healthcare industry? 09:23 What are the systems that start to bear down on individuals within the healthcare system? 10:15 EP391 with Scott Conard, MD. 10:53 EP415 with Rob Andrews. 11:50 EP326 with Rishi Wadhera, MD, MPP. 12:27 “The system has almost gamed them.” 15:44 How can alignment still be achieved in the face of cognitive dissonance? 17:12 EP431 with Kenny Cole, MD. 20:43 Why does it take more than one person to solve the dysfunction in the healthcare system? 23:01 What are some little changes that can help change the cognitive dissonance in healthcare? 24:57 Why is a hierarchical healthcare structure not necessarily beneficial? 27:12 The RaDonda Vaught story. 34:30 “Be happy in the small things.”

Kimberly Carleson, CEO of US Beacon, shares her expertise in payment integrity and the challenges of medical billing. She reveals the staggering prevalence of billing errors and their impact on healthcare costs. Kimberly emphasizes the necessity of third-party audits to catch inaccuracies and the importance of transparent communication in billing practices. She also discusses the rights of plan sponsors under various regulations and offers strategies for navigating complex medical billing systems, ultimately advocating for fairer costs and enhanced compliance.

Exploring the Complexities of Pharma Rebates with Ann Lewandowski In this Summer Short episode of Relentless Health Value, host Stacey Richter converses again with Ann Lewandowski about the intricate dynamics of pharmaceutical rebates, or as Lewandowski prefers, post-sale concessions.  The discussion delves into the nuances of these rebates, the impact they have on drug costs, and the hidden consequences for patients and plan sponsors.  They highlight articles and insights by Austin Chelko and Peter Hayes, touching on how rebates can disadvantage the pursuit of lower-cost generics and biosimilars, and can obstruct pharmacogenetic testing that ensures drug efficacy and safety.  The conversation also critiques the opacity of rebates, deemed trade secrets by pharma and PBM companies, and underscores the ethical and financial dilemmas posed by the current rebate-driven system. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP480 ✉️  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 📺  Subscribe to our YouTube channel   https://www.youtube.com/@RelentlessHealthValue 🎤  Listen on Apple Podcasts  https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤  Listen on Spotify  https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b === 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/ 07:24 What is a pharmaceutical rebate? 08:15 Why are pharma rebates so opaque? 09:52 Texas lawsuit on insulin pricing. 10:18 Why is focusing on a singular type of concession difficult with current pharma rebate structures? 10:50 EP397 with Paul Holmes. 13:55 EP353 with Pramod John, PhD. 14:29 How does pharma genomics testing affect pharma rebates? 14:52 EP465 with Chris Crawford. 15:52 EP426 with Nina Lathia, RPh, MSc, PhD.

Join Jon Camire, Managing Director and CFO at Equity Healthcare, and Andreas Mang, Senior Managing Director at Blackstone, as they delve into the complexities of stop-loss reinsurance for high-cost claimants. They discuss best practices for avoiding overpayment, the necessity of thorough contract reviews, and the significance of engaging expert brokers. The conversation highlights vital considerations for plan sponsors, including eligibility audits and financial risks, ensuring a comprehensive strategy to manage healthcare coverage effectively.

In a thought-provoking discussion, Justin Leader, CEO of BenefitsDNA, dives into the murky waters of third-party administrators (TPAs) and their impact on healthcare costs. He sheds light on hidden fees buried within weekly claims wires, including shared savings and pay and chase fees. Justin emphasizes the pressing need for transparency and fiduciary responsibility among self-funded employers. With references to ongoing legal cases and insights from Health Affairs, he urges listeners to scrutinize TPA contracts for a clearer understanding of their true costs.

In this engaging discussion, Andreas Mang, Senior Managing Director at Blackstone and CEO of Equity Healthcare, teams up with Jon Camire to shed light on stop-loss coverage in healthcare. They define what stop-loss insurance is and how it shields self-insured employers from hefty financial setbacks. The duo emphasizes the importance of expert consultants and dives into individual versus aggregate policies, exploring crucial strategies for managing high-cost claimants. A must-listen for those navigating the intricate world of self-insurance!

In this episode, Stacey Richter explores the impact of trust on healthcare outcomes, drawing from listener contributions and prior episodes of Relentless Health Value. The discussion underscores how trust or the lack thereof affects patients, clinicians, and healthcare systems. Key points include the importance of building trusted relationships, the detrimental effects of antitrust behaviors, and the broader implications for healthcare delivery. Stacey also highlights a bonus show featuring Charles Green on earning and maintaining trust. The episode concludes with an uplifting message about the collaborative and giving nature of the Relentless Health Value community. === LINKS === 🔗  Show Notes with all mentioned links: https://cc-lnk.com/EP477 🔗  Bonus Show - Show Notes https://cc-lnk.com/Bonus477:  ✉️  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/   00:47 What is the new, emerging through line becoming apparent in healthcare? 01:54 Bonus Episode with Charles Green. 02:52 What is the impact of trust in healthcare? 02:55 EP475 with Peter Hayes. 03:11 EP473 with Kenny Cole, MD. 05:31 EP295 with Rebecca Etz, PhD. 06:07 EP326 with Rishi Wadhera, MD, MPP. 07:06 Why does trust grow through proximity, and why do providers need to integrate this into care models? 07:59 Why antitrust is so prevalent in healthcare. 10:00 What are two main contributors to the lack of primary care doctors? 13:27 Why collaboration builds trust.