• Relentless Health Value™

  • 著者： Stacey Richter
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Relentless Health Value™

著者： 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.
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あらすじ・解説

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.
ビジネス・キャリア 政治・政府 衛生・健康的な生活 身体的病い・疾患
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  • Encore! EP384: How Shareholders Impact Carrier Behavior, Exactly and Specifically, With Wendell Potter

    Encore! EP384: How Shareholders Impact Carrier Behavior, Exactly and Specifically, With Wendell Potter
    2025/02/06
    I am drowning in all things Q1 right now. So, this week we’re going with an encore. But this is a great show to go back and reflect upon, as it’s about carriers and how shareholders impact the actions of said carriers. 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. And, yeah, I think it’s always been pretty clear heretofore that for shareholders, I don’t know, money is the mission. Brian Klepper, PhD, said that the other day in a different context, but yeah. And there’s a certain amount of okay about that. Like, the finance person in charge of ensuring the pension fund doesn’t run out of money for retirees. Right? Money is the mission, or the family office can continue for another generation. Money is the mission. Like, there’s a very vested interest in what amounts to profiteering. And if the business sells handbags or computer chips, I don’t know, profiteering is probably fine. No one blinks an eye about putting profits before, like, shoppers or profits before other businesses in the supply chain. But this is healthcare that we’re talking about, and patient lives are the product. And again, there just doesn’t seem to have been very many conversations about a distinction between what might be okay when the product is a handbag that might not be okay when the product is caring for human beings. This being said, I want to bring up an interesting caveat to this whole discussion and actually one reason I decided to encore the show with Wendell Potter from 2022. I’m gonna read a very well put post in LinkedIn by Richard Staynings, and he wrote this in mid-January 2025. Here’s the post: “UnitedHealth Group in the cross-hairs—not by patients and regulators but shareholders. … On Wednesday, UHG shareholders requested the company prepare a report on the costs and public health impact related to UnitedHealth’s practices that limit or delay access to healthcare. “The Interfaith Center on Corporate Responsibility (ICCR), a group representing faith-based shareholders, said it has filed a shareholder petition requesting the company to review how often prior authorization requirements and denials of coverage … lead to patients postponing or forsaking medical treatment as well as serious adverse events for individuals.” Wendell Potter, by the way, my guest today, commented on that press release. As interesting as the post itself, I found the comments on the post and kind of, you know, curbing enthusiasm with a dose of realism on those comments. George Mathew, MD, MBA, FACP, who also was on the podcast a couple of years ago (EP253), he commented, “Many of the large shareholders [at these carriers] may work at [UHC, and] they may vote against this type of transparency.” That is very thought provoking to see, actually, if the C-suite at these companies is more or less committed to patients/members than their shareholders. This podcast with Wendell Potter was recorded well prior to any shareholder uprising, however. Now, I do want to say this next part, and I’m gonna mention, coming up is a show with Vivian Ho, PhD, about the sky-high hospital prices being a big culprit for the high premiums that many American workers are saddled with. And that matters because, here’s the sentence that absolutely must be said: The problems with healthcare in this country and why some people call it the healthcare industrial complex, it’s a problem with the whole healthcare marketplace, not just one stakeholder. It’s everybody in concert doing some not great stuff, egged on by shareholders and professional capital and boards of directors, not one villain in a black hat tying someone to train tracks, like in some kind of talkie. Right? The problems that we have today are a confluence of a whole lot of folks, working at a whole bunch of different places, taking advantage of a whole lot of perverse incentives. So, with that, this is a really interesting encore. As I said again, please do listen to it. Here’s a Milton Friedman quote: “There is one and only one social responsibility of business—to use its resources and engage in activities designed to increase its profits so long as it [that entity] stays within the rules of the game, which is to say, engages in open and free competition without deception or fraud.” Okay, so this is Friedman, Milton Friedman, pretty much the most influential advocate of free market capitalism, stating quite clearly that an entity’s greatest responsibility lies in the satisfaction of its shareholders. His nod to social responsibility or ethics of any kind comes at the end there, where he says that for free market capitalism to function, there must be open and free competition and no fraud. So, let’s compare this to what’s going on in the payer space in the healthcare industry. First off, there was just a chart in the New York ...
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    35 分
  • EP462: Managing Populations of Whole, Actual People Who Are Not the Sum of a Bunch of Different Body Parts, With Scott Conard, MD

