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Relentless Health Value

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. 政治・政府 衛生・健康的な生活 身体的病い・疾患
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  • Take Two: EP438: Is It Mission and/or Margin? With John Lee, MD

    Take Two: EP438: Is It Mission and/or Margin? With John Lee, MD
    2025/07/03
    I am so focused right now on the intersection (or lack thereof) of mission and margin, so I’m taking a second listen to this episode right now with John Lee, MD, because it is so ridiculously relevant given that I am, as stated, on a bit of a tear. 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 mission/margin bender kicked off actually, if I had to diagnose the root cause, it’s because of all of the conversations that happen after what I’m calling the trust through line episode (EP477). Because if you think about it—and I have—if we are talking about trust, what does that even mean? Like, trust to what end? And when you start distilling it down, you wind up with trust that someone is gonna do right by patients and purchasers and the actual clinicians providing the care that even if there’s a stack of Benjamins to be had by doing the wrong thing, we can trust that mission will be put over margin—or at least balanced with it in some kind of palatable way. Right? That’s a big piece of what it means to be trustworthy in healthcare. “You are what you won’t do for money.” That was a headline to a Ryan Holiday article I read recently and wrote down, because … right? Now, it’s one thing for each of us listening here to contemplate mission and margin, and that matters. But it’s quite another thing for this contemplation to happen at scale, at status quo consolidated health systems, carriers; many status quo, not transparent brokerages, PBMs (pharmacy benefit managers), TPAs (third-party administrators); status quo stakeholders across the board. But because of this, actions being taken at the organizational level may not mirror the mission/margin ratio that you or I might aspire to. So, why this episode with Dr. John Lee, you may be wondering? How did this conversation get teed up for a Take Two in the midst of this mission/margin tear that I apparently am on right now? Dr. John Lee talks about and gives some advice for individuals in a status quo, not transparent organization how to find a mission to feel good about. I would also highly recommend listening to the show with Larry Bauer, MSW, MEd. It’s a Summer Short, and it’s called “Knights, Knaves, and Pawns.” So, here’s my conversation with Dr. John Lee, and next week come back because I’m gonna continue the mission margin conversation with Ben Schwartz, MD, MBA—and it’s a really good one. So, come back next Thursday, too. Let’s say a person believes they want to do well by patients but their performance review depends on, as just one example, making care less affordable for patients. But somehow, this individual is able to conclude that what they’re doing is a net neutral or a net positive despite (in this hypothetical, let’s just say) obvious indications that it is not. In this hypothetical, there are, say, clear facts that show that what this person is up to is indisputably a problem for patients. But yet at every opportunity, this person talks about their commitment to patients, this rationalization or earmuffs don’t look, don’t see is cognitive dissonance. Cognitive dissonance is when what someone winds up doing, their actions, are in conflict with what they believe in. Now, it’s harder to engage in cognitive dissonance the closer you are to patients because you see the impact up close. Unless these at-the-bedside clinicians enjoy a robust lack of self-awareness, those who are seeing patients don’t, a lot of times, have the luxury of pretending that what is going on is good for patients when they can see with their own two eyes that it is not good for patients. The further from the exam room or the community, however, the easier it is to not acknowledge the downstream impact, if you can even figure out what that downstream impact is. Sometimes it’s legitimately difficult to connect the dots all the way down the line to the customers, members, or patients. Today I am talking with Dr. John Lee about what to do in the face of all this when working in the, as I call it, the belly of the beast—working for a large healthcare organization such as a hospital. Because hospitals sometimes (and we certainly do not want to put all hospitals in the same category—they are a wildly diverse bunch), but sometimes some people at some hospitals do some things which are not things I think they should be doing anyway. They’re fairly egregious breaches of trust, actually. But yet within that same organization, you have doctors and other clinicians or others who are working really hard to serve patients as best they can. This is the real world that we’re talking about, and the question of the day is … so, now what? When you are a person not suffering from cognitive dissonance, at least to the level of those around you, what do you do to not get, I don’t know, demoralized? And ...
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    36 分
  • EP480: Payment Integrity Meets Health System Boasts, Such as Our Rates Are 2x Medicare, With Kimberly Carleson

    EP480: Payment Integrity Meets Health System Boasts, Such as Our Rates Are 2x Medicare, With Kimberly Carleson
    2025/06/26

    Enhancing Payment Integrity in Health Systems: An In-depth Discussion with Kimberly Carleson.

