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Relentless Health Value

Stacey Richter
100 episodes
Relentless Health Value is the podcast for business leaders working in payer/insurance carrier and provider organizations, as well as for pharmaceutical, medical device, patient advocacy, and other health care organizations. Health care–oriented venture capitalists (VCs) and digital health entrepreneurs also regularly engage with our show. Finally, we have a growing contingent of employer CFOs and benefits professionals who tune in. The podcast mission is to help transform health care by fostering collaboration and breaking down silos. Our panel of expert guests connects you with other health care leaders trying to achieve the quadruple aim of improving population health and patient and provider experience, while managing costs effectively. Relentless Health Value is one of the oldest and largest podcasts dedicated to health care industry decision makers trying to do the right thing.

Disclaimer: the content and artwork of this podcast are the property of its owner and are not affiliated with nor endorsed by Audiotrails.

EP321: How to Point Out Low-Value Care Without Starting a Fistfight, With Rich Klasco, MD

If you listen to this show on the regular, you probably have a pretty good bead on a couple of things I’ve been really into lately. One of them is high-value care versus low-value care. These are terms that are really easy to throw around. You also can get pretty much everybody to agree with a plan…

AEE15: A Sidebar Conversation About the Importance and Challenges for Health Systems to Collaborate With Pharma Manufac…

When I was talking with Dr. David Carmouche from Ochsner in EP316 about the importance of collaboration amongst anybody trying to actually pull off value-based care, we took a little detour, which I wound up cutting out, into the potential and challenges for health systems to collaborate and do v…

EP320: Is Telehealth vs In-Person Care Like Some Kind of Winner-Takes-All Cage Fight? With Christian Milaster From Inge…

If you want to hear what my mom and dad, both Medicare Advantage patients in their late 70s, have to say about telehealth (or teleconferencing, as my dad puts it), you’ll have to listen to the episode. They are not and have never been health care professionals, but they fully get that the question …

EP319: How Do We Improve Outcomes in Skilled Nursing and Also Assisted Living Facilities? With Grace Terrell, MD

I’ll tell you what I wanted to figure out: How does care improve in SNF (skilled nursing) or assisted living facilities? My starting point in contemplating a possible path toward this goal was advanced primary care. There is so much talk and evidence these days about advanced primary team-based car…

EP318: A Primer for Pharma Looking to Collaborate With Health Systems, From the Point of View of Troy Larsgard, a Pharm…

I heard someone say the other day, “Practicing medicine without pharmaceuticals is like running to the ten-yard line, putting down the ball, and walking off the field.” So, it’s pretty imperative that providers and Pharma know how to work together to get the best outcomes for patients. In this cont…

EP317: Wait, the Latest Action on Drug Pricing Reform Can Be Found in the Infrastructure Bill? With Josh LaRosa, MPP, P…

Let’s get a fast bead on what’s going on with drug pricing reform, shall we? Every time I wade into these waters, my head about explodes. So, I very much appreciate the opportunity to quiz Josh LaRosa from the always-well-informed Wynne Health Group. Here’s the goings-on in a nutshell: There’s go…

EP316: Unexpectedly Talking About Employers, With David Carmouche, MD, From Ochsner, a Large Health System

I don’t know what I thought we were going to talk about during my interview with David Carmouche, MD; but I’m glad it turned out exactly as it did. Lately, we’ve had a number of guests on Relentless Health Value talking from the point of view of the employer: what a self-insured employer wants and …

EP315: The Very Unsexy Essential for Technology to Drive Outcomes That Nobody Talks About, With Bob Matthews

Medicine is complex. It’s getting more complex. We double what we know in medicine every 73 days. There’s 800,000 journal articles published every year. It is impossible for any human to keep up. It’s just impossible. There’s a lot of talk about amazing technology to help humans manage the 26,000 v…

AEE14: A Short Lesson for Self-insured Employers: Dr. Doug Eby Gives Some Advice That Everybody Should Hear Who Is Inte…

