Relentless Health Value

Elizabeth Mitchell, President and CEO of the Purchaser Business Group on Health, dives into the complexities of value-based care. She discusses how the ideal intentions can be sidetracked by middlemen, causing inflated costs without delivering real value. Elizabeth advocates for transparent payment models that include prospective and bundled payments, urging cooperation among employers, employees, and primary care providers. Given the affordability crisis, she emphasizes the urgent need for innovative solutions to ensure genuine care that meets the needs of everyday Americans.

Will Shrank, MD, a venture partner at Andreessen Horowitz and former chief medical officer at CVS Health and Humana, discusses the shocking one trillion dollars wasted annually in U.S. healthcare. He highlights the need to align incentives with patient outcomes and the rising potential of primary care providers to combat this waste. The conversation delves into the evolution of value-based care, the challenges of the fee-for-service model, and innovative strategies to improve healthcare delivery and efficiency.

Dr. Amy Scanlan, a physician dedicated to integrating care, shares insights on the evolving landscape of healthcare. She highlights the financial and operational pressures facing doctors today and the necessity for strong teamwork in value-based care. Dr. Scanlan emphasizes the shift from traditional practices to collaborative care, discussing the importance of communication and real-time data in overcoming healthcare challenges. Her perspective reinforces the vital role physicians play in enhancing patient outcomes while adapting to a demanding environment.

Ashleigh Gunter, a healthcare messaging expert, dives into how effective communication can transform healthcare practices. She highlights a study showing that doctors respond better to patient-centric messaging, such as reminders about hand hygiene's impact on patient safety. Gunter discusses the importance of understanding healthcare professionals' motivations for initiating change and emphasizes that aligning change management strategies with organizational goals is crucial. Trust, strong leadership, and feedback are key elements for successful implementation.

Spencer Dorn, MD, MPH, MHA, is a medical professional dedicated to improving patient outcomes. He dives into the drawbacks of overly emphasizing technology, especially EHR systems, in healthcare discussions. The importance of context in technology evaluation is stressed, highlighting how human interaction shapes outcomes. Dorn encourages a nuanced approach, focusing on beneficial outcomes rather than the technology itself. The conversation challenges the conventional perceptions of healthcare tech, advocating for continual improvement while maintaining vital human connections.

Tom X. Lee, MD discusses the paradox of sustaining primary care practices independently. The podcast highlights the challenges faced by primary care entities in balancing revenue and high-cost services. Topics include the importance of enlightened leadership, value-based care, balancing financial incentives with societal impact, and recruiting dedicated doctors for long-term success.

In this encore episode of 'Relentlessly Seeking Value,' host Stacey Richter revisits a critically important conversation with ERISA attorney Paul Holmes about the complexities and hidden pitfalls in Pharmacy Benefit Manager (PBM) contracts. Aimed at CFOs and employer plan sponsors, Holmes highlights how poorly reviewed PBM contracts can lead to companies paying 30-40% over market for pharmacy benefits, discusses the potential legal exposures under the Consolidated Appropriations Act (CAA), and suggests the essential need for independent reviews. Holmes also delves into issues with Employee Benefit Consultants (EBCs) taking indirect compensation from PBMs and offers actionable advice for employers on how to mitigate these risks.  To read the full article, show notes as well as the links mentioned visit our episode page. While there, consider signing up for our free weekly newsletter.   07:41 What are Paul’s usual observations when a PBM contract crosses his desk? 08:34 “If you just sign … one of their model contracts …, you’re probably gonna pay 30% to 40% above market on your drug spend.” 12:11 What is a PBM lawyer? And why is it important to find an ERISA PBM lawyer? 17:12 EP379 with AJ Loiacono. 17:40 Who is on the hook for the cost of the PBM contracts? 21:05 What’s the problem with most ERISA lawyers today? 22:56 Lawsuit about PBM contract. 27:43 What’s Paul’s advice for benefits consultants? 31:40 How much might a plan sponsor be paying their consultant versus what a consultant might be making from a PBM?  

