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Relentless Health Value

Relentless Health Value

Written by: Stacey Richter
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 American Healthcare Entrepreneurs and Execs you might want to know. Talking. Relentless Health Value is a weekly interview podcast hosted by Stacey Richter, a healthcare entrepreneur celebrating fifteen years in the business side of healthcare. This show is for leaders in pharma, devices, payers, providers, patient advocacy and healthcare business. It's for health industry innovators, entrepreneurs or wantrepreneurs or intrapreneurs. Relentless Healthcare Value is the show for you if you want to connect with others trying to manage the triple play: to provide healthcare value while being personally and professionally fulfilled.©BD Bridges LLC, All Rights Reserved. Hygiene & Healthy Living Physical Illness & Disease Politics & Government
Episodes
  • EP496: Plan Sponsors Spend About $1.20 to Buy $1 of Healthcare, and Clinical Organizations Receive 80¢ for Every $1.20 Spent, With Mark Newman

    EP496: Plan Sponsors Spend About $1.20 to Buy $1 of Healthcare, and Clinical Organizations Receive 80¢ for Every $1.20 Spent, With Mark Newman
    Jan 8 2026
    I'm gonna do a little series here called "The Inches Are All Around Us," and in this series, at least to start, all of the inches I'm gonna mention are full-on administrative waste—waste that is particularly egregious because it has nothing to do with patient care. That's why when Shane Cerone said, "The inches are all around us" in episode 492 about hospitals and hospital prices, I really perked up. Because by fixing this friction, this administrative waste, we can actually improve patient care and reduce costs simultaneously. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. Along these same lines, I have also heard Zack Cooper, PhD, talk about the 1% steps to healthcare reform project, where he's like, look, find 10 or 30 or whatever 1% problems, and you'll probably transform healthcare faster than if you're trying to find a 10% or 30% solution. So, same idea. And finding these inches, these 1 percents, even in and of themselves, it's big dollars when it comes to how much the U.S. spends on healthcare, which is, by the way, projected to reach $5.6 trillion in 2025, according to NHE (National Health Expenditure) projections from federal actuaries. So, I decided to go on a bit of a quest for these inches—you know, get a bead on where they may be nestled for anyone looking on behalf of their plan or their country or their state maybe. To this end, also recall or be aware of the episode with David Scheinker, PhD (EP363). But David Scheinker in that episode gets into how much every industry pays something like 2% to administer a transaction. But in healthcare, the provider pays something like 14%, and the payer pays another 14% to submit and get paid for a claim, which is healthcare for a transaction. Don't get me wrong, it's the plan sponsors such as self-insured employers, members, and USA taxpayers who are ultimately paying for those two 14 percents. So that 28% of full-on administrative costs—most of which, we could agree, could go away and probably be better for patients, not worse—this, too, is coming out of the pockets of the ultimate purchasers of healthcare. Those costs are getting passed along. I say all this to say, to kick off this "the inches are all around us" exploration, I wanted to dig in a little more specifically into what goes on during these aforementioned transactions (ie, what this life of a claim kind of, like, looks like on the ground). I wanted to start here because, yeah, we haven't done this before; and this exploration is gonna continue into next week because we're gonna dip heavy into clearinghouses with Zack Kanter and what they do all day. And then after that, I'm talking payment integrity programs. I'm talking prepayment review programs with Mark Noel, because you know what? Employers don't wanna be bringing a knife to a gunfight. And I realized in the course of these conversations that any self-insured plan sponsor that is not doing, for real, payment integrity programs, for real, prepayment review, post-payment review. I'm getting ahead of myself, but when you listen to the show next week with Zack Kanter, you will so totally see what I mean. Today, as I mentioned earlier, I am speaking with Mark Newman, who is the CEO and founder of Nomi Health. Nomi aims to simplify the act of buying and paying for healthcare for self-insured employers. Look 'em up if that sounds intriguing. I also do need to thank Nomi Health for so generously offering to donate to RHV to cover the expenses of producing this episode. So, thank you so much to Nomi Health. Okay, lastly here, just to set the basic framework for this conversation that follows, Mark gets into two main revelations, reasons that kind of sit behind all a large part of the waste and friction in healthcare transactions. Again, otherwise known as a claim getting paid. And these two reasons are data isn't data isn't data. In other words, as a claim moves through the system to different stakeholders, the data starts to change and morph and come and go. Different people have different use cases for that data, so it starts to get added and subtracted, but nobody really has the universal level to tote up the difference in any organized fashion. So, we talk about that first. Then Mark Newman doubles down with another reason for the friction and waste. Here's the second revelation: A dollar isn't a dollar isn't a dollar. And same kind of rules apply here. A plan sponsor might spend a dollar and, yeah, is that dollar spent or is that dollar accrued to spend? Which is kind of wonky, but also relevant. And if you didn't understand that, we'll get to it. And then just because a dollar gets spent doesn't mean the provider gets that dollar. And by the way, I don't just mean, oh, there's spread pricing. How shocking. I mean that a plan sponsor could roll up to a hospital and say, "We spent $10 million last year,...
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    37 mins
  • INBW45: Extremely Actionable Themes That We Covered Throughout 2025

