In Episode 489 Part 2 of 'Relentlessly Seeking Value,' Stacey Richter continues the series on 'Mission Margin' by focusing on the financial sustainability aspect with guest Dan Greenleaf, CEO of Duly, a multi-specialty group. The episode dives into the balance between maintaining mission-driven healthcare, which includes affordability, accessibility, and quality, and achieving financial margins. 

Dan discusses practical strategies like reducing network leakage, negotiating effectively with payers, and leveraging technologies to lower operational costs. The conversation also highlights the significance of clinician involvement in leadership and the value of having aligned incentives across the organization. 

Additionally, the episode addresses the role of capital partners in sustaining such healthcare models and ensuring they are effective and sustainable.

=== LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP489-Part2

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09:56 How does Dan achieve his mission given the realities of margin?

14:49 How Duly Health’s approach and incentives differ from other health systems.

16:04 EP466 with Vivian Ho, PhD.

16:28 EP462 with Scott Conard, MD.

16:31 Summer Shorts episode with Stan Schwartz, MD.

17:27 EP460 with Rushika Fernandopulle, MD.

17:29 EP445 with Tom X. Lee, MD.

17:30 EP407 with Vivek Garg, MD, MBA.

18:50 How having physicians on the hospital board greatly improves margin and mission.

20:04 How Dan explains his approach to his capital partners.

22:23 Fee for service vs. institutional care.

In this episode of Relentless Health Value, Stacey Richter talks mission with Dan Greenleaf, CEO of Duly Health and Care. Next week we cover margin. The discussion delves into the crucial balance between mission and margin in healthcare, highlighting how focusing on mission can drive financial stability. 

The interview centers around four key quadrants of Duly's mission: affordability, access, consumer experience, and quality. Greenleaf emphasizes how these elements are interconnected and essential for providing better healthcare outcomes and financial viability. 

The episode is part of a series exploring the mission/margin dynamic in the healthcare industry, and sets the stage for a deeper dive into how mission-focused strategies can result in decent margins in next week's episode.

=== LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP489-Part1

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08:32 What should mission be in multispecialty?

08:54 Are mission and margin mutually exclusive?

10:47 What are the four “vectors” of Dan’s mission?

11:32 Why does affordability matter?

12:11 EP466 with Vivian Ho, PhD.

12:40 EP488 with Mark Cuban and Cora Opsahl.

13:32 Who are the three payers in the marketplace?

17:31 EP388 with Merrill Goozner.

19:19 How does access play into mission?

20:28 EP464 with Al Lewis.

21:07 EP467 with Stacey.

22:56 Why price transparency is important to consumer experience.

24:16 LinkedIn post from Patrick Moore.

29:06 EP481 with Benjamin Schwartz, MD, MBA.

Stacey Richter is joined by Mark Cuban, CEO and founder of Mark Cuban Cost Plus Drugs, and Cora Opsahl, Health Fund Director of the 32BJ Health Fund, to discuss pressing issues in American healthcare. 

The conversation centers on the inefficiencies and complexities created by high deductible health plans and the layers of vendors self-insured employers hire to manage healthcare claims. Mark Cuban and Cora Opsahl advocate for direct contracting and increased transparency as solutions to reduce costs and improve outcomes. 

They also explore the potential of simplifying the system back to a more straightforward model where healthcare prices are transparent, and patients and providers can establish trust. This episode emphasizes the importance of leadership and a proactive approach in managing healthcare costs.

If you are listening to this prior to October 9, 2025, go to the 32BJ Changing the Playbook on Hospital Prices event, where Mark Cuban will be keynoting. Cora Opsahl will also be speaking, and I will be there listening. https://32bjhealthinsights.org/2025-events/

=== LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP488 🔗  Healthcare Industry Acronyms and Terms https://relentlesshealthvalue.com/healthcare-acronymns

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06:25 What was the original rationale behind high deductibles?

07:38 How high deductibles are creating a class of functionally uninsured people.

09:29 EP482 with Preston Alexander.

10:20 “We’re using health insurance as a proxy for healthcare.” —Mark

12:30 How providers are now in the debt collecting business rather than the healthcare business.

12:55 EP486 with Stan Schwartz, MD.

15:16 “We have a fundamental reasonability problem.” —Cora

16:07 EP425 with Marshall Allen.