Have you never heard of the Nuka System of Care? If that’s the case, it is an award-winning and really remarkable health system in Alaska. In this 5-minute “An Expert Explains,” Dr. Douglas Eby, medical director over at Nuka, gets directly to the point. A key component to making sure that the peopl…

EP314: Why Do SNF (Skilled Nursing Facility) Patients Need Two Pharmacies and a PBM? Following the Kinda Long Long-term…

This episode is for anyone as curious as I have been about pharmaceutical supply chain goings-on in long-term care facilities like skilled nursing facilities, otherwise known as SNFs. There are a lot of players in the mix: You have your PBMs. You have your wholesale pharmacies. You have your LTC (m…

EP313: Partnering Up With Fiercely Local and Fiercely Independent Pharmacies, With Dan Strause and Drew Leatherberry

Let’s talk about one aspect of health care that’s not talked about possibly often enough: big national health care players siphoning money out of local communities—potentially a lot of money depending on where you are and considering that health care is inching toward about 20% of the GDP. But besi…

EP312: Radically Improving Population Health: Listen and Learn From One of Our Country’s Best-Kept Secrets, With Dougla…

This episode is a master class in raising health outcomes at lower costs from an award-winning health care system in … Alaska?! Who knew? In fact, I learned about the work of the Southcentral Foundation and the Nuka System of Care only because I happen to listen to Swedish health care podcasts and …

EP311: How Aging in Place Becomes a Business Problem for FFS Providers, With Sumit Nagpal

This episode might be about local providers getting disintermediated not by virtual front doors like I discussed with Jeff Hogan in EP309 but by entities providing virtual continuous care at home. Predictivae and proactive, the idea is to help reduce acute events requiring on-premises care. But i…

AEE13: Have You Ever Wondered How GoodRx Makes Money? With Ge Bai, PhD, CPA

In this health care podcast, Ge Bai explains GoodRx’s business model and how PBMs and pharmacies fit in to that business model. Here’s the short version: GoodRx takes advantage of the dysfunction in the pharmacy supply chain. And while they help patients save money, their master plan only works bec…

EP310: The 2020 Shkreli Awards for the Worst Examples of Profiteering and Dysfunction in Health Care, With Vikas Saini,…

The Shkreli Awards have been published each year, for the past five years and counting, by the Lown Institute. The Shkreli Awards are a much-anticipated top 10 list of the worst examples of profiteering and dysfunction in health care. This year’s list, celebrating the most excellently egregious pro…

EP309: FFS Providers Getting Locked Out of Referral Flows, Right Now, As We Speak, With Jeff Hogan

This episode is a tale of what happens when some employers decide to open up a few virtual front doors and when these virtual front doors lead only to referrals to providers who are willing to be accountable and offer financial predictability. That’s what these employers want, after all. They want …

EP308: At Least Two Surprising Insights About Value-Based Care, With Mark Fendrick, MD

And here I thought I knew a lot about value-based care. In this health care podcast, I am speaking with Mark Fendrick, MD, who is the director over at the University of Michigan Center for Value-Based Insurance Design. This conversation is for those of you who already know pretty much about value-b…

EP307: The Surprise Billing Legislation: Its Impact on Providers, Hospitals, Self-insured Employers, and (Most of All) …

In this health care podcast, I speak with Loren Adler, who is the associate director of USC-Brookings Schaeffer Initiative for Health Policy and has a particular focus on surprise billing. I wanted to talk to Loren about the surprise billing legislation that is going into effect on 1/1/22. I will…

EP306: A Deep Dive Into Amazon’s Pharmacy and the Amazon Pharmacy Model Some Employers Are Running With, With Ge Bai, P…

Here’s a trigger warning: This show gets pretty deep into some of the nether regions of PBM (pharmacy benefit manager) contractual terms with pharmacies. If you are not, I’m gonna say, pretty familiar with PBM goings-on, I’d suggest you listen to EP241 with Vinay Patel first or skip the first thi…

EP305: The 1% Most Expensive Claimants Racking Up Massive FFS Bills and Still Not Getting the Help They Need From Our H…

