Are you on the board of directors of a company? Or are you a shareholder of a publicly traded company? Or are you a CEO or a CFO or in-house counsel who reports to a board of directors or these shareholders? Well, this show is for you.

And it’s about how the healthcare industry has become financialized at the same time that providing health benefits has become the second-biggest line item after payroll for most companies. We talked about that in a recent encore with Mark Cuban (EP418) also, as well as the show with Cora Opsahl (EP452) and Claire Brockbank (EP453) from 32BJ.

In this encore episode of 'Relentless Health Value,' Stacey Richter interviews Andreas Mang from Blackstone about the financialization of health benefits for boards of directors and C-suites of self-insured employers.

They discuss the unseen financial layers in healthcare benefits and how companies can save significantly while improving employee satisfaction and health.

=== LINKS ===

🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP458

✉️ Enjoy this podcast? Subscribe to the free weekly newsletter:  https://relentlesshealthvalue.com/join-the-relentless-tribe

🫙 Support the podcast with a small donation to the Tip Jar:  https://relentlesshealthvalue.com/join-the-relentless-tribe 

=== CONNECT WITH THE RHV TEAM ===

✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ X https://twitter.com/relentleshealth/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social 

04:55 Why Andreas starts every conversation with the question, “How’s your healthcare company?”

07:38 Why is it important, as a self-insured employer, to treat your business as a small healthcare company?

09:16 Why is it unnatural for companies to be providing health insurance?

10:47 What can be achieved when there is alignment between employers and insurers?

12:41 What things can a company do to reduce spend by 10%?

14:14 Why is it better to have CFO engagement in the benefits plan throughout the year?

16:25 Why does self-insurance save 5% to 9% for companies automatically?

18:14 “The funding isn’t a healthcare thing; it’s a CFO thing.”

18:27 Why is it vital to have a reliable, trustworthy broker?

25:12 When is the last time your company has RFP’d their health plan?

27:39 Why does changing a health plan feel scary but is necessary?

28:31 What is a dependent eligibility audit?

31:20 Why are employers better together?

34:34 How do employers truly get a flat-fee model with brokers?

In Episode 458 of Relentless Health Value, host Stacey Richter speaks with Dr. Komal Bajaj about innovative strategies for addressing staffing shortages in the healthcare sector. They explore the importance of cultural alignment within organizations, emphasizing trust and shared values to retain staff. 

Dr. Bajaj shares surprising findings from surveys indicating that healthcare workers are motivated by the goal of providing high-quality, planet-friendly care. The discussion highlights the interconnectedness of environmental sustainability and healthcare quality, presenting tangible ways to engage and empower healthcare workers while addressing both local community health and broader environmental concerns.

The episode underscores the strategic importance of aligning organizational goals with the aspirations of the workforce to foster trust and mitigate staffing shortages.

Stacey's guest today is Dr. Komal Bajaj. Dr. Bajaj is an ob-gyn who serves as the chief quality officer for a couple of hospitals in the Bronx, New York, that are part of the municipal health system of New York. She also now serves as medical director of sustainability for the municipal health system NYC Health + Hospitals.

=== LINKS ===

🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP458

✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe

🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 

=== CONNECT WITH THE RHV TEAM === 

✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/

✭ Threads https://www.threads.net/@relentlesshealthvalue/

✭ X https://twitter.com/relentleshealth/

✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social 

08:20 How do we quantify the issue of staffing shortages?

11:18 Why do we need to look at the root cause of the shortages?

11:51 Deloitte survey on staffing shortages.

11:54 Why is trust one of the core problems when it comes to staffing shortages?

13:59 “Healthcare workers have choice.”

15:34 What are the strongest correlations that influence healthcare workers’ desire to stay?

18:17 What things give healthcare workers the most pause?

19:36 The U.S. Department of Health and Human Services Health Sector climate pledge.

20:20 The Commonwealth Fund survey on what health systems can do to address climate change.

22:29 What do we do about sustainable, climate-friendly healthcare being a driving factor in staffing?

27:28 How do you meet the desires of healthcare workers where they’re at?

In this episode of 'Relentlessly Seeking Value,' host Stacey Richter is joined by healthcare entrepreneur Cynthia Fisher to discuss the crucial issue of medical spread pricing and the need for contract transparency. 