18:25 Direct contracting versus self-funded employers.

19:27 EP436 with Elizabeth Mitchell.

19:30 EP480 with Kimberly Carleson.

19:33 EP372 with Cora Opsahl.

23:53 Why the current system doesn’t allow the accountability that is needed.

24:39 EP452 with Cora Opsahl.

26:34 How direct contracting gives strength back to independent practices that high deductible plans take away.

27:46 Who pays, what’s the price, and where does the power lie?

31:24 EP419 with Andreas Mang.

34:45 How it comes down to power and leverage when controlling healthcare costs.

38:13 EP483 (Part 1 and Part 2) with Jonathan Baran.

38:35 Why putting together a network and just buying healthcare—not discounts—is not as difficult as it seems.

40:10 Why we need to stop talking about disruption and start talking about change.

40:56 EP453 with Claire Brockbank.

41:02 EP484 with Dave Chase.

43:07 EP485 with Cristin Dickerson, MD.

44:32 EP487 (Part 1) with Kevin Lyons.

46:34 EP466 with Vivian Ho, PhD.

47:40 Why it’s the incentives that are different between American hospitals and hospitals in a single-payer program.

50:25 The main takeaways from the conversation.

51:08 Why you can’t fix the problems in healthcare without transparency.

In episode 487, part two, host Stacey Richter interviews Kevin Lyons, a former police detective and current Executive Director of the New Jersey State Police Benevolence Association about the application of detective skills to analyze healthcare spending. 

Following a discussion on the barriers driving up healthcare costs in part one, Lyons delves into techniques such as statement analysis and facial recognition to identify deceit and uncover where healthcare dollars are going. Lyons emphasizes the need for preparation, persistent questioning, and the importance of following the money, thereby encouraging a fearless approach to advocating for transparency and better healthcare management.

=== LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP487Part2

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00:00 Introduction and Episode Overview 00:25 Recap of Part One: Barriers to Reducing Healthcare Costs 03:01 Introducing Kevin Lyons: Detective Skills in Healthcare 03:52 Detective Techniques Applied to Healthcare 06:41 Challenges and Solutions in Healthcare Transparency 12:15 Final Thoughts and Acknowledgements 13:10 Closing Remarks and Podcast Information

In Episode 487 of Relentless Health Value, host Stacey Richter speaks with Kevin Lyons, a former police detective and current executive director at the New Jersey State Police Benevolence Association. They explore, in this two part episode, the significant challenges public sector employees face in obtaining cost-effective health benefits. 

The discussion highlights key issues, including the influence of industry profit motives, governmental hiring practices, and media sponsorship biases. Lyons shares insights on the rapidly escalating costs of healthcare for state workers, with specific examples from New Jersey, emphasizing the need for innovative solutions and improved legislative action. The conversation sets the stage for a subsequent episode where Lyons will delve deeper into applying detective skills to uncover financial trails and propose effective changes.

Tune in next week for  part 2 when Kevin talks about how he pulls out his notebook and uses what he learned as a detective to, first of all, figure out everything probably that we just talked about in this part one.

But also, you can't solve for something unless you do what most investigators do, which is follow the money.

=== LINKS ===

🔗  Show Notes with all mentioned links:  

https://relentlesshealthvalue.com/episodes

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00:00 Introduction to Episode 487

00:33 Viral Video and Metaphor for Healthcare

04:48 Healthcare Costs and Union Challenges

07:32   Interview with Kevin Lyons Begins

08:17 Why is it important to “dig in” right now on health benefit cost increases?

08:39 Barriers to Affordable Healthcare

10:16 The first barrier to better health benefits: profit defending profit.

10:54 Profit Defense and Political Influence

16:38 Why “throw money at the problem” isn’t a real solution.

18:31 The second barrier: why a lack of employed experts costs more money.

18:59 Government Inefficiencies and Conflicts of Interest

25:58 The third barrier: media sponsorship from incumbents prevents change.

26:19 Media Influence and Public Perception

28:55 EP483 (Part 1 and Part 2) with Jonathan Baran.

30:23 Conclusion and Teaser for Part Two

In this episode of Relentless Health Value, host Stacey Richter sits down with Dr. Stan Schwartz, co-founder of ZERO.health, to explore the practical realities and benefits of direct contracting in healthcare. 

