Are you on the board of directors of a company? Or a shareholder of a publicly traded company? Or a CEO, CFO, or in-house counsel who reports to a board of directors or shareholders? This encore episode is for you — 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 (a topic touched on in the recent encore with Mark Cuban, EP418, as well as the show with Cora Opsahl, EP452, and Claire Brockbank, EP453, from 32BJ). In this encore episode, 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. WHAT YOU'LL LEARN ✅ Why Andreas starts every conversation with the question "How's your healthcare company?" — and why every self-insured employer should think of itself as a small healthcare company ✅ Why it's structurally unnatural for companies to be providing health insurance in the first place, and what that means for how the benefit should actually be managed ✅ What can be achieved when there's real alignment between employers and insurers — and the concrete things a company can do to reduce spend by 10% ✅ Why self-insurance automatically saves companies 5% to 9% — and why "the funding isn't a healthcare thing, it's a CFO thing" ✅ Why CFO engagement in the benefits plan throughout the year matters, why a reliable and trustworthy broker is vital, and how employers can actually get a flat-fee model from their broker WHY THIS MATTERS Health benefits have quietly become one of the largest, least-scrutinized financial line items most companies carry — and treating that line item like "a healthcare thing" rather than a CFO thing is exactly why the financialization Andreas describes goes unnoticed. When was the last time your company RFP'd its health plan? For most boards and C-suites, the honest answer is a wake-up call. === LINKS === 🔗 Show Notes with all mentioned links: Episode Page ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ X ✭ Bluesky 00:00 Introduction 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?

In this episode, host Stacey Richter speaks with Dr. Komal Bajaj about innovative strategies for addressing staffing shortages in the healthcare sector. Dr. Bajaj is an ob-gyn who serves as chief quality officer for a couple of hospitals in the Bronx, New York, part of the municipal health system, and now also serves as medical director of sustainability for NYC Health + Hospitals. They explore the importance of cultural alignment within organizations, emphasizing trust and shared values to retain staff. Dr. Bajaj shares surprising findings from surveys indicating that healthcare workers are motivated by the goal of providing high-quality, planet-friendly care. The discussion highlights the interconnectedness of environmental sustainability and healthcare quality, presenting tangible ways to engage and empower healthcare workers while addressing both local community health and broader environmental concerns. WHAT YOU'LL LEARN ✅ How to actually quantify the staffing shortage problem, and why looking at the root cause changes the entire approach to solving it ✅ Why trust is one of the core problems underlying staffing shortages — and what a Deloitte survey found about what keeps healthcare workers in place ✅ The strongest correlations that influence a healthcare worker's desire to stay — and what gives them the most pause about staying long-term ✅ Why sustainable, climate-friendly healthcare is turning out to be a real driving factor in staffing decisions, per the U.S. Department of Health and Human Services Health Sector climate pledge and a Commonwealth Fund survey on what health systems can do ✅ How to meet healthcare workers' actual desires where they are, rather than where organizations assume they are WHY THIS MATTERS "Healthcare workers have choice." That simple fact reframes the staffing shortage conversation: retention isn't primarily a compensation problem, it's a trust and alignment problem, and increasingly a values problem tied to sustainability and mission. Organizations that treat climate-friendly, high-quality care as a genuine organizational value — not a side initiative — are finding it's also a genuine staffing advantage. === LINKS === 🔗 Show Notes with all mentioned links: Episode Page ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ X ✭ Bluesky 00:00 Introduction 08:20 How do we quantify the issue of staffing shortages? 11:18 Why do we need to look at the root cause of the shortages? 11:51 Deloitte survey on staffing shortages. 11:54 Why is trust one of the core problems when it comes to staffing shortages? 13:59 "Healthcare workers have choice." 15:34 What are the strongest correlations that influence healthcare workers' desire to stay? 18:17 What things give healthcare workers the most pause? 19:36 The U.S. Department of Health and Human Services Health Sector climate pledge. 20:20 The Commonwealth Fund survey on what health systems can do to address climate change. 22:29 What do we do about sustainable, climate-friendly healthcare being a driving factor in staffing? 27:28 How do you meet the desires of healthcare workers where they're at?

