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

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

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    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:
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    🎤 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 ===
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    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
  • Encore! EP450: When Your Health Plan Is $9 Million in the Hole, Who Are You Going to Call? A CPA. And Tell Them to Bring Their Spreadsheets, With Marilyn Bartlett, CPA, CMA, CFM, CGMA

    Encore! EP450: When Your Health Plan Is $9 Million in the Hole, Who Are You Going to Call? A CPA. And Tell Them to Bring Their Spreadsheets, With Marilyn Bartlett, CPA, CMA, CFM, CGMA
    Dec 18 2025

    In this encore episode of 'Relentlessly Seeking Value,' host Stacey Richter revisits an inspiring conversation with Marilyn Bartlett, a CPA who transformed the State of Montana's employee health plan from a $9 million deficit to a $112 million surplus within three years.

    Known for her fiscal discipline and patient-first approach, Marilyn shares her strategic steps, from identifying waste in the system and securing quick wins to negotiating better deals with hospitals and ensuring long-term success. She emphasizes the importance of assembling a strong team, maintaining transparency, and staying focused on the ultimate goal of creating real health value. This episode is a must-listen for anyone looking to drive meaningful change in the healthcare industry.

    === LINKS ===
    🔗 Show Notes with all mentioned links:
    https://cc-lnk.com/EncoreEP450

    ✉️ 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
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    07:09 What gave Marilyn the confidence to fix Montana's state health plan?

    08:35 Why Marilyn knew she would have enough power to make the changes needed in Montana's state health plan.

    09:35 What Marilyn achieved in her time as the administrator of the Montana State Employee Health Plan.

    11:03 What were the "quick wins" Marilyn was able to achieve when she first took over as administrator?

    17:55 EP453 with Claire Brockbank, which covers RFP in detail.

    18:12 How Marilyn structured her plan for the Montana State Employee Health Plan.

    21:42 What's the key to setting yourself up for success when doing what Marilyn was able to achieve?

    25:23 Why putting together your own team is so important.

    28:20 EP397 with Paul Homes.

    28:24 EP418 with Mark Cuban and Ferrin Williams, PharmD, MBA.

    29:28 What happened when Marilyn left the Montana State Employee Health Plan?

    31:28 Have the costs of the plan gone up since Marilyn's time working on it?
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    35 mins
  • EP495: Wait … Flip That—A Crazy Revelation I Had About Trying to Fix U.S. Healthcare, With Mick Connors, MD

    EP495: Wait … Flip That—A Crazy Revelation I Had About Trying to Fix U.S. Healthcare, With Mick Connors, MD
    Dec 11 2025
    In episode 495 titled 'Wait. Flip that. A Crazy Revelation I Had About Trying to Fix US Healthcare,' host Stacey Richter speaks with Dr. Mick Connors, an emergency room pediatrician and healthcare entrepreneur, about a groundbreaking insight into the US healthcare system. They discuss the paramount need to flip the way healthcare costs and outcomes are measured: moving towards unit-level cost accounting and whole-patient or whole-community outcomes assessment. The episode delves into the fundamental pitfalls of the current healthcare structure, emphasizing the misalignment between cost aggregation and patient-level outcome measurements. They explore the challenges faced by physicians in the current system, the role of investor mindsets, and the importance of dyad leadership and mission-driven practices to improve overall healthcare value. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP495 🔗 Visit this week's sponsor Payerset: https://payerset.com ✉️ 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= 🎤 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 06:32 How Dr. Mick Connors defines margin. 08:18 EP294 with Steve Schutzer, MD. 08:54 Why nobody wants to do cost accounting in healthcare. 09:20 EP490 with Shane Cerone and Sam Flanders, MD. 11:05 Infographic by Andrew Tsang showing streams of income. 12:27 What is the value equation? 15:55 EP404 with Suhas Gondi, MD, MBA. 15:59 EP466 with Vivian Ho, PhD. 16:01 EP482 with Preston Alexander. 16:25 EP474 with Yashaswini Singh, PhD. 17:44 How business decisions can really undermine the value proposition. 18:58 Classic article on incentivizing. 23:07 EP295 with Rebecca Etz, PhD. 24:21 Why it comes down to the 80/20 rule. 26:31 EP445 with Tom X. Lee, MD. 26:35 EP460 with Rushika Fernandopulle, MD. 26:40 Why mission return requires dyad leadership. 27:13 What does dyad leadership mean? 27:33 EP492 with Sam Flanders, MD, and Shane Cerone.
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    33 mins
  • EP494: Six Tensions of Pharmaceutical Drug Pricing, With Sarah Emond