Dr. Schwartz shares his journey from traditional healthcare to pioneering bundled payments and direct contracts, offering actionable insights for employers, providers, and anyone interested in making healthcare more affordable and predictable. The conversation covers the challenges of claims, cost variability, operationalizing direct contracts, and the impact on both patients and providers.

Discover how employers and providers can use bundled payments to cut costs, simplify administration, and deliver $0 out-of-pocket care for patients.

It was an honor to get Dr. Schwartz on the pod, and we are doubly thankful because he stepped up and offered to help support Relentless Health Value financially as well as spending his time with me and you. So, thanks to everyone over at ZERO.health for being part of the kind of folks who support shows like this one.

Dr. Stan Schwartz is co-founder over at ZERO.health. ZERO gets members access to high-quality providers for $0 out of pocket, leveraging bundled payments and direct contracting.

This episode, as I just said, is sponsored by ZERO.health, with an assist from Aventria Health Group.

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

🔗 Zero.Health https://zero.health.com

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07:59 How did ZERO.health start?

10:38 EP480 with Kimberly Carleson.

11:04 Why does the emotional energy behind understanding how the problem of healthcare affects individuals matter in changing healthcare?

12:45 “If you can schedule it, you can put a price on it.”

15:32 EP420 with Ge Bai, PhD, CPA.

16:38 EP436 with Elizabeth Mitchell.

18:21 How do employers ensure that patients and clinicians are coordinated and on board with direct contracting within their health plans?

20:26 EP475 with Peter Hayes.

22:52 Why is it important that this direct contracting system isn’t mandatory for health plan members?

24:50 How does direct contracting affect excessive utilization?

26:41 EP477 (Through Line Show) with Stacey.

27:29 Why is it important that your plan benefits benefit health?

29:39 Why is it important to educate not only members but also providers who agree to participate in the program?

31:06 “It’s all about simplicity.”

33:11 How do you ensure plan members use the service after it is installed?

Recent past interviews:

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

Dr Cristin Dickerson, Elizabeth Mitchell (Take Two: EP436), Dave Chase, Jonathan Baran (Part 2), Jonathan Baran (Part 1), Jonathan Baran (Bonus Episode), Dr Stan Schwartz (Summer Shorts), Preston Alexander, Dr Tom X Lee (Take Two: EP445), Dr Tom X Lee (Bonus Episode), Dr Benjamin Schwartz, Dr John Lee (Take Two: EP438)

In episode 485, Stacey Richter interviews Dr. Cristin Dickerson on the topic of direct contracting for imaging services. They discuss the high costs of imaging, which can account for 6-11% of a plan sponsor’s healthcare spend. The episode covers the potential for significant cost savings and improved patient access through direct contracting, bypassing traditional TPAs that may have conflicts of interest or contractual constraints. 

Dr. Dickerson, who is the founding partner of Green Imaging, explains how her organization has successfully implemented direct contracting, providing affordable and high-quality imaging services nationwide. They also address common barriers such as complexity in coding and payment processes, the reluctance of TPAs, and the habitual referral to 'down the hall' services. The conversation highlights the importance of price transparency, patient education, and how Green Imaging supports plan sponsors in navigating these challenges.

=== LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP486

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00:00 Introduction and Episode Overview 00:31 The Case for Direct Contracting in Imaging 01:43 Real-World Examples and Challenges 04:47 The Importance of Data and Transparency 08:49 Interview with Dr. Kristen Dickerson 12:39 Barriers to Direct Contracting 24:05 Overcoming Barriers and Final Thoughts 33:22 Conclusion and Contact Information

Exploring TPA and Health Plan Inertia with Elizabeth Mitchell: What Plan Sponsors Need to Know.

In this Take 2 of episode 436 of Relentless Health Value, host Stacey Richter speaks with Elizabeth Mitchell, President and CEO of the Purchaser Business Group on Health, about the challenges third-party administrators (TPAs) face, the issues around hidden fees, and the problems with health plan inertia. 

They discuss how self-insured employers can find reliable TPA partners, the impact of anti-competitive contracts, and the importance of transparency in healthcare procurement. Mitchell emphasizes the need for direct contracting between employers and providers to reduce costs and improve quality. 

The episode covers the implications of the Consolidated Appropriations Act, the role of brokers, and how employers can achieve better value for their healthcare spend.

=== LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP436-Take2

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08:06 What is the overarching context for health plans in healthcare purchasing?

11:31 Why is it important to reestablish a connection between the people paying for care and people providing care?

13:47 What are the needs of a self-insured employer when managing employee benefits?

19:00 Is it doable for employers to set their own contracts?

21:24 Is transparency presumed?

22:39 Will the new transparency upon us actually expose wasted expense?

24:23 EP408 with Chris Deacon.

25:58 “This is not about individual bad actors. … The systems … that is not aligned.”

27:39 Are there providers who want to work directly with employers?

30:53 Why is it important that incentives need to be aligned?

32:42 EP427 with Rik Renard.

33:51 What’s missing from the conversation on changing health plans?

In Episode 484 of Relentless Health Value, host Stacey Richter talks with Dave Chase from Health Rosetta about the three most pressing questions faced by self-insured employers today. 

The discussion covers how to verify if a benefits advisor truly protects employer interests, avoiding personal liability when third-party administrator contracts have hidden conflicts, and identifying if employers are being systematically overcharged on pharmacy costs despite PBM guarantees. 

The episode emphasizes the importance of accessing comprehensive data to identify conflicts and transparency in reporting, and it highlights open source resources available to create high-performance health plans. The conversation also mentions noteworthy related episodes and cases to provide further context and insights.

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

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06:36 What questions does a plan sponsor need to ask their consultant, EBC, or broker to ensure they are protecting the interest of the plan sponsor?

07:59 EP478 with Andreas Mang and Jon Camire.

08:49 EP453 with Claire Brockbank.

09:51 EP433 with Justin Leader.

09:53 EP436 with Elizabeth Mitchell.

11:03 How can plan sponsors avoid personal liability when their TPA has hidden conflicts of interest?

11:40 Tiara Yachts v. Blue Cross Blue Shield of Michigan lawsuit.

13:48 EP483 (Part 1) with Jonathan Baran.

14:18 EP457 with Cynthia Fisher.

16:18 The Marshall-Hickenlooper bill called the Price Tags Act.

16:50 Summer Short with Elizabeth Mitchell.

17:36 How do plan sponsors figure out if they are being overcharged for pharmacy benefits?

18:09 EP365 with Scott Haas.

20:18 EP397 with Paul Holmes.

20:22 EP465 with Chris Crawford.

20:37 EP429 with Luke Slindee, PharmD.

22:56 EP476 with Ann Lewandowski.

28:38 Where to find open-source resources to help guide plan sponsors with making better health plan decisions.

29:47 How the open-source trend is growing for health transparency.

30:48 What to look forward to at RosettaFest.

In the second part of this conversation with Jonathan Baran, CEO of Self Fund Health, the focus is on reversing the negative cycle of skyrocketing healthcare costs by shifting from buying discounts to investing in primary care and better benefit designs. 

The discussion highlights the current issues with the healthcare flywheel, driven by employers buying discounts, and offers solutions such as investing in direct primary care, incentivizing proper healthcare utilization, and improving patient navigation. 

The conversation also explores the potential for direct contracting between employers and health systems, aiming for a paradigm shift where employers, brokers, and health plans work collaboratively to improve member health and reduce 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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05:23 Where to start in reversing the flywheel.

06:57 Why investing in primary care is pivotal to containing healthcare costs.

10:02 EP453 with Claire Brockbank.

10:04 EP452 with Cora Opsahl.

10:07 EP457 with Cynthia Fisher.

10:12 EP365 with Scott Haas.

10:13 EP465 with Chris Crawford.

10:14 EP475 with Peter Hayes.

11:11 EP468 with Matt McQuide.

11:13 EP472 with Eric Bricker, MD.

12:14 “The most expensive thing in healthcare is the pen of the primary care doctor.”

13:04 How the role of the broker has to fundamentally change.

16:16 What will the single most challenging aspect of this restructuring become?

20:20 How self-funded employers can be amazing customers in containing the rising cost flywheel in healthcare.

22:56 How do EHRs and other medical record systems play into reversing the flywheel of rising healthcare costs?

23:57 Ramy Khalil, MD’s post on interoperability.

24:59 Why is it important for employers to drive volume differently?

25:38 How Self Fund Health is helping in this regard.