Relentless Health Value

Ten years and $200,000 to $300,000 in real dollars — that's roughly what it costs to become a physician, and yet most medical schools teach almost nothing about how the business of medicine actually works. In this episode, Stacey Richter talks with Adam Brown, MD, MBA, a board-certified ER physician and founder of ABIG Health, about his MedPage Today article making the case that medical schools are doing their students a disservice by leaving business education out of the curriculum — and about what that gap costs physicians, patients, and the system once those students become practicing doctors.

WHAT YOU'LL LEARN

✅ Adam Brown's five reasons medical schools should teach the business of medicine: the changed role of physicians, the expectation mismatch new doctors face, the need to advocate effectively, the reality that prescribing decisions drive costs patients and employers ultimately bear, and the alternative career paths physicians often don't know exist

✅ Why physicians who don't understand the business of medicine struggle to earn seats in boardrooms — and why so few doctors sit on the boards of major nonprofit hospitals as a result

✅ Why patients who fear they can't afford care skip doctors' orders, and why that's a business-of-medicine blind spot with direct clinical consequences, not just a billing issue

✅ Why moral injury and staff turnover are real organizational costs of leaving physicians out of business decisions — and why successful value-based care specifically depends on physicians understanding the business model underneath it

✅ What physician-administrators actually experience when they try to advocate with their "physician hat" on inside organizations built around administrator-determined goals

WHY THIS MATTERS

Too few mission-driven, business-savvy physicians in boardrooms means patients keep getting the kind of care — and the prices — the current system produces. Adam Brown's case isn't that doctors need an MBA; it's that basic business literacy is what lets physicians advocate for themselves, their colleagues, and their patients in terms decision-makers actually respond to. Without it, docs get squeezed out of the rooms where the rules get written, and value-based care efforts that depend on physician buy-in keep stalling for the same underlying reason.

MENTIONED IN THIS EPISODE

EP404 with Suhas Gondi, MD, MBA: Apple Podcasts | Spotify | Other Apps

LinkedIn post: Denver Sallee, MD, MMM's predictive scheduling work

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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🎤 Listen on Apple Podcasts

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=== CONNECT WITH THE RHV TEAM ===

✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X

00:00 Introduction.

08:49 What does it mean to teach the business of medicine?

11:04 The four Ps that are key within the business of medicine.

13:27 Why is it important for doctors to understand the business of medicine?

21:46 "Things don't happen without a physician's signature."

27:27 Why physicians who understand the business side of medicine can broaden the view of outcomes for the business decision-makers.

28:30 Why is it important to make sure physicians are in the boardroom?

30:52 "We are getting what we designed."

33:37 Dr. Brown's advice for clinicians in the boardroom.

"Morally abhorrent doesn't move the needle. What moves the needle is financial implications." That's the line from Rob Andrews that got Stacey Richter chasing this interview. In this episode, Stacey talks with Andrews, CEO of the Health Transformation Alliance (HTA) — an alliance of more than 60 jumbo self-insured employers covering over 8 million people and $30+ billion in annual healthcare spend — about the concrete financial case for buying better healthcare outcomes, using maternal health as the exemplar: readmissions down 29%, total cost of care 15% lower, and drug costs 25% less among HTA members who lean into paying for the right things.

WHAT YOU'LL LEARN

✅ Why "morally abhorrent doesn't move the needle" — and why financial implications, not appeals to conscience, are what actually get self-insured employers and the healthcare system to change

✅ Why maternal health is such a stark case study for this: avoidable NICU and ICU admissions for moms and babies cost employers and communities hundreds of thousands of dollars per case, directly and indirectly

✅ Rob Andrews's three-step strategy for employers: get objective, risk-adjusted data on performance; negotiate contracts that hold intermediaries accountable for outcomes with real performance guarantees; and be transparent with employees about relative quality

✅ Why "buying things" — even at a steep discount — isn't a strategy, and why cost-shifting onto plan members isn't either; both dodge the root-cause work of paying for outcomes

✅ The concrete results HTA members have seen from leaning into this approach: 29% lower readmissions, 15% lower total cost of care, and 25% lower drug costs

WHY THIS MATTERS

Rob Andrews's pitch to self-insured employers isn't a moral argument, it's a financial one — and that's precisely why it's persuasive to organizations that have to answer to a board or a CFO. When employers get real data, negotiate for outcomes instead of discounts, and hold intermediaries accountable, the numbers move: fewer readmissions, lower total cost of care, cheaper drugs. That's a case study jumbo employers not yet doing this work can actually replicate, not just admire from a distance.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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00:00 Introduction.

