In this Episode 283, Stacey Richter talks with Sylvia Romm, MD, MPH, chief innovation officer at Atlantic Health System, about why telehealth success can be a launchpad for broader health system innovation and human-centered health care. WHAT YOU'LL LEARN ✅ What "human-centered health care" means, and how it borrows from customer-centered design ✅ How data can be folded into a more human-centered approach without losing the human touch ✅ How human-centered health care fits into the quadruple aim ✅ Why organizations need to understand the "why" behind an innovation initiative for it to succeed ✅ Why telehealth can be the first practical step toward deeper health system innovation WHY THIS MATTERS Sylvia Romm coined the term "human-centered health care" to describe what happens when health systems apply customer-centered design thinking to the patient and provider experience — removing friction points and building a continuum of care people actually want to engage with. Recorded just before COVID-19 hit, this conversation reframes telehealth not as an endpoint but as a first successful proof point that health systems can build on toward more human-centered innovation. Romm's take: the health systems that had already gotten telehealth right had a real head start on the deeper organizational change management this kind of innovation requires. === 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 02:18 How Dr. Romm's background in research, public policy, and being a pediatric hospitalist intertwine to create great innovation strategies. 03:22 "How do we look at populations?" 03:31 "It's really about affecting the system in its entirety." 04:33 What human-centered health care means. 06:36 "You're only as effective as the rapport that you build with [this] person." 08:05 "What do people really need … but also, what do they find valuable?" 09:42 How data are folded into human-centered health care. 11:55 "The endgame is to figure out … how to have a better experience." 12:39 How this fits into the quadruple aim. 17:19 "We are going to have to earn and learn agility." 19:38 What has the most promise in deepening the connection between patients and providers. 20:32 "Is this about you, and how do we know … how people outside feel about creating a relationship?" 23:29 Is there a best practice for furthering the patient/doctor relationship from afar? 24:24 The need for a variety of approaches to patient/doctor connections. 27:30 What innovation initiatives need to be successful. 28:07 "People have to understand the 'why.'" 29:38 The classic tenets of change management. 30:02 A challenge Dr. Romm is proud of having solved. 31:56 Secret weapon: collaboration.

In this Inbetweenisode 27, Stacey Richter shares two metrics for measuring the value of care delivered — an idea born out of a keynote she was preparing before COVID canceled it. WHAT YOU'LL LEARN ✅ Why the metrics used to measure value in health care have to be unimpeachable and resistant to gaming ✅ Why "helping physicians help patients" is a more useful touchstone than an endgame built around nouns ✅ How optimizing time with patients became the first of Stacey's two proposed metrics ✅ Why financial toxicity belongs alongside clinical outcomes as a measure of care value ✅ What the two metrics — optimal time with patients and reduction of cost for patients — actually capture WHY THIS MATTERS American health care, Stacey argues, is one of the most sophisticated displays of game theory anywhere — which means the metrics used to measure value have to be built to resist being gamed. Drawing on the quadruple aim and thinking from voices like Robert Pearl, Gary Price, Danielle Ofri, Eric Topol, and Marty Makary, she lands on two metrics that get at what actually matters to patients: how much real time they get with the people caring for them, and how much financial toxicity they're spared along the way. It's a simple framework, but one built specifically to hold up against a system with every incentive to twist metrics toward profit instead of patient benefit. === 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 01:28 Health care profiteering and the halo effect. 02:16 Dr. Robert Pearl's book, Mistreated. 02:27 "If there's money on the table, it's really hard to not take it." 02:42 How Stacey came up with her first metric. 04:31 The impact of caring for the patient on patient outcomes. 06:09 The quadruple aim. 06:50 "An endgame of nouns" vs "the verbs which are going to get us there." 07:19 How are we helping patients and providers? 09:02 Making the touchstone "helping physicians help patients." 09:50 Gary Price, MD, on the Healthcare Strategies podcast from Xtelligent Media. 10:36 Danielle Ofri, MD, at danielleofri.com. 12:04 Eric Topol, MD, and "the gift of time." 12:36 The first metric: optimizing time for patients. 14:31 Financial toxicity in health care. 15:24 Marty Makary, MD, MPH, author of The Price We Pay. 17:11 Two metrics: optimal time with patients and reduction of cost for patients.

