In Episode 497 of Relentless Health Value, Stacey Richter engages in a detailed conversation with Zack Kanter, CEO of Stedi about the complexities and inefficiencies inherent in healthcare transactions and clearinghouses. They discuss how non-standardized processes and legacy systems result in exorbitant costs and delays in claims processing and eligibility checks, which are significantly higher compared to other industries.

Despite HIPAA's standardized rules, the lack of competitive pressure and outdated technology contribute to these issues, ultimately impacting patient care and administrative costs. Zack offers insights on how modernizing the clearinghouse infrastructure can lead to substantial cost savings and better patient outcomes.

=== LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP497

🔗 Visit Stedi: https://www.stedi.com

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09:47 What things are being paid for that we might not be aware we're paying for in healthcare?

12:09 Why HIPAA actually makes healthcare more standardized than other industries.

15:35 How healthcare is ahead in some ways and behind in others.

18:03 Where do the 4 to 5 days come from in healthcare transaction processing?

20:39 Why these transaction delays affect care delay.

23:14 EP482 with Preston Alexander.

23:18 EP472 with Eric Bricker, MD.

27:10 How should the process work from the time a provider clicks "validate"?

30:19 Why is the clearinghouse the right place to solve all these issues?

31:41 Why are we where we are in terms of these issues?

35:28 Why people should be looking at their clearinghouse costs.

36:59 What to know about Stedi.

In this episode of Relentless Health Value, Stacey Richter engages with Mark Newman, CEO and founder of Nomi Health, in a deep dive into the administrative and transactional inefficiencies plaguing the American healthcare system.

The conversation highlights how plan sponsors often spend more than a dollar to purchase healthcare, yet healthcare providers receive only a fraction of that amount due to data fragmentation and varied accounting practices. Mark Newman reveals two main issues: 'data isn't data' and 'a dollar isn't a dollar,' explaining how inconsistencies and misalignments in data and accounting methods lead to significant waste.

The discussion also explores innovative solutions Nomi Health is piloting to streamline payments, reduce friction, and ultimately lower healthcare costs while improving care.

=== LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP496

🔗 Visit our sponsor Nomi Health: https://www.nomihealth.com/

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06:48 What is actionable to know about the life of a claim?

08:14 How data can change as it moves through the claims process.

11:45 Why a dollar isn't a dollar in healthcare.

18:50 Why employers are actually paying more than a dollar to access a dollar of healthcare (the medical loss ratio).

21:54 Why cutting out the "friction" is actually better for employees and members.

22:48 EP482 with Preston Alexander.

22:50 EP472 with Eric Bricker, MD.

23:36 EP490 and EP492 with Sam Flanders, MD, and Shane Cerone.

23:53 Infographic by Andrew Tsang showing 27 streams of income.

26:53 How do we fix these issues?

28:05 LinkedIn comment from Sandra Raup.

28:59 How Nomi Health is experimenting with a no co-payment, no deductible model.

31:29 INBW42 with Stacey on moral hazard.

32:26 EP486 with Stan Schwartz, MD.

32:31 EP485 with Cristin Dickerson, MD.

32:56 The Innovator's Dilemma by Clayton M. Christensen.

34:55 How does Nomi Health work with and help employers?

In this Part 2 episode of 'Relentlessly Seeking Value,' host Stacey Richter recaps the prominent themes 4 and 5 from 2025. The focus is on two major themes: the lack of transparency in data access leading to overspending and the necessity of shifting from volume-based to value-based purchasing in healthcare.

The discussion includes insights from numerous healthcare professionals and case examples to underscore these vital themes affecting both patients and providers.

=== LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/INBW45

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00:00 Introduction

03:30 Theme 4: lack of transparency and data access.

04:46 Clip of Elizabeth Mitchell from EP436.

07:07 Is there a tipping point finally coming regarding transparency?

08:58 Why and how siloed data is also part of this transparency issue.

11:37 How opaque pricing leads to more opaque pricing.

13:21 The need for transparency around ownership and what that looks like in healthcare.

