In this episode, Stacey Richter explores the impact of trust on healthcare outcomes, drawing from listener contributions and prior episodes of Relentless Health Value.

The discussion underscores how trust or the lack thereof affects patients, clinicians, and healthcare systems. Key points include the importance of building trusted relationships, the detrimental effects of antitrust behaviors, and the broader implications for healthcare delivery.

Stacey also highlights a bonus show featuring Charles Green on earning and maintaining trust. The episode concludes with an uplifting message about the collaborative and giving nature of the Relentless Health Value community.

=== LINKS ===

🔗  Show Notes with all mentioned links: https://cc-lnk.com/EP477

🔗  Bonus Show - Show Notes https://cc-lnk.com/Bonus477: 

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00:47 What is the new, emerging through line becoming apparent in healthcare?

01:54 Bonus Episode with Charles Green.

02:52 What is the impact of trust in healthcare?

02:55 EP475 with Peter Hayes.

03:11 EP473 with Kenny Cole, MD.

05:31 EP295 with Rebecca Etz, PhD.

06:07 EP326 with Rishi Wadhera, MD, MPP.

07:06 Why does trust grow through proximity, and why do providers need to integrate this into care models?

07:59 Why antitrust is so prevalent in healthcare.

10:00 What are two main contributors to the lack of primary care doctors?

13:27 Why collaboration builds trust.

In this bonus add-on to episode 477 of Relentless Health Value, host Stacey Richter revisits a decade-old conversation with trust expert Charles Green, founder of Trusted Advisor Associates. Green discusses the intricacies of building and maintaining trust in healthcare, emphasizing four key trust principles: client focus, collaboration, long-term relationships, and transparency.

The discussion highlights the challenges within the healthcare industry, compounded by conflicts of interest and transactional dynamics. Green underscores the importance of individual actions and leadership in fostering trust, advocating for empathetic listening and genuine curiosity about others as foundational behaviors.

=== LINKS ===

🔗  Show Notes with all mentioned links: https://relentlesshealthvalue.com/episodes

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01:45 Four trust principles that can help you earn your clients trust and come off as more trustworthy from first impressions onward.

04:31 Charles’s words of wisdom for rebuilding lost trust.

05:46 Where does trusted leadership start?

06:38 Why trust in leadership is about embodying trust in actions, not words.

07:26 Why does personality have an outsized impact in leadership and trust?

08:21 “If we want to improve our trust, we just simply need to work on ourselves.”

08:56 Why listening with a sense of curiosity and respect drives reciprocal behavior and improves trust.

09:14 What is the best technique to immediately improve your trust relationship?

In this episode, host Stacey Richter speaks with Ann Lewandowski about whistleblowing in the healthcare industry, focusing on a significant case involving a whistleblower at an employee benefit consultant (EBC) firm. This EBC allegedly pocketed their clients' pharma rebates, violating the Consolidated Appropriations Act of 2021. 

The discussion highlights the nuances of being a whistleblower, the ethical dilemmas faced, compliance challenges, and the significant financial implications for companies and individuals involved in illegal activities. 

Ann Lewandowski provides insights into documenting and protecting oneself legally and discusses the broader context of trust and transparency in the healthcare sector.

Click through to the show notes below to access all of the mentioned links and prior episodes mentioned.

=== LINKS ===

🔗  Show Notes with all mentioned links:   https://relentlesshealthvalue.com/episodes

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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

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08:10 What does it mean to be a whistleblower?

09:05 What’s happening in the current whistleblower case about pharma rebates?

14:24 What are the disclosure requirements, and how does this affect contracts in healthcare?

15:05 EP379 with AJ Loiacono.

15:11 The 5500 form.

15:36 EP397 with Paul Holmes.

16:46 Why having a “defensive health plan” is important.

17:31 Matt Ohrt’s post about healthcare’s soul.

17:42 Michelle Bernabe’s post about how healthcare has lost its heart.

18:15 Why “trust and verify” is important when building contracts and relationships in healthcare.

18:42 Quote by W. Edwards Deming.

21:35 How has this case moved from state to federal court?

23:30 Whistleblower case on generic drug collusion.

24:01 What is a qui tam lawsuit?

28:08 What is an Upjohn warning and the issue of corporate Miranda rights?

30:01 What is Ann’s advice to employees who might be whistleblowers?

31:41 EP438 with John Lee, MD.