    EP462: Managing Populations of Whole, Actual People Who Are Not the Sum of a Bunch of Different Body Parts, With Scott Conard, MD
    2025/01/30
    Hello, Tribe. I hope everyone is holding up in this Q1 where there is so much going on. I feel like I’m juggling 10 plates while running on a treadmill that keeps stopping and starting at random intervals. How you doing? 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. This podcast with Dr. Scott Conard today, first of all, I enjoyed how it came to be. Brian Uhlig, an employee benefit consultant of some acclaim, came to me and offered to sponsor a show for someone else. Not himself. I gotta say, it’s stuff like this that warms my heart. It’s this village that we have here, this tribe of Relentless folks trying so hard to stand up for and help patients. So, thanks again to Brian Uhlig. Also (this has nothing to do with the show that follows), remember the episode with Cynthia Fisher (EP457) from December? This is the one where we talked about the growing problem of medical spread pricing. If you have no idea what I’m talking about, no worries. Just go back and listen to that show. But if you do, Brian Uhlig was able to save $80 million for a particular employer client. And he was doing a bunch of different things, but combating medical spread pricing was one of them. Okay … so, today I am speaking with Dr. Scott Conard. If that name sounds familiar, you might remember it from the earlier episode (EP391) where Dr. Conard told, for the first time ever, his story about how he had built an amazing advanced primary care practice, only to find it destroyed basically by perverse incentives. Yeah, it’s a dramatic and, I don’t know, pretty tragic tale actually. So, do go back and listen to that earlier show if you haven’t already. Dr. Scott Conard talks today about the evolution of his life’s work. Right now, Dr. Conard is doing a bunch of work with Mike Adams from 7-Eleven, helping their plan members. A lot of this work is centered on and about a few pretty striking but very common insights that many plan sponsors will find in their own data. It turns out about 70%, give or take, of people who wind up costing the plan whatever the high-cost threshold is in any given plan year. These higher-cost claimants didn’t fall out of the sky unexpectedly, 70% of them. They were actually high risk but low cost in prior years. So, the trick is to find these individuals and help them not fall into the high-risk and high-cost part of the graph. If the goal is how to best manage a population of members, a lot of that is, again, identifying high-risk patients who are currently in the low-cost zone, who, any given plan year, are gonna go out of that zone and get into the high-cost area. So, if we’re thinking about best practices to avoid this, I’m gonna run through Dr. Conard’s list that we mostly run through in the show that follows, although some of the steps in the stepwise we cover more thoroughly than others. Okay … so, here’s the stepwise best-practice approach to managing population health at the plan sponsor level. 1. Get the data. Not to divide everyone up into, you know, disease buckets or whatever you call them, but to run a whole-person risk score for each member. You got to treat a patient like a human being, after all, not the sum of a whole bunch of disconnected body parts. The metaphor that Dr. Conard uses to describe this is the car metaphor, right? Like, cars are actually the sum of a bunch of different parts. If your tires are worn out, you change your tires. The end. If you’re a human being, though, it doesn’t work that way. It is a horrible thing to hear stories about people who cannot get a needed operation because their cardiovascular markers are out of control, but they can’t take the med to control their cardiovascular markers because it’s contraindicated for their kidney disease or their liver disease. So, they get punted between doctors not talking to each other. Miriam Paramore has a harrowing story about her father’s end of life, if you want to dig in on that and cry a tear or two. But bottom line, human beings are one system, not a coterie of disconnected parts. So, that’s Step 1: Do the whole-person risk score with the data. 2. Get members access to advanced primary care teams, and those teams should be empowered and equipped to make referrals to demonstrably excellent specialists offering high-quality, appropriate, and optimized care. 3. Align benefit designs and what you want members to be doing to ensure that they have access to get this appropriate, optimized care that we just talked about. We don’t get into this a ton today, but I rabbit-holed on this exact topic for, like, 25 minutes last week (INBW42), so if you want to get into the moral hazard and low-value care versus high-value care whole diatribe, do go back and listen to that, yeah, rant. Also, Mark Fendrick, MD, talked about all of this on a show (EP308) from a couple of ...
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    34 分
  • INBW42: A Philosophical Rabbit Hole of Considerations for Plan Sponsors and Others

    INBW42: A Philosophical Rabbit Hole of Considerations for Plan Sponsors and Others
    2025/01/23

    In this inbetweenisode Stacey Richter dives into the complexities of benefit design in American healthcare. Highlighting insights from recent episodes with Bill Sarraille (EP459) and upcoming episode with Scott Conard, MD, Richter explores the impact of cost containment measures and the moral hazard of insurance, emphasizing the importance of creating balanced and efficient benefit plans that align with plan values and avoid unintended consequences.

    She discusses the challenges and implications of high deductible health plans and copay maximizers/accumulators, urging plan sponsors to strive for pareto optimality and practical solutions. This episode is a call to carefully consider patient behavior, healthcare utilization, and the broader impacts of financial incentives in healthcare.

    Going black and white or over-indexing to prevent outlier kind of stuff is probably not gonna end well. Not seeking a middle way can easily result in a solution that is possibly worse than the problem.

    Moral hazard is actually a thing. There are lots of implications to patients not being able to distinguish high-value and low-value care. But if we know this, then, philosophically at least, how do we conceptualize a solve? What should we be doing? If we’re not doing black and white, what does the gray in the middle look like?

    === LINKS ===
    🔗 Show Notes with all mentioned links:
    https://cc-lnk.com/INBW42

    ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter:
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    🎤 Follow on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1

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    📺 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/
    ✭ X https://twitter.com/relentleshealth/
    ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social

    00:00 Introduction to the Rabbit Hole

    04:05 Where did Stacey’s rabbit hole spiral start?

    05:40 What is the moral hazard of insurance?

    09:31 EP358 with Wayne Jenkins, MD.

    12:49 Why isn’t moral hazard mitigated in insurance?

    18:16 EP459 with Bill Sarraille.

    20:51 “How do we conceptualize a solve?”

    22:24 Why should we be striving for Pareto optimality?

    25:20 What is the theory of second best?
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    28 分
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