Relentless Health Value

Lessons for Private Equity and Others Trying to Do Right by PCPs and Their Patients, With Scott Conard, MD (EP391)

One Doctor's Journey Shows What Happens When Good Primary Care Meets Bad Incentives. Episode 391.

Stacey Richter talks with Scott Conard, MD, who shares his personal journey building a 510-clinician value-based primary care practice—and what happened to patient care after it was acquired by a hospital system with misaligned incentives.

WHAT YOU'LL LEARN

✅ Why a PCP can produce high-value care even within a fee-for-service model, given the right practice patterns

✅ How working in name-only "teams" without real support sets primary care up to fail

✅ What a "Whole-Person Risk Score" is and how it shifts care from transactional to relational

✅ Why doctors get pushed and pulled by decisions made far above the clinic level

✅ How one North Texas health system acquisition raised community healthcare spend by $100 million in a single year

✅ Why moral injury—not just burnout—results when good clinicians watch misaligned incentives override patient care

WHY THIS MATTERS

Conard's story is a case study in how even a proven, cost-saving value-based practice can get swallowed by incentives that prioritize revenue over population health. Understanding this pattern helps private equity, health systems, and PCPs themselves recognize the warning signs before good care gets sacrificed to fiduciary euphemisms.

MENTIONED IN THIS EPISODE

Encore! EP335 with Brian Klepper, PhD: Apple Podcasts | Spotify | Other Apps

EP381 with Karen Root: Apple Podcasts | Spotify | Other Apps

EP364 with David Muhlestein, PhD, JD: Apple Podcasts | Spotify | Other Apps

EP384 with Wendell Potter: Apple Podcasts | Spotify | Other Apps

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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=== CONNECT WITH THE RHV TEAM ===

✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X

00:00 Introduction.

05:26 What triggered Scott's career journey?

06:02 What caused Scott to rethink what is good primary care?

06:42 Why did Scott realize that he is actually a risk-management expert as a primary care doctor rather than someone who treats symptoms?

07:56 Encore! EP335 with Brian Klepper, PhD.

08:24 How did Scott's practice change after this realization?

08:35 What is a "Whole-Person Risk Score"?

11:37 "You start to move from a transactional model to a relationship model."

14:02 Did Scott have any risk-based contracts?

14:39 Why is it so important to look at total cost of care and not just primary care cost?

20:44 EP381 with Karen Root.

29:14 Why did Scott move over to help corporations?

31:42 EP364 with David Muhlestein, PhD, JD.

32:22 "Everybody thought they were honoring their fiduciary responsibility, and the incentives are completely misaligned."

33:02 EP384 with Wendell Potter.

33:15 "It's the system that's broken; it's not bad people."

What Legislators Need to Know About Hospital Prices, With Gloria Sachdev, PharmD, and Chris Skisak, PhD (EP390)

Why Hospital Balance Sheets Are Often as Much PR Campaign as Financial Statement. Episode 390.

Stacey Richter talks with Gloria Sachdev, PharmD, of the Employers' Forum of Indiana, and Chris Skisak, PhD, of the Houston Business Coalition on Health, about what legislators need to understand about hospital pricing—and how the Sage Transparency dashboard reveals which hospitals are operating on thin margins versus padding their balance sheets.

WHAT YOU'LL LEARN

✅ Why some hospital financial statements dress up healthy margins as financial distress

✅ How the Sage Transparency dashboard shows what a hospital actually needs to charge to break even

✅ Why nearly half of patients deferred care due to cost in 2022, even those with "good" insurance

✅ What legislative strategies employer coalitions are pursuing to bring rigor back to hospital pricing

✅ Why physician independence matters to a functioning, competitive healthcare market

✅ How employers becoming present in the legislative process can shift the balance of power

WHY THIS MATTERS

Legislators often take hospital financial-distress claims at face value, but Sachdev and Skisak's coalition-building work shows the data tells a different story for many systems. Transparency tools like Sage give employers, policymakers, and communities the leverage to distinguish real financial hardship from a well-dressed PR campaign.