    INBW45: Extremely Actionable Themes That We Covered Throughout 2025
    Dec 31 2025

    In this Part 2 episode of 'Relentlessly Seeking Value,' host Stacey Richter recaps the prominent themes 4 and 5 from 2025. The focus is on two major themes: the lack of transparency in data access leading to overspending and the necessity of shifting from volume-based to value-based purchasing in healthcare.

    The discussion includes insights from numerous healthcare professionals and case examples to underscore these vital themes affecting both patients and providers.

    === LINKS ===
    🔗 Show Notes with all mentioned links:
    https://cc-lnk.com/INBW45

    ✉️ 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/

    03:30 Theme 4: lack of transparency and data access.

    04:46 Clip of Elizabeth Mitchell from EP436.

    07:07 Is there a tipping point finally coming regarding transparency?

    08:58 Why and how siloed data is also part of this transparency issue.

    11:37 How opaque pricing leads to more opaque pricing.

    13:21 The need for transparency around ownership and what that looks like in healthcare.

    14:06 Theme 5: the need to shift purchasing from discounts/volume to value.

    14:52 Clip of Mark Cuban from EP488.

    16:35 Clip of Sarah Emond from EP494.

    17:02 How pricing transparency can eliminate the need for rebates and prior authorizations.

    18:30 Why healthcare needs a demand curve.

    22:09 Shows covered in 2025 that touched on other timely ideas.
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    23 mins
  • INBW44: The Relentless Health Value Themes That We Covered Throughout 2025—A Recap, Part 1

    INBW44: The Relentless Health Value Themes That We Covered Throughout 2025—A Recap, Part 1
    Dec 24 2025

    In this 'Inbetweenisode' of the Relentless Health Value podcast, Stacey Richter recaps the major themes covered throughout 2025 in healthcare. In this Part 1, Stacey dives into three critical themes: the necessity of trusted relationships and simplicity, treating primary care as an investment rather than a cost, and the impact of perverse financial incentives and profiteering.

    Various experts, including Dr. Kenny Cole, Ann Lewandowski, Jonathan Baran, and Yashaswini Singh, share insights on these subjects. The discussion highlights the pervasive lack of trust in the healthcare system, the financial implications of underfunded primary care, and the negative effects of misaligned financial incentives and profiteering within the industry.

    Check out the show notes using the link below for all of the mentioned links and episodes.

    === LINKS ===
    🔗 Show Notes with all mentioned links:
    https://cc-lnk.com/INBW44

    ✉️ 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

    📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue

    🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1

    🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b

    === 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/

    02:06 Theme 1: the critical need for trusted relationships and simplicity.

    02:28 The two categories of trust that are needed.

    02:43 Clip of Kenny Cole, MD, from EP473.

    03:43 Clip of Ann Lewandowski from EP476.

    06:07 Why simplicity and trust have to go together.

    08:30 Theme 2: primary care as an investment, not a cost.

    08:41 Clip of Jonathan Baran from EP483 (Part 1).

    09:01 Clip of Nikki King, DHA, from EP470.

    09:34 How broken primary care affects self-insured employers.

    10:12 Why there are perverse financial incentives to gut primary care.

    15:19 Theme 3: the dominance of perverse financial incentives and profiteering.

    15:46 Clip of Benjamin Schwartz, MD, MBA, from EP481.

    16:18 The actual definition of margin.

    16:55 Clip of Mick Connors, MD, from EP495.

    18:25 Clip of Yashaswini Singh, PhD, from EP474.
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    24 mins
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