Fisher explains how hidden fees and spread pricing by middlemen are leading to substantial overcharges for employers and patients in the U.S. healthcare system. The conversation delves into recent lawsuits that highlight these practices, the legislative strides made to enforce price transparency, and how transparency can potentially transform the industry. 

Look, this is a thing now, medical spread. And similar to how PBM spreads adds up to millions, billions of dollars, medical spread is not change in the couch cushions. Did you see the lawsuit against Cigna? Cynthia Fisher mentions it in the conversation that follows. Spoiler alert, here’s the numbers: Self-insured employer paid $4 million for a claim.

There’s a slide on this Cynthia Fisher gave me, by the way, if you want to see all this written out. So, the employer pays $4 million. The provider was paid—drumroll, please—$876,000. I’m pausing so that sinks in: $4 million paid by the employer; $876,000 of that makes it across the trench to the provider.

To view the meme we created for how carriers are learning to do spread pricing from the PBMs, visit our show notes page below. (continued after the links below)

=== LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP457

✉️  Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe

🫙  Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe

=== CONNECT WITH THE RHV TEAM === ✭ LinkedIn   https://www.linkedin.com/company/relentless-health-value/ ✭ Threads  https://www.threads.net/@relentlesshealthvalue/ ✭ X   https://twitter.com/relentleshealth/ ✭ Bluesky   https://bsky.app/profile/relentleshealth.bsky.social

Fisher emphasizes the importance of employers and unions demanding accountability, using existing laws to unveil true pricing, and advocates for a revolution in healthcare to ensure fair, equitable, and transparent billing. Insights are also shared from industry experts who were previous guests including Chris Deacon, Justin Leader, and Andreas Mang. You can find the links in the show notes on our site.

09:03 What is the goal of PatientRightsAdvocate.org?

10:28 Is American competitiveness being affected by healthcare spend?

13:47 Why is transparency a root cause to healthcare costs?

15:11 What’s going on across the country to empower transparency in healthcare?

19:31 “I think people are fed up.”

21:22 The Cigna lawsuit in California.

26:36 How do employers navigate contracts against anti-steering?

28:54 EP419 with Andreas Mang.

29:33 EP452 with Cora Opsahl and EP453 with Claire Brockbank.

29:45 EP433 with Justin Leader.

You can learn more at PatientRightsAdvocate.org.

In this special Thanksgiving episode of Relentlessly Seeking Value, Stacey Richter discusses the significance of being 'givers' in healthcare, advocating for collaboration over transactional relationships to deliver real value to patients.

She touches on the challenges and necessary shifts in healthcare market dynamics, emphasizing that true value is determined through bi-directional conversations between providers and end-users, like patients and plan sponsors. Stacey concludes with a call to action for listeners to reflect on their support networks and consider supporting valuable media and publications.

To read the show notes with the mentioned links visit the epsiode page.

If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe.

I want to drop a thank you right here to those who have left a tip in our tip jar and/or offer up a monthly contribution. From the bottom of my heart, thanks for the support. Thank you to Dr. Scott Tromanhauser, Marilyn Bartlett, Ann Kempski, Dr. Matthew Bunte. Also, thank you to Brian Uhlig, Dr. William Gailmard, Dr. John Lee, Dr. Paula Muto, and Linda Krebs.

Plus everyone else who left a lesser amount. You guys are my village, and this matters because, as it’s been said by me and others a million times, it will take a village to transform healthcare. So, if you haven’t already done so, because … yeah, Thanksgiving, consider who is on your own list of villagers to thank right about now in your world.

So, yeah, long story long, all the more thanks to everyone who has donated to our tip jar, who has written a nice review on Apple Podcasts or Spotify, or who interacts with our posts on LinkedIn. Thank you.

This is how pods like this and any of the publications that you like are able to continue. It’s also, if you want to get really “why do givers succeed” about it, it’s through these interactions that like 99% of guests I’d estimate who get invited on a podcast, probably any podcasts, come from, or who likely get their name in any publication come from. As I said, this is true for this pod at least. But I would say that who are most hosts or most reporters going to reach out to when they need information or insight and are looking to quote somebody?

It’s gonna be somebody that they know. It’s gonna be somebody that they like.

So, giving, the healthcare industry. This is the actual point I wanted to make before I completely distracted myself. And I talked about this at length actually at a recent thINc360 panel about delivering better patient outcomes.