07:29 How did Rob get to his current role?

09:11 The problem of maternal health and mortality rate, and how self-insured employers wind up directly and indirectly paying for this.

10:36 Why economic consequences move the needle, and why sometimes they don't.

12:36 Why the best way to address costs isn't to re-shift costs but to address them directly.

14:34 Why compensation that isn't dependent on outcomes is a problem.

18:09 "Strategy's not what people say; it's what they do."

21:40 How do you operationalize saving money with better outcomes?

29:46 How do employers turn conflict into collaboration?

31:41 What is the win-win-win structure among employers, payers, and providers in Rob's eyes?

34:13 To whom should the task of risk adjustment fall?

38:03 "Better contracts do improve outcomes."

Most conversations about value-based care happen at 50,000 feet. This one is much closer to the ground: a real, step-by-step how-to for how a specialist practice — an OB/GYN group, an orthopedic practice, whoever — can actually deliver coordinated, value-based care and get paid for doing it. In this episode, Stacey Richter talks with Justina Lehman, CNP, DNP, founder and president of Revolution Health, about why doing right by patients and growing the practice aren't actually in tension, and about the concrete process she uses to help physician groups make that case to payers.

WHAT YOU'LL LEARN

✅ Justina Lehman's eight-step process for building a "value alliance": assembling a self-selected physician committee, defining the gap between care as usual and ideal care, designing the transition plan, aligning it to real financial models, measuring results, building the payer pitch, recruiting more physicians, and maintaining it over time

✅ Why patients drawn to nonfragmented, coordinated care and purpose-driven clinicians who want to deliver it can combine into a genuine growth strategy, not just a values-driven side project

✅ The four financial avenues available with an engaged payer: prospective bundle payments, retrospective shared-savings payments, quality incentives layered onto or withheld from fee-for-service, and PMPM specialty quality programs

✅ What to do when the payer isn't engaged: banding together with other practices into a value alliance to build leverage, or aligning your care pathway to whatever is actually payable within the existing fee-for-service model

✅ Why specialists who don't figure out how to work with capitated primary care physicians risk losing referrals altogether, and why demonstrating better outcomes is the only way to earn that trust

WHY THIS MATTERS

The idea that value-based care and short-term financial growth are at odds is, per Justina Lehman, a false choice — coordinated, high-value care creates real demand from patients and real appeal to purpose-driven clinicians, and that combination drives growth on its own. For specialists sitting on the sidelines waiting for the incentives to align before they act, the risk isn't just missed opportunity: it's losing referral relationships with primary care physicians who are increasingly expected to prove outcomes before sending patients anywhere. Having an actual process to follow, rather than waiting for a perfect payer environment, is what turns intention into results.

MENTIONED IN THIS EPISODE

EP412 with Robert Pearl, MD: Apple Podcasts | Spotify | Other Apps

Summer Shorts 8 with Larry Bauer, MSW, MEd: Apple Podcasts | Spotify | Other Apps

EP402 with Amy Scanlan, MD: Apple Podcasts | Spotify | Other Apps

Summer Shorts 4 with Eric Gallagher: Apple Podcasts | Spotify | Other Apps

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction.

07:35 What has Justina been up to, and why is it relevant to this conversation?

08:23 What is high-value care, and how do we figure out what it is in reality?

10:08 "What is the clinical design of … high-value care?"

10:21 Care as usual vs ideal care.

12:23 How does Justina figure out what the benchmark is for high-value care?

12:36 Meeting patients where they are at, not where we want them to be.

18:28 "What is the story as a group to the payer? What is the story as a group to the self-funded employer?"

19:19 How do you align business operations and the financials?

20:16 What are the four avenues for getting paid for high-value care?

21:58 What are highly engaged payers most intrigued by in high-value care?

24:11 What are the different ways a practice can get compensated?

28:52 Are there programs that have advanced without payers leading the way?

29:37 What's the "hook" for payers?

31:12 What's a winning message to payers and employers?

34:13 "Not everyone needs to participate."

38:24 Can a program be successful even if a physician is a passive participant in the program?

Estimates suggest the US healthcare system wastes upward of a trillion dollars a year, split across two broad categories: administrative failures (fraud/waste/abuse, administrative complexity, pricing failures) and clinical failures (care coordination, care delivery, and low-value care). In this episode, Stacey Richter talks with Will Shrank, MD, a venture partner at Andreessen Horowitz and former chief medical officer at Humana, CVS Health, and UPMC's health plan, about where that waste actually goes, why it's so hard to cut (someone's waste is someone else's profit), and why primary care physicians organizing and demanding better models might be an underrated lever for change.

