Relentless Health Value

Let’s start at the beginning. You may be wondering what exactly is going on right now legislatively and with various proposals. It’s very difficult to keep track of it all. And what are pharma companies and PBMs and insurers mulling over as they contemplate their strategies to maintain their current level of control and keep their shareholders happy? Never fear. In this health care podcast, I speak with Josh LaRosa from Wynne Health Group. He sets us straight and gets us up to speed.

The Price We Pay: What Broke American Health Care and How to Fix It, With Marty Makary, MD (EP242)

"Billing Quality Is Medical Quality": A Conversation on What Broke American Health Care. Episode 242.

If operating on the wrong leg is a medical error, what do you call operating on someone who didn't need surgery in the first place? In this episode, Stacey Richter talks with Dr. Marty Makary about his book The Price We Pay: What Broke American Health Care—and How to Fix It, covering both basic price gouging — surprise billing and predatory pricing at scale — and the second, subtler category: high total prices driven by unnecessary care.

WHAT YOU'LL LEARN

✅ Why hospital bills are so often overinflated, and whether Americans are actually responsible for paying marked-up sticker prices

✅ Why Dr. Makary argues we should call it "predatory billing" instead of softening it as "bad debt"

✅ Why billing practices often happen without hospital leadership even realizing it — and what that means for accountability

✅ Concrete advice for hospital administrators, board members, and employers on how to start restoring honesty in health care pricing

✅ How overtreatment and the "crisis of appropriateness" drive overpricing, and why relationship-based clinics and "choosing wisely" approaches are part of the fix

WHY THIS MATTERS

Large hospitals are on track for the largest profit margins in their history even as patients, employers, and even hospital staff are hungry for honesty about pricing. Dr. Makary's framing — that billing quality is medical quality — reframes egregious pricing not as a side issue to clinical care but as a core part of it, which means fixing it requires the same rigor hospitals already apply to clinical outcomes.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction.

02:11 Marty's new book and its multiple examples of egregious pricing in health care.

02:41 The reason why hospital bills are often overinflated.

03:31 "Are Americans responsible for paying these marked-up, sticker-priced bills?"

04:58 Explaining the complexities of medicine, simplistically.

07:27 Balancing stories of price gouging with responsible billing.

07:59 "Hospitals were created in America as a safe haven for the sick and injured."

09:29 How everyone can work toward changing this at the individual level.

11:23 "Have a conversation with your hospital."

12:59 Marty's advice to hospital administrators and board members.

16:56 "We can restore honesty in health care."

17:01 How billing practices happen unbeknownst to hospital leaders.

17:35 Bad debt and mischaracterizing bad billing practices.

19:12 "Why don't we call it 'predatory billing'?"

22:12 "People are hungry for honesty in health care right now."

23:25 "Large hospitals are on track for the largest profit margin in their history."

24:50 Marty's advice for how employers can help address these egregious prices.

25:47 "Billing quality is medical quality."

27:03 Overtreatment as an element of overpricing in health care.

28:07 The "crisis of appropriateness."

30:19 "How can we talk about the root drivers of poor health?"

31:18 The grassroots movement to start the health care system from scratch.

32:04 Relationship-based clinics.

37:08 Choosing wisely.

37:39 Improving wisely.

43:48 "People are willing to pay for quality, but they just want honesty."

I speak with Dr. Marty Makary about his new book, The Price We Pay: What Broke American Health Care—and How to Fix It. It’s a page turner for hospital execs trying to do the right thing, employers trying to do right by their employees, insurance carriers looking for better ways to actually drive health care value, and doctors and nurses who are feeling burnout because they see their organizations demanding them to do things misaligned with their mission to do the best they can by patients.

Putting the Squeeze on Community Pharmacies, With Vinay Patel, Founder of Self Insured Pharmacy Networks (EP241)

65,000 Community Pharmacies Face an Existential Threat From PBM Pressure. Episode 241.