In this episode, host Stacey Richter talks with healthcare entrepreneur Cynthia Fisher about medical spread pricing and the case for contract transparency. Fisher explains how hidden fees and spread pricing by middlemen lead to substantial overcharges for employers and patients in the U.S. healthcare system — and lays out real numbers to prove it. In one example she cites, a self-insured employer paid $4 million for a claim; the provider was paid $876,000. The conversation covers recent lawsuits (including the one against Cigna) that expose these practices, the legislative progress being made on price transparency, and how transparency can ultimately transform the industry. Insights are also shared from industry experts who have been previous guests, including Chris Deacon, Justin Leader, and Andreas Mang. WHAT YOU'LL LEARN ✅ What medical spread pricing actually is, and why it isn't "change in the couch cushions" the way PBM spread pricing adds up to billions of dollars ✅ The real numbers behind one claim: an employer paid $4 million, and only $876,000 of that made it to the provider ✅ What the lawsuit against Cigna reveals about how carriers are learning to replicate PBM-style spread pricing tactics ✅ Why American competitiveness is affected by how much employers spend on healthcare, and why transparency addresses the root cause rather than a symptom ✅ What's happening across the country to empower price transparency in healthcare, and how employers can use existing laws to demand accountability WHY THIS MATTERS "This is a thing now, medical spread." Just as PBM spread pricing quietly added up to billions of dollars, medical spread pricing is doing the same thing on the medical claims side — hiding in plain sight inside contracts that employers signed without full visibility into the numbers. Contract transparency isn't a nice-to-have; it's the mechanism by which employers and unions can hold carriers and providers accountable for what they're actually being charged. MENTIONED IN THIS EPISODE EP419 with Andreas Mang: Apple Podcasts | Spotify | Other Apps EP452 with Cora Opsahl: Apple Podcasts | Spotify | Other Apps EP453 with Claire Brockbank: Apple Podcasts | Spotify | Other Apps EP433 with Justin Leader: Apple Podcasts | Spotify | Other Apps === LINKS === 🔗 Show Notes with all mentioned links: Episode Page ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ X ✭ Bluesky 00:00 Introduction 09:03 What is the goal of PatientRightsAdvocate.org? 10:28 Is American competitiveness being affected by healthcare spend? 13:47 Why is transparency a root cause to healthcare costs? 15:11 What's going on across the country to empower transparency in healthcare? 19:31 "I think people are fed up." 21:22 The Cigna lawsuit in California. 26:36 How do employers navigate contracts against anti-steering?

In this special Thanksgiving episode, Stacey Richter discusses the significance of being "givers" in healthcare, advocating for collaboration over transactional relationships to deliver real value to patients. She thanks listeners who left a tip in the tip jar, offered a monthly contribution, wrote a review, or interacted with the show's posts on LinkedIn — naming several by name — and reflects on how these interactions are exactly how podcasts and publications like this one are able to continue. She touches on the challenges and necessary shifts in healthcare market dynamics, emphasizing that true value is determined through bi-directional conversations between providers and end users, like patients and plan sponsors, and closes with a call to action for listeners to reflect on their own support networks. WHAT YOU'LL LEARN ✅ Why Stacey argues that "giving" — not transacting — is what actually determines who gets invited on podcasts, quoted by reporters, or featured in publications ✅ What it means to bring a giver mindset to healthcare relationships, and why collaboration beats transactional relationships when it comes to delivering real value to patients ✅ Why true value in healthcare is only knowable through bi-directional conversations between providers and end users like patients and plan sponsors ✅ Why plan sponsors specifically need to be part of the giving and collaboration equation, not just providers and vendors ✅ Why "it will take a village" isn't just a sentiment — it's the operating assumption behind any collective effort to transform healthcare WHY THIS MATTERS "It is this gang — the Relentless Tribe that listens to this show — it is you who will transform healthcare." The thank-you episode makes explicit what the show argues implicitly all year: healthcare change isn't delivered by any single actor, but by a network of givers — guests, listeners, tipsters, and reviewers — who collaborate rather than transact. Being a giver isn't altruism for its own sake; per Adam Grant's research on the subject, it's also how trust, and therefore influence, actually gets built. MENTIONED IN THIS EPISODE Encore! EP415 with Rob Andrews: Apple Podcasts | Spotify | Other Apps Summer Shorts 8 with Larry Bauer, MSW, MEd: Apple Podcasts | Spotify | Other Apps INBW39 with Stacey Richter: Apple Podcasts | Spotify | Other Apps EP399 with Stacey Richter: Apple Podcasts | Spotify | Other Apps EP400 with Stacey Richter: Apple Podcasts | Spotify | Other Apps === LINKS === 🔗 Show Notes with all mentioned links: Episode Page 🔗 Healthcare Industry Acronyms and Terms ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 📺 Subscribe to our YouTube channel 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 00:00 Introduction 01:33 How do you calculate the number of people you've helped? 02:46 Why is giving so important within healthcare? 03:16 Interview with Adam Grant. 05:47 How can you be a better giver? 07:50 Who is in charge of the bidirectional conversation of value? 11:35 Why is collaboration so important to value and being a giver? 12:58 Why is it important that plan sponsors are a part of all this giving and collaboration?