WHAT YOU'LL LEARN

✅ The six categories of healthcare waste, split between administrative failures (fraud/waste/abuse, administrative complexity, pricing failures) and clinical failures (care coordination, care delivery, and low-value care)

✅ Why cutting healthcare waste is so politically and economically difficult: nearly every dollar of waste is somebody else's revenue, which means constituencies exist to protect it

✅ Why aligning financial incentives with quality — paying for the longitudinal patient journey and for outcomes rather than volume — is Dr. Shrank's broad-stroke fix for the clinical-failures side of waste

✅ Why value-based care's slow pace of change is, per Dr. Shrank, more a reflection of how young the model still is than a sign it isn't working

✅ Why PCPs organizing and pushing back against being treated as RVU referral machines could become a meaningful source of leverage, especially if self-insured employers start demanding the same kind of value-based accountability

WHY THIS MATTERS

A trillion dollars of annual waste sounds like an obvious target, but as Will Shrank lays out, most of that waste is embedded in somebody's business model, which means fixing it requires realigning incentives, not just identifying the problem. Value-based care is the mechanism most likely to make that realignment happen, because it's the rare structure where reducing waste actually benefits the people positioned to reduce it. In the meantime, physicians and employers who are tired of waiting on that broader shift may have more collective leverage than they realize.

MENTIONED IN THIS EPISODE

EP363 with David Scheinker, PhD: Apple Podcasts | Spotify | Other Apps

Books: Robert Pearl's Uncaring

EP409 with Larry Bauer, MSW, MEd: Apple Podcasts | Spotify | Other Apps

EP359 with Dan O'Neill: Apple Podcasts | Spotify | Other Apps

Summer Shorts 2 with Scott Conard, MD: Apple Podcasts | Spotify | Other Apps

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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🎤 Listen on Apple Podcasts

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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction

05:56 Can we cut healthcare waste while improving patient care?

06:35 What does "healthcare waste" consist of?

06:48 What are the six categories of "healthcare waste"?

09:39 How much money does Dr. Shrank estimate is wasted each year in healthcare?

12:11 Where is that healthcare waste going, and why does it happen?

20:20 "We've built a backbone of extraordinary waste on a fee-for-service chassis."

25:04 Dr. Shrank's warning to providers out there.

30:43 Why there might be a generational shift among younger providers looking to work with different models.

If a hospital patient develops a central line infection that turns into sepsis, their odds of readmission within 30 days are nearly 99% — not a small cohort, and not a small problem. In this episode, Stacey Richter talks with Secretary David Shulkin, MD, former US Secretary of Veterans Affairs, and Erin Mistry, chief commercial officer at CorMedix, about a new innovation aimed at keeping dialysis patients from dying of bloodstream infections, and about a much bigger structural question: why hospitals often have a financial disincentive to adopt expensive new innovations at all, even when those innovations demonstrably improve outcomes.

WHAT YOU'LL LEARN

✅ Why bloodstream infections in dialysis patients with central venous catheters (CVCs) are a major, underappreciated driver of hospital readmissions, and why preventing them is such a clear-cut economic case for preventive care

✅ How DRG (Diagnostic Related Group) payments work: Medicare pays hospitals a flat sum for roughly 13,000 diagnoses and 5,000 procedures, regardless of what's actually used to deliver the care — which means a hospital that adopts a more expensive but better innovation simply eats the cost difference

✅ Why that flat-payment structure can push purchasing decisions toward the cheapest available option, even when it's not what clinicians or patients actually need

✅ What an NTAP (new technology add-on payment) is, and how CMS created it specifically to give hospitals a financial reason to adopt certain new, qualifying technologies instead of avoiding them

✅ What a QIDP (Qualified Infectious Disease Product) designation is, and why infectious disease innovations currently get prioritized status in the NTAP process