In this Episode 282, Stacey Richter talks with Aaron Mitchell, MD, MPH, an oncologist and health services researcher at Memorial Sloan Kettering, about how much cancer centers get paid to put patients on drugs. WHAT YOU'LL LEARN ✅ How the "buy and bill" payment model pays cancer centers a percentage of the drug's cost to infuse it ✅ Why this model creates a built-in incentive to gravitate toward more expensive drugs ✅ How financial toxicity affects patients even when the clinical benefit of a drug is marginal ✅ What reimbursement reform and capitated systems could look like as alternatives ✅ Why large and small oncology providers experience the buy-and-bill system differently WHY THIS MATTERS Aaron Mitchell lays out how the buy-and-bill payment model — where cancer centers buy chemo drugs and get reimbursed a percentage on top for infusing them — quietly rewards prescribing the most expensive option, since the fee scales with drug cost. As cancer drug prices climb, so does the money earned by the centers infusing them, while patients absorb greater cost sharing and employers and taxpayers foot much of the rest. Mitchell argues this dynamic is one reason financial toxicity gets so little institutional attention: the current system, as he puts it, works too well for too many people for change to come easily, even though patients are the ones losing out. === 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 03:00 Following the drug and following the dollar. 03:28 The "buy and bill" system. 04:15 The perverse and problematic incentives of the system. 07:24 "It creates the incentive for us to gravitate toward the more expensive drug." 07:28 The hesitancy to address the financial toxicity of drugs for patients. 08:40 Why the only person losing in this situation is the patient. 09:40 The financial impact from the patient perspective. 13:07 Are patients realizing this impact? 13:53 Solving the problem of oncology drug choice. 16:06 Reimbursement reform. 17:49 Capitated systems and incrementalist impacts to reimbursement reform, and what these look like. 23:04 Are we at a tipping point? 23:27 "The current system … works too well for too many people." 24:47 Who isn't well served by the current system. 26:27 Who has to lead the charge for change. 29:54 Large oncology providers vs small oncology providers in the buy and bill system.

In this Episode 281, Stacey Richter talks with Rob Austin, director of health systems at Guidehouse, about how badly managed health system supply chains steal from patients and the providers who let this happen. WHAT YOU'LL LEARN ✅ Why supply costs are the second-largest cost line item for most health systems, right behind labor ✅ How an average hospital could save more than $12 million a year with better supply chain management ✅ Why the most efficient supply chains are often also the most clinically effective ✅ Why improving nonlabor costs has to be driven from the C-suite to actually work ✅ How smaller organizations can get a handle on their supply chains by focusing on people, process, and data WHY THIS MATTERS Rob Austin makes the case that hospital supply chains — the second-biggest cost line after labor — are quietly leaving tens of millions of dollars a year on the table, money that could otherwise pay for more nurses, more PCPs, or thousands more knee replacements. The pandemic, counterintuitively, is a good moment to fix this: standardizing supplies and enhancing shared services can reduce costs while actually improving clinical outcomes, but only if leadership treats it as a C-suite priority rather than a back-office function. Left unmanaged, this waste ultimately gets passed on to patients and the workforce that could otherwise be better resourced. MENTIONED IN THIS EPISODE 🔗 EP279, with Peter Hayes === 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 02:04 Why the pandemic is actually a good time to get a handle on hospital supply chains. 03:21 "Supply costs, nonlabor costs, are the second largest costs any health system has." 04:08 The $24 billion opportunity for hospital systems. 04:35 How efficient supply chains help patients at large. 06:18 The hospitals that would benefit the most from streamlining supply chains. 07:05 The case of the haves and have nots in the supply chain. 07:36 EP279 with Peter Hayes. 09:46 "The most efficient supply chains … are also more clinically effective." 11:45 Standardizing supplies vs nonstandardization. 14:15 The biggest problems with a mismanaged supply chain. 15:50 Purchase services. 15:58 Areas of opportunity with supply chains. 19:27 The structural issues that add to the supply chain problem. 20:20 "To make an impact on your nonlabor costs … it needs to be driven initially from the C-suite." 22:10 The steps to focus on to improve your supply chain. 29:32 Value-based care in the supply chain. 31:16 How smaller organizations can get a handle on their supply chains. 31:47 "Focus on people, process, and data." 32:59 Amazon's role in the health care supply chain.