14:06 Theme 5: the need to shift purchasing from discounts/volume to value.

14:52 Clip of Mark Cuban from EP488.

16:35 Clip of Sarah Emond from EP494.

17:02 How pricing transparency can eliminate the need for rebates and prior authorizations.

18:30 Why healthcare needs a demand curve.

22:09 Shows covered in 2025 that touched on other timely ideas.

In this 'Inbetweenisode' of the Relentless Health Value podcast, Stacey Richter recaps the major themes covered throughout 2025 in healthcare. In this Part 1, Stacey dives into three critical themes: the necessity of trusted relationships and simplicity, treating primary care as an investment rather than a cost, and the impact of perverse financial incentives and profiteering.

Various experts, including Dr. Kenny Cole, Ann Lewandowski, Jonathan Baran, and Yashaswini Singh, share insights on these subjects. The discussion highlights the pervasive lack of trust in the healthcare system, the financial implications of underfunded primary care, and the negative effects of misaligned financial incentives and profiteering within the industry.

Check out the show notes using the link below for all of the mentioned links and episodes.

=== LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/INBW44

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02:06 Theme 1: the critical need for trusted relationships and simplicity.

02:28 The two categories of trust that are needed.

02:43 Clip of Kenny Cole, MD, from EP473.

03:43 Clip of Ann Lewandowski from EP476.

06:07 Why simplicity and trust have to go together.

08:30 Theme 2: primary care as an investment, not a cost.

08:41 Clip of Jonathan Baran from EP483 (Part 1).

09:01 Clip of Nikki King, DHA, from EP470.

09:34 How broken primary care affects self-insured employers.

10:12 Why there are perverse financial incentives to gut primary care.

15:19 Theme 3: the dominance of perverse financial incentives and profiteering.

15:46 Clip of Benjamin Schwartz, MD, MBA, from EP481.

16:18 The actual definition of margin.

16:55 Clip of Mick Connors, MD, from EP495.

18:25 Clip of Yashaswini Singh, PhD, from EP474.

In this encore episode of 'Relentlessly Seeking Value,' host Stacey Richter revisits an inspiring conversation with Marilyn Bartlett, a CPA who transformed the State of Montana's employee health plan from a $9 million deficit to a $112 million surplus within three years.

Known for her fiscal discipline and patient-first approach, Marilyn shares her strategic steps, from identifying waste in the system and securing quick wins to negotiating better deals with hospitals and ensuring long-term success. She emphasizes the importance of assembling a strong team, maintaining transparency, and staying focused on the ultimate goal of creating real health value. This episode is a must-listen for anyone looking to drive meaningful change in the healthcare industry.

=== LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EncoreEP450

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🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1

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07:09 What gave Marilyn the confidence to fix Montana's state health plan?

08:35 Why Marilyn knew she would have enough power to make the changes needed in Montana's state health plan.

09:35 What Marilyn achieved in her time as the administrator of the Montana State Employee Health Plan.

11:03 What were the "quick wins" Marilyn was able to achieve when she first took over as administrator?

17:55 EP453 with Claire Brockbank, which covers RFP in detail.

18:12 How Marilyn structured her plan for the Montana State Employee Health Plan.

21:42 What's the key to setting yourself up for success when doing what Marilyn was able to achieve?

25:23 Why putting together your own team is so important.

28:20 EP397 with Paul Homes.

28:24 EP418 with Mark Cuban and Ferrin Williams, PharmD, MBA.

29:28 What happened when Marilyn left the Montana State Employee Health Plan?

31:28 Have the costs of the plan gone up since Marilyn's time working on it?

In episode 495 titled 'Wait. Flip that. A Crazy Revelation I Had About Trying to Fix US Healthcare,' host Stacey Richter speaks with Dr. Mick Connors, an emergency room pediatrician and healthcare entrepreneur, about a groundbreaking insight into the US healthcare system.