WHY THIS MATTERS

When a hospital's payment for a procedure or diagnosis doesn't move regardless of what's used to deliver the care, the hospital's purchasing incentives and a patient's actual best interest can quietly diverge — and it's the hospital, not the innovator or the payer, left to eat the cost of doing better by the patient. Programs like NTAP exist because CMS recognized that gap and tried to close it with real money. Understanding how that mechanism works matters for anyone trying to get a genuinely better technology adopted inside a payment system built around flat, DRG-based reimbursement.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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A care gap is what happens when a transition of care goes wrong: a patient who doesn't understand discharge instructions, doesn't fill a prescription, or has uncontrolled hypertension or diabetes that no one ever adjusts the care plan for. Stacey Richter is re-airing this conversation with Carly Eckert, MD, PhD(c), MPH, a year later because she keeps finding herself quoting Dr. Eckert — even though the interview didn't go the way Stacey originally planned. She wanted to talk about closing care gaps; Eckert redirected the conversation toward something more fundamental: whether "closing care gaps" is even the right model of care to begin with, or just a reactive game of whack-a-mole.

WHAT YOU'LL LEARN

✅ Why "closing care gaps" can function as reactive whack-a-mole — treating each missed preventative opportunity as it surfaces rather than building a genuinely nonfragmented system of care

✅ What a truly nonfragmented state of care would actually require, and why identifying and addressing care gaps is only one piece of a much bigger population health picture

✅ Why taking small, individualized steps with patients matters more than a one-size-fits-all approach, and why peer support carries real, underused power in closing gaps

✅ Why workforce diversity is a meaningful lever for closing care gaps, and where providers still have room to improve transparency with patients

✅ Why provider organizations so often default to reactive, appointment-based care gap closure instead of proactive whole-person population health programs — and why, per Stacey's own follow-up reflection, weak financial incentives are usually the real reason why

WHY THIS MATTERS

Care gaps are expensive and dangerous in ways that compound: uncontrolled hypertension and diabetes left unaddressed for too long lead to heart failure, and chronic kidney disease is often the very thing driving those heart failure readmissions back up. But per Carly Eckert, treating each individual care gap as it appears is a fundamentally reactive model, not a fix. Real progress requires the harder, more upstream work of building genuinely coordinated, nonfragmented care — and, as Stacey noted after a follow-up conversation with Dan O'Neill (EP359), providers won't make that shift until payment models actually reward it.

MENTIONED IN THIS EPISODE

EP322 with Monica Lypson, MD, MHPE: Apple Podcasts | Spotify | Other Apps

EP347 with Ian Tong, MD: 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

🎤 Listen on Apple Podcasts

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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction

05:31 What is the true goal in making population health successful?

05:58 How does the clinical pathway need to manifest in population health?

06:29 How do we get a nonfragmented state of care?

06:54 What is the best model of care?

08:37 "Identifying and addressing care gaps is an important element of population health."

11:30 Closing care gaps vs creating a nonfragmented system of care.

15:38 "I think you have to take small steps with people."

16:45 "There's a lot of power in peer support."

17:18 Why should provider organizations connect with peer groups?

19:05 "The key is that it's not going to be the same for everybody."

23:09 Why is diversity of the workforce key to closing care gaps?

28:36 Where can providers improve transparency to help close care gaps?

In the old country-doctor days of medicine, there wasn't much science — mostly art: comfort and compassion, with little data to guide decisions. Today it's the opposite problem, or maybe the opposite opportunity: real data, real evidence-based standards of care, and a lot less room for going purely on personal recollection of what worked before. In this episode, Stacey Richter talks with Robert Pearl, MD, former 18-year CEO of The Permanente Medical Group, about what it takes to lead physicians through that shift, and why asking doctors to follow evidence-based guidelines instead of relying solely on their own experience can leave some feeling like they're just a cog practicing "cookie cutter" medicine.

WHAT YOU'LL LEARN

✅ Why medicine used to be mostly art (comfort and compassion, little data) and why today's evidence-based standards of care represent a fundamentally different — and more complicated — way of practicing

✅ Why intrinsic physician motivation has declined as standards of care increasingly ask doctors to follow evidence-based guidelines rather than personal experience, and why that can feel like devaluing their expertise

✅ Robert Pearl's "A to G" model for healthcare leadership: aspirational vision, behaviors, context, data, engagement, faculty, and governance

✅ Why financial incentives so often fail to work the way they were designed to in medicine, and what actually drives lasting change instead

✅ What leaders in healthcare organizations consistently underestimate, and why Dr. Pearl says communication and engagement matter more than compensation structure

WHY THIS MATTERS

Medicine's shift from art to science isn't just a clinical evolution — it's a leadership challenge, because asking physicians to follow evidence over instinct can register as a loss of professional identity and autonomy if it's handled poorly. Robert Pearl's framework treats that tension as something leaders have to actively manage, not something that resolves itself once the data is good enough. Getting physician buy-in for evidence-based care, rather than just mandating it, is what determines whether standards of care actually improve outcomes or just breed resentment.