In this Episode 280, Stacey Richter talks with Yauheni Solad, MD, medical director of digital health and telemedicine at Yale New Haven Health, and Rahul Dubey, founder of Percynal Health Innovations, about whether current technology advancements will end up disrupting traditional models of health care delivery and reimbursement. WHAT YOU'LL LEARN ✅ How COVID-19 accelerated interoperability and health systems' ability to innovate ✅ Why making technology that actually helps doctors deliver care beats dictating new tools to them ✅ How unlimited primary care and lower cost sharing could change utilization patterns ✅ Why reimbursement policy may become as consequential as HIPAA for how technology gets adopted ✅ What payers and providers should be doing right now to prepare for this shift WHY THIS MATTERS Yauheni Solad brings the provider point of view and Rahul Dubey brings the payer point of view to a shared question: once health systems have invested heavily in new digital capabilities during COVID, will that investment permanently reshape care delivery and reimbursement? Both agree the answer hinges on whether technology is built to genuinely help doctors deliver care rather than add administrative burden, and whether reimbursement models evolve to support technology-enabled care rather than just bolt it onto fee-for-service. The risk they flag: technology could just as easily drive overconsumption of care as it could drive better, lower-cost outcomes — the deciding factor is how deliberately payers and providers manage that transition. === 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 03:56 How COVID-19 affects interoperability. 07:06 "It's not only the data exchange; it's your ability as a health care system to innovate."—Dr. Solad 09:11 How close are we to adopting more innovative and better technologies? 11:32 "Make docs happy. That is a very foreign concept for … people that are not delivering care to think about."—Rahul 11:47 "We want to be able to enable the primary care physician to deliver care."—Rahul 12:03 Working doctors rather than "dictating upon them." 13:16 "I can't sell burnout … I can sell value of care and outcomes of less cost."—Rahul 18:44 "There might be an increase in overconsumption of care."—Rahul 19:14 The possible increase in utilization of care and the potential for lower cost sharing. 19:57 Unlimited primary care and the benefits this might offer. 22:59 Does this pose risks to health systems? 25:22 "Everything you do for the patient should have a clear value to them."—Dr. Solad 26:35 "What type of technology can provide this missing link for your particular health care system?"—Dr. Solad 28:18 Reimbursement as the new HIPAA. 29:15 "We need more evidence in data around the delivery of this technology-enabled service."—Dr. Solad 32:20 What payers and providers should be doing today. 35:16 Care management vs consumerism.

In this Episode 279, Stacey Richter talks with Peter Hayes, president and CEO of the Healthcare Purchaser Alliance of Maine, about how health systems got addicted to the inflated prices they charge employers and some patients. WHAT YOU'LL LEARN ✅ Why profit for a hospital has to come largely from commercial payers, not public pay ✅ Why most hospitals don't use real cost accounting and, in many cases, genuinely don't know their own costs ✅ How cost shifting from public to commercial payers affects employers and employees ✅ Why bundled payment programs offer a path away from inflated commercial pricing ✅ What employers can do locally to become market makers instead of market takers WHY THIS MATTERS Peter Hayes argues that health systems didn't arrive at today's inflated commercial prices by accident — someone wanted them to operate that way, and following the money reveals who. With hospitals often lacking real cost accounting, employers and their employees end up absorbing costs shifted away from public payers, while executive pay and inefficient purchasing go largely unexamined. Hayes's central point: it will take a village — employers shopping around for better benefit designs, purchasers organizing collectively, and everyone refusing to just accept the bill as given — to make it untenable for health systems to keep operating this way. MENTIONED IN THIS EPISODE 🔗 EP257, with Karl Bilimoria, MD === 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 03:36 Why employers are spotting the margin from commercial pay. 05:20 Public pay vs commercial pay, and why profit for a hospital has to come from commercial payers. 05:51 Inefficient costs in health systems. 07:22 How the health care system evolved this way. 09:12 "If you're a business, a manufacturer, you actually do cost accounting. … Hospitals don't use cost accounting. They really don't know." 12:00 The amount that taxpayers are actually subsidizing hospital systems. 12:24 Cost shifting and how this is affecting employers and employees. 14:45 How a hospital could increase its employer prices by such a large magnitude. 17:19 The perverse incentives that have made health plan premiums what they are today. 22:11 The case for the bundled payment program. 23:35 How purchasers shopping around for benefit designs can transform health pricing and make hospitals more willing to move from fee-for-service to bundled payments. 24:54 EP257 with Karl Bilimoria, MD. 25:46 Employers outside of the health care industry vs the health care industry, and how this plays out in state and federal legislature. 27:26 What else employers can be doing. 29:09 "Instead of being market takers, [it's time] to be market makers." 29:47 What employers can be doing at the local level. 34:30 Employers can find a transparent health broker by checking out Health Rosetta and Validation Institute. 35:17 "If we don't do something to have the market work, it's going to be done to us."