In this encore episode, Mark Cuban discusses his insights and experiences disrupting the healthcare and pharmacy benefits landscape with Stacey Richter. This show was one of the most popular episodes of the past year, and it's also extremely relevant right now given all of the PBM (pharmacy benefit manager) goings-on, as well as ongoing litigation like the J&J lawsuit. Joined by Ferrin Williams from Scripta, Cuban stresses the importance for CEOs and CFOs of self-insured companies to get actively involved in their healthcare plans to avoid overpaying. The conversation tackles the opaque practices of PBMs, the financialized nature of the healthcare industry, and introduces Mark Cuban's Cost Plus Drugs model, which aims for transparency and cost reduction. Key topics also include the potential legal implications for employers, the importance of trust in healthcare transactions, and the real-world savings achievable with greater involvement and transparency in healthcare management. WHAT YOU'LL LEARN ✅ Why Mark Cuban says "if you can't convince them, confuse them and hide it" is the actual operating principle behind opaque PBM rebate practices ✅ What Mark Cuban found when he personally dug into his own company's benefit program as a self-insured employer ✅ How Cost Plus Drugs aims to bring transparency and cost reduction to a financialized pharmaceutical supply chain ✅ Why rebates are going away without it changing PBM earnings, and what that reveals about where the real money is made ✅ Why CEOs and CFOs of self-insured companies specifically — not just HR or benefits teams — need to get personally involved to avoid overpaying WHY THIS MATTERS "When you think it through, you start to realize that money is being spent primarily by your sickest employees." That reframing is the crux of Mark Cuban and Ferrin Williams's argument: self-insured employers are already paying for their sickest employees' care whether they engage or not, so the only real choice is whether they engage with enough transparency to actually manage that spend well. === LINKS === 🔗 Show Notes with all mentioned links: Episode Page 🔗 Healthcare Industry Acronyms and Terms ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 📺 Subscribe to our YouTube channel 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 00:00 Introduction 06:29 What was Mark Cuban's own journey as a self-insured employer with Cost Plus Drug Company? 07:44 What did Mark find when he decided to go through and look through his company's benefit program? 09:12 "When you think it through, you start to realize that money is being spent primarily by your sickest employees." —Mark 10:02 How do you get CEOs and CFOs of self-insured employers to realize that their sickest employees are the ones subsidizing their checks? 13:00 What is the role of insurance in healthcare? 14:30 "If you can't convince them, confuse them and hide it." —Mark 15:24 The reality behind getting a rebate check. 16:21 Why are rebates going away, and why isn't that changing PBM earnings? 19:05 How do you get CEOs and CFOs to dig into their benefits plan? 20:59 Does morally abhorrent move the needle? 21:33 "What we're trying to do is just simplify the [healthcare] industry." —Mark 24:19 What's been changing in consumer behavior? 25:04 "Transparency is a huge part of building that trust." —Ferrin 25:19 Why CEOs and CFOs really have the power to change healthcare. 32:29 What are Cost Plus Drugs' plans to expand? 39:21 Where is the future of the prescription drug market going? 42:09 What will happen to the prescription drug market in 10 to 20 years? 48:40 The wake-up call self-insured employers should be acknowledging now. 52:02 Where is the real change in the healthcare industry going to come from?