MENTIONED IN THIS EPISODE

EP407 with Vivek Garg, MD, MBA: Apple Podcasts | Spotify | Other Apps

Books: Dr. Pearl's Mistreated and Uncaring

=== 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

🎤 Listen on Apple Podcasts

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=== CONNECT WITH THE RHV TEAM ===

✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X

00:00 Introduction.

04:50 What is the idea of the art of medicine?

09:32 Why has the intrinsic motivation of doctors plummeted?

09:48 Patient perspective versus doctor subjective response.

12:36 Why is there a fundamental change in what doctors and medical professionals can take pride in?

14:38 What did change management look like in the past?

15:24 "What does a patient really want? They'd like not to have a stroke, a heart attack … in the first place."

20:23 "How do leaders achieve evolution?"

23:57 "Incentives always work … the problem in medicine is, they rarely work the way you planned."

24:20 What's the way to make change happen, and why doesn't it involve financial incentives?

28:10 What do leaders in organizations today consistently underestimate?

29:11 What are the three parts of leadership?

29:25 What is the hardest part about leadership?

During the taping of EP409, Larry Bauer and Stacey Richter went on such a tangent about a 2010 JAMA article that it became this Summer Short instead. That article — "Societal Perceptions of Physicians: Knights, Knaves, or Pawns?" by Sachin Jain, MD, MBA, and Christine Cassel, MD — borrows a framework from British economist Julian Le Grand: people (physicians included) get cast as knights, motivated by virtue; knaves, motivated by rigid self-interest; or pawns, passive victims of their circumstances. In this final Summer Short of the season, Bauer and Richter dig into where physicians actually land, and why a small percentage of knave-y behavior ends up painting the whole profession with the same brush.

WHAT YOU'LL LEARN

✅ The knight/knave/pawn framework from British economist Julian Le Grand, and why Stacey and Larry Bauer land firmly on "most physicians are knights" based on who they've actually met in the healing community

✅ Why even a small percentage of knave-like behavior among physicians (revenue-maximizing decisions that hurt patients or colleagues) creates societal spillover that gets the whole profession painted with the same brush

✅ Why policy that restricts things like physician ownership of hospitals is, in part, downstream of that knave-tinted public perception

✅ Why recognizing our own biases about physicians and the medical community matters, and how the "suits versus scrubs" framing oversimplifies a much more nuanced reality

✅ Why getting doctors onto committees and getting policymakers out into the field matters more than abstract accountability measures alone

WHY THIS MATTERS

How society perceives physicians shapes the policy built around them, and Stacey and Larry Bauer make the case that current policy is calibrated for knaves when most physicians they've encountered are knights. That mismatch has consequences: restrictions meant to rein in a small number of bad actors end up constraining the doctors actually trying to do right by their patients. Getting this right requires the kind of self-reflection this episode models — recognizing our own biases, and building policy and committees that reflect who physicians actually are rather than a caricature.

MENTIONED IN THIS EPISODE

EP266 with Matt Anderson, MD, MBA: 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

🎤 Listen on Apple Podcasts

🎤 Listen on Spotify

📺 Subscribe to our YouTube channel

=== CONNECT WITH THE RHV TEAM ===

✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X

00:00 Introduction

07:36 Are physicians knaves or knights?

10:05 "Most of the people … that [I've met], I would actually put under the cap of knights."

10:21 "By and large, the healing community is quite ubiquitous."

10:38 What is more important than accountability in the healing community?

13:42 Why is it important to recognize our own biases in how we view physicians and the medical community?

18:16 Is it "the suits" versus "the scrubs"?

19:08 Why is it important to get doctors on committees and get policymakers on the ground?

A listener wrote in asking Stacey to explain something she'd mentioned on a previous episode without unpacking it: actuarial risk horizons, and how the different timelines actuaries and physicians work on affect patient care. So in this Summer Short, instead of answering it herself, Stacey brought in two actual actuaries — Keith Passwater, former chief actuary at Anthem (Elevance) and founder of Havarti Risk Services, and JR Clark, SVP of health plan product and strategy at Paytient Technologies and a former Anthem actuary — to explain risk horizons directly, and to dig into a bigger problem: most actuarial models don't treat the patient as a stakeholder at all.

