In Episode 347, Stacey Richter talks with Ian Tong, MD, chief medical officer at Included Health, about the Black Community Innovation Coalition — a new virtual-care program formed by Walmart, six other employers, and Included Health, aimed at combating health disparities among African American workers. The conversation covers how the coalition leverages existing employee resource groups (ERGs) to build engagement directly into program design, rather than treating engagement as an afterthought or a separate "marketing" function bolted on after the fact. WHAT YOU'LL LEARN ✅ What the Black Community Innovation Coalition is, and which partners are behind it ✅ Why a one-size-fits-all approach to employee health benefits isn't adequate or complete ✅ How the coalition uses existing ERGs (employee resource groups) as a channel to build trust and engagement ✅ Why the best practice is building the engagement mechanism into a program's design from the start, not treating it as an afterthought ✅ Why virtual primary care matters for self-insured employers, and why low-value encounters are something the system can't afford WHY THIS MATTERS If you take a one-size-fits-all approach to your employees, that is not going to be adequate or complete. So often engagement is treated as a separate, sequential "marketing" function bolted onto a program after it's already built. The Black Community Innovation Coalition's approach — building engagement into the design itself, using channels like ERGs that already carry trust — is worth considering for anyone trying to improve health equity and outcomes for populations the healthcare system doesn't serve well. MENTIONED IN THIS EPISODE EP338 with Nikki King, DHA: Apple Podcasts | Spotify | Other Apps EP295 with Rebecca Etz, PhD: 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 04:33 What is the Black Community Innovation Coalition? 05:06 Who are the partners behind the Black Community Innovation Coalition? 06:23 How is the Black Community Innovation Coalition focusing on patients? 08:05 "If you take a one-size-fits-all approach to your employees, that is not going to be adequate or complete." 08:56 How the Black Community Innovation Coalition is incorporating engagement into its core foundation. 13:18 "There's a great deal of hesitancy around engaging care, and there's a high level of avoidance." 15:26 EP338 with Nikki King, DHA. 16:34 "The technology is not making that experience worse. It's a bad experience, and it's broken already." 23:27 "I feel very strongly that everyone should probably have a virtual primary care clinician." 27:20 EP295 with Rebecca Etz, PhD. 28:15 "We really want to pay attention to that encounter being the best encounter possible because that … might be the only chance you get to engage that patient." 29:00 Why is virtual care important for self-insured employers? 32:08 "We cannot afford to have low-value encounters."

In this encore episode, Stacey Richter talks with Mike Schneider about the "Big Three" PBMs — Express Scripts, Optum, and CVS Caremark — spinning up their own group purchasing organizations (GPOs) to negotiate rebates with pharma companies. Traditionally, GPOs negotiated volume discounts on drugs and supplies for hospitals and providers; now these new PBM-owned GPOs, several based overseas in places like Switzerland and Ireland, are the entities negotiating rebates directly with pharma — sidestepping domestic rebate pass-through rules aimed at PBMs. WHAT YOU'LL LEARN ✅ Why the "Big Three" PBMs each set up their own GPO — Ascent (Express Scripts), an Ireland-based Optum operation, and Zinc (CVS Caremark) ✅ How these new GPOs differ from traditional GPOs, and why they now sit between PBMs and pharma companies for rebate negotiations ✅ Why an executive order requiring PBMs to pass through rebates to patients doesn't apply to GPOs, especially ones based overseas ✅ How the "Big Three" PBMs compete with each other and how employers choose between them ✅ Why one of the biggest beneficiaries of the rebate system as a whole may be the government itself WHY THIS MATTERS The PBM world as a whole is not very transparent, and moving rebate negotiations into GPO entities — some based in Switzerland and Ireland — makes that transparency problem worse, not better. It's a tangled web: rules designed to force PBMs to pass rebates through to patients don't say anything about GPOs having to do the same. MENTIONED IN THIS EPISODE Encore! EP216 with Chris Sloan: 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 02:48 What does a GPO add to a PBM? 05:23 Rebates vs driving more revenue. 10:39 PBMs vs safe harbors. 12:25 The net impact on the commercial side. 14:07 PBMs vs pharmaceutical manufacturers. 14:54 How the "Big Three" PBMs compete with each other, and how employers would choose between them. 15:56 What the net-net is here. 18:06 How PBMs are shifting their models. 20:42 How GPOs may be making things even less transparent. 21:31 "The PBM world as a whole is not very transparent." 25:00 "One of the biggest beneficiaries of this whole rebate [system] is the government." 25:46 "The question is, 'Who's paying those costs?'" 26:02 Encore! EP216 with Chris Sloan. 27:00 A better way to move money from Pharma to employers and plan sponsors. 28:04 "Put your money where your mouth is."

