Relentless Health Value

In this episode, Stacey Richter talks with Ron Wince, CEO of Myndshft, about how prior authorizations collide with trust between payers and providers.

WHAT YOU'LL LEARN

✅ Why payers put prior authorizations in place, and the three reasons behind them: cost, medical necessity, and compliance

✅ How the prior authorization system can fail both patients and payers

✅ The toll prior authorizations take on providers and patients alike

✅ What "gold carding" means and how it fits into the prior authorization landscape

✅ How technology like Myndshft's is trying to solve the "chasm of trust" at the center of prior auth

WHY THIS MATTERS

Ron Wince describes a vicious cycle: payers don't trust providers to deliver only appropriate care, so they impose prior authorization requirements; providers then learn to game those requirements to get patients care faster, which triggers even more arduous processes that catch good and bad actors alike in the same net. The result is moral injury and burnout for clinicians and painstaking delays for patients. Wince argues that technology at the intersection of AI and blockchain could help close this chasm of trust, but only if it addresses the underlying incentives driving the standoff between payers and providers.

MENTIONED IN THIS EPISODE

🔗 EP200, with Stacey Worthy

🔗 EP260, Shkreli Awards

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

01:29 What is a prior authorization?

02:45 The three reasons payers put prior authorization in place.

02:49 Cost, medical necessity, and compliance.

04:24 EP200 with Stacey Worthy.

05:15 "Clinicians are really managing clinicians in a lot of ways."

05:41 Why the prior authorizations system sometimes fails patients and payers.

08:13 Surprise care—can it be avoided?

09:53 The impact on providers.

14:52 The impact on patients.

16:46 Specialty pharmacy and prior authorizations.

18:43 Shkreli Awards (EP260).

19:25 The most complex prior authorizations.

21:03 E-prior authorizations.

24:19 Gold carding and what that is within prior authorizations.

28:08 The "chasm of trust."

29:11 Myndshft and its goal to solve prior authorization issues.

In this episode, Stacey Richter talks with Andrew Eye, CEO of ClosedLoop, about how population health leaders are actually using artificial intelligence right now.

WHAT YOU'LL LEARN

✅ How top-performing Medicare Advantage plans are already using AI to risk-stratify populations

✅ What predictive analytics actually means and where its real use cases lie

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

✅ What "data shaming" gets wrong, and why incomplete data can still be valuable

✅ Why the returns on more interoperability and more data for machine learning eventually diminish

WHY THIS MATTERS

Andrew Eye cuts through the AI hype to explain what's actually working in population health today: predictive models that flag which members are likely to become high-cost without intervention, built from real-world, messy health care data organizations already have. He pushes back on oversimplified thinking about risk and data completeness, and argues that most organizations don't need to wait for perfect interoperability to start using the data they already have to improve patient care. His advice is blunt: get started now, because the inefficiency the system can't afford isn't going away on its own.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

01:50 Artificial intelligence in health care, and the different things that this means to the health care community.

02:06 Image analysis, also known as replacing doctors with robots.

02:25 Chatbots for health care.

02:43 Predictive analytics.

04:39 "What they really care about is, How can this impact our business? How can this improve patient lives?"

04:51 "For us, this is all just better math."

08:13 What exactly predictive analytics is.

08:40 The use cases of predictive analytics value.

11:33 The oversimplification of how people think about risk.

13:13 "Did you have an impact or not?"

13:27 The public scorecard for predictive analytics.

18:16 "Explainability is a real hot topic in artificial intelligence, specifically in health care."

19:46 Data shaming—what's wrong with it, and why incomplete data are still important.

21:53 The possibilities that machine learning allows for in patient care in health care.

28:08 "Our health care system can't afford for that level of inefficiency."

29:21 "It's not a question of if; it's a question of when."

30:37 The diminishing returns of interoperability and more data for machine learning.

33:54 "You're running your business today, and whatever data you're using to run your business … you can use it to provide better patient care."

34:34 Andrew's advice: Get started now.

In this episode, Stacey Richter talks with Brian Van Winkle and Rishab Shah from Johns Hopkins Medicine's Sibley Innovation Hub about the ease of doing business with health systems, and their work with NODE.Health.