MENTIONED IN THIS EPISODE

EP334 with Sunita Desai, PhD: Apple Podcasts | Spotify | Other Apps

EP373 with Cora Opsahl: Apple Podcasts | Spotify | Other Apps

EP385 with Dan Mendelson: Apple Podcasts | Spotify | Other Apps

EP379 with AJ Loiacono: 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

📺 Subscribe to our YouTube channel

🎤 Listen on Apple Podcasts

🎤 Listen on Spotify

=== CONNECT WITH THE RHV TEAM ===

✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X

00:00 Introduction.

06:04 How could the healthcare market correct itself?

08:27 EP334 with Sunita Desai, PhD.

09:38 What strategies are needed to make changes in the healthcare market?

10:13 What can be done with respect to market forces?

12:33 What needs to happen in regard to healthcare legislation?

13:03 Gloria's ideas for legislation.

15:44 Why is it important to allow physicians to be independent again?

17:41 EP373 with Cora Opsahl.

18:21 Chris's thoughts on legislation.

22:51 Why is it important that employers become present in the legislative process?

26:48 What has been immensely helpful to better understand hospital financials?

31:08 EP385 with Dan Mendelson.

31:16 EP379 with AJ Loiacono.

32:11 Why is transparency foundational for healthcare market change?

The Clapback When Hospitals Cannot Constrain Their Own Prices, With Mike Thompson (EP389)

Why Nonprofit Status Lets Some Hospitals Avoid Market Discipline on Pricing. Episode 389.

Stacey Richter talks with Mike Thompson, CEO and president of the National Alliance of Healthcare Purchaser Coalitions, about why nonprofit status shields some hospitals from FTC scrutiny and financial discipline—and what employers can do to push back on unfair pricing.

WHAT YOU'LL LEARN

✅ Why nonprofit status excludes some hospitals from the FTC enforcement powers other industries face

✅ How overbuilding infrastructure, like extra MRI machines, can trigger a downward spiral into anticompetitive pricing behavior

✅ Why there's no correlation—and sometimes an inverse one—between high hospital prices and high quality

✅ The National Alliance's five-strategy playbook: check the fair commercial price, use reference-based pricing, monitor your ASO/TPA, join employer coalitions, and pursue legislation

✅ What the Sage Transparency dashboard shows about the gap between what hospitals charge and a fair commercial break-even price

✅ Why regulating uncooperative nonprofit hospitals like utilities may become a necessary last resort

WHY THIS MATTERS

When nonprofit status insulates a hospital from both market competition and antitrust enforcement, patients, employers, and taxpayers absorb the cost. Thompson's playbook gives purchasers concrete tools—starting with knowing the fair local price—to push back instead of just paying whatever gets billed.

MENTIONED IN THIS EPISODE

EP372 with Cora Opsahl: Apple Podcasts | Spotify | Other Apps

EP358 with Wayne Jenkins, MD: Apple Podcasts | Spotify | Other Apps

EP388 with Merrill Goozner: Apple Podcasts | Spotify | Other Apps

EP346 with Peter Hayes: 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

📺 Subscribe to our YouTube channel

🎤 Listen on Apple Podcasts

🎤 Listen on Spotify

=== CONNECT WITH THE RHV TEAM ===

✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X

00:00 Introduction.

05:37 Check EP372 with Cora Opsahl; EP358 with Wayne Jenkins, MD; EP388 with Merrill Goozner; and EP346 with Peter Hayes for a deep dive.

05:48 Why should an employer health plan be concerned about how much area hospitals are spending?

07:01 How are hospitals quantifying their prices?

08:10 "I think we're not paying a fair price is the end game."

10:45 How do we bring rigor back into the market?

11:12 What is NASHP?

15:10 What does the NASHP commercial breakeven take into account?

18:24 Why are hospitals conflicted when it comes to building a health system based on value and health?

20:17 Why is the onus on hospitals to defend the way they've spent the money they have?

21:58 "Where there are market dynamics, we typically see prices in that fair price range."

25:06 What can employers do from a market standpoint, a program design point, and a policy standpoint?