In Episode 346, Stacey Richter talks with Peter Hayes, president and CEO of the Healthcare Purchaser Alliance of Maine, about how health systems got hooked on charging employers and some patients inflated prices. Peter explains why many hospitals don't do real cost accounting, how nonprofit status and cost-shifting interact, and what self-insured employers can actually do to push back — including owning their claims data and demanding real accountability from carriers and consultants. WHAT YOU'LL LEARN ✅ Why many hospitals don't do real cost accounting, and how that shapes their claims about losing money on Medicare and Medicaid ✅ Whether cost is inversely connected to quality when it comes to hospital care ✅ Why purchasers — not hospitals — have to step up and demand more accountability and transparency if the market is going to change ✅ How new price transparency legislation is impacting plan sponsors and employers ✅ Peter's five pieces of advice for employers looking to limit hospitals' ability to take advantage of them WHY THIS MATTERS A lot of hospitals don't do cost accounting — so if hospitals don't know their own costs, how does Medicare know their costs? There's plenty of accountability to spread around for where the industry is today, but if this market is going to change, it's purchasers who have to step up and start demanding more accountability and more transparency. Nobody else is positioned to make it untenable for health systems to keep charging inflated prices. MENTIONED IN THIS EPISODE EP342 with Christin Deacon: Apple Podcasts | Spotify === 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 07:51 Who are the commercial payers? 08:48 Are hospitals actually losing money on Medicare and Medicaid? 11:26 Is cost inversely connected to quality when it comes to hospital care? 13:46 "A lot of hospitals don't do cost accounting." 13:59 If hospitals don't know their costs, how does Medicare know their costs? 15:52 "In the hospital financial world … they start the budget upside down." 18:48 "There's plenty of accountability to spread around for where we are." 20:30 Do employers have any options in the current health system situation? 21:39 "If this market's going to change, purchasers have to step up and start demanding more accountability, more transparency." 26:21 How is the new transparency legislation impacting plan sponsors and employers? 29:41 EP342 with Christin Deacon. 32:38 "I think the whole dialogue around how we pay for hospital services is going to really change." 32:45 What is Peter's advice to employers?

In Episode 345, Stacey Richter talks with Paul Simms, founder of Impatient Health and former chairman of eyeforpharma, about whether pharma can imagine what our health system will look like in the future. Paul argues that the sheer amount of money sloshing around the industry could actually be inhibiting R&D innovation — if you can make a ton of money without meaningfully improving outcomes, why take the risk of doing something genuinely new? The conversation draws on Clay Christensen's work on disruption and what it takes for a big incumbent to adapt when the habitat changes. WHAT YOU'LL LEARN ✅ Why having a ton of money sloshing around an industry can inhibit R&D innovation rather than fuel it ✅ How Clay Christensen's work on disruption applies to where pharma sits today ✅ Why falling prices could actually spark more innovation, not less ✅ What a "data-driven consumer relationship" business model looks like for pharma companies ✅ Why AQ — the ability to adapt — may matter more than IQ or EQ when an industry's habitat is changing WHY THIS MATTERS When the habitat changes, evolution happens, and entities that are able to adapt will thrive. Pharma is at a catalyst point where it could go one way or the other — and the industry's reaction to the pandemic has largely been "we need to double down" rather than genuinely rethink the model. MENTIONED IN THIS EPISODE EP300 with Bruce Rector, MD: 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 05:04 "We're at that catalyst point where we could go one way or the other." 05:39 How can the analogy of Web 1.0 vs Web 2.0 be applied to the future of healthcare business models? 07:06 "People need to improve their awareness at the very least as to a new generation of companies coming forward." 08:31 "What now is the new business model that can exist in that world?" 09:07 Is there a stage pre-agility that will allow pharma companies to pivot to future markets? 12:08 What are the new ways to think about things in the future of healthcare business? 14:09 "The mind boggles at what is possible but is not yet being achieved." 16:11 Why could prices falling actually spark more innovation? 16:49 EP300 with Bruce Rector, MD. 21:36 "It's these companies that have this data-driven consumer relationship that I think are very interesting." 25:16 "I just think that it's a mindset change first." 25:38 "I'm not here to be right or wrong. I'm just here to enable the conversation." 25:56 "What I find is that companies make significant efforts and that they don't quite gain the same traction as quickly as they might like to." 26:20 "It seems to be this great impatience that companies can turn around these non-medicine initiatives more quickly." 29:42 "It seems to me that the pharmaceutical industry's reaction to the pandemic has been, 'We need to double down.'"