WHAT YOU'LL LEARN

✅ Why the World Bank's Ease of Doing Business model inspired a health care equivalent

✅ Why health systems that are easy to work with attract the best entrepreneurs and start-ups

✅ The seven success factors an organization needs to improve its ease of doing business

✅ Why provider organizations can't be great at inventing everything themselves

✅ What it takes for health systems to become great aggregators of outside innovation

WHY THIS MATTERS

Brian Van Winkle and Rishab Shah argue that health systems face the same dynamic the World Bank identified among countries: organizations that are easy to do business with attract the talent and innovation that make everyone around them better off. Their Ease of Doing Business Initiative, built under NODE.Health with participation from a dozen or more leading health systems, ranks organizations across seven categories — from customer support and governance to data security and industry perception — to help hospitals see where friction is holding back the outside innovation they need.

=== 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.

03:46 Focusing on "outside-in" innovation.

04:09 The downside to hospitals and health systems not being easy to work with.

05:17 "You have to acknowledge that we're in a crisis state."—Brian

06:56 "Are we putting ourselves at a disadvantage by not … being easy to interface with?"—Rishab

08:25 Why hospitals might not be so easy to work with right now.

09:11 The correlation between a partnership strategy and health outcomes and metrics that matter.

09:42 The gap between health care players' workload and collaboration.

12:04 "Who is putting the focus on the requirements?"—Rishab

12:44 What the Ease of Doing Business Initiative is.

14:56 The opportunity for entrepreneurs to be involved in this process.

16:07 Ecosystem-based work groups.

17:22 "What box do you exist in?"—Brian

18:29 The seven success factors an organization needs to be good at to improve their ease of business.

18:53 Customer support and governance.

19:02 Contracting and legal.

19:11 Patient safety and clinical research.

19:21 Integration and technology.

19:27 Data security and availability.

19:32 Commercialization support.

19:39 Industry perceptions.

21:04 How health care systems view their own ease of doing business.

25:20 The intent of the Ease of Doing Business Initiative.

28:39 Outside innovation vs comprehensive innovation strategies.

In this episode, Stacey Richter talks with Fred Goldstein, president and founder of Accountable Health, LLC, about six essential steps to get population health right.

WHAT YOU'LL LEARN

✅ How population health and precision medicine intersect

✅ Why defining and assessing your population is the essential first step

✅ How social determinants of health and behavioral economics are being incorporated into individual assessment

✅ What effective interventions and measurement look like in population health

✅ Why patient-reported outcomes matter, and Fred's advice to payers: forget pilots, build something scalable

WHY THIS MATTERS

Fred Goldstein walks through what "good" population health actually looks like, starting with correctly identifying and assessing a population before ever designing an intervention. He connects precision medicine to population health as a way to get more targeted interventions, and emphasizes that culture change, social determinants, and patient-reported outcomes all matter as much as the clinical metrics organizations typically track. His closing advice to payers is blunt: stop running pilots and start building programs that can actually scale.

=== 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.

01:20 Population health vs precision medicine.

02:46 "What precision medicine allows us to do in population health is to get an even more precise and better intervention."

03:16 Pop health as precision medicine.

03:30 "We need to first note who our population is... and we take that group and we then assess them."

04:57 The variation in care, and how this effects outcomes and care.

05:46 How assessing individuals has improved over the years.

06:28 What the goal of assessment is.

06:46 "What does 'good' look like?"

09:18 The purpose of stratifying individuals.

10:50 The impact of social determinants and how this is being incorporated into individual assessment.

11:15 How the use of behavioral economics has helped.

11:37 "It's really about changing the culture."

12:57 Interventions and what these look like in population health.

17:03 Measurement in population health.

18:45 Population health outcomes, and what these might look like to patients.

19:38 Promising population health outcomes.

21:10 The importance of patient-reported outcomes.

24:47 How providers can tell if they're doing population health well.

26:15 Fred's advice to payers.

27:29 "Forget pilots, build something scalable."

In this episode, Stacey Richter talks with Josh LaRosa, MPP, policy director at the Wynne Health Group, for an update on the snowball of drug pricing initiatives moving through Washington.

WHAT YOU'LL LEARN

✅ The status of Part D redesign legislation and what it means for private industry's stake in lowering costs

✅ The legislative deadline pressure facing drug pricing bills

✅ Where the International Pricing Index Model stands

✅ What's happening with the administration's drug importation plan and its comment period

✅ The latest on 340B hospitals and Health & Human Services

WHY THIS MATTERS

Josh LaRosa returns with a status report on the many drug pricing initiatives zigzagging through Washington, building on the deeper dive from a previous episode. He covers Part D redesign, the International Pricing Index Model, the administration's importation plan and its comment period, and where things stand with 340B hospitals and HHS — giving listeners a quick way to track a fast-moving policy landscape without having to follow it day by day.