27:11 What is the National Alliance of Healthcare Purchaser Coalitions playbook?

30:15 Why is changing the dynamics in the press important to changing hospital pricing?

33:02 How fundamental is the employer's role in making sure that they're paying a fair price for the healthcare services their employees are receiving?

The Unfortunate News About HRRP, With Insight Into How to Fix It, With Rishi Wadhera, MD, MPP (Encore! EP326)

In this Encore, Stacey Richter revisits her conversation with Rishi Wadhera, MD, MPP, a cardiologist at Beth Israel Deaconess Medical Center, about why the Hospital Readmissions Reduction Program (HRRP) may be doing more harm than good — and how Goodhart's Law explains why.

WHAT YOU'LL LEARN

✅ What Goodhart's Law is: "When a measure becomes a target, it ceases to be a good measure"

✅ Why the 30-day readmission measure at the heart of HRRP is an incomplete, yes-no measure of hospital quality

✅ Why HRRP has disproportionately penalized hospitals serving poorer, more disadvantaged communities

✅ Why blunt, nationally rolled-out policies elicit mixed behavioral responses that policymakers should rigorously test first

✅ What a better approach to quality improvement might look like instead of anchoring it so tightly to payment

WHY THIS MATTERS

HRRP was designed to incentivize better discharge planning and follow-up care, but Dr. Wadhera's research shows it instead became a textbook case of Goodhart's Law — a blunt, poorly risk-adjusted policy that penalizes hospitals for factors like poverty and housing instability that are entirely outside their control. Two recent JAMA pieces now call for CMS to retire the policy altogether.

MENTIONED IN THIS EPISODE

Encore! EP295 with Rebecca Etz, PhD: Apple Podcasts | Spotify (pod.link, unconfirmed — Spotify outage) | 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

📺 Subscribe to our YouTube channel

🎤 Listen on Apple Podcasts

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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction

03:30 What was the Hospital Readmissions Reduction Program intended to do?

05:22 Why did CMS think some readmissions were preventable?

06:02 "The spirit of the HRRP was to incentivize hospitals to improve…discharge planning, transitions of care, and post-discharge follow-up."

06:58 How has research in the last few years changed thinking on the effectiveness of HRRP?

08:16 "The 30-day readmission measure — it's an incomplete measure."

11:48 "I think patients…are smart, and they know what's going on."

13:34 "What's happening is, we're just increasing the number of times they need to come back to the ER within that 30-day period."

13:55 "The weird thing about the HRRP is that when it evaluates hospitals' 30-day readmission rates, it's a yes-no phenomenon."

15:03 "What CMS does is, it risk adjusts…and that is what we should be doing."

18:30 "This program has been incredibly regressive."

19:04 "Poverty, neighborhood disadvantage, housing instability — these factors are out of hospitals' control."

21:50 "Blunt policies like this that are rolled out nationally probably elicit mixed behavioral responses."

22:06 "It just makes no sense to take resources away from hospitals."

22:32 Encore EP295 with Rebecca Etz, PhD, of The Larry A. Green Center.

23:47 What's the way to improve quality of care globally?

25:37 "CMS's approach to improving quality of care has really anchored…that to payment."

26:08 "It's time for us to rethink what our approach to quality improvement should be."

29:22 "Policy makers have an obligation to rigorously test the impact of these types of policies before they roll them out nationally."

31:41 Can you scale healthcare nationally?

PBM Spread Pricing on Generics, and Why GoodRx and Amazon Are Forcing a Response, With Ge Bai, PhD, CPA (Encore EP356)

How Spread Pricing Lets PBMs Profit — and Why GoodRx and Amazon Pharmacy Are Forcing a Change. Encore Episode 356.

