Relentless Health Value

In Episode 330, Stacey Richter talks with John Marchica, CEO of Darwin Research Group, about what an ongoing quarterly research study reveals about how health systems and integrated delivery networks (IDNs) are strategizing and reacting coming out of the COVID-19 pandemic.

WHAT YOU'LL LEARN

✅ What Darwin Research Group's top three health system findings were during COVID

✅ Why health systems have a renewed focus on primary care

✅ How infusion centers managed throughout the pandemic, and what screening gaps opened up in other areas

✅ Which telemedicine changes are likely to become permanent, and why reimbursement parity matters

✅ What health systems that own their own specialty pharmacy groups are doing right now

WHY THIS MATTERS

IDNs are, and are run, like businesses, nonprofit status notwithstanding — and the mountain of evidence showing that IDN consolidation drives up prices for patients, employers, and taxpayers is hard to deny. With aggregate IDN market size at $1 trillion in 2020 and projected to double by 2027, understanding what these powerful institutions are strategically prioritizing, from telemedicine to specialty pharmacy, matters well beyond their own walls.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

03:50 What were John's top three health system findings during COVID?

05:24 What is priority for integrated delivery network health systems right now?

08:57 Why do health systems have a renewed focus in primary care?

10:07 How did infusion centers manage throughout the pandemic?

13:58 "It's not just in cancer, people not getting screened and being diagnosed; it's in other areas as well."

14:17 Which of these telemedicine changes are permanent?

19:39 "A visit is a visit … so why would you reimburse at a lower rate?"

19:57 "Telemedicine … is, by its nature, more efficient … and they should be able to figure out how to make money."

27:17 What are health system plans that own their specialty pharmacy groups doing right now?

29:57 What does Darwin Research Group focus on?

In Episode 329, Stacey Richter talks with Joe Connolly, founder and CEO of Visana Health, about the promise and open questions surrounding virtual-first health care solutions — and why "virtual first" doesn't mean "virtual only."

WHAT YOU'LL LEARN

✅ What it actually means to be "virtual first" — and why it's not the same as virtual only

✅ How payers and purchasers can help employees discover that a virtual-first program is even available to them

✅ Whether virtual care will replace in-person care, and what empathetic virtual care delivery requires

✅ How virtual-first point solutions affect a patient's relationship with their PCP, and what "physician abrasion" means

✅ What virtual-first providers need to guard against to avoid perverse incentives

WHY THIS MATTERS

Virtual-first health care companies pulled in $6.7 billion in investment in a single quarter of 2021, chasing the same better-selection, better-convenience, better-price playbook that made Amazon dominant. But much of that promise has yet to be realized, and questions about care fragmentation, PCP relationships, and misaligned incentives remain very much open.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

05:01 What does it mean to be virtual first?

05:50 "It's meeting people where they are and where they want care to be delivered. It does not mean virtual only."

07:01 How do payers and purchasers know that a virtual-first program is available to them?

07:34 "We need to come up with new ways to increase engagement with these services."

10:59 Will virtual care replace in-person care?

15:01 What needs to happen in order to have an empathetic care delivery?

18:06 How should employers try to wade through the virtual health space?

19:41 What's the value in administration within virtual care?

20:27 How does virtual care affect the relationship of the patient with their PCP?

22:05 What does physician abrasion mean?

25:31 What do virtual-first providers need to make sure they're doing?

27:16 "There is the possibility for perverse incentives, and it's up to the virtual-first space to make sure that we don't give in to those perverse incentives."

28:28 Who is Visana and what do they do?

In Episode 328, Stacey Richter talks with Marshall Allen, investigative journalist and author of the New York Times best seller Never Pay the First Bill, about what his book's success means for health care executives — and the financial toxicity that health systems risk creating for themselves when patients wise up.

WHAT YOU'LL LEARN

✅ Why patients have come to be treated as outsiders rather than customers in the health care system

✅ What upcoding is, and how billing schemes get built into the system to increase revenue

✅ The difference between making a profit and profiteering

✅ The first-order and second-order consequences health systems face when patients get organized and informed

✅ Why employers may be the "sleeping giant" that finally forces accountability

WHY THIS MATTERS

A critical mass of Americans already believe health care will bankrupt them, and a book instructing patients how to fight back just hit the New York Times best seller list. For health system leaders, that's not just a public-relations problem — it's a signal that doctors are losing trust in their own employers, reputations are taking real damage, and employers and taxpayers are starting to realize they don't have to be passive about what they're charged.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

03:35 What's the point of view that Marshall is coming from with his investigative reporting?

