Relentless Health Value

Episode 425: Operationalizing Cash Payments in Clinical Practices with Marshall Allen 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, Stacey Richter speaks with Marshall Allen about how clinical practices can implement cash payment options for patients, which can often be cheaper than using insurance. They discuss the growing trend of patients struggling with high deductibles and the legal considerations for providers accepting cash, including using HIPAA to navigate insurance constraints. Allen shares insights on setting competitive cash prices, the potential financial benefits for practices, and resources like fairhealthconsumer.org to benchmark pricing. He also touches on the broader movement towards direct contracting and the importance of fostering healthcare financial literacy among patients. 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. 07:04 What Allen Health Academy is doing. 11:01 What’s the problem with the system now? 14:19 EP363 with David Scheinker, PhD. 14:27 EP413 with Will Shrank, MD. 14:34 What’s the hack Marshall Allen shares for insured patients paying cash? 15:06 How can patients cite HIPAA to pay cash instead of using their insurance? 19:00 What’s the first recommendation Marshall Allen has when dealing with healthcare billing? 21:26 EP297 with Jerry Durham. 21:48 What are the other benefits of a clinic accepting cash payments? 25:36 Why do we need to have more direct pay happening? 26:36 How should a medical provider set a cash price? 27:12 Research tools for fair pricing: fairhealthconsumer.org, BILLY, colonoscopyassist.com, Jason Health, Green Imaging. 32:36 How do you find the win-win between a patient and a doctor? 32:51 What’s the final tier of partners in creating more direct-pay opportunities? 34:30 What’s Marshall Allen’s opinion on having to pay credit card fees?  

The Narcissism of Small Differences in Healthcare: Building a Unified Village for Patient-Centric Solutions To read the full article and show notes with links mentioned as well as a full transcript, click here. In this inbetweenisode of 'Relentlessly Seeking Value,' Stacey Richter discusses the concept of the 'Narcissism of Small Differences' and its implications for the American healthcare industry. Richter explores how minor disagreements can prevent collaboration among healthcare professionals who share the same overarching goals. She emphasizes the need for unity to combat the profit-driven motives of large healthcare corporations and improve patient care. The episode also examines the role of conferences, the moral complexities faced by individuals within large entities, and the importance of focusing on collective goals rather than getting bogged down by insignificant differences. Richter encourages building a village of diverse yet aligned individuals to achieve meaningful healthcare reform. 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. 00:42 What “the narcissism of small differences” means. 02:18 How does this narcissism of small differences show up in the effort to fix the healthcare industry? 05:26 Quote from Jeff Hogan. 10:12 “What did the work we do add up to?” 16:31 Why we shouldn’t judge someone for working within the “belly of the beast.”

Five Realities Hospital Execs Need to Face in 2024 with Peter Hayes To read the full article and show notes with links mentioned as well as a full transcript, click here. In episode 424 of Relentless Health Value, host Stacey Richter speaks with Peter Hayes about five critical topics hospital system executives must address in 2024. They discuss the implications of the Consolidated Appropriations Act, the necessity for hospitals to become more administratively and technologically efficient, the shift from fee-for-service to episode-based care, the need for transparency and accountability regarding tax-exempt statuses and 340B drug pricing, and the imperative of ensuring high-quality and safe patient care. The episode emphasizes the growing demand for hospital systems to adapt to regulatory changes and market pressures while maintaining fiduciary responsibility, quality care, and trust within their communities. 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. For more on the wild problems with hospital pricing, check out this list of shows. But, spoiler alert, some of these are hair-raising. 08:04 Why do hospitals need to get real about the implications of the Consolidated Appropriations Act? 10:09 What is considered fair pricing for hospitals? 13:00 EP390 with Gloria Sachdev, PharmD, and Chris Skisak, PhD. 15:59 The medical transparency tool, Billy. 16:34 How does lowering prices become more challenging with consolidated hospital systems? 18:07 What is one of the solutions available to combatting this now? 19:31 Why do hospital systems need to get real about administrative and technology efficiencies? 22:27 EP373 with Cora Opsahl. 26:51 Why do hospitals need to get real about pivoting from fee-for-service reimbursement to episode-based care? 30:16 EP415 with Rob Andrews. 30:53 Why do hospitals need to get real about the 340B program and their tax-exempt status? 35:38 EP394 with Vikas Saini, MD, and Judith Garber, MPP. 38:19 What are the ethical and moral issues that are coming to a head with healthcare costs? 39:03 Why do hospitals need to reexamine their care quality and patient safety? 40:05 “We just need to make sure that the health industry is as accountable as some of our other industries.” 42:53 Why does Peter think it’s going to take regulation to move the dial?