The so-called Big Three pharmacy benefit managers — Express Scripts (ESI), OptumRx, and CVS — handle pharmacy benefits for roughly 95% of insured Americans, and they profit from spread pricing, a hidden markup on the generic drugs that make up 90% of all prescriptions written in the US. Now GoodRx, Amazon Pharmacy, Mark Cuban's CostPlusDrugs.com, and cost-plus pharmacies like Blueberry in Pittsburgh are exposing that spread and pulling patients out of their insurance entirely — and the PBMs are fighting back. In this encore episode, Stacey Richter revisits her conversation with Ge Bai, PhD, CPA, professor of accounting at the Johns Hopkins Carey Business School and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, about what this shift means for self-insured employers, plan sponsors, and patients.

WHAT YOU'LL LEARN

✅ How spread pricing lets PBMs collect a hidden markup between what plan sponsors and patients pay for generic drugs and what the PBM actually pays the pharmacy

✅ Why Express Scripts rolled out a Right Price solution that automatically applies discounts to generic prescriptions — a defensive response to losing patients to GoodRx and Amazon Pharmacy

✅ How Amazon's discount card and cost-plus pharmacies are forcing PBMs to compete on price for generic drugs for the first time

✅ Why UnitedHealth Group, the parent company of OptumRx, posted $24 billion in profit in 2021 — and what that says about how PBMs make money off generic drug arbitrage

✅ Why Ge Bai says naive plan sponsors are a big problem, and why she believes PBMs have to give a slice of their profit back to consumers

✅ Why 90% of prescriptions written in the US are for generic drugs, and how that scale is what makes PBM spread pricing so lucrative

WHY THIS MATTERS

For years, the Big Three PBMs collected what amounted to free money in the spread between what plan sponsors and patients paid for generic drugs and what the PBM paid the pharmacy — protected by contract terms that kept cash-pay pharmacy prices artificially high. GoodRx, Amazon Pharmacy, and a new wave of cost-plus pharmacies are breaking that information monopoly, giving patients and self-insured employers visibility into how much markup is built into a generic prescription. As Ge Bai puts it, this could be a potential sea change — but only if plan sponsors stop being naive about how PBM pricing actually works.

MENTIONED IN THIS EPISODE

EP344 with Steven Quimby, MD: Apple Podcasts | Spotify | Other Apps

EP334 with Sunita Desai, PhD: 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.

08:39 What is ESI doing by automatically applying discounts to generic drugs?

09:53 Why are PBMs losing money when consumers don't use their benefit?

10:40 "GoodRx disrupted the ongoing game."

10:58 How are PBMs using the Amazon discount card to discourage their patients from moving away from using their benefits?

12:07 Amazon pricing versus GoodRx pricing.

12:44 How much money is a PBM really making?

14:37 How is future fear playing into the PBM business model?

16:49 Is there a negative consequence to subtracting from the bottom line in a PBM model?

17:44 "I think to have strong PBMs does not mean necessarily bad things for patients."

19:33 What happens if everyone uses Amazon for drugs?

22:33 If every PBM gets their own discount cards, what will happen?

25:32 "We are actually witnessing a potential sea change."

26:19 How do cost-plus pharmacies factor into the current market?

29:09 Is a profit shortfall inevitable?

29:28 "PBMs have to give a slice of their profit back to consumers. That's just reality."

30:05 Can anything be done on the PBM side to generate a higher margin in the generic space?

31:34 "Naive plan sponsors are a big problem."

Harnessing the Miracle of the Commons to Improve the Patient Journey Nationwide, A Conversation With Dave Dierk, Co-President of Aventria Health Group (INBW37)

Stacey Richter is joined by Dave Dierk, co-president of Aventria Health Group, to introduce Groundswell — Aventria's framework for getting diverse healthcare stakeholders to collaborate on closing care gaps, inspired by Elinor Ostrom's Nobel Prize-winning "miracle of the commons" research.

WHAT YOU'LL LEARN

✅ What Aventria's Groundswell Solution is and how it improved best-practice guideline usage for end-stage liver disease patients by 23% nationally

✅ What Elinor Ostrom's Nobel Prize-winning "miracle of the commons" research reveals about how humans collaborate to solve shared problems

✅ Why simply flagging a care gap — without knowing the how or why — is enough to start a Groundswell collaboration

✅ How curated, highly targeted information delivered at the point of care can close awareness gaps for clinicians

✅ Why understanding each stakeholder's different goals is essential to serving "many masters" in a successful collaboration

WHY THIS MATTERS

Aventria's Groundswell work shows that diverse stakeholders — even ones with different, sometimes competing goals — can collaborate to meaningfully close care gaps when the effort starts small, with a flagged gap and a willingness to meet people where they are. The 23% national improvement in liver disease guideline adherence is proof that this kind of grassroots, cross-stakeholder collaboration scales.