In this episode, Stacey Richter speaks with Rob Andrews, CEO of the Health Transformation Alliance (HTA) and former Congressman, about the strategic steps jumbo employers can take to achieve improved health outcomes while reducing cost. They delve into the importance of using data to discern effective practices, negotiate contracts, and hold intermediaries accountable. The discussion highlights maternal health as a critical area of focus, with successful interventions shown to reduce NICU admissions and overall healthcare costs. Andrews emphasizes the role of self-insured employers in driving systemic changes that align financial incentives with health outcomes. Getting better health for the 160 million Americans covered by commercial insurance, in Andrews's view, is all about rates, rights, and power. WHAT YOU'LL LEARN ✅ What strategic steps jumbo employers can take to improve health outcomes while reducing total cost of care ✅ Why using data to identify effective practices, negotiate contracts, and hold intermediaries accountable is central to the Health Transformation Alliance's approach ✅ Why maternal health is a critical area of focus, and how successful interventions have been shown to reduce NICU admissions and overall healthcare costs ✅ Why self-insured employers have a unique role in driving systemic change that aligns financial incentives with actual health outcomes ✅ Rob Andrews's framing for the 160 million Americans covered by commercial insurance: it all comes down to rates, rights, and power WHY THIS MATTERS "Strategy's not what people say; it's what they do." Rob Andrews's blueprint for jumbo employers isn't a philosophy — it's an operational discipline built on data, contract leverage, and accountability. Getting better health outcomes for the 160 million Americans on commercial insurance, per Andrews, comes down to three things: rates, rights, and power. === LINKS === 🔗 Show Notes with all mentioned links: Episode Page 🔗 Healthcare Industry Acronyms and Terms ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 📺 Subscribe to our YouTube channel 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 00:00 Introduction 07:34 How did Rob get to his current role? 09:08 The problem of maternal health and mortality rate, and how self-insured employers wind up directly and indirectly paying for this. 10:27 Why economic consequences move the needle, and why sometimes they don't. 12:26 Why the best way to address costs isn't to re-shift costs but to address them directly. 13:22 Why compensation that isn't dependent on outcomes is a problem. 16:23 "Strategy's not what people say; it's what they do." 18:21 How do you operationalize saving money with better outcomes? 26:26 How do employers turn conflict into collaboration? 28:20 What is the win-win-win structure among employers, payers, and providers in Rob's eyes? 30:53 To whom should the task of risk adjustment fall? 34:43 "Better contracts do improve outcomes."

In this comprehensive episode, host Stacey Richter sits down with Brian Reid to discuss pivotal aspects for the pharmaceutical industry. Key topics include understanding product value from the perspectives of plan sponsors, patients, and society, and the significance of benefit design in improving patient affordability. The discussion delves into the complexities of drug pricing, the roles of Pharmacy Benefit Managers (PBMs) and brokers, and the impact of healthcare consolidation on costs. Reid emphasizes the importance of transparent communication among stakeholders, the detrimental effects of cost containment strategies, and the necessity of considering policy and reputational impacts. Throughout the conversation, examples such as the Hepatitis C drug illustrate the broader implications on drug access and affordability. Listeners are provided with critical insights into how pharmaceutical companies can better engage with ultimate purchasers to ensure patients receive necessary, cost-effective treatment. WHAT YOU'LL LEARN ✅ How to think about "value" in pharma from the perspectives of plan sponsors, patients, and society all at once ✅ Why benefit design plays such a significant role in patient affordability, and what the Kaiser Employer Health Benefits Survey reveals about it ✅ Why pharma needs to showcase its value even when PBMs are often "locked in" at the moment of a formulary decision ✅ Why Brian is celebrating companies that put their prices directly in their press releases ✅ Why hospital monopoly behavior and healthcare consolidation are just as relevant to pharma's affordability conversation as PBM contracting is WHY THIS MATTERS Reid's core argument: pharma has an obligation to explain its value — not just claim it — to plan sponsors, patients, and society simultaneously. Transparent communication among stakeholders, not just clever positioning, is what actually improves patient access to necessary, cost-effective drugs, as the Hepatitis C example discussed in the show makes clear. MENTIONED IN THIS EPISODE EP300 with Bruce Rector, MD: Apple Podcasts | Spotify | Other Apps EP448 (Part 1) with Shawn Gremminger: Apple Podcasts | Spotify | Other Apps EP426 with Nina Lathia, RPh, MSc, PhD: Apple Podcasts | Spotify | Other Apps EP370 with Erik Davis and Autumn Yongchu: Apple Podcasts | Spotify | Other Apps === LINKS === 🔗 Show Notes with all mentioned links: Episode Page 🔗 Healthcare Industry Acronyms and Terms ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 📺 Subscribe to our YouTube channel 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 00:00 Introduction 08:29 Why is it important to understand the term "value" in respect to medicine? 10:07 Why is it important to consider all the players affected by the idea of this "value"? 11:06 Who are the ultimate purchasers in Pharma? 12:23 Findings of the Kaiser Employer Health Benefits Survey. 14:52 Why does it matter that we consider what value looks like to all players affected by Pharma? 20:04 What does Pharma need to do to showcase their value when PBMs are often "locked in" at the moment? 23:11 Why Brian is celebrating companies that put their prices in their press releases. 32:31 Why does Pharma have an obligation to explain their value? 33:39 Why is it important for Pharma to keep an eye on hospital monopoly behavior? 37:44 Why Pharma needs to capitalize on alignment.

