Relentless Health Value

Dr. John Lee, an ER physician and chief medical information officer, discusses navigating cognitive dissonance in healthcare, highlighting the importance of celebrating small wins, fostering a supportive culture, and driving incremental improvements. He emphasizes the challenges of delivering better patient care within a system that values financial incentives over preventive care and the significance of aligning actions with personal values despite obstacles.

Healthcare analyst Brian Klepper discusses the influential yet obscure RUC committee within the American Medical Association, revealing how its specialist-dominated composition impacts primary care economics. The episode explores the skewed financial incentives, challenges in assigning true value to healthcare services, and the need for a better understanding of American healthcare to address its shortcomings.

Elizabeth Mitchell from PBGH discusses the gap in the market for independent TPAs not owned by health plans, emphasizing the shift towards direct contracting between employers and providers. The conversation highlights the need for efficient and unbiased TPAs to improve access, quality, and outcomes in healthcare.

Stacey Richter speaks with David Scheinker, PhD, to explore practical strategies for halving the administrative burden in healthcare. The discussion delves into the significant costs of healthcare transactions, the inefficiencies within the system, and actionable steps to reduce these costs. Key highlights include the potential of standardizing healthcare contracts, the role of telemedicine in building efficient systems, and the importance of competitive pressure in driving sector-wide improvements. The episode emphasizes real-world examples and research-backed recommendations to illustrate the financial and operational benefits of reducing administrative waste in the healthcare industry. If you'd like to read the full transcript, article or signup for our free weekly newsletter, see the links below. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/Encore363 ✉️ 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/ 10:39 What's the quantitative administrative cost in an average transaction? 11:05 What's the quantitative administrative cost in a healthcare transaction? 11:58 What does the healthcare billing and administration cost add to the US's overall healthcare spend? 12:53 Is it possible to cut billing and administrative costs in healthcare? 14:17 "In some ways, the problem for healthcare should be simpler." 15:30 What does the complexity of the current system look like in a doctor's office? 18:42 How did David go about studying healthcare administrative costs? 21:34 "It doesn't have to be simple; it should be standardized." 24:50 What would be the pushback on standardizing contracts in healthcare? 25:43 Why is it possible to gain more value by losing customization in contracts? 27:20 "Never let a good crisis go to waste." 27:41 "It's much easier in healthcare to build something new than to change something that exists." 30:47 What benefits does telemedicine have to cutting administrative costs? 32:17 What is another significant benefit of using standardized contracts? 33:26 Why haven't standardized contracts become a common thing in the current healthcare system?

Optimizing Pharmacy Benefits in Value-Based Care: A Conversation with Dan Mendelson In Episode 435 of 'Relentless Health Value,' Stacey Richter hosts Dan Mendelson from Morgan Health to discuss the importance of integrating pharmacy benefits into the broader context of value-based care. The conversation stems from a LinkedIn post by Mendelson outlining five key considerations for optimizing pharmacy benefits. Topics include the total cost of care, the need for value-based decision-making in pharmacy benefits, the integration of clinical teams in formulary development, and the critical role of patient engagement. The episode also explores how employers can better manage healthcare costs by aligning incentives and navigating the complexities of the pharmaceutical landscape. Key advice for various healthcare stakeholders, including pharma companies, hospitals, and primary care doctors, is also provided. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP435 ✉️ 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/ 00:00 Introduction 00:28 The Intersection of Pharmacy Benefits and Value-Based Care 00:57 The Critical Role of Pharmacy in Healthcare Outcomes 03:16 Exploring Pharmacy Benefits Optimization with Dan Mendelson 03:39 Morgan Health's Mission and Healthcare Innovation 04:46 The Conversation with Dan Mendelson: Deep Dive into Pharmacy Benefits 06:13 Strategies for Optimizing Pharmacy Benefits in Value-Based Care 11:19 The Future of Pharmacy Benefits and Employer Concerns 12:40 Advice for Pharma Companies in a Value-Based Healthcare System 16:13 Innovative Approaches to Managing Pharmacy Benefits 16:56 Engaging Patients in Pharmacy Benefit Decisions 18:06 Experimental Drug Tiers and Formulary Design 21:49 The Importance of Value-Based Contracting for Pharma 31:23 Lightning Round: Advice for Various Healthcare Stakeholders 34:47 Closing Thoughts and Invitation to Engage Further

In Episode 434 of 'Relentless Health Value,' host Stacey Richter interviews Dr. Ben Schwartz, an orthopedic surgeon and prolific writer, about bundled payments in the healthcare industry. The discussion focuses on four key surprises related to bundled payments: the all-encompassing nature of the 90-day post-surgery cost coverage; the reluctance of commercial payers to engage with bundled payment models; the shifting dynamics towards more integrated care between primary care physicians and specialists; and the complex realities of Centers of Excellence (COE) programs. The episode also highlights lessons learned from existing bundled payment models and potential future directions for more sustainable and efficient healthcare practices. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP434 ✉️ 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/ 06:07 Where are we in the development of the bundled payments space? 08:09 What are the four types of bundled payments? 09:52 How can bundled payments create perverse incentives? 11:04 What are the positives in bundled payments, and how can they help push us toward value-based care? 13:02 What is surprising about bundled payments? 18:50 EP415 with Rob Andrews. 27:03 How do Centers of Excellence connect back to bundled payments? 29:00 EP346 with Peter Hayes. 30:29 EP294 with Steve Schutzer, MD. 33:38 EP331 with Al Lewis. 33:43 EP372 and EP373 with Cora Opsahl. 37:13 What does Dr. Schwartz think the future is for bundled payments? Recent past interviews: Click a guest's name for their latest RHV episode! Justin Leader, Dr Scott Conard (Encore! EP391), Jerry Durham (Encore! EP297), Kate Wolin, Dr Kenny Cole, Barbara Wachsman, Luke Slindee, Julie Selesnick, Rik Renard, AJ Loiacono (Encore! EP379)