MENTIONED IN THIS EPISODE

🔗 EP243, Drug Pricing Snowball

=== 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

01:01 Updates on the drug pricing front on the national level.

01:44 The three major updates on national drug pricing.

01:48 Part D redesign legislation.

02:54 Giving private industry more stake in the game of keeping costs lower.

03:01 Check out EP243 for more info on drug pricing deals.

05:18 The legislative deadline for any of these drug pricing bills to take place.

06:39 The International Pricing Index Model.

08:49 The administration's importation plan.

10:13 The end of the comment period and how long stakeholders have to give their input on the importation plan.

12:29 Updates on 340B hospitals and Health & Human Services (HHS).

In this episode, Stacey Richter talks with Shannon Brownlee, senior VP, and Vikas Saini, MD, president and CEO, of the Lown Institute, about the latest Shkreli Awards for the worst examples of profiteering and dysfunction in the health care industry.

WHAT YOU'LL LEARN

✅ What the Shkreli Awards are and what they're meant to spotlight

✅ How the decline in public trust correlates with hospital rankings on the Shkreli list

✅ Why converting nonprofits to for-profits isn't a fix for the underlying incentive problems

✅ Where private equity shows up in stories of profiteering and dysfunction

✅ Why "fraud is just a fact of life" but the bigger problem is bad behavior that's perfectly legal

WHY THIS MATTERS

Shannon Brownlee and Vikas Saini walk through the Lown Institute's annual Shkreli Awards, a top 10 list naming the worst examples of health care profiteering and dysfunction, named for the infamous "pharma bro." Beyond the individual stories — fraud schemes, corporate pressure on clinicians who raise safety concerns, opioid marketing malfeasance — the conversation returns to a consistent theme: the biggest problem in health care isn't just outright fraud, it's bad behavior that's perfectly legal and normalized. Brownlee and Saini argue real transparency around hospital behavior is what's needed to start shifting incentives.

=== 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.

03:21 What the Shkreli Awards are.

05:17 What the Shkreli Awards are meant to do by spotlighting these areas of health care.

07:24 The categories that the Shkreli Awards winners fall into.

08:56 Balancing the business side with the mission side of health care organizations.

09:33 The correlation between the decline in trust and hospital rankings on the Shkreli Awards list.

12:30 The constraints of the current system and how these affect the behavior of nonprofit hospitals.

13:27 Why making nonprofits for-profit isn't the answer.

16:43 Where private equity plays into profiteering and dysfunction in health care.

19:54 The opioid "kingpins" and the oncology organization that made the Shkreli list.

21:43 "Fraud is fraud; that's just illegal."

26:27 "Fraud is just … a fact of life … the biggest problem [is] bad behavior that's perfectly legal and everybody thinks is okay."

27:10 Shannon and Dr. Saini's advice for organizations looking to avoid getting on the Shkreli list.

27:25 "We need real transparency around hospital behavior."

29:24 "You can't legislate the heart."

29:31 You can see the list at lowninstitute.org/shkreli-2019.

29:46 What the Lown Institute is and what they do.

In this episode, Stacey Richter talks with Rahul Dubey, founder of Percynal Health Innovations and former chief innovation officer at AHIP, about what payers are looking to solve for right now.

WHAT YOU'LL LEARN

✅ The four core challenges Rahul Dubey's strategic working groups keep surfacing across payers and providers

✅ Why payers should think of themselves as "great aggregators" of data and solutions

✅ Why information transfer without extracting real value from it doesn't work anymore

✅ How relationship innovation and business model innovation matter as much as technology

✅ Rahul's advice to health plans and providers looking to collaborate better

WHY THIS MATTERS

Rahul Dubey brings a structured lens to payer innovation: get to real population health management, cut operational inefficiencies, stop trafficking information without extracting value from it, and level up health literacy. He argues payers are increasingly becoming aggregators — of data, of solutions, of services — rather than just risk-bearing entities, and that the innovation happening right now is more about relationships and business models than pure technology. His closing question for anyone in this space is simple but pointed: who are we actually trying to serve?