33:31 What are some red flags that employees should look for to understand what kind of company they work for?

In this episode of Relentless Health Value, host Stacey Richter sits down with Peter Hayes to discuss the major forces driving change in the healthcare industry. Hayes outlines three critical factors: changing public opinion, heightened transparency, and new regulations such as the Consolidated Appropriations Act. 

He emphasizes the unprecedented convergence of these elements, creating a pivotal moment for healthcare transformation. The discussion delves into the erosion of trust within the healthcare system and the growing public unrest over high costs and inefficiencies. 

Hayes also highlights the role of state-level initiatives as experimental laboratories for potential national solutions. The episode concludes with a call to focus on root causes and collaborative approaches to restore trust and improve healthcare affordability and quality.

=== LINKS === 🔗  Show Notes with all mentioned links:   https://relentlesshealthvalue.com/episodes

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05:28 What things are adding to the urgency in this moment of healthcare?

05:55 The three things that have brought us to a tipping point in healthcare.

07:05 Why is now the real moment for this tipping point?

10:35 EP458 with Komal Bajaj, MD.

13:01 Article by (and tribute to) Uwe Reinhardt.

13:27 Hospital ratings by The Leapfrog Group.

14:08 EP358 with Wayne Jenkins, MD.

15:07 EP474 with Yashaswini Singh, PhD.

16:29 How is regulation changing in healthcare?

21:48 How the “trifecta” of change is working together to create this movement of change in healthcare.

23:54 What do we need to look at to address the problems pushing this change in healthcare?

25:44 EP465 with Chris Crawford.

30:04 Why is federal and state collaboration going to be important to this healthcare change?

31:51 EP455 with Beau Raymond, MD.

In Episode 474 of 'Relentless Health Value', host Stacey Richter interviews Dr. Yashaswini Singh, an economist and assistant professor at Brown University, about the growing influence of private equity (PE) in healthcare. 

The conversation delves into the corporate transformation of medicine, highlighting the potential misalignment between business interests and patient care. Dr. Singh discusses the diverse strategies PE firms use to drive profitability, such as increasing negotiated prices, consolidating market share, employing real estate leasebacks, and emphasizing performance metrics that may not align with patient benefits. 

The episode also examines the significant impacts these strategies have on physicians, including increased turnover and changes in practice patterns, as well as the broader implications for patients and communities. Dr. Singh stresses the importance of informed leadership, education, policy enforcement, and transparency to ensure that private investments ultimately benefit healthcare systems without compromising patient care.

=== LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP474

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05:53 What is the tension between business and medicine?

07:05 What is the impact of private equity on healthcare?

08:46 How does healthcare change when private equity invests in medical facilities?

10:54 What are the intuitive impacts of private equity in healthcare?

12:28 What are the less intuitive effects of private equity on healthcare?

13:36 EP472 with Eric Bricker, MD.

14:15 What are the misconceptions about private equity investors acquiring healthcare facilities?

16:17 The Steward saga.

16:24 The death of Hahnemann Hospital in Philadelphia.

19:27 Are there any positive outcomes to private equity investment in healthcare?

21:17 EP445 with Tom X. Lee, MD.

22:45 EP420 with Ge Bai, PhD, CPA.

22:47 EP465 with Chris Crawford.

22:49 EP460 with Rushika Fernandopulle, MD.

22:55 Is there ever a need for private investment in healthcare?

25:40 How do the changes private equity firms create affect patients?

27:20 Study in Health Affairs on physician turnover rates following private equity acquisitions.

29:30 How can private equity disrupt physician employment as well?

34:13 What remedies might there be for consolidation in healthcare and private equity investing in medicine?

This episode of Relentless Health Value features Dr. Kenny Cole from Ochsner Health System. The discussion emphasizes the critical role of trusted relationships and excellent primary care teams in keeping patients out of the emergency room, thus reducing healthcare costs.

Stacey Richter revisits this conversation to highlight the importance of care teams building trust with patients and the concept of primary care as an investment in health and wellness. The episode outlines four key points for delivering great primary care, including accountability for outcomes, belief in clinical goals, standardized care flows, and building patient trust.