=== 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

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=== CONNECT WITH THE RHV TEAM ===

✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X

00:00 Introduction

03:03 How can areas of improvement be flagged in such a fragmented patient care journey?

04:06 What is "the miracle of the commons"?

04:54 How is the miracle of the commons being used at Aventria and QC-Health?

07:51 What is Groundswell, and how does it utilize the miracle of the commons?

11:13 "Is the answer, then, to drive more knowledge and more awareness?"—Dave

11:35 "What about using technology to provide curated, highly targeted information that can support them at the point of care?"—Dave

13:25 "You want to identify where these gaps are across the full spectrum of the journey."—Dave

15:08 "This is something that is not commonly happening on its own."—Dave

16:40 "Done in the right way, people are excited…to improve care and improve outcomes."—Dave

18:50 "Our aim is really to meet people and teams where they are."—Stacey

19:35 "You don't have to know how or why or where — merely that I think this outcome is not what it could be. That's the place to start."—Dave

20:01 "You have to understand the different goals of the different stakeholders."—Dave

21:14 "If we can do the right things the right way, then we can serve many masters."—Dave

Merrill Goozner on the Future of Healthcare and Glide Paths to Get There. Three Realistic Glide Paths to Rightsizing Healthcare Spending Relative to GDP. Episode 388.

Stacey Richter talks with Merrill Goozner, former editor in chief of Modern Healthcare and author of The $800 Million Pill, about three concrete glide paths that could bring U.S. healthcare spending down toward a more sustainable share of GDP.

WHAT YOU'LL LEARN

✅ Why the goal isn't cutting healthcare spending outright but holding cost growth below GDP growth

✅ How high-deductible plans are driving patients to avoid care out of fear of what the bill will be

✅ The three glide paths Goozner proposes: accountable care with real provider budgets, paying primary care more and salarying physicians, and all-payer pricing like Maryland's

✅ Why patients, employers, and taxpayers converging on "no more" is the spark needed to start the transformation

✅ How technology and new market entrants could chip away at incumbent hospitals that have broken trust with their communities

✅ Why removing the incentives that reward low-value care is the throughline connecting all three glide paths

WHY THIS MATTERS

Predictions of a healthcare cost reckoning have been wrong for a decade, but Goozner's framework—paired with concrete mechanisms like all-payer pricing and accountable budgets—gives stakeholders an actual roadmap instead of another vague call to bend the cost curve.

MENTIONED IN THIS EPISODE

EP364 with David Muhlestein, PhD, JD: Apple Podcasts | Spotify | Other Apps

EP363 with David Scheinker, 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

✉️ 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.

06:24 How is the rise of the high-deductible plan affecting the nation's health?

07:20 What is one of the big issues not being discussed in America today?

08:33 What kind of tipping point is in store for hospitals in this decade?

09:01 What two trends are we going to see in healthcare in the coming decade?

10:50 What are the ways in which the changes in healthcare go well, and what pitfalls do we need to look out for?

11:14 "[This] is about what is sustainable and what is not sustainable."

12:35 "Healthcare is misnamed. It's sick care."

13:12 Why do we need to talk more about who gets sick in this country?

13:51 "Pricing is part of the problem, but volume is the other part [of the problem]."

15:40 "The world is gonna change, you're gonna change, and we're gonna provide you a glide path … because this is what we need as a society."

17:20 What should be the overall goal for healthcare spend?

18:45 EP364 with David Muhlestein, PhD, JD.

19:40 Why do we need to address physician pay?

25:31 Why does the single pricing system create equality?

30:11 EP363 with David Scheinker, PhD.