Justin Leader, an expert on healthcare cost transparency, discusses the hidden fees lurking in weekly claims wires for self-funded employers. He breaks down the various charges like pay and chase fees and shared savings fees that often go unnoticed. Justin emphasizes the importance of transparency for fiduciary responsibility and challenges plan sponsors face in understanding invoices. The conversation highlights how erroneous billing and lack of oversight can lead to significant financial implications, urging listeners to scrutinize these hidden costs.

In this encore episode, Stacey Richter discusses the challenges and opportunities in primary care transformation with Dr. Scott Conard. The conversation explores the conflict between mission-driven healthcare and profitability, drawing from Dr. Conard's personal and professional experiences. Key topics include advanced primary care models, perverse incentives in the healthcare system, the impact of large health systems on local communities, and the complex dynamics of healthcare management. The episode illustrates the importance of leadership, systemic change, and balancing patient care with business imperatives. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/Encore391 ✉️ 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/ 06:54 What triggered Scott's career journey? 07:31 What caused Scott to rethink what is good primary care? 08:11 Why did Scott realize that he is actually a risk-management expert as a primary care doctor rather than someone who treats symptoms? 09:25 EP335 with Brian Klepper, PhD. 09:53 How did Scott's practice change after this realization? 10:04 What is a "Whole-Person Risk Score"? 11:08 Scott's book, The Seven Numbers (That Will Save Your Life). 13:05 "You start to move from a transactional model to a relationship model." 15:31 Did Scott have any risk-based contracts? 16:08 Why is it so important to look at total cost of care and not just primary care cost? 21:08 Scott's book, The Art of Medical Leadership. 22:13 EP381 with Karen Root. 30:43 Why did Scott move over to help corporations? 33:10 EP364 with David Muhlestein, PhD, JD. 33:51 "Everybody thought they were honoring their fiduciary responsibility, and the incentives are completely misaligned." 34:31 EP384 with Wendell Potter. 34:43 "It's the system that's broken; it's not bad people."

In this encore episode of Relentless Health Value, host Stacey Richter delves into a crucial yet often ignored aspect of patient engagement and clinical success with Jerry Durham from the Client Experience Company. The discussion emphasizes how the front desk can significantly influence positive patient outcomes and mitigate clinician burnout. Jerry outlines the 'patient life cycle' and the vital role of the front desk in establishing trust and setting up provider success. Highlighting real-world examples and research, the conversation explores how proper front desk management can enhance patient satisfaction, retain patients, and contribute to the overall efficiency of healthcare practices. The episode also addresses common issues in patient-provider interactions and offers practical solutions for integrating the front desk into a cohesive, patient-centered care team. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/Encore297 ✉️ 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/ 05:49 What is the patient life cycle? 06:48 What are the milestones of the patient life cycle? When does it start? 10:05 "This isn't a business solution; this is a patient-driven solution." 10:21 "What is best for the patient is best for business." 13:25 "The takeaway there is that your team members are all driving toward the same goal." 14:34 How does the front desk impact health outcomes? 16:41 What is the objective of a front desk to reduce provider burden? 20:03 EP236 with Liliana Petrova. 21:18 "There's actually three roles at the front desk." 30:37 EP228 with Julie Rish, PhD.

In Episode 432 of 'Relentlessly Seeking Value,' host Stacey Richter discusses with behavioral epidemiologist and digital health entrepreneur Kate Wolin about the challenges and opportunities in merging clinical care with efficient business practices. They explore the pitfalls of scaling healthcare services while maintaining patient outcomes and why human-centered approaches are vital. They stress the importance of aligning investors, founders, and clinical leaders, measuring meaningful outcomes, and fostering a mission-driven culture to ensure both financial sustainability and high-quality patient care. The episode also highlights relevant episodes and resources for further exploration. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP432 ✉️ 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/ 00:00 Welcome to Episode 432: Navigating Healthcare's Margin and Mission 00:32 Gratitude and Progress in Healthcare 01:25 The Peril of Cutting 'Clinical Waste' in Healthcare 04:00 Kate Wolin's Optimism and Advice for Healthcare Entrepreneurs 05:56 Exploring Effective Healthcare Interventions and Their Challenges 14:33 The Impact of Money on Healthcare Mission and Margin 26:51 Advice for Healthcare Entrepreneurs and Investors 37:51 Closing Thoughts and Invitation to Subscribe