    In Episode 481 of Relentless Health Value, host Stacey Richter speaks with Kimberly Carleson, CEO of US Beacon, about payment integrity within health systems. They delve into strategies some hospitals use to maximize revenue without raising rates and discuss the importance of accurate billing.

    Key takeaways include the high prevalence of billing errors, which can lead to significant overcharges for plan sponsors, often due to documentation gaps and complex coding systems. Kimberly provides actionable advice for both healthcare providers and plan sponsors on how to mitigate billing inaccuracies and enhance transparency.

    Emphasized points include the necessity of third-party claim audits, understanding legal rights under various acts, and the importance of maintaining clear communication and compliance with legal billing standards.

    === LINKS ===
    🔗 Show Notes with all mentioned links:
    https://cc-lnk.com/EP480

    ✉️ 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/

    08:36 What’s the magnitude of the lack of payment integrity within healthcare?

    12:11 EP285 with Dawn Cornelis.

    12:46 How is lack of coordination a main culprit of lack of payment integrity?

    13:42 How does reading the records reveal whether health plans are being overcharged?

    15:43 A real-world example of how reviewing the charges can drastically reduce your healthcare costs.

    18:32 Do you have a right to a review of your claim?

    19:37 EP370 with Erik Davis and Autumn Yongchu.

    22:08 How can contracts contradict what can legally be charged?

    23:46 EP472 with Eric Bricker, MD.

    25:04 How can hospitals update their billing to have better payment integrity?

    28:44 Advice for hospital executives and their finance teams.

    29:03 Advice for plan sponsors.
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    32 分
  • Pharma Rebates: A Few Nuances You May Not Have Thought Of, With Ann Lewandowski—Summer Shorts

    Pharma Rebates: A Few Nuances You May Not Have Thought Of, With Ann Lewandowski—Summer Shorts
    2025/06/19

    Exploring the Complexities of Pharma Rebates with Ann Lewandowski

    In this Summer Short episode of Relentless Health Value, host Stacey Richter converses again with Ann Lewandowski about the intricate dynamics of pharmaceutical rebates, or as Lewandowski prefers, post-sale concessions.

    The discussion delves into the nuances of these rebates, the impact they have on drug costs, and the hidden consequences for patients and plan sponsors.

    They highlight articles and insights by Austin Chelko and Peter Hayes, touching on how rebates can disadvantage the pursuit of lower-cost generics and biosimilars, and can obstruct pharmacogenetic testing that ensures drug efficacy and safety.

    The conversation also critiques the opacity of rebates, deemed trade secrets by pharma and PBM companies, and underscores the ethical and financial dilemmas posed by the current rebate-driven system.

    === LINKS ===
    🔗 Show Notes with all mentioned links:
    https://cc-lnk.com/EP480

    ✉️ 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/

    07:24 What is a pharmaceutical rebate?

    08:15 Why are pharma rebates so opaque?

    09:52 Texas lawsuit on insulin pricing.

    10:18 Why is focusing on a singular type of concession difficult with current pharma rebate structures?

    10:50 EP397 with Paul Holmes.

    13:55 EP353 with Pramod John, PhD.

    14:29 How does pharma genomics testing affect pharma rebates?

    14:52 EP465 with Chris Crawford.

    15:52 EP426 with Nina Lathia, RPh, MSc, PhD.
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    19 分

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