04:06 "How does this affect the people who are paying for it and the people who are undergoing the care?"

04:58 "There's a lot of good people working within this very messed up system."

05:12 Why are patients considered outsiders in the health care system?

05:55 "What's happened in health care is that the stakeholders treat each other more as the customer."

07:54 What is upcoding?

11:27 "These are schemes that have been created within the industry to increase revenue."

11:56 "This system is not set up for the benefit of the patient."

12:22 "On the financial side, the industry is actually oppressing the American people."

12:39 Can a critical mass of patients force health systems to become more accountable?

16:02 "We have been expected to pay whatever aggregate sum is thrown at us."

17:09 Why have patients been so passive toward this crooked health care system so far?

18:04 "They're violating the trust of the American people when they don't treat us fairly."

19:28 "It's totally legal to do that, [but] is it ethical?"

20:11 What's the difference between making a profit and profiteering?

21:43 "It's hard to argue against your own paycheck."

29:57 "The things that matter most to people are their health and their money."

33:51 What are the first-order and second-order consequences of what's happening in health care right now, and which of these consequences will actually drive change?

34:56 "When you tell the truth about what's going on … they become so ashamed … that they change their behavior."

36:10 "The patient … is not their most important customer."

39:03 "The sleeping giant is the employers."

In this Encore episode, Stacey Richter talks with Andrew Eye, CEO and founder of ClosedLoop.ai, about how his start-up beat out IBM, Deloitte, and Mayo to win Medicare's AI contest — and what predictive analytics and machine learning can actually do for population health, risk stratification, and reducing financial toxicity in health care.

WHAT YOU'LL LEARN

✅ What predictive analytics actually is, and where it delivers the most value in health care

✅ Why explainability is such a hot topic in health care AI specifically

✅ What "data shaming" gets wrong, and why incomplete data still has value

✅ Why top-performing Medicare Advantage plans already use advanced analytics and AI to risk-stratify their populations

✅ Why the diminishing returns of interoperability and more data don't have to stop you from getting started now

WHY THIS MATTERS

ClosedLoop.ai beat out over 300 rivals with a system that forecasts adverse health events and surfaces action steps for clinicians directly in the EHR. As excessive upcoding and gaming in Medicare Advantage continue to cost taxpayers a fortune, AI-driven risk adjustment and predictive analytics are moving from marketing pitch to real, deployable tools — and the health care system, as Andrew puts it, can't afford that level of inefficiency much longer.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction

04:34 What exactly predictive analytics is.

05:05 The use cases of predictive analytics value.

07:23 The oversimplification of how people think about risk.

09:03 "Did you have an impact or not?"

09:17 The public scorecard for predictive analytics.

13:59 "Explainability is a real hot topic in artificial intelligence, specifically in health care."

15:24 Data shaming—what's wrong with it, and why incomplete data are still important.

17:34 The possibilities that machine learning allows for in patient care in health care.

23:45 "Our health care system can't afford for that level of inefficiency."

24:57 "It's not a question of if; it's a question of when."

26:04 The diminishing returns of interoperability and more data for machine learning.

29:21 "You're running your business today, and whatever data you're using to run your business … you can use it to provide better patient care."

30:01 Andrew's advice: Get started now.

In Episode 327, Stacey Richter talks with Naomi Fried, PhD, founder and CEO of PharmStars, about why the gap between Pharma and digital health start-ups is so hard to close — and what each side needs to understand about the other to actually make partnerships work.

WHAT YOU'LL LEARN

✅ What the pharma–start-up gap actually looks like, and why it's so hard to navigate Big Pharma

✅ Why a lack of understanding on both sides drives much of the friction in these partnerships

✅ Where start-ups run into regulatory oversight and compliance surprises when working with Pharma

✅ Why start-ups are often surprised by how many stakeholders are involved in pharma decision-making

✅ What start-ups need to understand about what Pharma actually needs and will pay for

WHY THIS MATTERS

Pharma may be one of the only entities with the bandwidth, money, and expertise to fill certain patient care gaps — especially in narrow therapeutic categories like rare diseases — without necessarily driving up the price of care, if the spend comes out of existing budgets. But even when the will is there, start-ups and Pharma often can't find each other or communicate well enough to make it work, which is exactly the gap PharmStars is trying to close.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

03:42 What does the pharma–start-up gap look like?

