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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

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

    🎤 Follow 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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    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
  • EP461: Pick Only One, Plan Sponsors: Do You Want to Control GLP-1 Volume or Control GLP-1 Unit Cost? With Chris Crawford

    EP461: Pick Only One, Plan Sponsors: Do You Want to Control GLP-1 Volume or Control GLP-1 Unit Cost? With Chris Crawford
    2025/01/16

    This episode with Chris Crawford, CEO of RxSaveCard, is not about the when, why, or how of GLP-1s for weight loss or best-practice prescribing. This episode very, very specifically is about the how and why of the pickle plan sponsors get themselves into often enough where if they impose formulary restrictions to limit the volume of meds that they are paying for, then unit prices go up, which is a thing for GLP-1s.

    And this is critical just given how the costs associated with GLP-1s for weight loss contribute to some pretty significant increases in pharmacy trend for plan sponsors who choose to cover the GLP-1s for weight loss.

    Chris Crawford and Stacey Richter discuss the challenges plan sponsors face with the rising costs of GLP-1 medications for weight loss. They explore how plan sponsors’ efforts to manage pharmacy trends often result in a tradeoff: lowering unit costs by increasing volume or vice versa. Chris also introduces a potential solution leveraging the growing cash marketplace, where employers can bypass traditional PBM contracts to achieve cost savings. Tune in for actionable insights into the perverse incentives in the pharmacy supply chain and innovative ways to navigate them. (Continued below the links)

    === LINKS ===
    🔗 Show Notes with all mentioned links:
    hhttps://cc-lnk.com/EP461

    ✉️ 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 ===
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    Bottom line, there are some really impactful and not frequently delved into perverse incentives at play here. And we’re gonna talk about these today. And these are really key for anybody on or about the pharmacy supply chain in the U.S. to know about. This is very actionable insight.

    So, again, there’s an unfortunate tradeoff, as it stands right now, for many plan sponsors. Lower your volume and raise the unit price or vice versa.

    This episode is sponsored by RxSaveCard, and a big thanks for that. I really appreciate RxSaveCard for its financial support because this episode covers a really important topic that we probably would have covered anyway over here at Relentless Health Value.

    And so, RxSaveCard standing up and offering their financial support to cover it was a really nice thing to do. And I thank them for their generosity.

    07:57 What are the two pieces going on with GLP-1 PBM prices and rebates for employers?

    10:00 Is the cash price for these name brand drugs currently less than the rebated PBM price?

    11:49 Why does the rebate for GLP-1s disappear if employers try to put restrictions on who can receive access to these drugs?

    15:07 Where does RxSaveCard come in to play here?

    19:55 “We exist to save people money.”

    20:45 EP456 with Brian Reid.

    21:16 EP356 with Ge Bai, PhD, CPA.

    21:37 EP439 with Luke Slindee, PharmD.
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    23 分
  • EP460: Rushika Fernandopulle, MD’s Theory of Change Starts With Status Quo Healthcare

