Moving to Value Unscripted

Why is your insurance card the only card in your wallet without a chip?

Surgeon, health policy advisor and Apptly Health Technologies (formerly UBERDOC) Founder Dr. Paula Muto joins us to dismantle the middleman bureaucracy, prior authorization traps and 1960s institutional thinking that run up specialty care costs.

Drawing from over two decades in solo surgical practice, Dr. Muto explains how an epiphany on a squash court grew into a national direct-pay marketplace that eliminates claims friction, pays doctors immediately at the point of care and arms employers with transparent outpatient alternatives.

Tune in for a raw, unfiltered look at why bypassing legacy hospital networks is the real key to lowering costs, rescuing the American paycheck and restoring the doctor-patient relationship.

Find the transcript of this episode at movingtovalue.org/transcript/muto

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Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/members.

Specialty care—surgeries, cancer care, and complex procedures—drives nearly half of all employer health spend and is rising faster than any other category.

Brent Nicholson, Co-Founder and Chief Growth Officer of Carrum Health, joins us to explore how high-value specialty networks are disrupting traditional fee-for-service waste. Brent breaks down how Carrum Health expands beyond elective orthopedics into complex oncology and substance use care, leveraging prospective bundled payments with built-in complication warranties.

From code-level physician quality curation to independent RAND Corporation data proving 30% surgical avoidance, an 80% drop in readmissions, and $16,000 average savings per procedure, learn why employers are moving toward bold steerage to capture hard-dollar healthcare savings.

Find the transcript of this episode at movingtovalue.org/transcript/nicholson

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Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/members.

Why should we accept impossible healthcare cost increases without questioning the numbers?

We sit down with Emma Fox, CEO of Foxwatch Consulting and EVP at Liberty Company Insurance Brokers, to name and shame the hidden fees, opaque broker traps and massive ERISA fiduciary liabilities draining employer budgets.

From her transition out of legacy insurance carriers to navigating her own medical bankruptcy, Emma pulls back the curtain on an industry structured around misaligned incentives. She breaks down real-world examples of extreme claims mismanagement, explaining why passive plan sponsors face growing legal exposure and how standard broker "benchmarking" spreadsheets offer nothing more than a false sense of security.

The solution doesn't require stripping benefits or causing chaos for employees. Emma reveals how strategic adjustments like integrating Direct Primary Care, enforcing pass-through pharmacy contracts and auditing claims data can eliminate waste and slash health plan spend.

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Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/members.

With US healthcare spending reaching an unsustainable $5.7 trillion, employers face a turning point as double-digit renewal hikes threaten their bottom line. Jeff Hogan, Co-Founder and Managing Director of The Judi Group and former host of Moving to Value Unscripted, returns to break down how plan sponsors can transition from passive buyers into active fiduciaries.

Jeff uncovers the hidden contract mechanisms, PBM spread pricing, and TPA fees that siphon off 25% to 33% of employer healthcare spend. He outlines what business leaders must do to comply with expanded Consolidated Appropriations Act (CAA) rules, enforce claims-data rights and protect themselves from personal fiduciary liability. Tune in to discover actionable strategies for taking back control of your health plan over the next 12 to 24 months.

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Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/members.

"Never ask a barber if you need a haircut."

Misaligned incentives within the fee-for-service structure have normalized more spending on low-value services and less spending on high-value care.

You might think that the highest value services — think vaccines, insulin, early screenings — should be the easiest for patients to access. And yes, when a service is free and widely available, it is typically popular. Case in point, the more than 250 million Americans who got a free COVID-19 vaccine.

But big insurance doesn't provide full coverage out of the goodness of their hearts. There are legal provisions, most notably the Affordable Care Act's preventive services provision, requiring full coverage of certain services.

Dr. Mark Fendrick, director of the University of Michigan's Center for Value-Based Insurance Design, helped draft this language in the Affordable Care Act and has dedicated his career to advancing Value-Based Insurance Design (VBID). He joins us to discuss why increased spending on high-value care is still being debated.

And yes, our foreheads are bruised from banging our heads against the wall.

Find the transcript of this episode at movingtovalue.org/transcript/fendrick

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Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/members.

Re-release of a conversation recorded in July 2025.