They discuss the paramount need to flip the way healthcare costs and outcomes are measured: moving towards unit-level cost accounting and whole-patient or whole-community outcomes assessment. The episode delves into the fundamental pitfalls of the current healthcare structure, emphasizing the misalignment between cost aggregation and patient-level outcome measurements. They explore the challenges faced by physicians in the current system, the role of investor mindsets, and the importance of dyad leadership and mission-driven practices to improve overall healthcare value.

=== LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP495

🔗 Visit this week's sponsor Payerset: https://payerset.com

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06:32 How Dr. Mick Connors defines margin.

08:18 EP294 with Steve Schutzer, MD.

08:54 Why nobody wants to do cost accounting in healthcare.

09:20 EP490 with Shane Cerone and Sam Flanders, MD.

11:05 Infographic by Andrew Tsang showing streams of income.

12:27 What is the value equation?

15:55 EP404 with Suhas Gondi, MD, MBA.

15:59 EP466 with Vivian Ho, PhD.

16:01 EP482 with Preston Alexander.

16:25 EP474 with Yashaswini Singh, PhD.

17:44 How business decisions can really undermine the value proposition.

18:58 Classic article on incentivizing.

23:07 EP295 with Rebecca Etz, PhD.

24:21 Why it comes down to the 80/20 rule.

26:31 EP445 with Tom X. Lee, MD.

26:35 EP460 with Rushika Fernandopulle, MD.

26:40 Why mission return requires dyad leadership.

27:13 What does dyad leadership mean?

27:33 EP492 with Sam Flanders, MD, and Shane Cerone.

In Episode 494 of Relentless Health Value, host Stacey Richter engages in a detailed discussion with Sarah Emond, CEO of ICER, about the intricate dynamics of pharmaceutical drug pricing. They explore six primary tensions within the current system, including the fair valuation of drugs, the misalignment between drug prices and patient affordability, the disconnect between lifetime drug value and short-term insurance assessments, and the challenge of integrating societal and individual perceptions of value.

Emond and Richter also discuss potential solutions, emphasizing the need for value-based pricing models free from financial conflicts of interest. They highlight the critical role of payers, PBMs, and drug manufacturers in aligning pricing with value to improve patient access and reduce overall healthcare costs.

=== LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP494

🔗 Visit our sponsor Payerset https://payerset.com

✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe

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🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1

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08:18 Why list prices are a lie.

10:59 How does the rebate model sometimes get in the way of paying for value?

12:50 Bonus clip with Sarah Emond.

13:14 EP491 with Elizabeth Mitchell.

13:20 EP490 and EP492 with Shane Cerone and Sam Flanders, MD.

14:37 The tension that is created between affordability and adherence.

15:03 When cost sharing makes sense in pharmaceutical drug pricing.

17:26 INBW42 with Stacey on moral hazard.

18:53 How GLP-1s are "wildly cost effective."

21:32 Why the sticker shock on cost-effective drugs is a failure in the system for paying for value.

22:38 ICER's report on GLP-1s.

26:59 EP385 with Dan Mendelson.

28:57 How employers and payers can have a value assessment approach and a health insurance system that allows access to cost-effective drugs.

29:48 How cost-effective prices are calculated.

31:55 One of the core value underpinnings for value assessment of drugs.

34:54 Why manufacturers and pharmacy benefit managers should work together more by referencing something like an ICER report.

36:55 EP426 with Nina Lathia, RPh, MSc, PhD.

38:21 "We can make different choices."

In this bonus episode of 'Relentlessly Seeking Value,' host Stacey Richter engages in a conversation with Sarah Emond, CEO of the Institute for Clinical and Economic Review (ICER). They discuss the complex 'arms race' of pharmaceutical pricing in the current healthcare system, emphasizing issues like inflated drug list prices, patient affordability, and cost-effectiveness.

They highlight ICER's role in conducting value assessments of prescription drugs to ensure fair pricing and improve affordability and access. The episode underscores the need for multi-stakeholder dialogues to deescalate financial tensions and promote value-based healthcare choices.

=== LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP494-BonusClip

🔗 Visit our sponsor Payerset: https://payerset.com

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06:51 EP293 ("Game Theory Gone Wild") with Dea Belazi, PharmD, MPH.