In this Episode 278, Stacey Richter talks with Maura Calsyn, managing director of health policy at the Center for American Progress, about whether COVID-19 will result in a new normal for value-based pharmaceutical pricing. WHAT YOU'LL LEARN ✅ Why lowering a drug's price can sometimes backfire when physicians are paid a percentage of that price to administer it ✅ How the "Netflix Model" and "Australian Model" of drug payment differ from true value-based pricing ✅ Why a transparent, replicable process matters more than any single pricing formula ✅ How cost shifting complicates efforts to make drug pricing reflect actual clinical value ✅ Why there needs to be a way to keep funding drug development even as pricing models change WHY THIS MATTERS Maura Calsyn unpacks why value-based pharmaceutical pricing is harder to pin down than it sounds — some of the tools marketed as "value-based" are really just proxies that don't fully capture value, and pricing based on what the market will bear has historically meant setting prices as high as possible rather than as accessible as possible. With COVID-19 exposing just how much financial pain the system can absorb before something breaks, Calsyn argues this may be the moment value-based pricing models like the Netflix or Australian approaches get real traction, provided any new framework preserves the incentive to keep developing new drugs in the first 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 03:48 The value of pharmaceutical products. 06:58 "We're dealing with what might seem like an infinite amount of resources, but it's really not." 07:03 The "Netflix" or "Australian" payment models vs value-based pricing. 09:35 "You need a transparent and really replicable process." 10:41 Considerations of equity and affordability. 11:10 "Everybody wants people to get the drugs that they need … I think the question really is just, 'Who is paying for it?'" 11:44 What value-based pricing really means in the pharma industry. 13:22 "We're confusing what is actually a value-based price with some of the tools that are used to try to get closer to that." 14:03 Why extracting prices by future impact holds implications for the health industry on the whole. 15:44 "Value-based pricing is a tool to be able to lower health care prices across the board." 16:15 The problem with shifting costs. 17:20 Generic pricing and the patent system. 18:30 Leveraging fear. 20:40 "There's the ability for extraordinary amounts of money to be made here in a way that really does not advance the health of the country." 21:33 Next steps for value-based pricing in Pharma. 23:08 "How are you going to justify those prices?" 23:28 "If you keep pressing and pressing and pressing, there's going to become a breaking point." 24:42 "We need to preserve a way to make sure that those products are developed." 26:26 "Are there other ways that we need to finance and bring to market drugs?" 27:43 The call to action for value-based pricing in Pharma.

In this Episode 277, Stacey Richter talks with Eric Weaver, DHA, MHA, executive director of the Accountable Care Learning Collaborative, about whether now is the time for value-based payments to finally overcome fee-for-service. WHAT YOU'LL LEARN ✅ Why health systems with more revenue in value-based agreements weathered the pandemic's elective-procedure drop-off better ✅ Why cognitive services have historically been undervalued compared to procedural, volume-based care ✅ How the patient experience factors into the value-based care equation ✅ Why purchasers like employers and commercial carriers need to come to the table alongside providers and payers ✅ Why standardized quality measurement remains essential to making value-based care work WHY THIS MATTERS Eric Weaver argues the pandemic exposed a structural risk in fee-for-service: health systems whose revenue depended on elective-procedure volume watched that revenue evaporate overnight, while organizations with capitated, value-based contracts kept getting paid to actually take care of populations. That contrast, he says, is the strongest argument yet for accelerating the shift to value-based payment — not as an aspirational nice-to-have, but as a real hedge against the next disruption. Getting there requires providers, payers, and purchasers to all show up to the table together, since no single stakeholder can make the switch alone. === 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 03:23 Is this pandemic an inflection point for value-based care? 04:10 "If United Kingdom built their National Health System post-World War II, why can't we rebuild ours?" 04:40 "If it's ever gonna happen, it's gonna happen now. I just think we need to wake up." 05:04 Do volume decreases equal payment decreases? 06:10 Where value-based care plays into specialty care vs primary care. 06:21 "There just hasn't been a value on cognitive services as there has been on procedural volume-based care." 06:55 "I really think that independents have to be in the driver's seat here." 06:59 The possible silver lining in this pandemic. 08:07 Why it's mostly about economic incentive … with a couple of caveats. 12:21 More or less hospitals when this shakes out? 14:01 "There has to be some standard of measurement for quality, and we all know that." 17:00 Where the patient experience plays into the value-based care equation. 21:54 "We have to be thinking about the consumer and the patient." 22:25 Where employers land in this equation. 25:14 What happens to the value-based care measures that were in place and aren't anymore? 27:20 How carriers buying providers impacts value-based care. 29:54 "I really think we're … [looking at] a new normal." 30:49 "We have to go all in."

