Relentless Health Value

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.

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. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP428 ✉️ 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/ 05:48 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.

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. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/Encore379 ✉️ 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/ 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?

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. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP426 ✉️ 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/ 06:34 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.

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. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP425 ✉️ 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/ 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?

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. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/INBW39 ✉️ 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/ 00:42 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."

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. For more on the wild problems with hospital pricing, check out this of episodes in the Show Notes (link below). But, spoiler alert, some of these are hair-raising. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP424 ✉️ 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/ 08:04 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?