In Episode 344, Stacey Richter talks with Steven Quimby, MD, author of Billions in Your Generic Drugs, about why generic medications — 90% of all prescriptions written in this country — can still carry surprisingly high prices despite razor-thin costs of goods. Dr. Quimby explains the ongoing generic drug price-collusion lawsuits, why generics and branded generics account for just 19% of invoice-level spending but a full 65% of patient out-of-pocket costs, and why so few patients realize their insurance plan may not actually be offering the lowest price. WHAT YOU'LL LEARN ✅ Why generic drug manufacturers are facing major price-collusion lawsuits despite having no R&D costs and low costs of goods ✅ Why generics and branded generics represent 19% of invoice-level spending but 65% of patient out-of-pocket costs ✅ Why the generic drug supply chain is so opaque, and why acquisition and sale prices are hard to pin down ✅ Why so many patients don't know their insurance doesn't always offer the lowest generic drug price — and haven't heard of GoodRx or similar tools ✅ Why it matters for prescribers to know a patient's out-of-pocket drug cost at the point of prescribing WHY THIS MATTERS Ninety percent of the prescriptions written in this country are for generics — five billion scripts a year — so generic medications touch far more lives than new branded drugs. When the industry is this opaque and nobody can get legitimate acquisition and sale prices, the core question becomes: how can we judge value when we don't know price? MENTIONED IN THIS EPISODE AEE13 with Ge Bai, PhD, CPA: Apple Podcasts | Spotify | Other Apps EP241 with Vinay Patel: Apple Podcasts | Spotify EP284 with Carm Huntress: Apple Podcasts | Spotify EP334 with Sunita Desai, PhD: 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 05:54 What are the current lawsuits involved in the generic drug space right now? 06:52 How is price fixing happening in the generic drug space? 07:58 "If I was the major payer for drugs … I'd want to know answers." 08:06 What's the scale on new and generic drugs? 09:02 What's the problem with using price tools for generic drugs? 10:22 "I think right now, virtually everyone should be checking [those sites vs] their insurance price." 10:47 Are payers paying too much for generic drugs? 11:53 Who are these generic manufacturers? 12:10 "They're distinctly different corporations than those that we have called Big Pharma." 13:55 Why is it important to have adequate numbers of manufacturers for generic drugs? 17:03 "We just can't get legitimate acquisition and then sale prices of the actual drugs." 17:17 "The industry's opaque to all of these things." 19:39 "The prices that patients are getting at the prescription counter are so high that some studies say a third of them or more are walking away without buying the drug." 20:02 AEE13 with Ge Bai, PhD, CPA, on the GoodRx model. 20:50 EP241 with Vinay Patel. 22:05 What and who should be on formulary? 26:24 "If they'd give us the numbers, we could see when it happens." 28:58 How can we overcome the challenges of these high generic drug costs? 30:38 EP284 with Carm Huntress. 30:46 EP334 with Sunita Desai, PhD. 31:26 "How can we judge value when we don't know price?"

In Episode 343, Stacey Richter talks with David Carmouche, MD, about what provider leadership teams need to know to operationalize value-based care. Dr. Carmouche breaks down the three things that have to align for value-based care to actually work: the payment model itself, physician and administrative incentives, and leadership skills that can drive the cultural shift from fee-for-service thinking to a team-based, mission-driven approach. WHAT YOU'LL LEARN ✅ Why provider organizations straddling fee-for-service and value-based payment models face real operational and cultural challenges ✅ Why physician and administrative incentives have to align with value-based goals — not reward driving up downstream costs ✅ Why leadership needs to be mission-driven and willing to take short-term revenue hits for longer-term value-based success ✅ How psychological safety for nurses, social workers, and staff connects directly to patient safety scores and quality ✅ What leadership skills — vision, communication, and courage — are required to make value-based care work WHY THIS MATTERS In the value-based care world, a physician has to recast themselves as part of a team — and that's an enormous cultural shift, but ultimately one that the facts mandate. Value-based care is a team sport, and teams require leadership that has a compelling vision and belief that value-based care offers benefits to all of the actors in the healthcare ecosystem. === 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 06:31 How do you operationally deal with conflicting FFS and VBC processes? 07:23 "It's pretty clear in Medicare that our strategy in the future … is one of value." 11:31 "I think a bigger challenge, though, is that in many markets, there are just no opportunities to have experienced value-based care." 13:18 "How do we engage in collaborative relationships that would allow us to move into value?" 14:01 "No one wants to rush through their day in a series of seven-minute visits." 15:53 "In a fee-for-service environment … you're forced to bring people into the office to create an encounter who don't necessarily need to be there." 19:22 "We haven't really changed how we select and train physicians … in the last hundred years." 20:32 "We, as physicians, were taught to be accountable for outcomes; and we create probably an unnecessary and unfair burden on ourselves." 21:30 "In the value-based care world, a physician does have to recast themselves as part of a team." 22:30 "It is an enormous cultural shift … but ultimately, it's one that the facts … mandate." 26:58 "You have to have a compelling vision and belief that value-based care offers benefits to all of the actors in the healthcare ecosystem." 27:24 "You have to be able to communicate effectively across sectors." 27:43 "You have to have courage." 28:29 What are the leadership skills required to make value-based care work?

