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:  

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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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🎤  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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=== 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/

07:59 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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🎤  Listen on Apple Podcasts  https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1

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

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=== 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/

08:06 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

✉️  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/

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

✉️  Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe

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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

📺  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/

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.

In this episode Stacey Richter speaks with Jonathan Baran, CEO of Self Fund Health in a detailed exploration of what they term the 'Flywheel Downward Spiral' of American healthcare costs. The conversation delves into how electronic health records (EHR) and the incentives driving insurers, brokers, and hospital systems contribute to consistently rising healthcare premiums. 

Key points include how insurers profit from high premiums, the misleading marketing focus on discounts rather than actual costs, and the role of EHR systems in maximizing hospital profits rather than improving patient care. The episode sets the stage for a subsequent discussion on reversing these trends, aiming to align healthcare outcomes with cost reductions.

Self Fund Health, I am so pleased to tell you, as I am always so pleased to tell you, did make such a kind offer to help out Relentless Health Value financially. You and the tribe here are really, really great folks who I truly appreciate. Please support Self Fund Health if you are in Wisconsin.

This episode is sponsored by Self Fund Health.

=== LINKS === 🔗  Self Fund Health: https://selffundhealth.com

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

✉️  Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe

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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

📺  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/

08:46 Entering the health system “flywheel” at the renewal phase.

09:46 What goes on in the renewal season that contributes to the health system “flywheel”?

12:28 Why is the standard 9% increase in healthcare costs during renewal season actually problematic?

13:22 How does the purchase of discounts contribute to the skyrocketing cost of healthcare and distract from discussing the actually underlying cost of healthcare?

16:07 EP465 with Chris Crawford.

17:01 Why do employers need to learn to buy healthcare and not insurance?

20:32 Rina Tikia’s post on self-funded plans.

23:18 Why are hospital executives incentivized to buy and own all of the primary care in a market?

26:35 How big electronic medical record systems play into this increase in healthcare costs.

28:27 Acquired podcast on one EHR system.

31:09 What needs to happen to reverse this flywheel of increasing healthcare costs?

In this bonus clip from Episode 483 of Relentless Health Value, host Stacey Richter discusses the efforts of individuals working within large healthcare organizations to improve patient outcomes despite systemic challenges. 

Guest Jonathan Baran, co-founder and CEO of Self Fund Health, highlights how incentives within the healthcare system drive behaviors that often conflict with patient and member interests. 

The discussion emphasizes the importance of not generalizing the intentions of all employees based on organizational actions and encourages a deeper understanding of underlying incentive structures to foster meaningful changes. 

Self Fund Health, I am so pleased to tell you, as I am always so pleased to tell you, did make such a kind offer to help out Relentless Health Value financially. You and the tribe here are really, really great folks who I truly appreciate. Please support Self Fund Health if you are in Wisconsin.

This episode is sponsored by Self Fund Health.

=== LINKS === 🔗  Self Fund Health:   https://selffundhealth.com

🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP483-BONUS

✉️  Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe

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📺  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/

03:11 A brief background on Jonathan and Self Fund Health.

04:24 Why is it imperative that individuals stop identifying wholly with the organization that they work with?

05:48 Why is it important to be direct and call out the behavior without calling out the individual?

07:14 EP483 (Part 1) with Jonathan Baran.

In this episode, Stacey Richter talks with Dr. Stan Schwartz, co-founder of ZERO.health about the tension between mission-driven healthcare and financial incentives within the healthcare system. Highlighting examples like the Comprehensive Primary Care Initiative and other advanced primary care efforts, Schwartz shares insights on how health system economics, particularly the reliance on emergency room admissions, often undermine initiatives aimed at reducing costs and improving patient outcomes. 

The discussion delves into the role of employer-sponsored health plans as potential change agents in the healthcare system, given their significant influence over commercially insured patients, who are highly attractive to providers. Dr. Schwartz underscores the importance of aligned financial incentives and collective action among employers to drive meaningful change in healthcare.

If you would like to get a copy of the mentinoed personal integrity and “are you in healthcare for the right reasons” policy called the Guiding Principles Policy that Doug Geinzer and Amy Mecham from High Performance Providers put together.please either check your inbox for the newsletter this week that you just got when this show went live and find the link to download or sign up for the newsletter and I will include it again next week on Thursday.

=== LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/SUMS11

✉️  Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe

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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

📺  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/

08:11 What was Dr. Schwartz’s “Pelican Brief” moment?

09:09 How Dr. Schwartz’s advanced primary care structure and health information exchange beat out competing states for CMMI funding.

12:53 What did “good” look like with this advanced primary care program?

15:06 EP391 with Scott Conard, MD.

15:42 EP438 with John Lee, MD.

16:57 What got Dr. Schwartz interested in employer-sponsored healthcare?

18:46 EP419 with Andreas Mang.

18:48 EP453 with Claire Brockbank.

18:50 EP452 with Cora Opsahl. 

In this episode, Stacey Richter discusses 'Three Surprising Ways Carriers Make Lots of Money' with Preston Alexander. The episode highlights how carriers leverage financial strategies—like using premium dollars as float, intracompany eliminations, and upcoding in Medicare Advantage—to enhance their profits. 

The discussion emphasizes the importance for plan sponsors and policymakers to understand these tactics to better manage healthcare costs. Alexander advises collaborating with unbiased consultants who are experts in health plan design to navigate these complex financial dynamics effectively.

=== LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP482

✉️  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/

08:29 What is float, and why is it a surprising way that carriers make money?

14:01 Summer Shorts on pharma rebates with Ann Lewandowski.

14:41 Why carriers really do denials and delays of payouts.

17:34 What are intercompany eliminations, and how do they make carriers more money?

22:21 How do carrier-owned pharmacies play into this?

23:19 How are carriers creating profit off of Medicare Advantage and Medicaid Advantage markets?

27:18 How the fee-for-service price increases affect Medicare prices.

28:12 Why aren’t large insurance carriers motivated to make costs go down?

32:42 What is a potential way forward to fix the rising cost of healthcare?

33:36 As a plan sponsor, how do you address carriers making profit on your float?

35:07 EP478 with Andreas Mang and Jon Camire.

36:34 “Our economy’s not gonna survive healthcare.”