Relentless Health Value

In this Episode 273, Part 1, Stacey Richter talks with Jonathan Thierman, MD, PhD, chief medical information officer at LifeBridge Health, about at what level telehealth will survive after the end of the pandemic.

WHAT YOU'LL LEARN

✅ What telehealth was doing pre-COVID, and how dramatically that changed once the pandemic hit

✅ What percentage of patients doctors are actually able to see well via telemedicine

✅ Why a window into a patient's home can offer a better view of their social determinants of health

✅ How AI is starting to play a role in telemedicine encounters right now

✅ Why improving access to care also tends to improve demand for care

WHY THIS MATTERS

Jonathan Thierman, an ER doctor and chief medical information officer who'd already been building out telehealth capabilities before COVID, offers a grounded take on what the technology can and can't replace. Most of medicine outside surgical services, he argues, is fundamentally a "mental game," which is why telehealth can work so well — and a virtual visit can even reveal social determinants of health a clinician might miss in an exam room. But Thierman is careful to note that improved access also means improved demand, raising real questions about whether more frequent telehealth touch points ultimately improve or complicate health care quality and cost.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

03:26 What was happening with telehealth pre-COVID-19.

04:50 What's happened to telehealth and primary care practices post-COVID-19.

06:28 How quickly telehealth medicine appointments are growing.

07:30 What percentage of patients are doctors able to see via telemedicine?

08:24 Are patients getting adequately cared for?

10:20 "The vast majority of medicine, except for surgical services, really is a mental game."

14:15 "If you have a window into the home, you probably have a better view of the social determinants of health."

14:25 How AI plays into telemedicine right now.

16:52 Where telehealth visits will land after the pandemic.

18:40 "When you improve access, you also improve demand."

19:22 Is telehealth consumer driven?

20:48 "For the most part, patients are most connected to their actual physician."

21:37 Why more frequent touch points via telehealth will benefit health care quality and costs in the future.

28:20 "It's about the patient, and it's about really keeping them well."

In this episode, Stacey Richter talks with Guy Culpepper, MD, founder and CEO of an independent physician group in North Texas, about why the COVID-19 pandemic is a game changer for primary care physicians and the employers and health plans who pay them.

WHAT YOU'LL LEARN

✅ Why independent PCPs are furloughing staff and considering shuttering practices in the middle of a pandemic

✅ How the pandemic is a flash point that's triggering abrupt, transformational change in the business of primary care

✅ What direct primary care (DPC) and direct-to-employer models actually look like

✅ Why independent doctors, not those inside accountable care organizations, may be best positioned to drive real change

✅ What health plans and employers should be doing right now to support primary care

WHY THIS MATTERS

Guy Culpepper argues that the pandemic has exposed just how broken fee-for-service reimbursement is for primary care physicians, many of whom are furloughing nurses and questioning their practices' survival even as patient need for care is obviously high. He sees this moment as a flash point that could finally force a shift toward direct primary care and direct-to-employer contracting, cutting out traditional insurance and FFS altogether. Culpepper is blunt that if independent doctors don't survive this moment, there's nothing left to break the chain of a system he sees as often abusive to both physicians and patients.

MENTIONED IN THIS EPISODE

🔗 EP270, with Dave Chase

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

02:22 What a PCP's average day looks like during the pandemic.

03:48 How likely is it that PCPs can transition easily to telehealth?

06:00 Why the pandemic is a flash point game changer for telehealth and PCP reimbursement.

08:54 "It's like a perfect storm of multiple tragedies coming together."

10:47 How primary care is going to alter after this.

13:24 "We need to totally change the way that our country pays us."

14:29 What is the incentive for health plans and hospitals to change financial models in all of this?

16:26 "The ones who are going to change are the ones who need to change."

18:13 Why the employers will be demanding this change in financial model.

19:12 Why being independent vs being part of an accountable care organization matters during this pandemic.

21:07 "If we don't save the independent doctors, there's nothing to break this chain of abuse."

24:34 "Higher income doesn't always mean more happiness; it often means less sense of freedom."

25:53 "There's a point where a little bit more money and a loss of freedom are no longer properly balanced."

27:53 Untangling the FFS reimbursement.

30:00 Why right now is a flash point for PCP reimbursement.

30:38 "No one else can do what we can do in effective primary care. No one … in this market."

31:49 What payers should be doing right now.

33:27 EP270 with Dave Chase of Health Rosetta.