05:49 Why is it hard to navigate Big Pharma when trying to partner with start-ups?

09:53 "A lot of what contributes to that pharma–start-up gap is a lack of understanding."

10:05 What's the best way to navigate the pharma–start-up partnership?

10:55 "There's not a clear path as to who should be engaged from the pharma side, because the value proposition wasn't well articulated."

12:27 "Even if … the product is better, if it's such an uphill battle to get them through the hoops and to work with them, they may not be the partner of choice."

13:45 Why are start-ups surprised at who all is involved with the decision-making process on the pharma side?

15:51 Where might start-ups run into regulatory oversight compliance issues?

20:41 "Setting expectations and talking early on … really, just understanding on both sides … they have to meet each other and work around these requirements."

22:02 "Start-ups really are under financial pressure."

26:33 "Pharma has a lot to offer digital health start-ups."

27:40 Is Pharma any good at selling something to a provider?

29:22 What do start-ups need to keep in mind when pitching to Pharma?

30:35 "Understanding Pharma's needs, how they work, what they will pay for is so important for start-ups."

In Episode 326, Stacey Richter talks with Rishi Wadhera, MD, MPP, cardiologist at Beth Israel Deaconess Medical Center, about his retrospective analysis of the Hospital Readmissions Reduction Program (HRRP) — and how Goodhart's Law explains why so many value-based care and quality metrics backfire.

WHAT YOU'LL LEARN

✅ What the Hospital Readmissions Reduction Program was originally intended to do

✅ Why the 30-day readmission measure is an incomplete way to judge hospital quality

✅ How HRRP penalties have disproportionately and regressively hurt hospitals serving disadvantaged communities

✅ Why tying quality improvement directly to payment can create perverse incentives

✅ Why policymakers should rigorously test policies before rolling them out nationally

WHY THIS MATTERS

Goodhart's Law — "when a measure becomes a target, it ceases to be a good measure" — is the root of a lot of what goes wrong in value-based care. HRRP penalizes hospitals for 30-day readmissions using a blunt, yes-no measure that doesn't account for factors like poverty and housing instability that are outside a hospital's control, and it can end up pulling resources away from the hospitals that need them most. Anyone designing quality programs or chasing value-based care success should take the lesson to heart: sometimes the shortest way home is the long way around.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

03:10 What was the Hospital Readmissions Reduction Program intended to do?

05:05 Why did the Centers for Medicare & Medicaid (CMS) think some readmissions were preventable?

05:46 "The spirit of the Hospital Readmissions Reduction Program was to incentivize hospitals to improve … discharge planning, transitions of care, and post-discharge follow-up and care."

06:54 How has research in the last few years changed the thoughts on the effectiveness of the Hospital Readmissions Reduction Program?

08:14 "The 30-day readmission measure—it's an incomplete measure."

12:12 "I think patients … are smart, and they know what's going on."

14:01 "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."

14:22 "The weird thing about the HRRP is that when it evaluates hospitals' 30-day readmission rates, it's a yes-no phenomenon."

15:30 "What CMS does is, it risk adjusts … and that is what we should be doing."

19:16 "This program has been incredibly regressive."

19:51 "Poverty, neighborhood disadvantage, housing instability—these factors are out of hospitals' control."

22:56 "Blunt policies like this that are rolled out nationally probably elicit mixed behavioral responses."

23:12 "It just makes no sense to take resources away from hospitals."

25:22 What's the way to improve quality of care globally?

27:19 "CMS's approach to improving quality of care has really anchored … [that] to payment."

27:49 "It's time for us to rethink what our approach to quality improvement should be."

31:28 "Policy makers have an obligation to rigorously test the impact of these types of policies before they roll them out nationally."

34:05 Can you scale health care nationally?