    EP460: Rushika Fernandopulle, MD’s Theory of Change Starts With Status Quo Healthcare
    2025/01/09
    In this Relentless Health Value episode, Dr. Rushika Fernandopulle discusses with Stacey Richter his four-prong theory of change for transforming the American healthcare system. Key topics include the necessity of new payment models, process innovation, employing a relational technology infrastructure, shifting the cultural mindset towards team-based care, and emphasizing the importance of long-term partnerships. The conversation underscores the urgent need to move away from the current status quo to ensure better health outcomes and affordable care for all Americans. This is one of those episodes where we consider top-line strategic imperatives and key drivers. There was no better person to do this with than Rushika Fernandopulle, MD, who, in case you were unaware, was the founder of Iora Health, an advanced primary care group that was sold to One Medical and then to Amazon. They discusses his four-prong theory and as Stacey says, "I can’t leave well enough alone, so I plucked one more prong from our conversation and stuck it on the end." For a summary of this 5 prong approach, visit the show notes page where we also list all of the links mentioned in the episode. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP460 ✉️ 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/ ✭ X https://twitter.com/relentleshealth/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social 06:39 How Dr. Rushika Fernandopulle found himself where he is now. 08:06 Dr. Fernandopulle’s conversation with Kenny Cole, MD. 10:33 Why is it important to have new payment models? 12:21 EP453 with Claire Brockbank. 14:50 EP455 with Beau Raymond, MD. 16:19 Why it makes sense to change as quickly as possible. 19:55 How to be proactive and not be reactive and achieve value-based reimbursement for good care. 21:41 Why team-based care is so important for change. 23:37 Why is it important to have a different set of technology tools? 24:38 EP391 with Scott Conard, MD. 25:24 Why changing the culture is important. 27:01 “Getting doctors to do things they don’t like is a waste of time.” 33:22 “Healthcare is local.” 35:31 EP364 with David Muhlestein, PhD, JD. 35:43 Study by Zack Cooper, PhD. 36:53 EP404 with Suhas Gondi, MD, MBA. 39:04 Why long-term partnerships are the only way to make things better.
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    41 分
  • EP459: Cost Containment by Co-Pay Maximizer or Co-Pay Accumulator: Points to Ponder, With Bill Sarraille

    EP459: Cost Containment by Co-Pay Maximizer or Co-Pay Accumulator: Points to Ponder, With Bill Sarraille
    2025/01/02

    In Episode 459, host Stacey Richter speaks with healthcare attorney Bill Sarraille about co-pay maximizers and accumulators, mechanisms designed to extract maximum co-pay support dollars from pharmaceutical companies.

    They discuss the financial implications for patients, plan sponsors, and pharmacy benefit managers (PBMs), emphasizing the legal and ethical issues and potential patient harm due to high out-of-pocket costs and surprise expenses.

    Sarraille provides five key pieces of advice for plan sponsors and highlights the importance of transparency and proper utilization management to minimize patient access problems and legal risks. Listen or read the show notes on our site for the full list.

    (continued below the links)

    === LINKS ===

    🔗 Show Notes with all mentioned links:
    https://cc-lnk.com/EP459

    ✉️ 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

    ===CONNECT WITH THE RHV TEAM ===

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    Co-pay maximizers and accumulators are programs designed to capture maximum co-pay assistance from phara. Maximizers spread pharma co-pay support evenly throughout the year, ensuring plan sponsors benefit while, in theory, patients face minimal costs. More on how that can go wrong in the episode.

    Accumulators, however, design their plan to deplete pharma dollar support quickly, surprising patients with significant out-of-pocket expenses mid-year when they go visit the pharmacy.

    These programs usually exclude pharma assistance dollars from deductibles, potentially causing financial hardship because when pharma is paying your co-pay, those payments don't count against your deductible.

    09:31 What should plan sponsors be aware of right now?

    14:01 What is the justification for maximizers, and why is this at odds with the purpose of insurance?

    18:05 Where does the issue of “fairness” land within cost containment?

    20:00 Brian Reid’s LinkedIn post on insurance company access challenges.

    21:30 What are the real legal issues presented by some of these co-pay maximizers and co-pay accumulator programs?

    27:06 How are these programs creating perverse incentives?

    29:28 EP450 with Marilyn Bartlett, CPA, CGMA, CMA, CFM.

    32:16 “If you’re covered by the ACA, I think this is unlawful.”

    32:57 What advice does Bill have in regard to these programs?

    33:49 What potential litigations does Bill see coming in the near future in regard to these co-pay maximizers and co-pay accumulator programs?
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    40 分
  • INBW41: End-of-Year Wrap-Up and My Personal Charter Encore: Where the Rubber Hits the Road

    INBW41: End-of-Year Wrap-Up and My Personal Charter Encore: Where the Rubber Hits the Road
    2024/12/26

    In this Inbetweenisode titled 'End of Year Wrap Up and My Personal Charter Encore,' Stacey Richter extends heartfelt thanks to listeners and healthcare workers for their dedication.