33:39 Dr. Culpepper's message to Medicare.

In this episode, Stacey Richter talks with Al Lewis of Quizzify, along with guests Rachel Miner of Thrive Benefits, David Contorno of E Powered Benefits, and health care attorney Doug Aldeen, about a surprise billing defense strategy for patients and employers in the middle of the COVID-19 pandemic.

WHAT YOU'LL LEARN

✅ Why surprise billing risk hasn't disappeared during the pandemic, even with CARES Act protections for COVID-19 patients

✅ How the Quizzify wallet card works as a surprise billing defense strategy for patients and employees

✅ Why self-insured employers and health plans, not just patients, can be on the hook for uncapped COVID-19 treatment costs

✅ What to do if a balance bill arrives despite using the wallet card

✅ Why advance preparation is the key to avoiding egregious ER bills

WHY THIS MATTERS

Al Lewis and his guests unpack a practical defense against surprise billing: a wallet card patients can present in the ER that sets terms in advance rather than signing an open-ended financial consent. The conversation traces how COVID-19 complicates the picture — the CARES Act protects patients who test positive, but uncovered costs can still land on self-insured employers and plans, and non-COVID emergencies haven't stopped happening. David Contorno, Rachel Miner, and Doug Aldeen add perspective on why employers should proactively distribute this protection and what recourse exists even after a balance bill shows up.

MENTIONED IN THIS EPISODE

🔗 EP249, with Dale Folwell

🔗 EP186, with David Contorno

=== 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.

04:26 What is the likelihood of a surprise bill in the time of coronavirus?

07:41 What the surprise billing wallet card looks like and what it does when you use it.

09:55 Rachel Miner's experience with the Quizzify surprise billing wallet card.

14:42 EP249 with Dale Folwell.

15:33 Should employers be advocating for the use of the Quizzify wallet card?

16:22 How an employer should get the wallet card out to their employees.

17:29 David Contorno explains the inspiration behind the Quizzify wallet card.

19:29 "Because of that federal law, you do not need to sign that financial consent."—David

19:42 "Don't obligate yourself financially to some unknown amount."—David

19:56 The legal standard: a battlefield consent.

21:18 Negotiating vs not negotiating.

22:38 Why employers should care about surprise billing.

22:58 Best practices for employers educating employees on why this wallet card is important.

24:19 "This is not something your employer is doing to you; this is something your employer is doing for you."—David

24:25 EP186 with David Contorno.

27:19 Doug Aldeen on what happens after using the wallet card and then gets the balance bill.

30:47 What happens after you sign the financial contract after editing.

32:01 Asking for the director of revenue cycle management after getting your surprise bill.

36:36 "It's not as daunting as people think."—Doug

36:56 "The general rule … is that the more you do in advance, the better."—Al

37:49 Why 2x Medicare is the sweet spot for reasonable price.

38:38 What employers should be doing right now to distribute these Quizzify wallet cards.

In this episode, Stacey Richter talks with Dave Chase, cofounder and CEO of Health Rosetta, about how to save primary care practices with the Marshall Plan for prospective payment models during COVID-19.

WHAT YOU'LL LEARN

✅ Why an estimated 60,000 family practices were at risk of closing during the pandemic

✅ Why transitioning to telehealth isn't as simple as flipping a switch for independent PCPs

✅ What happens to patients and communities when independent PCPs go out of business

✅ What Health Rosetta's Marshall Plan asks of self-insured employers and commercial health plans

✅ Why prospective payment models could be the key to keeping primary care independent

WHY THIS MATTERS

Dave Chase argues that COVID-19 is accelerating a crisis that was already building for independent primary care: fee-for-service reimbursement simply doesn't cover what PCPs do, and if independent practices fold, patients lose access right as private equity and large payers scoop up captive PCP populations. His Marshall Plan calls on self-insured employers and health plans to move toward prospective payment models now, both to keep community-based primary care alive and to prevent further consolidation that tends to raise costs for employers down the line.

=== 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.

03:15 The state of independent fee-for-service PCPs during COVID-19.

03:57 CMS and telehealth, and why these aren't really aiding PCP revenue.

05:52 Worst-case scenario of where COVID-19 is going to leave our PCPs.

06:58 Looking to Optum's PCPs and what's happening there.

08:46 "There's a biological virus that's running rampant in our country, but there's been a metaphorical virus running through our health care system."

