Relentless Health Value

Is the Surprise Billing Gold Rush Screeching to a Halt? With Devon Herrick, PhD (EP226)

When Free-Market Think Tanks and Progressive Socialists Agree Surprise Billing Is Egregious. Episode 226.

Surprise billing has managed to unite unlikely allies: free-market think tanks and progressive advocates alike now view unfettered, market-driven surprise billing as egregious. In this episode, Stacey Richter talks with Devon Herrick, PhD, health care economist, public policy analyst, and adviser to the free-market Heartland Institute, about why the surprise billing gold rush may finally be facing real pushback.

WHAT YOU'LL LEARN

✅ Why surprise billing has become one of the rare issues where free-market think tanks and progressive advocates find common ground

✅ What's driving increased public attention and legislative momentum against surprise billing practices

✅ What hospital and insurance carrier executives should be doing right now in response — beyond industry-centric lobbying

✅ Devon Herrick's perspective as a health economist who has written extensively on the topic

WHY THIS MATTERS

When think tanks on opposite ends of the political spectrum agree that a practice is egregious, that's a signal the status quo is running out of runway. Hospital and insurance executives who use this moment to protect patients — rather than just lobby to preserve revenue — are the ones likely to come out ahead as surprise billing reform gains steam.

=== 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

It turns out, patient-centric care that produces outcomes patients care about is usually less expensive than care that is not. The Patient-Centered Outcomes Research Institute (PCORI), an independent nonprofit, nongovernmental organization in Washington, DC, was authorized by Congress in 2010.

PCORI was established to fund research that can help patients make better-informed decisions, guided by clinicians, payers, and others. In other words, help nudge health care into a patient-centric place, for the good of everyone involved in a quadruple aim sort of way. Since December 2012, PCORI has funded hundreds of studies that compare health care options to learn which work best, given patients’ circumstances and preferences.

Today I speak with Dr. Joe Selby, executive director of PCORI.

Joe V. Selby, MD, MPH, is the executive director of the Patient-Centered Outcomes Research Institute (PCORI). A family physician, clinical epidemiologist, and health services researcher, Dr. Selby has more than 35 years of experience in patient care, research, and administration. He is responsible for identifying strategic issues and opportunities for PCORI and implementing and administering programs authorized by the PCORI Board of Governors.

Can We Afford to Make Health Care Patient-Centric? With Joe Selby, MD, MPH, of PCORI (EP225)

Patient-Centric Care Usually Costs Less, Not More. Episode 225.

Patient-centric care that produces outcomes patients actually care about turns out to usually be less expensive than care that doesn't — a finding at the heart of the Patient-Centered Outcomes Research Institute's (PCORI) mission. In this episode, Stacey Richter talks with Dr. Joe Selby, executive director of PCORI, about how the Congress-authorized nonprofit has funded hundreds of studies since 2012 comparing health care options to find what actually works given patients' circumstances and preferences.

WHAT YOU'LL LEARN

✅ Why patient-centric care that delivers outcomes patients actually value tends to cost less than care that doesn't account for patient preferences

✅ How PCORI, authorized by Congress in 2010, funds research to help patients make better-informed decisions alongside clinicians and payers

✅ What PCORI has learned since 2012 funding hundreds of comparative-effectiveness studies across different patient circumstances

✅ How PCORI's work aims to nudge the entire health care system toward a patient-centric model that benefits every stakeholder

WHY THIS MATTERS

The assumption that patient-centered care is a costly luxury gets the economics backwards — PCORI's research suggests the opposite is often true. Understanding why patient-centric outcomes and lower costs tend to go together gives payers, providers, and employers a concrete reason to prioritize patient preference, not just clinical protocol.

=== 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

Underestimate Employers at Your Peril, With Suzanne Delbanco, PhD, of Catalyst for Payment Reform (EP224)

"Those Who Say It Cannot Be Done Are Usually Interrupted by Others Doing It." Episode 224.

Employee deductibles now cost as much as a new midsize sedan every year, and employer health care spend is chewing up what would otherwise be raises — leaving employers and their CFOs in a position where acting on health care costs is no longer optional. In this episode, Stacey Richter talks with Suzanne Delbanco, PhD, executive director of Catalyst for Payment Reform and founding CEO of The Leapfrog Group, about the real change employers are capable of driving.