Unpacking Pharmacy Benefit Management: Maximizer Programs and Patient Impacts with Joey Dizenhouse To read the full article and show notes with links mentioned as well as a full transcript, click here. Episode 423 of 'Relentless Health Value' features a conversation with Joey Dizenhouse about the tactics employed by PBMs and pharmacy benefit schemes to manage drug costs, often leading to misaligned incentives. Joey outlines how maximizer programs work, differentiating between spread and transparent models, and the potential consequences for plan sponsors and patients. The discussion dives deep into copay assistance programs and the complex dynamics behind drug pricing and patient access. Key advice for plan sponsors includes applying purchasing discipline, understanding program structures, and being aware of the broader implications on patients. 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. 06:21 How was the first iteration of maximizers conceived? 10:59 “I’d always encourage you to come back to the underlying incentives.” 11:18 What does maximizer acceleration look like? 12:24 What are the two kinds of maximizers? 12:43 What is the spread model for a maximizer? 13:02 What is the transparent model for a maximizer? 15:26 “Ask the questions: How do you make money? Prove it!” 15:56 EP419 with Andreas Mang. 16:25 How might Pharma be making more money with maximizers? 26:14 What is the “it’s not covered” approach? 32:29 “The right kind of program has been properly narrowed.” 33:51 Is there a purpose that some of these programs can serve, issues aside? 35:57 How does a free drug program actually cost money?  

Episode 422: The Financial Struggles and Unexpected Insights of Independent Pharmacies with Benjamin Jolley To read the full article and show notes with links mentioned as well as a full transcript, click here. In this episode, Stacey Richter interviews Benjamin Jolley, a multi-generational pharmacy leader and consultant, who discusses the financial challenges faced by independent pharmacies. Jolley reveals that a significant portion of a pharmacy's profits comes from a mere 10% of prescriptions. The conversation dives into the detrimental impact of Pharmacy Benefit Managers (PBMs) on pricing and reimbursement, the inefficiencies in the system, and explores potential models like direct pharmacy care to create more sustainable business practices. The discussion also touches on the broader implications for local communities and the healthcare system overall. 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. 04:47 Benjamin Jolley’s recent revelation. 06:14 What are the 10% of drugs that provide all the profit for pharmacies? 09:21 What’s happening with the other 90% of drugs that pharmacies are filling? 11:05 What is the breakdown of costs when fulfilling prescriptions and running a pharmacy? 18:50 EP379 with AJ Loiacono. 21:42 What is the “cost savings” within the “insane system” of PBMs not sharing profit with independent pharmacies? 23:00 What is one of the things that PBMs and pharmacies don’t often talk about? 26:39 What can employers do so that patients aren’t getting overcharged by PBMs? 27:51 “How do I make the PBMs irrelevant?” 33:30 What’s the difference between an independent pharmacy delivery service and a service like Express Scripts? 34:36 What’s the other potential solution in solving the problems independent pharmacies face, and why does Benjamin Jolley feel that it’s not the best solution to pursue?

The podcast discusses the importance of evidence in healthcare decision-making and the limitations of Electronic Health Records (EHRs). It explores the need for tools to capture patient journeys outside of clinical visits and the role of clinicians in addressing social determinants of health. The significance of team-based care and building strong relationships in healthcare is emphasized. Lastly, it delves into the importance of accurate medical records and patient empowerment in digital health.

Harnessing Data for Smarter Health Fund Management with Cora Opsahl from 32BJ 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 talks with Cora Opshal, Director of the 32BJ Health Fund, about the imperative for employers and unions to obtain and effectively use their health data. The conversation details the significant benefits of data analytics, such as smart decision-making, reducing waste, and forecasting financial trends. Various case studies, including kicking out an expensive hospital network to save millions and offering low-cost maternity and joint replacement programs, are discussed. The episode emphasizes the critical role of data ownership and transparency in managing healthcare costs and improving benefit designs for members. 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. 06:53 How much data does 32BJ Health Fund have, where do they get it, and how do they use it? 08:52 How did 32BJ Health Fund successfully demand their data from 100% of their vendors? 09:42 “We feel it’s really important that we own this information ourselves.” 10:05 “It always concerns me—if a vendor doesn’t want to give you the information, what are they hiding?” 10:32 “It’s not just getting the data; it’s then using the data.” 13:41 “Without data, you’re really just taking a guess; and guesses are never gonna get you where you need to go.” 15:19 EP285 with Dawn Cornelis. 15:40 Is the cost of creating a data analytics team worth the cost savings of those data discoveries? 19:03 “The use of data has really built our knowledge.” 20:52 “It’s really important to us that as we make benefit decisions, we’re doing it smartly.” 25:27 EP358 with Wayne Jenkins, MD. 25:38 How is 32BJ Health Fund making their data knowledge actionable? 28:11 “If we can figure out how to make telehealth accessible … there may be an opportunity for telehealth … to upset some of these … monopoly systems or low-choice options.” 30:22 “It’s really easy to think that we can solve this problem through benefit design … but in the end … it’s the price.”