09:33 The incredibly fast transition to digital health because of COVID-19.

10:56 CMS's prospective payment model.

14:43 "In my view, we are not returning to normal."

15:21 Dave's call to action for saving PCPs during COVID-19.

22:07 Dave's advice for what PCPs should be doing right now.

24:01 "Here's the egg; crack it open."

In this episode, Stacey Richter talks with Eric Bricker, MD, from AHealthcareZ, about prepping for the next wave of COVID-19 and what payers and providers should be doing right now to get ready.

WHAT YOU'LL LEARN

✅ How COVID-19 is squeezing revenue for insurance carriers, PBMs, and self-insured employer plans

✅ Why health systems could face a "cash crunch" even as they treat the surge

✅ Why telehealth revenue is more complicated than it appears right now

✅ How shifts from high-deductible plans to Medicaid could affect population health outcomes

✅ What hospitals need to be thinking about as they come out of the peak

WHY THIS MATTERS

Eric Bricker walks through how nearly every health care stakeholder's revenue picture is being reshaped by COVID-19, from carriers bracing for employer layoffs to PBMs and health systems facing their own cash pressures. He and Stacey discuss the coming second wave — not of infections, but of patients who deferred care and will need it urgently — and what that backlog could mean for population health outcomes as people shift coverage and care-seeking behavior changes.

MENTIONED IN THIS EPISODE

🔗 EP251, with Dr. Kimberly Noel

🔗 EP267, with Dr. Marty Makary

🔗 EP268, with Dr. Marty Makary

=== 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 How COVID-19 is impacting insurance carriers and payers.

06:16 How COVID-19 is going to affect payers with self-insured employers.

07:59 "The carrier's revenue is going to go down because of layoffs."

09:05 Other helpful or harmful COVID-19 factors to insurance carriers.

12:37 The risk to pharmacy benefit manager (PBM) revenue.

13:14 The financial stability of recent health system mergers.

14:03 The potential "cash crunch" for health systems because of COVID-19.

17:01 The issue with telehealth revenue right now.

20:57 EP251 with Dr. Kimberly Noel.

21:32 "In health care, you add technology and the price tends to go up."—Stacey

22:02 "Telemedicine allows for geographic competition."

22:19 How COVID-19 will affect specialty from a revenue perspective.

24:31 "An economic truism … one person's spending is another person's income."

27:06 "Pain causes change."

28:01 Do population health outcomes go up or down after COVID-19?

29:15 The high number of moves from high-deductible plans to Medicaid and how that will affect patient outcomes.

32:38 EP267 and EP268 with Dr. Marty Makary.

33:02 Coming out of this peak, what hospitals need to be thinking about.

In this episode, Stacey Richter talks with Doug Aldeen, an attorney who helps employers settle hospital bills, and Al Lewis of Quizzify, about COVID-19 billing under the newly signed CARES Act.

WHAT YOU'LL LEARN

✅ What the CARES Act's No Cost Sharing for COVID-19 Testing and Vaccines provision actually requires

✅ Why hospitals and diagnostic testing companies can effectively name their price on COVID-19 tests

✅ Why waived cost sharing for COVID-19 treatment doesn't protect patients from bills for other conditions treated at the same time

✅ What happens when a patient is treated at a hospital outside their plan's network

✅ How the Quizzify wallet card can help protect patients and employers from COVID-19 surprise billing

WHY THIS MATTERS

Doug Aldeen breaks down the fine print in the CARES Act's COVID-19 testing provision: insurers must cover testing without cost sharing, but that requirement effectively lets hospitals and labs set their own prices, with employers and insurers on the hook to pay. He warns that waived cost sharing for COVID-19 treatment doesn't extend to unrelated conditions a patient might be treated for during the same hospital stay, nor does it resolve out-of-network exposure. Al Lewis closes with a preview of the Quizzify wallet card as a practical defense employers and employees can use against these surprise bills.

=== 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

04:12 Hospital billing as it relates to COVID-19.

05:45 Who is "on the hook" for paying these COVID-19 bills.

08:17 "Reasonable payment" in the case of COVID-19.

08:45 Is COVID-19 different than every other billing situation?

10:12 What's going to come out of the out-of-network COVID-19 costs?

11:29 What employers should be doing right now.

12:50 The takeaway for everyone "bankrolling" COVID-19.

13:26 "This whole thing is tilting towards, 'Who's going to pay for all this stuff?'"