So, collaborate, give. And thank you to all of you who do both of these things every day, despite the cognitive dissonance and corporate forces and the lack of time and resources that may plague your efforts. I appreciate you very, very much. And it is this gang—the Relentless Tribe, that listens to this show—it is you who will transform healthcare. It’s really you. And again, from the bottom of my heart, I thank you.

01:33 How do you calculate the number of people you’ve helped?

02:46 Why is giving so important within healthcare?

03:16 Interview with Adam Grant.

05:47 How can you be a better giver?

07:50 Who is in charge of the bidirectional conversation of value?

11:35 Why is collaboration so important to value and being a giver?

12:58 Why is it important that plan sponsors are a part of all this giving and collaboration?

13:22 Encore! EP415 with Rob Andrews.

14:34 Summer Shorts 8 with Larry Bauer, MSW, MEd.

15:08 INBW39 with Stacey on the narcissism of small differences.

15:12 EP399 and EP400 with Stacey.

In this encore episode, Mark Cuban discusses his insights and experiences on disrupting the healthcare and pharmacy benefits landscape with Stacey Richter. This show from last year was one of the most popular episodes of the past year. And it’s also extremely relevant right now, given all of the PBM (pharmacy benefit manager) goings-on, as well as ongoing litigation like the J&J lawsuit, etc. Listen to the show with Julie Selesnick (EP428) for more on that one.

You can find the show notes with all links mentioned and a transcript on our episode page.

If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe.

Joined by Ferrin Williams from Scripta, Cuban stresses the importance for CEOs and CFOs of self-insured companies to get actively involved in their healthcare plans to avoid overpaying. The conversation tackles the opaque practices of PBMs, the financialized nature of the healthcare industry, and introduces Mark Cuban's Cost Plus Drugs model which aims for transparency and cost reduction.

Key topics also include the potential legal implications for employers, the importance of trust in healthcare transactions, and the real-world savings and benefits achievable with greater involvement and transparency in healthcare management.

What do all of these numbers have in common: $140,000, $3 million, $35 million, and $3 billion?

These are all actual examples of how much employers, unions, and some public entities saved on healthcare benefits for themselves and their employees. The roadmap to saving 25% on pharmacy spend and/or 15% on total cost of care in ways that improve employee health and satisfaction always begins when one thing happens. There’s one vital first step.

That first step is CEOs and/or CFOs or their equivalents roll up their sleeves and get involved in healthcare benefits. 

Read the full article/show notes with all the mentioned links here: https://cc-lnk.com/Encore418

06:29 What was Mark Cuban’s own journey as a self-insured employer with Cost Plus Drug Company?

07:44 What did Mark find when he decided to go through and look through his company’s benefit program?

09:12 “When you think it through, you start to realize that money is being spent primarily by your sickest employees.” —Mark

10:02 How do you get CEOs and CFOs of self-insured employers to realize that their sickest employees are the ones subsidizing their checks?

13:00 What is the role of insurance in healthcare?

14:30 “If you can’t convince them, confuse them and hide it.” —Mark

15:24 The reality behind getting a rebate check.

16:21 Why are rebates going away, and why isn’t that changing PBM earnings?

19:05 How do you get CEOs and CFOs to dig into their benefits plan?

20:59 Does morally abhorrent move the needle?

21:33 “What we’re trying to do is just simplify the [healthcare] industry.” —Mark

24:19 What’s been changing in consumer behavior?

25:04 “Transparency is a huge part of building that trust.” —Ferrin

25:19 Why CEOs and CFOs really have the power to change healthcare.

32:29 What are Cost Plus Drugs’ plans to expand?

39:21 Where is the future of the prescription drug market going?

42:09 What will happen to the prescription drug market in 10 to 20 years?

48:40 The wake-up call self-insured employers should be acknowledging now.

52:02 Where is the real change in the healthcare industry going to come from?

In this episode, Stacey Richter speaks with Rob Andrews, CEO of the Health Transformation Alliance (HTA) and former Congressman, about the strategic steps jumbo employers can take to achieve improved health outcomes while reducing cost. They delve into the importance of using data to discern effective practices, negotiate contracts, and hold intermediaries accountable.

To Read The Show Notes With All Mentioned Links, Visit the Episode Page.

If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe.

The discussion highlights maternal health as a critical area of focus, with successful interventions shown to reduce NICU admissions and overall healthcare costs. Andrews emphasizes the role of self-insured employers in driving systemic changes that align financial incentives with health outcomes.