=== 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.

02:08 The stated needs of payers.

03:24 "Where are the inefficiencies that we can actually cut out of the system?"

05:14 A reverse approach to meeting the needs of payers.

06:35 Information transfer—what this means.

09:42 "Innovation is a team sport."

13:12 The "optimal solution."

18:49 "The lines of communication and business model creation … it's getting very creative right now."

20:10 Data play and finding key insights.

20:49 "A more definitive risk."

21:24 Vendors as "solution providers."

21:33 "The great aggregators"—collaborating optimally.

22:39 Brian Van Winkle and Rishab Shah on NODE.Health's "Ease of Doing Business."

25:16 "It's more relationship innovation and business model innovation than technology."

27:02 Rahul's advice to health plan collaborators, like insurance carriers.

29:44 Rahul's advice on how providers can collaborate better.

30:37 What's essential to payer success.

30:56 "Who are we trying to serve?"

In this episode, Stacey Richter talks with seven health care thought leaders — Kimberly Noel, MD, Eric Weaver, Suzanne Delbanco, Sue Schade, Naomi Fried, Joe Grundy, and Adrian Rubstein — about the areas of promise they see in health care heading into 2020.

WHAT YOU'LL LEARN

✅ Why inclusive innovation matters as AI moves from hype into real application

✅ Why relationship-driven, team-based primary care keeps coming up as an area of promise

✅ How employers are seeking out high-value health care in nontraditional ways

✅ Why eliminating clinician burnout and improving patient engagement are linked areas of promise

✅ Where AI, CRISPR gene editing, and virtual/augmented reality show up as emerging bright spots

WHY THIS MATTERS

Seven thought leaders spanning health systems, payers, pharma, IT, and consulting each name where they see genuine promise in health care for 2020. Common threads emerge across very different vantage points: AI moving past the hype cycle into real applications, primary care shifting toward relationship-driven and direct models, employers demanding better data and higher-value care, and a shared push to break down silos so all stakeholders — including pharma — work toward better patient outcomes together.

=== 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.

02:41 Dr. Kimberly Noel and her thoughts on areas of promise.

02:53 Advocacy for inclusive innovation.

04:01 Why inclusive innovation is an area of promise in the advent of artificial intelligence (AI).

04:52 "Who is most likely to be disadvantaged?"

05:27 Eric Weaver's thoughts on areas of promise.

05:42 Relationship-driven, team-based primary care.

07:14 What investors are focused on right now.

07:34 Where the tipping point is in value-based care.

08:03 AI as another trend that will help improve health care.

08:48 Incorporating social determinants into primary care and the transformative potential of AI.

11:07 Suzanne Delbanco of Catalyst for Payment Reform and her thoughts on areas of promise.

11:26 Employers making the health care space work better for them as an area of promise.

11:52 Employers seeking out high-value health care in nontraditional ways.

13:10 Where to look to seek high-value health care.

14:37 Employers bringing in really good data.

16:15 Sue Schade's thoughts on areas of promise.

16:32 How leveraging electronic health records is an area of promise.

16:58 Why eliminating clinician burnout is also part of this area of promise.

17:26 Patient engagement and the patient journey as another area of promise.

18:08 "You have to approach all of these from a partnership between digital, IT, and operations."

18:30 Enterprise resource planning (ERP) as a third area of focus/promise.

19:01 AI as an area of promise and an area of hype.

19:48 Naomi Fried's thoughts on areas of promise in health care.

20:02 Digital health developments from the pharma perspective.

22:15 The digital health start-up world as another area of interest and promise.

22:37 The importance of data and the importance of validating those data for digital health solutions.

23:02 Personalized medicine and digital health.

24:32 More jobs in digital health within clinical-grade solutions.

25:01 Joe Grundy's thoughts on areas of promise in health care.

25:06 The direct primary care model as an area of promise.

26:08 "Questioning the very validity of our understanding of 'quality' in health care."

28:01 Adrian Rubstein's thoughts on areas of promise in health care.

28:08 AI in emergency medicine as an area of promise.

28:53 CRISPR gene editing as an area of promise.

29:59 Virtual reality/augmented reality as another area of promise in health care.

In this episode, Stacey Richter talks with Karl Bilimoria, MD, surgical oncologist and VP of quality at Northwestern Medicine, about rating the raters of hospital quality.