30:34 EP370 with Erik Davis and Autumn Yongchu.

30:55 What are the three glide paths for the future of healthcare?

Medicare Advantage Trends and How Medicare Advantage Plans Will or Will Not Succeed, With Betsy Seals. What Separates Medicare Advantage Plans That Succeed From Those That Flame Out. Episode 387.

Stacey Richter talks with Betsy Seals, CEO and cofounder of Rebellis Group, about the critical success factors—scale, broker and provider relationships, and hyperlocal market knowledge—that determine whether a Medicare Advantage plan thrives or crashes into regulatory scrutiny.

WHAT YOU'LL LEARN

✅ Why big MA carriers can succeed financially through scale, specialized departments, and deep local market knowledge

✅ Why a benefit design that works well in one market can be a medical-trend disaster in another

✅ What issues upstarts commonly overlook when entering the Medicare Advantage market

✅ Why risk-based contracting between MA plans and physician groups is a key driver of quality outcomes

✅ What special needs plans (SNPs) are and why they're becoming a bigger trend in the MA space

✅ Why "Is MA better than traditional Medicare?" doesn't have one universal answer—it depends on the patient and the specific plan

WHY THIS MATTERS

The MA-versus-traditional-Medicare debate often gets flattened into a binary argument, but Seals's on-the-ground consulting experience shows outcomes hinge on execution—local knowledge, provider risk arrangements, and compliance discipline—not just which program a beneficiary is enrolled in.

MENTIONED IN THIS EPISODE

No past-episode citations in this episode's timestamped chapter list.

=== 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

📺 Subscribe to our YouTube channel

🎤 Listen on Apple Podcasts

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=== CONNECT WITH THE RHV TEAM ===

✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X

00:00 Introduction.

06:16 Is Medicare Advantage still a cash cow?

06:42 Why should Medicare Advantage be the most lucrative line of business?

07:07 "If there weren't a lot of money in it, nobody would do it."

07:29 What should you know before jumping into the Medicare Advantage market?

14:04 What issues do upstarts overlook when getting into Medicare Advantage?

17:07 What is one of the next areas that Betsy thinks CMS will crack down on?

18:24 "Look at the data."

19:53 "I think there's a lot of lessons that you could see over the past years in the industry."

20:52 "That's what we see a lot of times is expansion without enough due diligence and thought put behind it."

21:02 Why don't common business models always work in healthcare businesses?

22:29 What are the new key trends coming out of the Medicare Advantage space?

26:04 Why is it important to bring in your clinicians when entering a dual market?

27:52 What's going on in the chronic conditions space?

32:14 What's necessary to the infrastructure with any kind of SNP product?

32:56 What's Betsy's forecast for the future of Medicare Advantage?

Will Healthcare Stakeholders Who Don't Collaborate Wind Up With a Business Problem? (INBW36)

Stacey Richter recaps the "why collaborate" argument from two earlier inbetweenisodes, then makes the financial case: real-world examples from ChenMed, the Nuka System of Care, and others show that paying for health instead of sick care improves outcomes, patient satisfaction, and the bottom line.

WHAT YOU'LL LEARN

✅ Why multi-morbid Medicare patients seeing 5 to 13 doctors makes coordination essential, not optional

✅ Real-world proof points from ChenMed, Johns Hopkins, and the Nuka System of Care showing coordinated care improves outcomes and cuts costs

✅ Why physicians in pay-for-health models report less burnout than those stuck in fee-for-service's "two canoes messy middle"

✅ Financial evidence that taking on risk pays off, from Ochsner's Medicare Advantage strategy to One Medical's Iora-driven revenue

✅ Why CMS is pushing traditional Medicare toward 60% risk-based accountability by 2024 and 100% by 2030

WHY THIS MATTERS

The case for healthcare stakeholder collaboration isn't just moral — it's financial. From reduced hospitalizations at ChenMed to Nuka's 96% patient satisfaction rate, the evidence shows that aligning payers and providers around paying for health, not sick care, improves outcomes, reduces burnout, and increasingly pencils out for the organizations willing to take on risk.