In Episode 325, Stacey Richter talks with Mai Pham, MD, MPH, former chief innovation officer at CMS and co-author of Penn's "Future of Value-Based Payment" white paper, about three premises of value-based care she disagrees with — plus the massive, under-addressed gap in care for people with intellectual and developmental disabilities.

WHAT YOU'LL LEARN

✅ Why sweetening the value-based care pot with more money isn't a sustainable path to adoption

✅ How commercial prices actually drive up Medicare prices, not the other way around

✅ Why value-based care may need to become a mandate, alongside making fee-for-service less attractive

✅ Why value-based care isn't really what has driven health system consolidation

✅ The scope and impact of inadequate care for the 10–16 million Americans with intellectual and developmental disabilities

WHY THIS MATTERS

Markets get distorted when huge quantities of dollars rush in — look no further than Medicare Advantage and all the brainpower devoted to upcoding at scale. Dr. Pham argues policymakers can't just keep sweetening the value-based care pot; at some point, cost-driving health systems need a mandate to get on board, and fee-for-service needs to become less attractive. She also makes the case that commercial rate negotiations by hospital systems are themselves driving up Medicare prices — a dynamic worth understanding before blaming Medicare rates alone.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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=== MENTIONED IN THIS EPISODE ===

🔗 EP263 (Apple) / EP263 (Spotify) with Andrew Eye from ClosedLoop.ai

=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction.

04:22 What are the nuances within the promises of value-based care?

05:34 "For the first 10 years of … value-based care, it was right in order to generate momentum and get as much participation as possible."

06:41 "When you leave yourself open to tackling prices, now you open up a whole world of possibilities in terms of how you could redirect sources."

08:00 "Not all providers are the same."

09:24 "It's time to stop tracking the phenomenon and actually pay for change."

10:29 "We haven't done our best to actually make the alternative to value-based payment as bad as it could be."

12:14 What's the path forward in value-based care, especially for specialists?

15:43 "There has been tremendous business opportunity in Medicare Advantage, not to the benefit of the trust funds."

17:13 "As a citizen, I gotta ask, 'How much is enough?'"

19:03 "It's not like we're talking about replacing a really superlative gold standard."

19:34 EP263 with Andrew Eye from ClosedLoop.ai.

22:02 "It's not just about taking dollars away from certain subsectors; it's about reallocating some of those dollars."

23:34 "Policy making itself tends to be siloed."

25:02 "This is about paying some people in health care modestly less."

25:35 "Most of the costs are driven by fixed costs."

29:25 "Value-based care is not what has driven consolidation."

In Episode 324, Stacey Richter talks with Nicole Bradberry, CEO of the Florida Association of ACOs, and Kelly Conroy, director at Pinnacle Healthcare Consulting, about whether ACOs actually improve quality and reduce costs — and what separates the high performers from the unimpressive national average.

WHAT YOU'LL LEARN

✅ Why the average ACO shows less than 1% net savings, and what separates high performers from the pack

✅ How Medicare Shared Savings Program (MSSP) ACO attribution and shared savings actually work

✅ Why patient engagement and physician engagement are equally critical success factors

✅ What data-driven benchmarking contributes to a successful ACO

✅ Why home health and behavioral health belong in a well-rounded ACO care team

WHY THIS MATTERS

A recent white paper found that the average ACO nets less than 1% in savings per beneficiary with only modest quality gains — not exactly a ringing endorsement of the model. But Nicole Bradberry and Kelly Conroy have both built ACOs that far outperform that average, and their experience points to what separates success from mediocrity: patient and physician engagement, smart use of data, and a willingness to treat fee-for-service, not each other, as the real competition.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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=== MENTIONED IN THIS EPISODE ===

🔗 EP321 (Apple) / EP321 (Spotify) with Rich Klasco, MD

=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction.

05:44 ACOs: What's in it for the patient?

08:10 Is the upside of ACOs enough to justify the cost?

11:23 "You can either keep on doing what you're doing and end up like Blockbuster, or you can really pivot and be Netflix."—Nicole

12:26 Why would MIPS incentivize providers to sign up for an ACO?

15:22 What are the big ACO failures?

18:27 "Just as patient engagement is a number one key success indicator, so is physician engagement."—Kelly

19:57 "It's not individual benchmarks; it's the whole ACO."—Kelly

20:15 "Honestly, data is key to that conversation."—Nicole

21:55 EP321 with Rich Klasco, MD.