In this conversation, Stacey Richter engages with healthcare leader Dr. Beau Raymond from Ochsner Health Network to explore the blueprint for better patient care through enlightened leadership, data-driven strategies, and localized health initiatives. The discussion covers shifting from 'sick care' to preventative healthcare, integrating technology and data tools like glucometers for health coaching, and addressing health equity through accurate data and regional strategies. The conversation explains the importance of stakeholder engagement, setting clear goals, financial incentives aligned with patient care, and continuous improvement through feedback loops. Practical steps such as weekly huddles for primary care teams and the role of digital health in managing chronic conditions like diabetes and hypertension are also highlighted to improve healthcare outcomes and operational excellence. WHAT YOU'LL LEARN ✅ Why enlightened leadership is described as critical to achieving measurably better patient care, and what that looks like day to day ✅ How data-driven strategies and localized health initiatives combine to shift care from "sick care" toward preventative healthcare ✅ How integrating technology and data tools like glucometers supports health coaching for chronic conditions like diabetes and hypertension ✅ Why accurate data and regional strategies are essential to addressing health equity, and how Ochsner approached this without singling out individual physicians ✅ Why weekly huddles for primary care teams and continuous feedback loops matter more than one-time initiatives for sustaining improvement WHY THIS MATTERS "It's really about engaging with the patient." Dr. Raymond's blueprint ties enlightened leadership, data, and local execution together: goals have to be clear, financial incentives have to align with patient care, and feedback loops have to be continuous — otherwise data-driven strategy stays theoretical instead of showing up in weekly huddles and patient outcomes. === LINKS === 🔗 Show Notes with all mentioned links: Episode Page 🔗 Healthcare Industry Acronyms and Terms ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 📺 Subscribe to our YouTube channel 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 00:00 Introduction 10:44 Why is it important to be flexible while keeping your goals in sight? 11:48 Dr. Eboni Price-Haywood's article on disparities in COVID. 12:29 How is equity a data point to achieving overall care improvement? 15:01 "If you can't measure it … accurately, you're not going to be able to do anything differently." 20:52 What strategies have been successful in using data to improve healthcare outcomes? 23:17 Why did Ochsner Health avoid looking at the individual physician standpoint in regard to an equity standpoint? 30:40 Why engaging patients in their healthcare actually improved patient visits and did not necessarily reduce patient visits. 34:49 "It's really about engaging with the patient."

In this episode, host Stacey Richter and guest Brendan Keeler dive deep into the significant legal clash between Epic and Particle over electronic health record (EHR) data access and market competition. This episode examines the broader repercussions on healthcare data exchange, including antitrust concerns, data liquidity, and the ethical considerations around secondary use of treatment data. The discussion brings to light how the outcome of such lawsuits could influence data transparency, interoperability, and the rules governing data sharing among plan sponsors, employers, and healthcare providers. Notable points include the shift to a judicial era impacting health tech companies and the potential for regulatory and judicial actions to improve data access and efficiency within healthcare networks. The episode emphasizes the critical need for clear pathways, accountability, and structured regulations to enhance patient care and reduce fraud in the healthcare data ecosystem. WHAT YOU'LL LEARN ✅ What the Epic v Particle lawsuit is actually about, and why it matters for plan sponsors and public health efforts trying to access data ✅ Who can gain access to EHR data, and what limits (if any) exist on how that data can be used secondarily ✅ Why this moment represents a shift to what Brendan calls a "judicial era" for health tech companies ✅ What progress has been made since the lawsuit began, and who else stands to be affected by the rule this case is likely to set ✅ Why clear pathways, accountability, and structured regulations are needed to improve data access while also reducing fraud in the healthcare data ecosystem WHY THIS MATTERS The Epic v Particle dispute is a proxy fight over who controls health data liquidity — and its outcome will shape interoperability rules well beyond the two companies involved. Brendan Keeler's read: regulatory and judicial action, not voluntary industry cooperation, is what's actually going to move data access and efficiency forward from here. === LINKS === 🔗 Show Notes with all mentioned links: Episode Page 🔗 Healthcare Industry Acronyms and Terms ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 📺 Subscribe to our YouTube channel 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 00:00 Introduction 07:21 Who can gain access to EHR data? 10:31 Are there limits to how EHR data can be used secondarily? 11:36 Can EHR data be shared secondarily? 15:47 Part one and part two of Brendan's comprehensive account of the Epic/Particle dustup. 15:57 What was the dispute that started Epic v Particle? 18:21 What are the two viewpoints in this dispute with Epic's actions? 26:16 What progress has been seen since this lawsuit began? 28:00 Who else will be impacted by the likely rule cementing from this lawsuit?