In this Episode 276, Part 2 of a two-part conversation, Stacey Richter talks with Brian Scott of Point6 Healthcare about advice for self-insured employers and that prediction of a 4% to 40% premium increase in the fully insured market. WHAT YOU'LL LEARN ✅ Why provider billing behavior shifts triggered by COVID are likely to outlast the pandemic itself ✅ How the fully insured market differs from the self-insured market in its incentive to control costs ✅ What could happen to fully insured carriers who can no longer raise premiums to cover COVID costs ✅ What self-insured employers should avoid doing right now ✅ How to think about cost vs value of care when trying to avoid outlier claims WHY THIS MATTERS Brian Scott brings a background spanning underwriting, complex claims management, and stop-loss consulting to the question of where employer health costs are headed post-pandemic. His take: COVID-driven changes in provider billing behavior are likely to stick around well beyond the pandemic itself, and self-insured employers face very different incentives and exposure than the fully insured market, which some predict could see premium increases anywhere from 4% to 40%. For employers trying to avoid big outlier claims, Scott's advice centers on understanding the real cost-vs-value tradeoffs in their plan design rather than reacting to headline premium numbers alone. === 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 health care costs and revenue look like further out—2021. 06:13 Can and will employers meaningfully impact the price of care? 07:59 "A lot of it has to do with, 'Who do I receive direction from?'" 10:54 The fully insured market vs the self-insured market. 14:15 The cost of care for COVID-19 cases and the cost of care for cases that turn out not to be COVID-19. 14:41 "Provider billing behavior is going to be impacted well beyond COVID." 16:02 Covered California in the time of COVID-19. 17:15 Does a fully insured carrier have the incentive to cut costs? 17:40 What will happen to fully insured carriers who can no longer raise premium costs to cover COVID-19 costs. 19:13 What self-insured employers shouldn't be doing right now. 20:07 Examining cost vs value of care. 23:42 "How can you create the best chance that you're not going to have really big outlier costs on your plan?" 24:35 Where the name Point6 Healthcare came from.

In this Episode 275, Part 1, Stacey Richter talks with Brian Scott of Point6 Healthcare about whether self-insured employer costs will ultimately go up, and how to protect a company from predatory health care pricing. WHAT YOU'LL LEARN ✅ How to think about the "additions" and "subtractions" that determine whether an employer's health costs rise or fall post-COVID ✅ Why telemedicine is likely to be the point of care most utilized after the pandemic ✅ What a health care model without a traditional PBM might look like ✅ Why COVID could be a flash point for real structural change in employer health costs ✅ Why digging into individual plan concerns, not just macro trends, is where real savings live WHY THIS MATTERS Brian Scott breaks down the equation self-insured employers are wrestling with: added costs from COVID-19 treatment weighed against reduced costs from deferred elective care, with doctor visits down 35% to 80% depending on specialty. Whether that nets out to higher or lower total costs depends heavily on how care-seeking behavior shifts long term, especially around telemedicine, and how PBM and formulary dynamics evolve. Scott sees COVID as a genuine flash point — a moment that could either normalize predatory pricing further or finally force the structural changes self-insured employers have needed for years. MENTIONED IN THIS EPISODE 🔗 EP273, with Jonathan Thierman, MD, PhD 🔗 EP274, with Jonathan Thierman, MD, PhD 🔗 EP264, with Ron Wince === 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 03:27 Contemplating the additional costs an average employer might incur relative to employees and COVID-19. 04:34 "People want to interact differently with the health care system moving forward than they have in the past." 06:55 "It's not necessarily intuitive." 07:03 The biggest point of care that's probably going to be utilized post-COVID: telemedicine. 09:19 EP273 and EP274 with Jonathan Thierman, MD, PhD. 09:34 The health care shifts we're likely to see moving forward. 13:00 Some of the negative consequences of COVID-19. 15:25 What a health care model without a pharmacy benefits manager (PBM) might look like moving forward. 17:22 "Their solution might be, 'Change the formulary.'" 19:39 EP264 with Ron Wince. 21:02 "Finding ways to really dig into … these individual concerns … are not necessarily top of mind." 22:37 COVID creating a flash point for change. 23:04 "I don't know if it's best to call it an opportunity." 24:52 The different health model changes being discussed. 27:28 The incentive carriers have to make this COVID analysis. 28:51 "Costs have to come down."