WHAT YOU'LL LEARN

✅ Why employee deductibles have grown to the point that employees effectively can't afford to use the health plans they're enrolled in

✅ Why employers and their CFOs are being forced to act on health care costs rather than treating it as optional

✅ How organizations like Catalyst for Payment Reform are helping employers translate their purchasing power into real change

✅ Suzanne Delbanco's perspective from also having founded The Leapfrog Group, another organization built around employer-driven health care accountability

WHY THIS MATTERS

Providers, carriers, and pharma companies that dismiss employers as a weak force for change do so at their own risk — the economics of rising deductibles and stagnant wages are pushing employers toward exactly the kind of collective action Catalyst for Payment Reform represents. Suzanne Delbanco's track record suggests this isn't a passing trend.

=== 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

Last time I looked this up online, there were more than 5000 companies offering digital medicine tools. Which ones worked? Which ones are less good than others? Which ones have not been tested? How were they tested: apples to apples or a whole fruit basket of standards? If you’re a clinician or the head of population health or an insurance carrier and you’re trying to figure out whether a digital tool could help solve a problem your patients are having … at this juncture, may the force be with you and I hope you know how to use Excel.

The Digital Therapeutics Alliance (DTA) aims to put definitions and standards around what can be legitimately called a digital therapeutic and how these tools are best deployed so that patients are best equipped to get the best possible outcomes. Today I speak with Megan Coder, executive director of the Digital Therapeutics Alliance.

Megan Coder, PharmD, MBA, is executive director of the Digital Therapeutics Alliance (DTA), whose mission is to broaden the understanding, adoption, and integration of clinically validated digital therapeutic solutions into mainstream health care through education, advocacy, and research. With more than a decade of experience in the health care industry, Megan’s expertise extends from strategic growth and partnership development within the digital health sector to the direct delivery of patient care.

Digital Therapeutics: Which Ones Make the Cut? With Megan Coder of the Digital Therapeutics Alliance. 5,000+ Digital Medicine Companies — Which Ones Actually Work? Episode 223.

There are more than 5,000 companies offering digital medicine tools, with no consistent standard for how — or whether — they've actually been tested. In this episode, Stacey Richter talks with Megan Coder, PharmD, MBA, executive director of the Digital Therapeutics Alliance (DTA), about the organization's effort to define what can legitimately be called a digital therapeutic and how these tools should be evaluated and deployed.

WHAT YOU'LL LEARN

✅ Why more than 5,000 digital medicine companies exist with no consistent apples-to-apples standard for evaluating whether their tools actually work

✅ How the Digital Therapeutics Alliance is building shared definitions and standards for what qualifies as a legitimate digital therapeutic

✅ Why clinicians, population health leaders, and insurance carriers currently have few reliable tools for evaluating digital health products

✅ How DTA's work on education, advocacy, and research aims to broaden adoption of clinically validated digital therapeutic solutions

WHY THIS MATTERS

Without shared standards, clinicians and payers are left guessing which of the thousands of available digital health tools are actually backed by evidence versus which are just well-marketed. Megan Coder's work at the Digital Therapeutics Alliance gives the industry a common language for separating clinically validated digital therapeutics from the rest of the field.

=== 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

How to Get Real Results From Your Innovation Department, With Naomi Fried (EP222) Crossing the "O-Gap": Why Deciding to Innovate Isn't the Same as Doing It. Episode 222. Say you're a provider, an insurance carrier, or a pharma company, and you've realized you need to innovate — to cut costs, deliver better care, hedge against an upstart disrupting your business, or make sure your risk-based contracts actually go well. Deciding to be innovative is one thing; getting your organization to actually do innovation is another. In this episode, Stacey Richter talks with Naomi Fried, CEO of Health Innovation Strategies, about what it takes to cross what she calls the "o-gap," or operationalization gap. WHAT YOU'LL LEARN ✅ Why deciding to innovate and actually operationalizing innovation are two completely different challenges ✅ What Naomi Fried means by the "o-gap" — the operationalization gap between an innovation strategy and real organizational execution ✅ Why innovation matters not just for growth, but as a hedge against upstarts disrupting an established business model ✅ How risk-based contracts raise the stakes for getting innovation right, not just aspirational ✅ How Naomi's background at Kaiser Permanente, Boston Children's Hospital, and Biogen shapes her approach to building innovation departments that actually deliver WHY THIS MATTERS Plenty of organizations can articulate a desire to innovate; far fewer can actually cross the gap from strategy to execution. Naomi Fried's framing of the "o-gap" gives providers, carriers, and pharma companies a concrete way to diagnose why their innovation efforts stall — and what it takes to get real results instead of just good intentions. === 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