    EP494: Six Tensions of Pharmaceutical Drug Pricing, With Sarah Emond
    Dec 4 2025
    I was out drinking martinis with Cora Opsahl, director of 32BJ Health Fund, and Cora said, "Look, most plan sponsors' biggest expense is health system spend, hospital spend." I know this is an unexpected start to an episode about pharmaceutical pricing and value featuring Sarah Emond, CEO of ICER (Institute for Clinical and Economic Review). But yeah, 50% of most plan sponsors' spend these days goes to health systems. Fifty percent! One half! 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. So, if a patient who is adherent to a drug and that drug keeps that patient out of the hospital, why do I want to make a patient have excessive skin in the game to get that drug, which everybody knows at this point this "skin in the game" can cause said patient to not be adherent in many cases, cost being a very big reason patients give for not taking medications as prescribed. So then we have this not adherent patient who winds up in the hospital, via the ER often enough. The core issue here that surfaced, bottom line—and I'm not sure if this was in spite of the martinis or as a result of them—but while hospital spend is the largest health expense, high-value drugs that prevent hospitalization often face patient cost sharing and access restrictions, which leads to poor patient adherence and ultimately higher system cost potentially. So then Cora and I spent the next half hour debating when the statement is empirically true and when it's not. And you know what it all boils down to? What's the value of the drug? Do we even know what that means to start? But if it's determined that the drug is relatively high value, then the plan desperately should want to do everything possible to keep that patient on that medication, and cost sharing is a huge barrier to adherence. Today, as I said, I'm speaking with Sarah Emond, CEO over at ICER, and we get into all of this in the conversation that follows. In fact, most of the conversation that follows explores the tensions that exist in the current way that we sell and buy pharmaceutical products. I'm just gonna sum up these tensions in a list here at the top of this show. There's six of them that Sarah Emond and I discussed today by my counting, and each of these we explore in some depth. So, here's the list. Tension 1: The value of any given drug (in other words, what is the fair price for that drug considering the health gains that it delivers) versus the total cost to the plan for the total population taking that drug. GLP-1s have entered the chat. GLP-1s (by ICER's analysis, at least) are super high-value drugs that also can bankrupt plans due to the number of folks who may benefit from taking the drug. Definitely a tense tension to kick off our list here. Tension 2: The list or net price of a drug versus patient access and affordability. Again, this can be tense in an area of much misalignment. You can have a great well-priced drug with huge patient affordability and access challenges because drug net price and coinsurance amounts often have nothing to do with each other. Tension 3: Lifetime value of a drug versus a 3-, 2.5-year, whatever time horizon that many plan sponsor actuaries use in their value assessment. We discussed this today, but there's a Summer Short (SUMS7) on actuarial value horizons with Keith Passwater and JR Clark if you wanna dig in on this further. Tension 4: The tension between the societal value of a drug or even the patient's perceived value of a drug versus what an employer plan sponsor might perceive as the value. What is the formula used to determine value? What's in and what's out? So, that's a bigger conversation just beyond the time horizon for what's included in this calculation. Tension 5: Exacerbating the what's included in the value contemplation beyond just what you include in there is the tension between what is hypothetically of value and what is possible to measure. If you have pharma datasets and medical datasets separate in silos, who knows how many hospital readmissions were prevented by whatever drug? And how much presenteeism or absenteeism exists. I mean, it is an outlier, again, if anyone even knows the net price they paid for a drug, just to level set context here. Tension 6: Lowering financial barriers for patients to take drugs that are of value versus status quo goals and incentives. Like, for example, PBMs (pharmacy benefit managers) are often told that their goal is to reduce drug spend. Okay … so, how do I do that? Oh, reduce access either by prior auths or delay tactics or really high coinsurance, which is gonna reduce adherence by design. And it's someone else's problem—if I'm just thinking like a status quo PBM—if medical spend goes up, right? So, that's our last and not insignificant tension. And look, who comes out the loser in all of these tensions when they get tense? Patients. Not ...
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    40 mins
  • Bonus Add-on for EP494: Who Is ICER and What Is the Arms Race of Pharmaceutical Pricing That the Status Quo Has Created? With Sarah Emond

