Relentless Health Value

Mission vs. Margin: Dr. Scott Conard's Journey in Transforming Primary Care 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. To read the full article and show notes with links mentioned as well as a full transcript, click here. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe.   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.”

Unlocking the Front Desk: The Overlooked Key to Patient and Clinician Success 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. To read the full article and show notes with links mentioned as well as a full transcript, click here. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 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.

Balancing Mission and Margin in Healthcare: Lessons from Kate Wolin 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. To read the full article and show notes with links mentioned as well as a full transcript, click here. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 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

Exploring the complexities of the US healthcare system and the need for multidimensional approaches to address challenges. Emphasizing the importance of healthcare providers being accountable for measurable outcomes and building trust with patients. Insights on optimizing metformin treatment for type 2 diabetes and transforming healthcare to prioritize patient-centered care and outcome accountability.

In this podcast, they discuss selling digital health solutions to employers, emphasizing the profitability and transformative potential. They delve into market needs, challenges, and strategies for success, highlighting the importance of tailoring solutions to employers' needs. They also touch on navigating PMPM pricing models and exploring innovative solutions for healthcare and employee productivity.

Exploring pharmacy acronyms like AWP and WAC, the podcast dives into the complexities of drug pricing and rebates. It unravels the hidden world of pharmacy supply chain economics and the impact on patients and plan sponsors. The discussion delves into the challenges faced by pharmacies dealing with Pharmacy Benefit Managers and the pricing dynamics of generic drugs. Dysfunction in the pharmaceutical industry is also explored, revealing its consequences on pharmacy operations and patient access.

Practical Steps for Plan Sponsors Post-J&J and DOL vs. BCBS Lawsuits In Episode 428 titled 'Do It Now Advice From the J&J and the DOL versus BCBS lawsuits,' host Stacey Richter discusses the implications of two major legal cases on plan sponsors with guest Julie Selesnick, an attorney specializing in fiduciary responsibilities. The episode covers essential actions for plan sponsors, brokers, and employee benefit consultants to avoid conflicts of interest and ensure fiduciary compliance. Selesnick, a senior counsel at Berger Montague's Employee Benefits and ERISA Group, emphasizes the importance of obtaining and effectively using claims data, renegotiating administrative services agreements, and conducting independent claims reviews. The discussion also highlights practical strategies like carving out certain high-cost services and establishing a health and welfare fiduciary committee. To read the full article and show notes with links mentioned as well as a full transcript, click here. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 05:48 What’s happening with the J&J lawsuit? 07:38 What’s going on with the DOL v BCBS case? 08:49 What do these cases mean for plan sponsors? 09:21 Why is engaging with claims data critical? 12:30 EP408 with Chris Deacon. 14:20 EP379 with AJ Loiacono. 16:58 What’s one solution to avoiding a conflict of interest? 18:02 Why there’s still not a total understanding about what to do with claims data once acquired. 20:58 NADAC (National Average Drug Acquisition Cost) to check pharmacy prices. 21:31 What advice do plan sponsors need to know that never gets recommended to them when dealing with conflicting interests? 27:02 EP337 with Olivia Webb. 28:41 EP285 with Dawn Cornelis. 30:24 “As a fiduciary, your money should only go to pay your plan’s benefits, not to other plan benefits.” 30:59 What’s Julie’s advice to advisors? 33:17 “Giving nonconflicted advice … is something you really can only do if you have no conflicts.” 35:57 What’s Julie’s advice for administering whole plans?

Exploring digital health vendors' impact on patient outcomes, the podcast emphasizes standardization, clear care processes, and structured care pathways for better healthcare delivery. It discusses the challenges faced by vendors in meeting payer demands and optimizing patient outcomes through innovative care paths, data quality, and AI implementation.

Unveiling Hidden Compensation: How Employee Benefit Consultants and Brokers Profit from Plan Sponsors To read the full article and show notes with links mentioned as well as a full transcript, click here. In this encore episode of 'Relentlessly Seeking Value,' Stacey Richter interviews A.J. Loiacono, CEO of CapitalRx. They delve into the hidden compensation practices of Employee Benefit Consultants (EBCs) and brokers engaging with plan sponsors. The discussion unveils the potential conflicts of interest and self-serving behaviors of these intermediaries, who sometimes prioritize their own financial gain over the best interests of employers and employees. With the enforcement of the Consolidated Appropriations Act (CAA), plan sponsors now have the power and responsibility to request full disclosure of all direct and indirect compensations being made. The conversation brings to light the murky and often unethical practices within the industry and emphasizes the importance of transparency and diligence for self-insured employers to avoid unreasonable and secretive fees that ultimately increase their total costs. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 07:09 Who can get in trouble for mismanaging employee funds? 07:48 “When you talk about conflicts of interest, they’re everywhere.” 13:13 “You’re paying for access.” 13:34 Why is it important to request that they disclose direct and indirect compensation? 14:04 What are the layers to these hidden fees and compensations? 18:13 What is a reasonable fee for a good plan admin? 19:27 “I think people need to take a step back and say, ‘How many different ways are they getting compensated?’” 24:50 “The compensation is not just unreasonable, but if they were to move it, they would lose access to an entire column of revenue.” 25:06 “For every good broker consultant, there’s a horrible individual lurking out there and it’s easy to figure out: Ask for them to disclose their fees.” 28:08 “You can’t win if you can’t even pay the house fee to come in.” 31:35 Why do you need to ask for disclosure, and what do you need to ask specifically? 32:21 What are some of the characteristics of a good plan consultant?    

Cost Containment vs Value-Based Drug Purchasing with Nina Lathia To read the full article and show notes with links mentioned as well as a full transcript, click here. In this episode of 'Relentless Health Value,' host Stacey Richter discusses with Nina Lathia the complex debate between cost containment and value-based drug purchasing strategies. They delve into the negative impacts of poor pharmacy benefit strategies, such as increased healthcare costs, bankruptcies, and reduced member satisfaction. They explore why employers struggle with value-based purchasing due to factors like lack of price negotiation power, siloed pharmacy spending, short-term actuarial horizons, and FDA's approval based on limited evidence. The episode provides actionable advice on establishing a value-based formulary, including having a clear goal, considering overall healthcare spend, understanding drug value-based pricing, exploring risk-sharing agreements, and ensuring effective communication with plan members. Lathia, a pharmacist and consultant with a Ph.D. in health economics, shares her expertise on making evidence-based drug purchasing decisions that balance cost and clinical effectiveness. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 06:34 What does cost containment mean? 07:43 Why is it important to consider health outcomes? 10:00 What does value-based purchasing mean in Pharma? 11:09 What are the principles of cost-effectiveness analysis? 12:50 Pharmacy plan time horizons versus employer time horizons. 14:42 Why is it increasingly important for payers to take a more global look at health and cost outcomes? 16:14 Why is the first step establishing a value-based price for drugs? 16:43 Why is the second step thinking about risk-sharing agreements with manufacturers? 18:57 LinkedIn article by Bryce Platt, PharmD. 19:20 What should an employer do if there’s only one drug option and the price is too high? 21:20 What’s a specialty carve-out solution? 21:26 EP352 and EP353 with Pramod John, PhD, of VIVIO. 22:10 Why should employers get more comfortable with saying “no” to certain drugs? 25:36 Why is patient engagement key? 28:23 What does “good” look like for employers implementing drug-spend changes? 29:51 EP337 with Olivia Webb.