My guest in this health care podcast is Darrell Moon, who is the CEO over at Orriant. I was super intrigued by some of the work that Darrell and his team are doing regarding high-cost claimants. Said a different and probably better way, certain people in need of care were identified because they …

AEE12: Steve Blumberg and I Discuss the 2020 Humana Value-based Care Report

Humana recently came out with their Value-based Care Report. The subhead is Physician Progress and Patient Outcomes. It’s a very fancy report with a lot of pages and graphics, and this impressive format definitely caught the attention of some of our industry. I read one blog post really keying in o…

EP304: How a Provider Population Health Leader Who Went to Work for a Payer Thinks About Health Care Transformation, Wi…

In this health care podcast, I speak with Steve Blumberg, VP of practice transformation for GuideWell Health, a subsidiary of GuideWell. How’s this for an interesting career trajectory? Steve spent the last decade working on population health and value-based care delivery ... on the provider side…

Encore! EP216: How Medicare Part D Plans Became Addicted to Drug Rebates, With Chris Sloan From Avalere Health

Alex Azar, who is the current Health and Human Services (HHS) secretary (until January 21 anyway), came out with a reboot of the proposal that effectively halts the practice of pharma manufacturers paying rebates to Part D plans. This reboot is supposed to go into effect on 1/1/2022. But this podca…

Encore! EP231: Pharmaceutical Contracting, PBMs, Pharmacies, Employers, and the Latest HHS Rebate Proposal, With AJ Loi…

In November 2020, there was an Executive Order entitled “Lowering Prices for Patients by Eliminating Kickbacks to Middlemen.” And we had HHS (US Department of Health and Human Services) Secretary Alex Azar and the HHS Office of Inspector General finalizing a regulation to eliminate the current syst…

INBW29: The Secret to Transforming Our Health Care System Revealed—A Summary of the Wisdom of Relentless Health Value G…

I had a vision for this inbetweenisode. I wanted to highlight the wisdom of our amazing guests this year. I really wanted to find some theme that might be a key to our health care transformation. To achieve maximum suspense, here’s the very short story of how I got from “Is there a common thread of…

EP303: The Conflict Between QALYs for Drug Value and Specific Well-Funded Patient Advocacy Groups, With Anna Kaltenboec…

You know back in the olden days when a foot of measurement was actually the measure of your own foot? So, I might measure something and it’s, like, 19 feet. And then you measure the same exact thing and it’s 38 feet because you have tiny feet. This is the analogy that kept running through my mind a…

EP302: The Gigantic Problem I Have With Talk About Telehealth, With Blake McKinney, MD, From CirrusMD

Sometimes when I overhear a conversation/argument about telehealth, it occurs to me that there’s a lot of fighting words about some things and very, very little about other things which I’d regard as equally, or maybe even more, important. Some of the sparring tends to jump immediately to tactics a…

Encore! EP206: Turns Out, High‑Deductible Plans Do Not Drive High‑Quality, Cost‑Effective Care, With Ashok Subramanian,…

There’s lots going on these days with transparency. Three cost transparency rules, as a matter of fact, just came out of CMS, for example. These rules demand that hospitals and payers make available cost information so patients can shop and employers can also shop. That last part there, about emplo…

EP301: What Is Up With the Hospital and Payer Transparency Rules From CMS Now and Also After January 20? With Jeff Leib…

Three transparency rules have come out of CMS in the past months. My guest in this health care podcast, Jeff Leibach, calls these three rules three steps on a ladder. They build on each other. The first rule was announced last year, and it was for hospitals to post their chargemasters. You could …

EP300: Getting the Right Drugs Developed and Thinking Different About How to Pay for Them, With Bruce Rector, MD

Wow! It’s episode 300. That’s a milestone. Because of you, we’ve grown to be one of the largest podcasts for health care executives—so, thank you to every one of you who has recommended the show to your friends and colleagues, which is really the highest compliment. Thanks also to all the listeners…