In Episode 342, Stacey Richter talks with Christin Deacon about how the Consolidated Appropriations Act (CAA) and ERISA fiduciary requirements are an anchor for self-insured employers navigating the complexity of healthcare. Christin explains what ERISA fiduciary responsibility actually means, why self-insured employers — not their brokers or consultants — bear that responsibility, and why owning claims data is the linchpin for knowing whether a plan is paying reasonable fees. WHAT YOU'LL LEARN ✅ What ERISA is, and what fiduciary obligation actually means for a self-insured employer ✅ Why brokers and consultants don't bear ERISA fiduciary responsibility or CAA compliance — the employer does ✅ Why owning your claims data is the linchpin for knowing whether your plan is paying reasonable fees ✅ Why HIPAA doesn't actually block a self-insured employer, as a covered entity, from accessing deidentified claims data ✅ What's new in the Consolidated Appropriations Act (CAA), and how it ups the ante on fee disclosure WHY THIS MATTERS If you don't have your claims data, how do you know you're paying reasonable fees? The self-insured market holds the keys to unlocking value in healthcare — they're just not always using them. ERISA fiduciary responsibility only has as much teeth as the self-funded employer is willing to learn about it and willing to push back. === 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 04:10 What is ERISA, and what does it stand for? 05:40 What is a fiduciary obligation for an employer? 08:18 "We're now at a point of spending 17.7% of our GDP on healthcare costs." 09:39 "You absolutely have the keys to … controlling that spend." 13:35 "You have to own your data." 15:04 "If you don't have your claims data, how do you know you're paying reasonable fees?" 15:31 "If your carrier is telling you, 'Oh, HIPAA … you can't look at your data,' you need to pull out that red BS card." 16:25 How do employers navigate carriers refusing to share claims data? 21:36 "It has only as much teeth as the self-funded employer is … willing to learn about it and … willing to push back." 22:22 "This is not aspirational; this is an absolute floor." 24:11 "What does value mean?" 27:41 "Become familiar with HIPAA beyond just the privacy piece." 29:30 "At the end of the day, it's about people." 29:38 "If you're not paying reasonable fees, you're using plan assets to enrich others." 32:21 "The self-insured market … they hold the keys to unlocking value. And they're holding them; they just have to use them." 34:10 Marshall Allen's new book.