    Bonus Add-on for EP494: Who Is ICER and What Is the Arms Race of Pharmaceutical Pricing That the Status Quo Has Created? With Sarah Emond
    Dec 4 2025

    In this bonus episode of 'Relentlessly Seeking Value,' host Stacey Richter engages in a conversation with Sarah Emond, CEO of the Institute for Clinical and Economic Review (ICER). They discuss the complex 'arms race' of pharmaceutical pricing in the current healthcare system, emphasizing issues like inflated drug list prices, patient affordability, and cost-effectiveness.

    They highlight ICER's role in conducting value assessments of prescription drugs to ensure fair pricing and improve affordability and access. The episode underscores the need for multi-stakeholder dialogues to deescalate financial tensions and promote value-based healthcare choices.

    === LINKS ===
    🔗 Show Notes with all mentioned links:
    https://cc-lnk.com/EP494-BonusClip

    🔗 Visit our sponsor Payerset:
    https://payerset.com

    ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter:
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    🎤 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 ===
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    06:51 EP293 ("Game Theory Gone Wild") with Dea Belazi, PharmD, MPH.

    02:38 What is ICER?

    02:54 What does the Institute for Clinical and Economic Review do?

    05:14 The importance of still showing up, even when others don't understand or disagree.

    09:12 Why it's important to think about population health and how our choices impact affordability for everyone.
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    12 mins
  • INBW43: Five Baskets of Thank Yous to Hand Out, Along With a Plug for Big Demand Curve Energy

    INBW43: Five Baskets of Thank Yous to Hand Out, Along With a Plug for Big Demand Curve Energy
    Nov 26 2025

    In this special Thanksgiving episode of Relentless Healthcare Value, the focus is on gratitude and giving thanks to various contributors within the healthcare community. Host Stacey Richter extends her 'baskets of thank yous' to colleagues, mentors, and partners committed to transforming healthcare.

    These baskets recognize those who maintain respectful dialogues despite small disagreements, those who collaborate and pay it forward within the community, and those who support the concept of a 'demand curve' in healthcare markets.

    === LINKS ===
    🔗 Show Notes with all mentioned links:
    https://cc-lnk.com/INBW43

    ✉️ 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/
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    01:25 First thank you: to those who do not succumb to healthcare narcissism.

    01:36 INBW39 with Stacey.

    02:51 INBW37 with Stacey.

    03:00 EP399 and EP400 with Stacey.

    05:40 Second thank you: to those willing to pay it forward.

    05:53 EP489 with Dan Greenleaf.

    08:12 EP452 with Cora Opsahl.

    08:38 Third thank you: to those who aid the demand curve in healthcare.

    09:14 EP490 with Shane Cerone and Sam Flanders, MD.

    09:16 EP491 with Elizabeth Mitchell.

    09:17 EP492 with Sam Flanders, MD, and Shane Cerone.

    09:49 Why healthcare needs a demand curve.

    13:34 Fourth thank you: to those who have contributed financial support to the Relentless Health Value podcast.

    15:47 The final thank you: to the listeners.
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    17 mins