Dr. Cole also discusses the real-world challenges and strategies for achieving clinical and financial success in primary care. The episode serves as a guide for plan sponsors, clinicians, and healthcare executives looking to improve primary care delivery and align it with financial viability. The discussion is further enriched with insights on digitizing care pathways and the importance of measuring and sharing best practices to achieve high standards of care.I

Stacey revisits, in a take two, this episode with Dr. Kenny Cole because she's listening to it this time with a new focus. That focus is the theme that keeps coming up over and over and over again on Relentless Health Value these past few months.

=== LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP473

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07:35 Is there an optimal care pathway where there might be a lot of treatment variability?

10:52 EP412 with Robert Pearl, MD.

12:32 Why is it important to start with the end in mind?

15:44 How do you scale clinical excellence?

18:18 EP315 with Bob Matthews.

19:12 EP242 with Marty Makary, MD.

21:29 Why is it important simply to demonstrate what’s possible for better health outcomes?

22:33 EP427 with Rik Renard.

23:18 How do we reinvent the business model of healthcare?

24:51 EP466 with Vivian Ho, PhD.

25:06 EP415 with Rob Andrews.

26:51 EP391 with Scott Conard, MD.

30:14 EP455 with Beau Raymond, MD.

34:22 Dr. Cole is published in various healthcare journals; check out his most recent article.

In Episode 472, Stacey Richter speaks with Dr. Eric Bricker about the impactful strategies hospital systems use to maximize revenue from high-cost patients. They explore the financial complexities and contracting tactics that enable hospitals to profit significantly from a small percentage of high-cost claimants.

Key points include the negotiation of provider stop-loss contract provisions, strategic adjustment of charge masters, and the intentional steerage of patients to high-revenue service lines. This episode highlights the intricacies of hospital finance and the hidden mechanisms that drive healthcare costs for self-insured employers and other plan sponsors.

We could have 0.5% to 1% of total plan members costing upwards of 40% of total plan dollars. And I bring this up just to highlight the magnitude of the money here. In that show from last week, we take the issue of high-cost claimants from the standpoint of the plan sponsor.

Today, however, we’re gonna be looking at this from the standpoint of the hospital system. If we were to come up with a motto for the show today with Dr. Eric Bricker, it’s that all costs are somebody else’s revenue. And when it’s revenue and profit of the magnitude that we’re talking about with many high-cost claimants, it starts to be less of an accidental “Oh, wow! How did that CABG patient wind up in our clinic? What are the odds?” and more of a “Whoever is not steering patients is letting someone else with a big profit incentive lock down that steerage in deeply embedded ways.” 

=== LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP472 

📺 Dr. Bricker's AhealthcareZ Channel www.youtube.com/@ahealthcarez 

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05:06 From a hospital revenue perspective, where do high-cost claimants fall?

08:45 How do hospitals structure their stop-loss provisions so that they ensure they’re always maximizing their revenue?

12:15 How hospitals acquire providers to steer as many patients as possible through specific service lines.

20:21 Why do carriers let hospitals get away with these rates and stop-loss negotiations?

21:06 How do Medicare Advantage and Medicare rates play into all of this?

22:00 What should a benefit consultant be doing here?

23:37 What are the keys to direct contracting?

27:21 Why is it important to get trusted relationships set up ahead of time?

28:04 The Company That Solved Health Care by John Torinus Jr.

29:23 What needs to be the clinical consideration for specialists?

30:46 What is the advantage that employers have in all of this?

33:06 Dr. Bricker’s video on 32 examples of healthcare deception.

Recently on Relentless Health Value, we’ve been tinkering around with a few recurring themes—recurring through lines—that are just true about American healthcare these days.

In this episode of Relentless Health Value, host Stacey Richter speaks with Dr. Christine Hale about high cost claimants and the implications for healthcare plans in 2025 and beyond. They discuss the importance of trust in patient care, the financial incentives behind patient steering, and the critical role of timely and comprehensive data analysis.

Dr. Hale emphasizes the need for an integrated approach to medical and pharmacy claims data to avoid expensive consequences and improve patient outcomes. She also shares strategies for plan sponsors to effectively manage high cost claimants through evidence-based care, appropriate treatment settings, and creative problem-solving, while underlining the importance of patient engagement and satisfaction.

Don't miss next week's episode with Dr. Eric Bricker for a deeper dive into these topics.

=== LINKS ===

🔗  Show Notes with all mentioned links:  

https://relentlesshealthvalue.com/episodes

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05:22 What is a high-cost claimant, and how is the definition changing?

