Episodios

  • EP475: Is This a Moment or a Movement? With Peter Hayes

    EP475: Is This a Moment or a Movement? With Peter Hayes
    May 8 2025
    I was talking to Peter Hayes, my guest this week; and I said, “Peter, you post a lot about many, many different topics on LinkedIn and elsewhere. If you had to roll up all of your posts into a few main, I don’t know, change-making vectors or forces of change, roads to Damascus, what would they be? And, you know, do you wanna come on the pod and tell the tribe here what you’re thinking?” And Peter said, “I would love to.” For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. So, this show is going to be a top-down kind of let’s try to get a handle on said major forces of change and how those forces have swirled together to create the place that we are now. So, most of this episode, I’m gonna strongly suggest Relentless Health Value Tribe members who tune in frequently there’s not any “Oh, wow! What a revelation! Probably that’s gonna happen” in the show today. And to be frank, that’s kind of the point. It wouldn’t be a major force if you all weren’t aware of it now, would it? The goal here is to figure out how to organize so many posts about so many different things on LinkedIn. There’s so many of these micro-moments, maybe I’d call them. How do we organize them into a manageable number of strategic fundamental goings-on that we all can wrap our brains around? That was my ask of Peter, and that is not easy, because it’s a valid question a lot of times when talking about healthcare transformation: Is it a moment, or is it a movement? This show is, again, what Peter Hayes thinks the movements are. The thing is, though, it is surprisingly hard to discern what the forces of change actually are. What we often experience as a big dramatic inflection point has almost always been gestating for a while. This creates an opportunity for us all here in the tribe because if we see the changes early or, even better, spark the changes, an inflection point can really be a strategic boon. And let me tell you, I want everyone listening to have a strategic advantage over those who, I don’t know, maybe are a little bit less concerned with putting patients before profits. But yeah, usually inflection points have been a long time coming because forces of change have been battering away for a while until they finally break through. I say this to acknowledge we’ve been talking about tipping points, and the total cost of healthcare simply cannot get any higher. We’ve been talking about this for probably decades, but Peter says right now he firmly believes we have a force majeure of bridges too far, of obvious over-the-line activities that offend normal people’s sense of justice and fair play. Peter believes we’re at a really unprecedented place right now. So, even if there’s some starts and stops, some too bigs to fail, like, for example, some of the lawsuits are getting thrown out because it’s legally unclear who the “aggrieved” party is. Yeah, too much of this country is feeling like an aggrieved party, so it’s only a matter of time. This is the major takeaway from the show today: Peter’s view of how three main forces in the ecosystem all braid together and reinforce each other and have created a kind of inexorableness that something’s gotta give. And part of the equation here is just—and I’m mentioning this because we keep talking about it—is a brutal lack of trust that’s really pervasive across so many parts of the industry: patient to healthcare system, clinician to healthcare system, etc. As you listen to the show, definitely consider the shows from earlier with Kenny Cole, MD (EP473) and Christine Hale, MD, MBA (EP471) about high-cost claimants. These shows are another view into this exact basic topic. They also show what trust can bring us if we earn it. I’m kind of thinking it could be cool to do shows like this periodically where we get different people to answer the question: What are the major forces of change? How are you rolling them up? And what is your assessment of where we are now in the journey of transformation? If I get enough of you who are, like, “Yeah, that’s a great idea,” I probably will be less likely to forget about it. Peter Hayes, my guest today is (technically, at least) retired. He was director of benefits at Hannaford Supermarkets for about 25 years. He’s been on the advisory boards of Express Scripts and Definitive Health, among others. He served on two healthcare reform commissions in Maine, appointed by two different governors. He headed up the Purchaser Alliance in Maine. Also mentioned in this episode are Kenny Cole, MD; Christine Hale, MD, MBA; Chris Crawford; Komal Bajaj, MD; Wayne Jenkins, MD; Yashaswini Singh, PhD; Ann Lewandowski; Al Lewis; John Rodis, MD, MBA, FACHE, CPHQ; Beau Raymond, MD; and Scott Conard, MD. You can learn more by following Peter on LinkedIn. Peter Hayes retired ...
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    34 m
  • EP474: Private Equity in Healthcare—The Big Data Points You Really Need to Know, All Together in One Episode, With Yashaswini Singh, PhD