There are 65,000 community pharmacies in the United States, and the total cost to locate, staff, and operate all of them is about 9% of national drug spending — less than 1% of total national health expenditure, and falling. In this episode, Stacey Richter talks with Vinay Patel, pharmacist and founder of Self Insured Pharmacy Networks, about the mounting pressure traditional PBMs are putting on community pharmacies, and what's at stake if that pressure pushes them out of business.

WHAT YOU'LL LEARN

✅ Why community pharmacies matter disproportionately given how little they actually cost the system — especially since roughly 85% of the nation's prescription fills are unbranded generics

✅ Why many patients rely on walk-in pharmacies for same-day fills, pharmacist advice, and an extension of their care team — especially in rural areas where a pharmacist may be the only accessible provider

✅ How the three dominant PBMs — Express Scripts (ESI), CVS Caremark, and OptumRx — are increasingly squeezing community pharmacies through the pressures they apply on the demand side

✅ Who actually hires and pays these PBMs: employers, insurance carriers, and government programs like Medicare Part D

WHY THIS MATTERS

Community pharmacies operate on razor-thin margins relative to the value they provide, and PBM mail-order pressure threatens to push many of them out of business entirely. For patients — especially in rural areas — that's not just an inconvenience; it can mean losing the only accessible point of care they have.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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=== CONNECT WITH THE RHV TEAM ===

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In this health care podcast I speak with Vinay Patel, who is the founder of Self Insured Pharmacy Networks. He’s also a pharmacist, and he’s also an expert in these matters.

Are Patients Consumers? A Definitional Deep Dive (INBW24)

"It Is Tough to Be a Consumer When You Don't Have the Information You Need to Be One." Episode INBW24.

Are patients consumers? Literally, by Webster's definitions, yes — a consumer is a person who uses or pays for something, and patients use and sometimes pay for health care. But the literal answer isn't the interesting one. In this episode, Stacey Richter digs into why the "consumer metaphor" in health care both illuminates and obscures what patients actually need, and why the question itself may be more useful than any answer to it.

WHAT YOU'LL LEARN

✅ Why the literal, dictionary answer to "are patients consumers?" is yes — and why that answer isn't very useful

✅ How the "consumer metaphor" can erode physician professionalism and why some see it as a problematic way to talk about patient care

✅ Why patients are, in a meaningful sense, "basically incapable of achieving health care consumer status" in the current system — because being a good consumer requires information that patients often don't have

✅ Practical tips for patients who want to be better health care consumers anyway: being suspicious, getting second and third opinions from subspecialists, and more

WHY THIS MATTERS

Whether you call patients "consumers" shapes how the entire system treats them — as informed shoppers who should bear responsibility for their choices, or as people navigating a system that rarely gives them the information they'd need to shop well. Getting this framing right matters for anyone designing benefits, communications, or care navigation aimed at patients.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

✉️ Enjoy this podcast? Subscribe to the free weekly newsletter

🫙 Support the podcast with a small donation to the Tip Jar

🎤 Listen on Apple Podcasts

🎤 Listen on Spotify

📺 Subscribe to our YouTube channel

=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction.

02:32 Why patients are not consumers.

02:41 A better way to define consumer.

03:15 When "patients are not consumers" is even more correct.

03:40 Where the definition of consumer starts to devolve or evolve.

04:17 The definition of consumer according to an article by The Hastings Center.

05:01 The "consumer metaphor" and eroding physician professionalism.

05:26 The problematic points at demonizing the consumer patient.

06:36 EP205 with Maya Dusenbery.

08:59 How "patient" may not be the best way to define our goals for the patient experience.

10:34 "It is tough to be a consumer when you don't have the information that you need to be one."

13:08 The paradox: Patients are not, and also are, consumers.

13:31 "The question itself is the answer."

13:41 "Patients … are basically incapable of achieving health care consumer status in this country today."

13:57 Things to consider for those who don't think patients should try to be consumers.

15:21 "If you're a patient … do the best you can to be a good health care consumer."