In Episode 341, Stacey Richter talks with Gary Campbell, CEO of Johnson Health Center, a Federally Qualified Health Center (FQHC) in Lynchburg, Virginia, about how to cut administrative waste while also attracting and retaining doctors and nurses. Gary explains why FQHCs, with no ability to cost-shift to commercial payers, have to be efficient by necessity — and why the process of cutting waste, done right, produces the same culture and process discipline that makes an organization a great place to work. WHAT YOU'LL LEARN ✅ Why FQHCs have zero ability to cost-shift, and why that forces real operational efficiency ✅ How overstaffing without workflow analysis can actually drive cost per patient up, not down ✅ Why cutting administrative waste and becoming a great place to work are two sides of the same coin ✅ Why effective leadership — visible, values-driven, willing to have hard conversations — is the real lever behind operational efficiency ✅ How core values, consistently applied, can guide every organizational decision WHY THIS MATTERS An estimated 25% of the $3.6 trillion the US spends on healthcare annually is potentially wasteful — and reducing administrative waste may be the safest form of healthcare cost savings, since virtually no one argues administrative costs should stay high. But getting there isn't a lean/Six Sigma exercise so much as a leadership exercise: it all ladders up to leaders who commit to putting patients first and who actually live their organization's core values. === 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 05:15 Why is there no opportunity to cost shift in an FQHC? 05:46 What happens when an FQHC is operating inefficiently? 06:12 "Have you workflowed it out? … You can overstaff yourself in a way that your cost per patient goes way up." 06:37 Why is taking a lean approach not an excuse to cut staff? 08:05 "The nurses are linchpins to everything." 09:05 How does standardizing care lead to personalization of care? 10:28 "Our clinical teams see that we care." 10:48 "If you don't have a vision for where you want to be two and three years down the road, you're struggling." 11:03 "I want everybody to understand, What is their why?" 20:10 "They don't teach leadership in most medical schools."—Dr. Robert Pearl 21:19 "Get to know these clinicians … sincerely." 23:11 "From a core values perspective, you can make every single decision … on core values." 23:35 "We always start with those values. … They're embedded in everything we do." 24:16 "You have to project plan things out that you want." 25:09 How does an FQHC or private practices that are patient-oriented attract talent? 30:45 "First and foremost, be visible."

In Episode 340, Stacey Richter talks with Kristin Begley, PharmD, chief commercial officer at Wildflower Health, about how digital front doors can enable value-based care. Kristin describes the next generation of digital front doors — portals that fold in payer, provider, and employer data, plus a patient's own behavioral data — to spot rising risk early and steer patients toward the right care, and even toward value-based provider arrangements, before a costly ER visit happens. WHAT YOU'LL LEARN ✅ What a "digital front door" actually means in healthcare, and how the next generation connects payer, provider, and employer data ✅ How a shared portal can flag rising patient risk early enough to intervene before an ER visit ✅ Why patient engagement is the hardest part of making digital front doors work ✅ How digital front doors can also serve as a shared, neutral space where value-based arrangements between providers and payers actually function ✅ Why personalized content for patients is essential to succeeding in value-based care WHY THIS MATTERS How will providers and payers ever be successful in value-based care if we don't have activated, educated, motivated patients? Digital front doors aren't just a convenience layer — they can be the hub where payer, provider, and employer data come together to actually make value-based arrangements work, while also easing the administrative burden that leads patients to delay or forgo care. === 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 04:20 What do we mean by "digital front door" in healthcare? 05:27 "In healthcare, the next generation of digital front door is connecting all those stakeholders that try to help patients stay healthier." 06:20 "What we're trying to migrate to is … walk into any front door." 07:24 Why is engagement the hardest part? 10:24 "Are they digital providers … or are they healthcare providers?" 12:25 "When we live in a capitalistic healthcare system, we all have a price tag on our head." 14:01 "How will providers and payers ever be successful in value-based care if we don't have activated, educated, motivated patients?" 16:36 "I don't know how … we succeed in value-based care without having … personalized content for everyone." 18:24 "What does a consumer want?" 26:52 How does Wildflower Health achieve their value-based care network effect? 29:54 What do stakeholders want relative to value-based care?

In this An Expert Explains episode, Stacey Richter talks with David Contorno, founder of E Powered Benefits, about employers and reference-based pricing (RBP). David explains how reference-based pricing actually works — employers paying providers some percentage over a reference point like the Medicare rate — and how to do it in a way that avoids the balance-billing problems that have given RBP a bad reputation. WHAT YOU'LL LEARN ✅ What reference-based pricing (RBP) actually means, and how employers typically set a percentage over the Medicare rate ✅ Why RBP has gotten a reputation for balance bills, and how to structure it so that doesn't happen ✅ What pricing methodology 97% of healthcare is actually using ✅ Why hospitals have multiple revenue streams, and why the commercial rate is consistently the highest of them ✅ How E Powered Benefits has worked to minimize the noise and confusion around reference-based pricing WHY THIS MATTERS Very few people really recognize that hospitals have multiple revenue streams — and of those streams, commercial is consistently the highest price. Reference-based pricing done right doesn't have to result in balance bills for employees; the problems show up when it's done without the right guardrails in place. === 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 01:37 What does good reference-based pricing look like? 01:57 What is the pricing methodology that 97% of healthcare is using? 04:25 How has E Powered Benefits minimized the noise around reference-based pricing? 04:55 "You're getting what we view as balance bills all the time." 06:47 "What very few people really recognize is that hospitals have multiple revenue streams." 07:36 "Which is the highest price? The answer is, commercial."