What would healthcare look like if it were truly built around the people it serves? In this episode, we take a closer look at Alaska’s Southcentral Foundation and its internationally acclaimed Nuka System of Care — a model that has redefined what value-based care can mean when relationships, trust and community ownership are at the center.

Joining us are April Kyle, President and CEO of Southcentral Foundation, and Dr. Doug Eby, the system’s founding medical director and one of Nuka’s chief architects. Together, we explore how an Alaska Native–owned health system transformed itself from a federal bureaucracy into one of the world’s most respected models of integrated, relationship-based care. April and Doug share the principles and practices that have led to dramatically improved outcomes and high patient and employee satisfaction at significantly lower costs.

Through the story of Nuka, we consider what’s possible when healthcare shifts from doing things to patients to partnering with people — and how lessons from Alaska might chart a course toward more human, more effective value-based systems around the country (and the world).

Find a transcript of this episode at movingtovalue.org/transcript/nuka

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Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/members.

What if a generic medication retailing for $15 was billed to your company’s health plan for over $6,000?

James Murray, Founder and Managing Director of Murray Strategic Healthcare Ventures, spotlights these massive markups happening every day in corporate healthcare.

With 35 years of Wall Street capital markets experience, Murray brings an institutional risk manager’s lens to the opaque world of Pharmacy Benefit Managers (PBMs). He identifies the middleman fees draining employer budgets and employee retirement assets, and shares how self-insured plan sponsors can use public Form 5500 filings and new CAA disclosure mandates to demand fee transparency at the renewal table.

Tired of accepting healthcare spending as an uncontrollable expense? This episode is a roadmap to reclaiming control.

Find a transcript of this episode at movingtovalue.org/transcript/murray

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Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/members.

The legacy insurance machine is running out of time, and the pendulum is swinging back toward employers.

Healthcare innovation pioneer François de Brantes lays out a ruthless, no-compromise blueprint for self-insured employers to reclaim control of their healthcare spend. Currently the Executive Vice President of Payment Innovation and Network Performance at XO Health, de Brantes pulls zero punches in discussing how the industry has crossed the line into unabashed stealing from corporate pockets.

He breaks down a 25-year industry regression, as corporate giants which once demanded 100% unredacted claims data ceded that power to carriers. He exposes the opaque consultant commission schemes serving as the carriers' last line of defense, and he outlines how employers can use new transparency mandates to fulfill their legal fiduciary duties and protect themselves from liability.

Stop playing defense and stop settling for point-solution pennies. Tune in for an unfiltered masterclass on how to finally force transparency and real value from the healthcare system.

Find a transcript of this episode at movingtovalue.org/transcript/debrantes

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Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/members.

The American healthcare system is financially engineered to wait for expensive medical disasters rather than preventing them. Perhaps no one has a clearer view of how to dismantle this "rescue medicine" trap than Dr. Bill Bestermann.

A preventive cardiologist and former President of the South Carolina affiliate of the American Heart Association, Bestermann has spent decades fighting the "medical-industrial complex" from the inside—as an ICU director, health plan advisor, and chief medical officer.

As the author of the Slow Aging and Delayed Chronic Disease Development newsletter, Bestermann exposes how Wall Street insurance companies and obsolete, 50-year-old billing models actively protect highly profitable specialty silos at the expense of patient health. He is a fierce champion of optimal medical therapy, a low-cost, protocol-driven approach that arrests chronic disease at the root cellular level.

He joins us to unpack the staggering economic disparity between standard procedure-driven care and molecular prevention, explaining how self-insured employers and communities can bypass bloated hospital networks to buy actual, measurable value.

Find a transcript of this episode at movingtovalue.org/transcript/bestermann

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Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/members.

Picture a healthcare plan with free primary care visits, physicals and health screenings, $0 copays for most services and prescriptions and negotiated direct contracts for most major procedures, as well as on-site fitness, flu shots, vaccines, family planning, nutritional services and more.

This is the reality for thousands of employees of Rosen Hotels & Resorts in Orlando, Florida, leading to high primary care compliance and huge savings — $500 million to date. As most employers brace for double-digit premium increases, Rosen's costs remain roughly half the national averages.

Ashley Bacot, the architect of Rosen's world-renowned healthcare plan, joins us to discuss how this model can serve as a blueprint for scaling up sustainable, value-based healthcare across the country.

Find the transcript of this episode at movingtovalue.org/transcript/bacot

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Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/members.