Healthcare consultant Ann Kempski discusses the unintended consequences of state healthcare laws CON and COPA. They explore issues with market consolidation, impact on costs, and potential monopolies. The episode highlights the need for vigilant oversight and diverse stakeholder involvement in regulatory terrain.

To read the full show notes with links mentioned, be sure to visit our episode page and consider signing up for our free weekly newsletter. Episode 443 of Relentless Health Value pays tribute to the late Marshall Allen, an investigative journalist dedicated to exposing injustices within the American healthcare system. Hosted by Stacey Richter, the episode features Dave Chase, founder of Health Rosetta, who shares memories and insights into Marshall's tireless work in investigative reporting. The episode highlights Marshall's impact on healthcare legislation, his significant contributions to ProPublica, and his book 'Never Pay the First Bill,' which empowers patients and employers to fight back against corrupt billing practices. The episode also includes an earlier interview with Marshall, focusing on his perspective as an investigative reporter, the exploitation within the healthcare system, and the importance of patients and employers demanding transparency and fairness. The episode encourages listeners to continue Marshall's legacy by subscribing to the Marshall Health Academy and purchasing access for employees. 09:28 What’s the point of view that Marshall is coming from with his investigative reporting? 09:57 “How does this affect the people who are paying for it and the people who are undergoing the care?” 10:49 “There’s a lot of good people working within this very messed up system.” 11:03 Why are patients considered outsiders in the healthcare system? 11:45 “What’s happened in healthcare is that the stakeholders treat each other more as the customer.” 13:45 What is upcoding? 17:18 “These are schemes that have been created within the industry to increase revenue.” 17:46 “This system is not set up for the benefit of the patient.” 18:13 “On the financial side, the industry is actually oppressing the American people.” 19:14 “We have been expected to pay whatever aggregate sum is thrown at us.” 20:21 Why have patients been so passive toward this crooked healthcare system so far? 22:05 What’s the difference between making a profit and profiteering? 29:45 What are the first-order and second-order consequences of what’s happening in health care right now, and which of these consequences will actually drive change? 30:45 “When you tell the truth about what’s going on … they become so ashamed … that they change their behavior.” 32:00 “The patient … is not their most important customer.” 32:50 “The sleeping giant is the employers.”

In Episode 442 of 'Relentless Health Value,' host Stacey Richter shares an intriguing outtake from a previous episode featuring Andreas Mang, senior managing director at Blackstone, discussing the critical issue of cost management in oncology side effect treatment. The conversation delves into the inefficiencies and patient harms caused by inadequate side effect management, particularly dehydration due to chemotherapy, and the resulting financial burdens on employers, taxpayers, and patients.  Stacey explores the importance of a value-based mindset in drug purchasing, integrating oncology care, and the potential financial and health benefits of better side effect management. She highlights various expert opinions and studies supporting these points, encouraging listeners to reconsider their approach to healthcare cost structures and patient care protocols. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe.  01:12 Andreas Mang on oncology medication side effect management. 03:12 Mark Lewis, MD’s Tweet. 03:39 Celena Latham’s response. 04:22 How integrative oncology can save money and what it looks like. 04:47 EP157 with Ethan Basch, MD. 06:20 Why PBMs saving money doesn’t necessarily mean savings for employers and payers. 07:36 EP435 with Dan Mendelson. 08:20 EP372 with Cora Opsahl. 08:40 EP331 with Al Lewis. 09:50 Stacey’s second rumination. 10:19 Why having a value mindset when purchasing is a thing. 10:42 Stacey’s third rumination. 12:03 EP370 with Erik Davis and Autumn Yongchu. 13:07 Why FFS does not pay or pay adequately for side effect management. 14:31 Stacey’s final rumination. 17:08 Summarizing Stacey’s four ruminations on this topic.