Relentless Health Value

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

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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

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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

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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

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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

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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

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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

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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

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=== CONNECT WITH THE RHV TEAM ===

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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

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=== CONNECT WITH THE RHV TEAM ===

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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."

In this Episode 274, Part 2, Stacey Richter continues her conversation with Jonathan Thierman, MD, PhD, chief medical information officer at LifeBridge Health, about what telehealth means after the pandemic.

WHAT YOU'LL LEARN

✅ How EHR integration actually works for telehealth, and why it matters

✅ Whether relaxed telehealth regulations are likely to snap back to their pre-pandemic form

✅ How natural language processing and AI are starting to fold into the telehealth experience

✅ Why training clinicians in "webside manner" matters as much as the technology itself

✅ Why telehealth doesn't have to be as expensive as organizations assume

WHY THIS MATTERS

Picking up where Part 1 left off, Jonathan Thierman digs into the operational reality of running telehealth at scale: what good EHR integration looks like, how data captured through virtual visits opens up insights health systems are still learning to use, and why training clinicians and patients alike is as critical as the technology. Thierman's bottom line for organizations newer to telehealth is straightforward — jump in now, because it's here to stay, and it doesn't have to cost as much as people assume.

MENTIONED IN THIS EPISODE

🔗 EP251, with Dr. Kimberly Noel

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

✉️ Enjoy this podcast? Subscribe to the free weekly newsletter

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00:00 Introduction.

03:15 The net effect of adopting telemedicine during the pandemic.

06:42 "Data is key."

09:20 "There's a lot more communication going on now between health care providers and their patients than there was before."

09:40 "Even now, we're still scratching the surface of what insights we can gain from the data."

12:42 EP251 with Dr. Kimberly Noel and training doctors in webside manner.

13:00 How telehealth and EHR systems align.

14:02 The telehealth value points that are coming.

17:23 The necessity of training for clinicians embarking on this telehealth adaptation.

18:50 "Jump in, because it's … here to stay."

19:30 "It doesn't have to be as expensive as you think."