Improving Maternity Outcomes: The Role of Trust and Community-Based Care To read the full article and show notes with links mentioned as well as a full transcript, click here. In Episode 421, 'Wildly Improving Outcomes When The Patient Is, For Reals, In The Center. For Maternity and Beyond,' host Stacey Richter interviews Jodilyn Owen, clinical director of the Rainier Valley Birth and Health Center. They discuss the systemic issues in the U.S. healthcare system where financial incentives do not align with patient outcomes, especially in maternity care. They highlight Jodilyn's clinic's successful outcomes despite being located in a medically underserved area. They explore the importance of relationship-based care, the economic challenges of quality care provision, and the failures of venture-backed healthcare startups to understand community needs. The conversation underscores the need for trust, listening, and community integration in improving maternal health outcomes. 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. 07:12 How much cost savings is there when you avoid a NICU admission? 09:43 How is “slow care” feasible among an ob-gyn shortage in many communities? 10:42 “Start people at the risk that they are appropriate for.” 11:37 EP407 and Summer Shorts 3 with Vivek Garg, MD, MBA. 13:50 “To effect change, we have to unwind what has been wound so tightly and so carefully through medical … education.” 14:13 “It’s not a people problem; it’s a system problem.” 18:46 What does relationship-based care mean? 22:32 “Everything in pregnancy at least is a trend.” 28:01 How does Jodilyn’s practice work with payers? 31:08 EP409 with Larry Bauer, MSW, MEd. 32:24 Why is it important to address the root of this problem in the education space?  

Uncovering the Economics of Paying Cash for Generic Drugs with Ge Bai To read the full article and show notes with links mentioned as well as a full transcript, click here. In this episode, Stacey Richter talks with Dr. Ge Bai, a professor at Johns Hopkins, about the rationale and financial implications of paying cash for generic drugs instead of using insurance. The discussion highlights the inherent inefficiencies and high administrative costs associated with PBMs (Pharmacy Benefit Managers) and insurance systems when it comes to low-cost generics. Key insights from studies are discussed, revealing that for a significant portion of generics, paying cash is often cheaper than using insurance. The conversation also explores alternative solutions such as Health Savings Accounts (HSAs) and the role of policy and market dynamics in improving drug affordability. 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. 06:13 What is the background on generic drugs that is need-to-know? 06:39 EP344 with Steven Quimby, MD. 07:04 Do we have affordability for generic drugs? 15:40 What’s the policy failure around generic drugs? 18:34 Why is there a huge health equity issue? 20:13 How do PBMs have both a monopoly and a monopsony? 21:59 What should be the goal for cheap generics? 23:36 “Whenever we have no competition, we’ll see high price.” 26:00 What’s the best approach to addressing operational challenges behind generic drug costs? 28:42 How do we solve generic drug costs on the back end? 31:15 “Healthcare insurance is not the same as health.” 36:07 “It’s time for us to reflect and think whether there is a better way to try.”

The Financialization of Health Benefits: A Boardroom Imperative To read the full article and show notes with links mentioned as well as a full transcript, click here. In episode 419 of Relentless Health Value, Stacey Richter interviews Andreas Mang from Blackstone on the financialization of healthcare benefits for corporate boards and C-suite executives. The discussion highlights the transformation of healthcare benefits into a significant business aspect, emphasizing the importance of C-suite involvement to combat waste and financial exploitation by vendors. Andreas offers practical steps to save companies up to 10% on healthcare costs while improving employee satisfaction, including self-insurance and careful selection of brokers. The episode underscores the need for enhanced purchasing discipline and strategic alignment among company leadership to manage healthcare expenses effectively. 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. 04:19 Why Andreas starts every conversation with the question, “How’s your healthcare company?” 07:04 Why is it important, as a self-insured employer, to treat your business as a small healthcare company? 08:42 Why is it unnatural for companies to be providing health insurance? 10:13 What can be achieved when there is alignment between employers and insurers? 12:07 What things can a company do to reduce spend by 10%? 13:40 Why is it better to have CFO engagement in the benefits plan throughout the year? 15:51 Why does self-insurance save 5% to 9% for companies automatically? 17:41 “The funding isn’t a healthcare thing; it’s a CFO thing.” 17:54 Why is it vital to have a reliable, trustworthy broker? 24:38 When is the last time your company has RFP’d their health plan? 27:06 Why does changing a health plan feel scary but is necessary? 27:58 What is a dependent eligibility audit? 30:48 Why are employers better together? 34:02 How do employers truly get a flat-fee model with brokers?