This encore is very relevant after the shows with Cora Opsahl (EP452), Claire Brockbank (EP453), and Marilyn Bartlett (EP450). Getting better health for the 160 million Americans covered by commercial insurance is all about rates, rights, and power.

07:34 How did Rob get to his current role?

09:08 The problem of maternal health and mortality rate, and how self-insured employers wind up directly and indirectly paying for this.

10:27 Why economic consequences move the needle, and why sometimes they don’t.

12:26 Why the best way to address costs isn’t to re-shift costs but to address them directly.

13:22 Why compensation that isn’t dependent on outcomes is a problem.

16:23 “Strategy’s not what people say; it’s what they do.”

18:21 How do you operationalize saving money with better outcomes?

26:26 How do employers turn conflict into collaboration?

28:20 What is the win-win-win structure among employers, payers, and providers in Rob’s eyes?

30:53 To whom should the task of risk adjustment fall?

34:43 “Better contracts do improve outcomes.”

In this comprehensive episode host Stacey Richter sits down with Brian Reid to discuss pivotal aspects for the pharmaceutical industry. Key topics include understanding product value from the perspectives of plan sponsors, patients, and society, and the significance of benefit design in improving patient affordability.

For the show notes with all links mentinoed, visit the episode page.

If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe.

The discussion delves into the complexities of drug pricing, the roles of Pharmacy Benefit Managers (PBMs) and brokers, and the impact of healthcare consolidation on costs. Reid emphasizes the importance of transparent communication among stakeholders, the detrimental effects of cost containment strategies, and the necessity of considering policy and reputational impacts.

Throughout the conversation, examples such as the Hepatitis C drug illustrate the broader implications on drug access and affordability. Listeners are provided with critical insights into how pharmaceutical companies can better engage with ultimate purchasers to ensure patients receive necessary, cost-effective medications while navigating a changing healthcare landscape.

For the show notes with all links mentinoed, visit the episode page.

08:29 Why is it important to understand the term “value” in respect to medicine?

10:07 Why is it important to consider all the players affected by the idea of this “value”?

11:06 Who are the ultimate purchasers in Pharma?

12:23 Findings of the Kaiser Employer Health Benefits Survey.

14:52 Why does it matter that we consider what value looks like to all players affected by Pharma?

16:46 EP300 with Bruce Rector, MD.

18:38 EP448 (Part 1) with Shawn Gremminger.

20:04 What does Pharma need to do to showcase their value when PBMs are often “locked in” at the moment?

23:11 Why Brian is celebrating companies that put their prices in their press releases.

32:31 Why does Pharma have an obligation to explain their value?

33:16 EP426 with Nina Lathia, RPh, MSc, PhD.

33:39 Why is it important for Pharma to keep an eye on hospital monopoly behavior?

35:55 EP370 with Erik Davis and Autumn Yongchu.

37:44 Why Pharma needs to capitalize on alignment.

In this conversation, Stacey Richter engages with healthcare leader Dr. Beau Raymond from Ochsner Health Network to explore the blueprint for better patient care through enlightened leadership, data-driven strategies, and localized health initiatives. 

The discussion covers shifting from 'sick care' to preventative healthcare, integrating technology and data tools like glucometers for health coaching, and addressing health equity through accurate data and regional strategies.

To Read the Show Notes with Mentioned Links and a Full Transcript, Visit the Episode Page.

If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe.

The conversation explains the importance of stakeholder engagement, setting clear goals, financial incentives aligned with patient care, and continuous improvement through feedback loops. Practical steps such as weekly huddles for primary care teams and the role of digital health in managing chronic conditions like diabetes and hypertension are also highlighted to improve healthcare outcomes and operational excellence.

A rate critical to attain better care for patients, I’m gonna say, is enlightened leadership—maybe dyad leadership—at a clinical organization. I am saying this because without enlightened leaders, it’d be harder to build from the blueprint that Beau Raymond, MD, talks about today on the show.

10:44 Why is it important to be flexible while keeping your goals in sight?

11:48 Dr. Eboni Price-Haywood’s article on disparities in COVID.

12:29 How is equity a data point to achieving overall care improvement?

15:01 “If you can’t measure it … accurately, you’re not going to be able to do anything differently.”

20:52 What strategies have been successful in using data to improve healthcare outcomes?

23:17 Why did Ochsner Health avoid looking at the individual physician standpoint in regard to an equity standpoint?