    She reflects on the challenges of maintaining personal integrity in a profit-driven healthcare system and introduces her personal charter. This charter, focused on ensuring net positive outcomes for patients, acknowledges that achieving transformational change in healthcare requires a collective effort.

    Stacey discusses the complexities of balancing ethical decisions, financial constraints, and the broader impact on patient care, urging others to reflect on their own guiding principles.

    Here's her manifesto which she is now calling her Personal Charter below which she breaks down in this podcast episode:

    "If the thing results in a net positive for patients, then I will do it. The timeframe is short-term or medium-term. And the assumption is that it will take a village and I am not alone in my efforts to transform healthcare or do right by patients."

    === LINKS ===

    🔗 Show Notes with all mentioned links: https://cc-lnk.com/INBW41

    ✉️ 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:
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    === CONNECT WITH THE RHV TEAM ===

    ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/
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    06:52 “It’s a zero-sum game.”

    07:02 Is the amount of profit fair?

    07:13 What is an inescapable fact of the healthcare industry?

    07:30 What does the financialization of healthcare mean?

    07:55 Why does the self-interest in healthcare matter?

    09:54 “It’s basically up to us as individuals to do the right thing.”

    13:39 What is the first part of Stacey’s personal charter?

    13:54 How does Stacey calculate the net positive of an impact?

    14:17 What are two major upsides/downsides that Stacey contemplates?

    17:08 Why are incremental change and disruptive change not mutually exclusive?

    21:16 “I always try to keep in mind that it will take a village.”

    22:55 Why finger pointing is killing innovation in healthcare.
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    26 分
  • Encore! EP419: The Financialization of Health Benefits for Boards of Directors and C-Suites of Self-Insured Employers, With Andreas Mang

    Encore! EP419: The Financialization of Health Benefits for Boards of Directors and C-Suites of Self-Insured Employers, With Andreas Mang
    2024/12/19

    Are you on the board of directors of a company? Or are you a shareholder of a publicly traded company? Or are you a CEO or a CFO or in-house counsel who reports to a board of directors or these shareholders? Well, this show is for you.

    And it’s about how the healthcare industry has become financialized at the same time that providing health benefits has become the second-biggest line item after payroll for most companies. We talked about that in a recent encore with Mark Cuban (EP418) also, as well as the show with Cora Opsahl (EP452) and Claire Brockbank (EP453) from 32BJ.

    In this encore episode of 'Relentless Health Value,' Stacey Richter interviews Andreas Mang from Blackstone about the financialization of health benefits for boards of directors and C-suites of self-insured employers.

    They discuss the unseen financial layers in healthcare benefits and how companies can save significantly while improving employee satisfaction and health.

    === LINKS ===

    🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP458

    ✉️ 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

    === CONNECT WITH THE RHV TEAM ===

    ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/
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    04:55 Why Andreas starts every conversation with the question, “How’s your healthcare company?”

    07:38 Why is it important, as a self-insured employer, to treat your business as a small healthcare company?

    09:16 Why is it unnatural for companies to be providing health insurance?

    10:47 What can be achieved when there is alignment between employers and insurers?

    12:41 What things can a company do to reduce spend by 10%?

    14:14 Why is it better to have CFO engagement in the benefits plan throughout the year?

    16:25 Why does self-insurance save 5% to 9% for companies automatically?

    18:14 “The funding isn’t a healthcare thing; it’s a CFO thing.”

    18:27 Why is it vital to have a reliable, trustworthy broker?

    25:12 When is the last time your company has RFP’d their health plan?

    27:39 Why does changing a health plan feel scary but is necessary?

    28:31 What is a dependent eligibility audit?

    31:20 Why are employers better together?

    34:34 How do employers truly get a flat-fee model with brokers?
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    39 分