=== 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

📺 Subscribe to our YouTube channel

🎤 Listen on Apple Podcasts

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=== CONNECT WITH THE RHV TEAM ===

✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X

00:00 Introduction

05:03 When physician practices get paid to deliver health and not paid for sick care, does patient health actually improve?

05:46 What is the ChenMed Case Study?

06:26 Can a care coordination model be associated with improved outcomes, including substantial cost reduction?

06:38 Are there examples of really great patient results when care is coordinated and payers are aligned to pay for health?

07:29 Do patients actually want this stuff?

07:46 Are employees choosing lower-cost plans just as much for the lower premiums as for the care coordination?

08:29 What is the Nuka System of Care in Alaska?

09:25 "Any physician practices looking to take better care of patients…get aligned with payers (CMS or otherwise). That's step one."

10:45 Are doctors happy in these models where payers are paying for health?

11:16 "Burnout reduces here because burnout is moral injury in a cheap Halloween costume." —Physician leader

13:25 "There's a world of difference between a well-functioning accountable care model and a very terrible one."

13:59 "Life can get really hard for PCPs…they get to be care gap cowboys and cowgirls while, at the same time, having to do all of the FFS coding."

14:43 Is taking on risk worth it from a financial standpoint?

16:05 "There's likely a downside to making zero effort on the accountable care front and banking on FFS being a forever cash cow."

17:11 "I have never seen my entire career more CEOs of Fortune 500 companies…who are actively taking a role in their employee health benefits."

17:54 "Only high-performing docs are in network — and this includes specialists."

Everybody in the Healthcare Industry Getting Up in Everyone Else's Business, With Eric Bricker, MD (Encore! EP351)

In this Encore, Stacey Richter revisits her conversation with Eric Bricker, MD, founder of AHealthcareZ and medical director of SimplePay Health, about the horizontal and vertical consolidation reshaping healthcare — and why everybody, from payers to digital health disruptors, is increasingly swimming in everyone else's lane.

WHAT YOU'LL LEARN

✅ Why horizontal consolidation among payers, PBMs, and hospital systems has pushed commercial insurance costs up 4x the rate of other goods and services

✅ How high healthcare costs contribute to wage stagnation, since money spent on premiums is money not spent on salaries

✅ Why vertical integration — payers, providers, and PBMs all moving into each other's traditional territory — is reshaping competitive dynamics

✅ Why no competition means little incentive to improve patient experience, since there's nowhere else for members to go

✅ Why the payment change has to come first before behavior actually changes

WHY THIS MATTERS

Decades of horizontal and vertical consolidation have left patients with fewer alternatives and less negotiating power, while the resulting lack of competition removes any real incentive for payers, PBMs, or hospital systems to improve patient experience. Dr. Bricker's blunt read — "the money wins" — is a reminder that fixing this requires changing the financial incentives first, not waiting for good behavior to show up on its own.

MENTIONED IN THIS EPISODE

EP330 with John Marchica: Apple Podcasts | Spotify (pod.link, unconfirmed — Spotify outage) | Other Apps

EP343 with David Carmouche, MD: Apple Podcasts | Spotify (pod.link, unconfirmed — Spotify outage) | Other Apps

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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00:00 Introduction

05:50 What is this "megatrend" happening in healthcare right now?

07:11 How has consolidation changed the healthcare landscape?

09:41 What is vertical integration within healthcare?

11:07 Why doesn't inorganic growth benefit patients?

12:52 "What is best for the patient does not necessarily make the most money."

14:02 "It's not that it's above the law…it is just intentionally obscured."

18:16 "Healthcare is glacial. It is slow."

22:36 "The largest source of healthcare costs is hospitals."

25:00 EP330 with John Marchica.

28:20 "What have the historical priorities been of the administrators of those hospitals?"

28:35 "Every hospital CFO knows that they need sick people."

29:21 EP343 with David Carmouche, MD.

30:01 "The payment change has to come first."

31:19 "The money wins."

33:16 "You've got to put the financial incentives in place…to make people actually behave the way that they should."