WHAT YOU'LL LEARN

✅ What prompted Dr. Bilimoria and colleagues to "rate the raters" of hospital and physician quality

✅ Which major publicly reported hospital rating systems were evaluated, and how they compared

✅ The six criteria used to judge the rating systems themselves

✅ What conflicts of interest show up among these rating systems

✅ Dr. Bilimoria's advice to employers on how to pick a rating system, and why to triangulate the data

WHY THIS MATTERS

Karl Bilimoria set out to answer a question that had been nagging at Stacey after a personal experience visiting a "top-rated" hospital that had readily apparent quality issues: how good are the major hospital rating systems, really? His team evaluated systems like CMS Hospital Compare, Healthgrades Top Hospitals, Leapfrog Safety Grade, and U.S. News & World Report Best Hospitals against six criteria, uncovering meaningful differences in methodology and conflicts of interest. His bottom-line advice for employers and health care consumers: interpret any single rating system cautiously, and triangulate across multiple sources rather than trusting one "gold standard."

=== 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.

02:06 The impetus for Dr. Bilimoria deciding to rate the raters.

03:38 How high the stakes are when considering these ratings.

05:01 Breadth vs depth when choosing how and what to measure among the rating systems.

05:38 What rating systems the Rate the Raters looked at and why.

06:11 Who got the best scores as a rating system and who got the worst?

06:58 Dr. Bilimoria and the Rate the Raters' qualifications on rating these rating systems.

07:35 The methodology and criteria that the Rate the Raters came up with to evaluate these rating systems.

08:01 The six criteria that the Rate the Raters system uses to evaluate rating systems.

08:39 "At every step, we included the rating systems."

09:14 The intent behind Rate the Raters.

09:55 Why having grades is a positive for the health care consumer.

10:41 What conflicts of interest might be of concern among these rating systems?

12:22 "Notable notes" for these rating systems, and what each rating system incorporates or doesn't incorporate, and how these things affected their rating.

18:22 Creating a gold standard and finding ways to move the field forward.

22:05 Getting to better data in the short term and the long term by doing meaningful audits.

24:09 Individual ratings vs institutional ratings and where these intersect.

26:27 Dr. Bilimoria's advice to employers and how to pick a rating system.

27:45 "These rating systems should be interpreted very cautiously, even the best of them."

28:03 "Triangulate the data."

30:07 What Dr. Bilimoria and Rate the Raters are currently working on.

In this episode, Stacey Richter talks with Ron Vianu, founder and CEO of Covera Health, about a major health care cost driver hiding in plain sight: misdiagnoses in radiology.

WHAT YOU'LL LEARN

✅ How misdiagnoses that start with imaging can send an entire treatment plan down the wrong path

✅ Why so few people are talking about radiology's role in health care costs and outcomes

✅ Why there's currently no real visibility into which imaging centers deliver accurate diagnoses

✅ How evidence-based medicine can be derived and applied to radiology quality

✅ Why there's no widely accepted metric to measure quality in radiology today

WHY THIS MATTERS

Ron Vianu makes the case that radiology misdiagnosis is a hidden but massive driver of wasteful health care spending: when an MRI, CT, or ultrasound reading is inaccurate, the resulting treatment plan is aimed at the wrong problem from the start. He argues patients and purchasers currently have almost no visibility into which radiologists or imaging centers reliably deliver accurate diagnoses, and that the industry lacks a real metric to measure radiology quality. Covera Health's approach is to build the data and evidence base needed to change that, starting with better-informed relationships between patients, providers, and imaging centers.

=== 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.

01:53 Why radiology is so relative to health care outcomes and outcomes costs.

02:23 Why very few people are talking about radiology, and why they should be.

03:41 Shopping for value vs price and quality in radiology.

04:18 "The real problem is that there's no visibility."

04:37 "What is the likelihood of that patient walking out of either imaging center with an accurate diagnosis?"

04:55 The importance of the radiologist in the health outcomes of the patient.

09:45 Working toward yielding an accurate diagnosis in radiology by striking down misconceptions.

12:15 Deriving evidence-based medicine.

16:14 "What relationships exist amongst certain … providers?"

17:56 The data that Covera Health can access and use.

19:51 The incentive for accurately viewing and diagnosing in radiology.

22:24 "There is no metric to measure quality today."