13:53 Connecting the dots with COVID-19 billing.

15:25 Using the Quizzify wallet card, and how this can help avoid COVID-19 surprise billing.

16:17 Download the wallet card at quizzify.com.

In this episode, Stacey Richter talks again with Marty Makary, MD, MPH, surgeon at Johns Hopkins and author of "The Price We Pay," about action steps for hospitals, payers, employers, and pharma after June, once the reactive phase of the COVID-19 pandemic winds down.

WHAT YOU'LL LEARN

✅ What "normal" is likely to look like once the pandemic starts winding down

✅ Why patients who need basic medical care right now aren't getting it, and what backlog that creates

✅ Why prioritizing which patients get care first is a new challenge for American medicine

✅ Why lowering insurance deductibles could be key to a successful recovery on the other side of the pandemic

✅ What hospital executives, payers, employers, and pharma should be planning for months out

WHY THIS MATTERS

Marty Makary looks past the immediate crisis to the second phase of COVID-19: a backlog of deferred elective surgeries, postponed visits, and skipped lab tests and imaging that will demand a kind of care prioritization the US health system has never really had to do. He argues the pandemic is exposing gaps in teamwork and coordination in medicine, and that decisions made now around deductibles, pharmacy access, and hospital planning will shape how well the system recovers. Makary sees real opportunity buried in the disruption, alongside a hard question few in health care have had to answer before: who gets to go first?

=== 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.

02:23 What "normal" will look like in June.

03:46 Why people who need basic medical care right now aren't getting that care.

06:13 "For the first time, we've got to think now about prioritizing which patients need to get in line first."

07:51 "We see gaming of the system."

08:05 "We don't do a good job of prioritizing."

10:07 Why teamwork and team building are a problem in medicine.

12:57 The incredible heritage of the medical profession.

13:52 Will there be a decrease in outcomes?

14:33 Why lowering insurance deductibles will be key in making successful strides on the other side of this pandemic.

17:23 The great things to come out of the pandemic.

21:41 "Everybody's right … [they're just] looking at it from their point of view."

21:56 What's in store for pharmacies coming out of this pandemic.

24:53 What hospital executives should be doing, looking and planning months out from now.

25:48 "We've never asked ourselves, 'What would take priority?'"

In this episode, Stacey Richter talks with Marty Makary, MD, MPH, surgeon at Johns Hopkins and author of "The Price We Pay," about action steps for hospitals, payers, employers, and pharma from now until June, during the reactive phase of the COVID-19 pandemic. Episode 267.

WHAT YOU'LL LEARN

✅ What made Marty Makary sound the alarm bells early on COVID-19

✅ What the next four to six weeks were likely to look like for hospitals and health care workers

✅ What business leaders should be doing right now to support the pandemic response

✅ Why rural hospitals were a particular point of concern

✅ What pharma and researchers should be prioritizing during this initial phase

WHY THIS MATTERS

Marty Makary lays out what the worst weeks of the pandemic's first wave were likely to demand: rapidly building hospital capacity, protecting frontline health care workers, and getting business leaders and pharma pointed at the right priorities. He's candid that "anything that can wait 3 months must wait 3 months," and that overfunding hospitals right now is a risk worth taking. The conversation sets up a second episode, released later that week, covering what comes after this acute phase.

=== 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.

01:38 What happened that made Marty Makary sound the alarm bells on COVID-19.

03:12 Paul Kennedy's "The Rise and Fall of the Great Powers."

04:21 "Everyone has an opinion, but no one's listening."

06:00 What the next 4-6 weeks will look like.

08:22 What we should do to support our highest-risk patients: health care workers.

09:16 How long will this initial phase last?

13:10 What business leaders should be doing right now.

16:11 "Critical care generally pays very well."

17:15 Marty's concern for rural hospitals.

17:30 "If we're going to overfund [something], I'd like it to be our hospitals."

20:54 "I think the pharma industry has also gotten a wake-up call … Maybe we should start working on viruses."

24:04 "We're at war with COVID-19 right now."

25:32 "We need to help researchers that are working specifically on lowering deaths from COVID-19."

28:23 "Anything that can wait 3 months must wait 3 months."

30:37 "We need everybody."

31:38 "Hospitals need to be focused on building capacity, number one."

In this episode, recorded prior to COVID-19 hitting the US, Stacey Richter talks with Matt Anderson, MD, MBA, innovation lead at Banner Health, about why partnership between "scrubs" and "suits" leads to better outcomes for everyone except those looking to exploit patients.