22:14 What are the essentials for a successful ACO?

27:31 Who do you need to add to the ACO mix?

28:55 How does home health play into the ACO system?

29:33 "The whole behavioral health—just adding in a really good care team."—Kelly

29:48 "There's just a whole host of things that having all this data opens up the physician and the provider's eyes."—Kelly

32:56 "We really think fee for service is the competition."—Kelly

In this Encore episode, Stacey Richter talks with Lee Lewis, chief strategy officer at the Health Transformation Alliance, about his three-part playbook for jumbo employers — the "how," the "what," and the "who" — for cutting health care spend while improving outcomes.

WHAT YOU'LL LEARN

✅ What the "administrative superstructure" is, and why it's the first chapter of any employer health benefits playbook

✅ How to connect the "what" of care delivery to the clinical conditions driving the most cost

✅ Why overseeing the pharmacy benefit manager (PBM) is critical to controlling drug spend

✅ Why centers of excellence make sense for steering employees to high-cost, high-value care

✅ How enabling and properly paying PCPs fits into an employer's cost and quality strategy

WHY THIS MATTERS

Large self-insured employers are uniquely positioned to disrupt health care revenue streams that don't deliver adequate outcomes for the dollars spent — and when done well, both employer and employee win: costs go down, and employees get better care with less time lost navigating the health care system. Lee Lewis's three-chapter playbook (the how, the what, and the who) gives employers, and the providers, consultants, carriers, and pharma companies who serve them, a concrete framework for making that happen.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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=== MENTIONED IN THIS EPISODE ===

🔗 EP241 (Apple) / EP241 (Spotify) with Vinay Patel

🔗 EP240 (Apple) / EP240 (Spotify) with Olivia Ross

=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction

04:00 A playbook to reduce health care spend and achieve better outcomes.

04:08 The "how," or "administrative superstructure."

05:19 What Lee typically does when working with companies.

08:57 The "what" of delivery—connecting the "what" to the "clinical."

10:52 Overseeing the pharmacy benefit manager (PBM).

12:37 EP241 with Vinay Patel.

12:50 Looking at the medical side of health.

15:46 Improving spend and improving quality simultaneously.

18:10 EP240 with Olivia Ross.

18:53 Why centers of excellence make sense.

21:54 The "who"—who is providing the care.

24:06 Enabling and empowering PCPs and improving PCP pay to compensate for that.

26:57 Lee's advice for brokers.

28:02 Lee's advice for provider organizations, hospitals, and centers of excellence.

29:07 "Hospital systems are not [a] monolith."

In Episode 323, Stacey Richter talks with Arshad Rahim, MD, MBA, FACP, senior medical director of population health at Mount Sinai, about the mismatched language around "throughput" — and what happens to patient care and physician burnout when digital tools optimize for volume over relationships.

WHAT YOU'LL LEARN

✅ Why "throughput" and "quality time with patients" describe the same trade-off using different language

✅ How throughput-maximizing digital tools often mask a fee-for-service agenda behind a patient-care mission statement

✅ When and how throughput negatively affects diagnostic accuracy and patient outcomes

✅ What patients actually want and need from a health care interaction

✅ What doctors need from their organizations to sustain a high level of care

WHY THIS MATTERS

Stakeholders on opposite sides of the throughput debate often talk past each other because they're using different vocabulary for the same underlying trade-off, and vague compromises like "quality time while maximizing throughput" produce no real change. Tech vendors selling throughput-boosting tools often pitch patient-care missions on their first slide and speed or billing codes on their second — and real health improvement requires confronting, head-on, that quality time with patients means less throughput, not more.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction.

07:37 When does throughput negatively affect patient care?

08:55 Why does diagnostic inaccuracy become a problem with throughput?

09:27 Do population health outcomes decline with less throughput?

10:20 "The way you can also be most financially successful is by taking care of sicker patients."

10:53 What do patients actually want and need?

11:55 "The emotionality in a health care interaction is always there … [when] you're focused on throughput, you can definitely lose the healing and calming presence."

14:18 What do doctors need from their organizations to sustain a high level of care?

15:59 "The actions vary across the spectrum from very supportive to not very supportive at all."

17:02 "There definitely is a challenge of competitive pay."