30:40 Why engaging patients in their healthcare actually improved patient visits and did not necessarily reduce patient visits.

34:49 “It’s really about engaging with the patient.”

In this episode, host Stacey Richter and guest Brendan Keeler dive deep into the significant legal clash between Epic and Particle over electronic health record (EHR) data access and market competition.

To Read the Show Notes with Mentioned Links and a Full Transcript, Visit the Episode Page.

This episode examines the broader repercussions on healthcare data exchange, including antitrust concerns, data liquidity, and the ethical considerations around secondary use of treatment data. The discussion brings to light how the outcome of such lawsuits could influence data transparency, interoperability, and the rules governing data sharing among plan sponsors, employers, and healthcare providers.

Notable points include the shift to a judicial era impacting health tech companies and the potential for regulatory and judicial actions to improve data access and efficiency within healthcare networks. The episode emphasizes the critical need for clear pathways, accountability, and structured regulations to enhance patient care and reduce fraud in the healthcare data ecosystem.

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07:21 Who can gain access to EHR data?

10:31 Are there limits to how EHR data can be used secondarily?

11:36 Can EHR data be shared secondarily?

15:47 Part one and part two of Brendan’s comprehensive account of the Epic/Particle dustup.

15:57 What was the dispute that started Epic v Particle?

18:21 What are the two viewpoints in this dispute with Epic’s actions?

26:16 What progress has been seen since this lawsuit began?

28:00 Who else will be impacted by the likely rule cementing from this lawsuit?

In this episode, host Stacey Richter delves into the complexities of the Third Party Administrator (TPA) Request for Proposal (RFP) process with guest Claire Brockbank from 32BJUnion. 

The discussion highlights the critical role of contracts in managing health plans effectively and the potential pitfalls of accepting contracts crafted by TPAs without thorough review. Drawing from Claire's experience, they explore tactics like starting with your own contract paper in RFP processes to gain negotiation leverage, and the benefits of employer coalitions in navigating health care complexities.

To Read the full article which includes mentioned links visit the episode page.

If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to become a member of the Relentless Tribe.

Real-world examples underscore the financial impacts of poorly negotiated contracts and highlight successful strategies for health plan sponsors to optimize costs and services. The episode aims to empower employers with tools and insights to negotiate effectively and ensure their health plan contracts align with their strategic goals, ultimately paving the way for better population health management and cost-effective care delivery.

As but one example—and Cora Opshal spoke about this last week and Claire talked about this today—it’s about how allowing upside-down payments, for example, that are in a lot of ASO contracts, this allowing of upside-down payments. I mean, it turns out that 32BJ spent around $10 million paying more than the bill was for one year. If somebody signs that contract as handed to them by the carrier, then the plan is now contractually obligating themselves to pay more than the price the clinical practice was charging. So, doc sends bill for $100, and the carrier pays that practice $200 on behalf of the plan sponsor.

So now the plan sponsor is paying $200 for a $100 bill. Is this conflict of interest? Is it imprudent? Is it not reasonable? Said another way, is that a bit of a fiduciary breach on the plan sponsor?

So it's understandable why the team at 32BJ pushed back and pushed back hard. We all can see why the leading edge of plan sponsors and more and more C-suites are hotfooting it into conference rooms to plan their RFP process and doing it in the way that Claire Brockbank talks about today.

For an open-source contract and some other free tools, please do head over to the 32BJ Insights Web site.

05:36 How does the initial contract writing affect how events in your healthcare plan will go?

06:56 What happens if a plan sponsor or employer doesn’t do the contracting right?

10:42 How much could be saved by doing contracting right?

11:01 EP433 with Justin Leader.

12:22 How do you start an RFP process with your own contract?

14:06 What Claire Brockbank recommends doing to do a TPA RFP process in a way that’s best for you.

19:46 What factors do carriers need to get an ASO or TPA to respond to using your contract?

21:11 Open-source contract available from 32BJ.

21:57 Why it’s important to really probe brokers, despite loyalty to your broker/consultant.

24:30 Who are the reliable agents and experts when carriers are looking to start this process?

26:24 EP428 with Julie Selesnick.

27:56 What’s the silver lining to this effort?

29:17 Why is it important to make it clear why you’re doing what you’re doing for your lawyers and any other support team you need?

31:39 What does “good” look like in this process?

34:15 Why is it important to continue to hold your ASO accountable?