07:42 Why buy-and-bill pharmaceuticals can be so costly for plan sponsors.

10:19 What are plan sponsors getting wrong about this situation?

11:28 What do you need as an employer to understand your plan data fully?

13:41 EP462 with Scott Conard, MD.

17:35 What are plan sponsors currently doing that they should not being doing?

19:54 Why starting small is important.

23:02 EP468 with Matt McQuide.

25:37 What are the steps employers should take to improve their high-cost claimant spend?

31:02 EP371 with Erik Davis and Autumn Yongchu.

33:46 EP467 with Stacey.

Recent past interviews:

Click a guest’s name for their latest RHV episode!

Nikki King, James Gelfand (Part 2), James Gelfand (Part 1), Matt McQuide, Stacey Richter (EP467), Vivian Ho, Chris Crawford (EP465), Al Lewis, Betsy Seals, Wendell Potter (Encore! EP384), Dr Scott Conard

In this episode, host Stacey Richter revisits a conversation with Nikki King, CEO of Alliance Health Centers, discussing the critical issues facing rural hospitals and healthcare systems. They delve into the impacts of Medicaid cuts, the financial struggles of rural hospitals reliant on commercial insurance, and potential solutions like freestanding emergency rooms, telehealth, and the expanded roles of nurse practitioners. 

The conversation also covers the complexities of maternity care and mental health services in rural areas, emphasizing the urgent need for systemic reforms to ensure equitable access to healthcare.

=== LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP470

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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

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08:14 How dire is the rural hospital situation right now?

08:33 How could freestanding ERs be a potential solution for rural hospitals?

09:56 Advice from CHQPR: Rural hospitals should not be forced to eliminate inpatient care.

11:22 Why is broadband a roadblock to telehealth as a solution for rural health access?

14:52 What are other potential rural health access solutions?

15:37 The “hot potato” of nurse practitioners in the healthcare world.

16:34 “The number of residencies for physicians each year is not increasing, but the population … is increasing.”

20:28 EP312 with Douglas Eby, MD, MPH, CPE, of the Nuka System of Care.

22:00 What’s the issue with maternity care in rural America?

24:09 “As healthcare becomes more and more specialized, [the] ability to treat high-risk cases is better, but access gets worse.”

27:57 How is mental health care affected in rural communities?

28:29 “Rural communities are trying very hard to hang on to what they have.”

29:52 “When you look at the one market plan that’s available in a rural community, you probably can’t afford it.”

31:37 What’s the single biggest challenge to moving to a model that incentivizes keeping people healthy?

32:32 “The easiest low-hanging fruit … is having national Medicaid and have that put under the same hood as Medicare.”

In part 2 of episode 469, host Stacey Richter discusses the implications of Medicare site neutral payments and Health Savings Account (HSA) reforms with James Gelfand, president and CEO of the ERISA Industry Committee (ERIC). 

The episode details how plan sponsors should adapt to Medicare's site neutral payment policies aimed at curbing hospital consolidation and inflated prices through facility fees and markups. Gelfand provides insights into how HSA reforms currently in Congress could expand the scope of preventive care covered before deductibles are met, benefitting both employers and employees. 

The conversation also touches on the challenges high deductible health plans pose and the potential benefits of codifying recent IRS guidance to allow greater flexibility in pre-deductible coverage. The discussion underscores the importance of plan sponsors staying ahead of Medicare policies to avoid higher costs.

=== LINKS ===

🔗  Show Notes with all mentioned links:  https://relentlesshealthvalue.com/episodes

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

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05:42 What does Medicare site-neutral payments mean?

08:59 How do markups play into the dynamics here?

09:52 Upcoming episode with Christine Hale, MD, MBA.

10:36 What does the “narrow” start for these changes mean?

11:42 What action steps should plan sponsors be taking?

13:01 What options do plan sponsors have in highly consolidated markets?

14:27 EP371 with Erik Davis and Autumn Yongchu.

14:53 EP448 (Part 1 and Part 2) with Shawn Gremminger.

15:46 Will this bill potentially make changes to HSA plans?

17:40 Why has the thinking behind healthcare usage changed since the inception of HSAs?

18:42 INBW41 with Stacey.

23:24 How are preventive care and first-dollar coverage connected within the context of HSAs?

25:48 Why would it be difficult to completely get rid of a high-deductible health plan and offer HSAs without them?