In this episode, host Stacey Richter delves into the complexities of the Third Party Administrator (TPA) Request for Proposal (RFP) process with guest Claire Brockbank from 32BJ Union. The discussion highlights the critical role of contracts in managing health plans effectively and the potential pitfalls of accepting contracts crafted by TPAs without thorough review. Drawing from Claire's experience, they explore tactics like starting with your own contract paper in RFP processes to gain negotiation leverage, and the benefits of employer coalitions in navigating healthcare complexities. As one example — and Cora Opsahl spoke about this in the prior episode, and Claire talks about it here too — allowing upside-down payments, common in a lot of ASO contracts, meant that 32BJ spent around $10 million paying more than the bill was for in one year. If a plan signs the contract as handed to them by the carrier, the plan is contractually obligating itself to pay more than the price the clinical practice actually charged: a doctor sends a bill for $100, and the carrier pays that practice $200 on the plan sponsor's behalf, leaving the plan sponsor paying $200 for a $100 bill. Real-world examples underscore the financial impact of poorly negotiated contracts and highlight successful strategies for health plan sponsors to optimize costs and services. WHAT YOU'LL LEARN ✅ Why accepting a TPA's own contract paper without review can quietly cost a plan sponsor millions — illustrated by 32BJ's real $10 million upside-down-payment example ✅ How starting an RFP process with your own contract paper, instead of the carrier's, gives plan sponsors real negotiation leverage ✅ What "upside-down payments" are, and why they can turn a $100 bill into a $200 charge to the plan sponsor ✅ Why employer coalitions and open-source contracts, like the one 32BJ makes available, help level the playing field against carriers and TPAs ✅ Why it's important to keep probing brokers and consultants, even loyal ones, throughout the RFP and contracting process WHY THIS MATTERS Is paying $200 for a $100 bill a conflict of interest? Imprudent? A fiduciary breach? Claire Brockbank's answer, backed by 32BJ's own numbers, is that plan sponsors who sign TPA-drafted contracts without review are often unknowingly agreeing to exactly this kind of upside-down payment structure — and the fix starts with writing the contract yourself. MENTIONED IN THIS EPISODE EP433 with Justin Leader: Apple Podcasts | Spotify | Other Apps EP428 with Julie Selesnick: Apple Podcasts | Spotify | Other Apps === LINKS === 🔗 Show Notes with all mentioned links: Episode Page 🔗 Healthcare Industry Acronyms and Terms ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 📺 Subscribe to our YouTube channel 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 00:00 Introduction 05:36 How does the initial contract writing affect how events in your healthcare plan will go? 06:56 What happens if a plan sponsor or employer doesn't do the contracting right? 10:42 How much could be saved by doing contracting right? 12:22 How do you start an RFP process with your own contract? 14:06 What Claire Brockbank recommends doing to do a TPA RFP process in a way that's best for you. 19:46 What factors do carriers need to get an ASO or TPA to respond to using your contract? 21:11 Open-source contract available from 32BJ. 21:57 Why it's important to really probe brokers, despite loyalty to your broker/consultant. 24:30 Who are the reliable agents and experts when carriers are looking to start this process? 27:56 What's the silver lining to this effort? 29:17 Why is it important to make it clear why you're doing what you're doing for your lawyers and any other support team you need? 31:39 What does "good" look like in this process? 34:15 Why is it important to continue to hold your ASO accountable?