15:59 Tips for being a good health care consumer.

16:30 Articles on how to be a good consumer online.

17:00 "It pays to be suspicious."

17:15 Get second, third, and fourth opinions from subspecialists.

Are patients consumers? Defining the terms patient and consumer will get us started here and also provide the insight and common understanding that we need to tackle this seemingly elusive question.

How Medical Travel to Centers of Excellence Improves Outcomes and Lowers Costs, With Olivia Ross (EP240)

"If Operating on the Wrong Leg Is a Medical Error, What Do We Call Operating on Someone Who Didn't Need Surgery?" Episode 240.

Quality metrics in health care today mostly assess care from a patient-safety standpoint — but they rarely ask whether the patient needed the procedure in the first place, or whether the outcome matched what the patient actually hoped for. In this episode, Stacey Richter talks with Olivia Ross, associate director of the Employers Centers of Excellence Network (ECEN), about how a curated network of centers of excellence is helping employers get patients to providers who not only deliver excellent outcomes but also only treat the patients who are truly appropriate to treat.

WHAT YOU'LL LEARN

✅ How ECEN selects centers of excellence (COEs) — provider organizations that commit to prospective bundled payments for services like orthopedic surgery, oncology, and bariatric surgery

✅ Why COEs distinguish themselves not just by delivering excellent outcomes, but by only treating patients who are genuinely appropriate candidates for treatment

✅ How employers like Walmart, Lowe's, and McKesson use the ECEN network to intercept employees at the right point in their care journey

✅ How employees travel to a COE for care and are then repatriated back to their local primary care provider for follow-up

WHY THIS MATTERS

Most quality measurement in health care today stops at "was the procedure done safely," without asking "did the patient need the procedure at all." Medical travel to centers of excellence is one concrete way employers are trying to close that gap — steering employees toward providers who are rigorous about appropriateness, not just technical execution.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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🎤 Listen on Apple Podcasts

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=== CONNECT WITH THE RHV TEAM ===

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In this health care podcast, I speak with Olivia Ross. Olivia has a reputation as a “rock star in the employer coalition world,” and I say this because it was a direct quote from an email I received after I mentioned that she was coming on the show. Olivia earned her rock star chops at the Pacific Business Group on Health (PBGH). Olivia is the associate director of the Employers Centers of Excellence Network, otherwise known as ECEN.

How to Escape Legal Purgatory When Collaborating in Health Care, With Bill Tanenbaum of Polsinelli (EP239)

When a BAA Takes a Year to Sign for a Two-Week Project, Something's Broken. Episode 239.

The legal side of any sale, install, collaboration, or interoperability effort in health care can be a serious impediment when every venture takes months or even years to get through contracting. In this episode, Stacey Richter talks with Bill Tanenbaum, co-chair of health care technology and innovation at Polsinelli, about practical advice for minimizing time spent in BAA and contracting purgatory so organizations can actually move forward on improving patient care.

WHAT YOU'LL LEARN

✅ Why business associate agreements (BAAs) and other contracting steps can take far longer than the projects they're meant to enable

✅ How prolonged legal processes discourage organizations from innovating, even incrementally, whenever outside partners or alliances are involved

✅ Why the hassle and expense of switching vendors keeps organizations stuck with substandard or overcharging vendors

✅ Practical strategies for moving through contracting more efficiently without sacrificing the diligence it's meant to provide

WHY THIS MATTERS

Every month spent in contracting purgatory is a month patients don't benefit from a collaboration that could improve their care. Bill Tanenbaum's practical advice matters because the legal bottleneck isn't just an annoyance — it actively discourages the kind of cross-organizational innovation that health care badly needs.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

✉️ Enjoy this podcast? Subscribe to the free weekly newsletter

🫙 Support the podcast with a small donation to the Tip Jar

🎤 Listen on Apple Podcasts

🎤 Listen on Spotify

📺 Subscribe to our YouTube channel

=== CONNECT WITH THE RHV TEAM ===

✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X