WHAT YOU'LL LEARN

✅ Why physician leadership matters more than ever when fast, good decisions are required

✅ The difference between technology that burdens clinicians and technology that strengthens the clinician-patient bond

✅ Why low-revenue care sometimes serves patients better than high-revenue care

✅ Why building a culture where it's okay to fail matters for innovation in health systems

✅ How educating clinicians on the business of health care earlier could change decision-making

WHY THIS MATTERS

Matt Anderson argues that when "the suits" and "the scrubs" make decisions together, patients and the business both come out ahead — but decisions made about care delivery from far outside the exam room tend to go poorly. He connects this to the Shkreli Awards and a broader theme of physicians demanding a seat at the leadership table, not to undermine administrators, but to ensure clinical reality and sustainability inform each other. Recorded before COVID-19 hit, the conversation reads as a case for exactly the kind of physician-administrator partnership a crisis demands.

MENTIONED IN THIS EPISODE

🔗 EP260, with Shannon Brownlee and Vikas Saini, MD

=== 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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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction.

02:30 Distinguishing between billing technology and technology improving bonds between clinicians.

04:03 "The scribe is literally just there to take the burden of the EMR off the physician."

04:41 "If all of your goals begin and end with patients, you're not gonna go wrong."

06:07 "We gotta get a little bit tribal in medicine."

06:27 "Physicians have to be leaders in this space."

07:21 Suits vs scrubs.

08:47 Why low-revenue care is sometimes better than high-revenue care.

13:49 EP260 with Shannon Brownlee and Vikas Saini, MD, from the Lown Institute.

16:11 "There's a role to play for all of our clinical partners in the leadership of our health care systems."

16:38 "You have to be able to be curious."

18:35 The movement to humanize medicine with technology, led by Eric Topol.

20:45 Creating a culture where it's okay to fail.

22:31 Starting the educational process on the business of health care earlier.

25:48 Technology as top-down vs physicians as bottom-up.

In this episode, Stacey Richter talks with Randy Vogenberg, PhD, principal at the Institute for Integrated Healthcare, about the what, the how, and the questionable why of digital therapeutic formularies.

WHAT YOU'LL LEARN

✅ What a digital formulary actually is, and why PBMs are drawn to creating them

✅ Why the word "formulary" implies more than a technology assessment — it implies a promise of reimbursement

✅ Whether a third party disconnected from the care setting should be selecting which digital tools get used and paid for

✅ Why a more crowdsourced, bottom-up approach to digital health tool selection might work better

✅ What's standing in the way of resetting reimbursement for digital therapeutics

WHY THIS MATTERS

Randy Vogenberg questions whether digital therapeutic formularies, largely driven by PBMs, actually serve patients or mostly serve as a new revenue opportunity dressed up as market need. He argues that health care is fundamentally local and relationship-driven, which makes top-down technology selection a poor fit, and suggests that those who actually use digital tools — clinicians and patients — need a real seat at the table in deciding what gets adopted and reimbursed. The conversation surfaces just how many unresolved questions remain around cybersecurity, harm, and what's genuinely worthy of reimbursement in digital medicine.

=== 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

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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction.

02:51 What a digital formulary is.

03:52 PBMs and digital formularies.

04:41 The changing landscape of PBMs and digital health.

06:00 The intersection of PBMs and digital health tools.

10:18 "Arbitrage, full on."—Mark Blum, from America's Agenda.

12:21 The inherent differences between a health plan and a PBM.

15:58 The original purpose of a pharmacy/therapeutics committee.

16:58 "There's a lot of change happening, is the bottom line."

18:18 The risk assessment behind medical software.

18:29 Harm vs digital therapeutics and digital medicine.

18:52 Cybersecurity in digital therapeutics.

19:08 Reimbursement in digital therapeutics.

19:43 The question of "how" in reimbursement.

20:37 "How do we reset health care in just one state, let alone the whole country?"

22:13 Taxpayers, patients, and employers vs the health care industry.

22:56 The slow move away from fee for service, and why.

24:13 The timeline for incorporating digital tools into the health care system.

24:33 "It's a real problem for the consumer side."

25:09 "What's really going to be worthy of reimbursement?"

25:50 "There's only two major payers in the health care system … that's the government, and it's the private sector employers and state programs or unions."