02:38 What is ICER?

02:54 What does the Institute for Clinical and Economic Review do?

05:14 The importance of still showing up, even when others don't understand or disagree.

09:12 Why it's important to think about population health and how our choices impact affordability for everyone.

In this special Thanksgiving episode of Relentless Healthcare Value, the focus is on gratitude and giving thanks to various contributors within the healthcare community. Host Stacey Richter extends her 'baskets of thank yous' to colleagues, mentors, and partners committed to transforming healthcare.

These baskets recognize those who maintain respectful dialogues despite small disagreements, those who collaborate and pay it forward within the community, and those who support the concept of a 'demand curve' in healthcare markets.

=== LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/INBW43

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🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1

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01:25 First thank you: to those who do not succumb to healthcare narcissism.

01:36 INBW39 with Stacey.

02:51 INBW37 with Stacey.

03:00 EP399 and EP400 with Stacey.

05:40 Second thank you: to those willing to pay it forward.

05:53 EP489 with Dan Greenleaf.

08:12 EP452 with Cora Opsahl.

08:38 Third thank you: to those who aid the demand curve in healthcare.

09:14 EP490 with Shane Cerone and Sam Flanders, MD.

09:16 EP491 with Elizabeth Mitchell.

09:17 EP492 with Sam Flanders, MD, and Shane Cerone.

09:49 Why healthcare needs a demand curve.

13:34 Fourth thank you: to those who have contributed financial support to the Relentless Health Value podcast.

15:47 The final thank you: to the listeners.

This OG of directly contracted high-value networks or Centers of Excellence networks came up, name dropped and everything in the episode with Elizabeth Mitchell from PBGH, the Purchaser Business Group on Health, from two weeks ago. That was episode 491.

So, welcome to this deep cut episode with Olivia Ross from way back, pre-pandemic times.

This episode of Relentless Health Value revisits the concept of directly contracted high value networks or Centers of Excellence (ECEN) with Olivia Ross. The discussion explores the impact and potential of the ECEN network, emphasizing the importance of quality, price transparency, and multidisciplinary approaches in healthcare.

Olivia delves into the reasons why ECEN was significant in past PBGH projects and its current relevance, despite its eventual dismantling due to corporate changes. The episode highlights the benefits for employers in creating their own high-value networks and the positive outcomes from fewer unnecessary surgeries and better quality care. Additionally, it covers the rigorous process of selecting Centers of Excellence and how continuous quality improvement efforts benefit both employers and healthcare providers.

=== LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/Take2-EP240

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07:40 Prospective bundles and the cost of care.

08:22 How the largest cost savings come from the improvements in quality.

09:51 What Olivia looks for in choosing centers of excellence.

10:36 Creating market pressure and avoiding consolidation.

11:17 Creating positive disruption in the healthcare system.

12:17 How Olivia chooses the centers and providers she works with in the Purchaser Business Group on Health.

13:12 The quality metrics Purchaser Business Group on Health looks at when assessing providers and centers.

14:04 What a team assessment is, and why it's important.

15:07 How local PCPs have to factor into this health care model.

17:57 How Purchaser Business Group on Health intervenes in the patient journey to ensure that the patient and the employer are getting the best quality care for the best price.

19:39 Olivia's suggestions on how to have an intervening conversation with a patient who has already been told he or she needs surgery.

20:18 EP468 with Matt McQuide.

20:20 EP471 with Christine Hale, MD, MBA.

20:22 EP472 with Eric Bricker, MD.

25:27 "Even at a more competitive price point, there's still an upside to them getting this new business."

25:52 How choosing specific physicians is part of the COE designation process.

27:35 How COEs and their physicians are also involved in continuous quality improvement.

30:56 Employers Centers of Excellence Network collaboration with The Leapfrog Group.

32:24 How the Employers Centers of Excellence Network program is open to any employer, no matter the size.

32:54 What it takes to join the Employers Centers of Excellence Network.