WHAT YOU'LL LEARN

✅ What a "risk horizon" actually means to an actuary, and why the time interval over which a plan hopes to affect healthcare costs shapes nearly every downstream decision

✅ Why most actuarial models leave the patient or member out of the equation entirely — despite clear evidence that copays and coinsurance above a certain threshold cause patients to abandon care

✅ Why ignoring the patient as a stakeholder isn't just a moral problem but arguably a math problem: care abandonment has real, sometimes fast-arriving financial consequences for plans

✅ What counts as a "risky investment" from an actuary's point of view, and how keeping premiums down looks different depending on whether the time horizon is short or long

✅ How the length of a risk horizon changes what options are actually on the table for benefit design

WHY THIS MATTERS

Every healthcare transformation effort eventually runs into an actuary's math, whether anyone in the room realizes it or not. When that math treats the patient as an afterthought instead of a stakeholder, the result isn't just worse for patients — it may genuinely be the wrong answer, since abandoned care and delayed diagnoses carry real financial consequences that a patient-blind model simply doesn't see coming. Understanding risk horizons is a starting point for anyone trying to build a better benefit design, and it means getting comfortable working hip to hip with the actuaries setting the timelines.

=== 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

🎤 Listen on Apple Podcasts

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=== CONNECT WITH THE RHV TEAM ===

✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X

00:00 Introduction

02:39 Why is it a problem for actuaries to ignore the patient as stakeholders in benefit design plans?

04:37 What is a risk horizon for actuaries?

05:38 "What's the time interval over which we hope to impact healthcare costs?"

07:25 What is a risky investment from an actuary's point of view?

08:05 How do you keep premiums down when the time horizon is short in an actuary's point of view?

10:31 How do actuaries assess risk horizons or health insurance, and why do they choose those risk horizons?

14:05 What options are on the table when the risk horizon is longer?

16:06 How does the length of risk horizon affect benefit design?

Lauren Vela is back with a Summer Short that started as a section of EP406 that got cut for running tangential to that episode's theme — but the insight is too good to leave on the floor. Lauren's market research turned up three consistent findings when she asked ordinary people about their benefits: nobody reads their benefit information, they're unhappy with it anyway, and the one thing they want most is choice — plus a hard pass on anything that smells like "managed care." Stacey reconciles that with a Henry Ford quote ("If I asked my customers what they wanted, they would have told me a faster horse") and a Steve Jobs line about anticipating what customers want before they can articulate it themselves — because most employees have never actually experienced comprehensive, coordinated primary care, so they can't ask for it. What they have experienced is narrow networks wielding cost containment like a blunt instrument, and HMO-era gatekeeping with impossible wait times. So the "choice" they're demanding may really be a vote against the worst version of managed care they've seen, not a vote against integrated care done well.

WHAT YOU'LL LEARN

✅ The three things Lauren Vela's market research turned up when she asked people outside the healthcare industry about their benefits: nobody reads the materials, they're unhappy anyway, and choice is what they say they want most

✅ Why the Henry Ford "faster horse" quote and Steve Jobs's take on anticipating customer needs both apply directly to employee benefit design

✅ Why most employees have never experienced true comprehensive, coordinated primary care — so asking them what they want in benefit design is asking them to imagine something they've never seen

✅ How narrow networks that exclude things like NCI-designated cancer centers, and HMO-era gatekeeping with long wait times, are what actually shaped employees' distrust of "managed care"

✅ Why rolling out integrated or advanced primary care requires real communication with employees, not just a plan design change

WHY THIS MATTERS

Asking employees what they want in their benefits and then designing around the literal answer can backfire, because most people are reacting to the worst version of managed care they've personally experienced — narrow networks and gatekeeping — not rejecting integrated, coordinated primary care itself, which almost none of them have ever actually experienced. Advanced primary care can save money and produce better outcomes and happier patients and clinicians alike, but none of that works if employers roll it out without explaining what it actually means and how it differs from what employees fear. Communication isn't a nice-to-have here — it's the difference between a benefit design that lands and one that gets rejected on principle.

=== 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

🎤 Listen on Apple Podcasts

🎤 Listen on Spotify

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=== CONNECT WITH THE RHV TEAM ===

✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X

00:00 Introduction

05:15 Do employees really understand what it means to have integrated care?

06:57 Why employees want choice and avoid the notion of managed care.

07:15 "I'm not sure that Americans really know what would be better."

07:19 What would be a better way to do integrated primary care in America?

08:04 How do you fix it without disrupting what everyone thinks would be better?