    EP474: Private Equity in Healthcare—The Big Data Points You Really Need to Know, All Together in One Episode, With Yashaswini Singh, PhD
    May 1 2025
    In Episode 474 of 'Relentless Health Value', host Stacey Richter interviews Dr. Yashaswini Singh, an economist and assistant professor at Brown University, about the growing influence of private equity (PE) in healthcare. The conversation delves into the corporate transformation of medicine, highlighting the potential misalignment between business interests and patient care. Dr. Singh discusses the diverse strategies PE firms use to drive profitability, such as increasing negotiated prices, consolidating market share, employing real estate leasebacks, and emphasizing performance metrics that may not align with patient benefits. The episode also examines the significant impacts these strategies have on physicians, including increased turnover and changes in practice patterns, as well as the broader implications for patients and communities. Dr. Singh stresses the importance of informed leadership, education, policy enforcement, and transparency to ensure that private investments ultimately benefit healthcare systems without compromising patient care. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP474 ✉️ 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 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 05:53 What is the tension between business and medicine? 07:05 What is the impact of private equity on healthcare? 08:46 How does healthcare change when private equity invests in medical facilities? 10:54 What are the intuitive impacts of private equity in healthcare? 12:28 What are the less intuitive effects of private equity on healthcare? 13:36 EP472 with Eric Bricker, MD. 14:15 What are the misconceptions about private equity investors acquiring healthcare facilities? 16:17 The Steward saga. 16:24 The death of Hahnemann Hospital in Philadelphia. 19:27 Are there any positive outcomes to private equity investment in healthcare? 21:17 EP445 with Tom X. Lee, MD. 22:45 EP420 with Ge Bai, PhD, CPA. 22:47 EP465 with Chris Crawford. 22:49 EP460 with Rushika Fernandopulle, MD. 22:55 Is there ever a need for private investment in healthcare? 25:40 How do the changes private equity firms create affect patients? 27:20 Study in Health Affairs on physician turnover rates following private equity acquisitions. 29:30 How can private equity disrupt physician employment as well? 34:13 What remedies might there be for consolidation in healthcare and private equity investing in medicine?
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    41 m
  • EP473: Keeping Patients out of the ER: How Trusted Relationships in Primary Care Should Work. A Take 2 With Kenny Cole, MD

    EP473: Keeping Patients out of the ER: How Trusted Relationships in Primary Care Should Work. A Take 2 With Kenny Cole, MD
    Apr 24 2025
    This episode of Relentless Health Value features Dr. Kenny Cole from Ochsner Health System. The discussion emphasizes the critical role of trusted relationships and excellent primary care teams in keeping patients out of the emergency room, thus reducing healthcare costs. Stacey Richter revisits this conversation to highlight the importance of care teams building trust with patients and the concept of primary care as an investment in health and wellness. The episode outlines four key points for delivering great primary care, including accountability for outcomes, belief in clinical goals, standardized care flows, and building patient trust. Dr. Cole also discusses the real-world challenges and strategies for achieving clinical and financial success in primary care. The episode serves as a guide for plan sponsors, clinicians, and healthcare executives looking to improve primary care delivery and align it with financial viability. The discussion is further enriched with insights on digitizing care pathways and the importance of measuring and sharing best practices to achieve high standards of care.I Stacey revisits, in a take two, this episode with Dr. Kenny Cole because she's listening to it this time with a new focus. That focus is the theme that keeps coming up over and over and over again on Relentless Health Value these past few months. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP473 ✉️ 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 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 07:35 Is there an optimal care pathway where there might be a lot of treatment variability? 10:52 EP412 with Robert Pearl, MD. 12:32 Why is it important to start with the end in mind? 15:44 How do you scale clinical excellence? 18:18 EP315 with Bob Matthews. 19:12 EP242 with Marty Makary, MD. 21:29 Why is it important simply to demonstrate what’s possible for better health outcomes? 22:33 EP427 with Rik Renard. 23:18 How do we reinvent the business model of healthcare? 24:51 EP466 with Vivian Ho, PhD. 25:06 EP415 with Rob Andrews. 26:51 EP391 with Scott Conard, MD. 30:14 EP455 with Beau Raymond, MD. 34:22 Dr. Cole is published in various healthcare journals; check out his most recent article.
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    35 m
  • EP472: The Well-Honed, Three-Prong Hospital Playbook to Maximize Revenue From High-Cost Claimants, With Eric Bricker, MD

    EP472: The Well-Honed, Three-Prong Hospital Playbook to Maximize Revenue From High-Cost Claimants, With Eric Bricker, MD
    Apr 17 2025

    In Episode 472, Stacey Richter speaks with Dr. Eric Bricker about the impactful strategies hospital systems use to maximize revenue from high-cost patients. They explore the financial complexities and contracting tactics that enable hospitals to profit significantly from a small percentage of high-cost claimants.

    Key points include the negotiation of provider stop-loss contract provisions, strategic adjustment of charge masters, and the intentional steerage of patients to high-revenue service lines. This episode highlights the intricacies of hospital finance and the hidden mechanisms that drive healthcare costs for self-insured employers and other plan sponsors.

    We could have 0.5% to 1% of total plan members costing upwards of 40% of total plan dollars. And I bring this up just to highlight the magnitude of the money here. In that show from last week, we take the issue of high-cost claimants from the standpoint of the plan sponsor.

    Today, however, we’re gonna be looking at this from the standpoint of the hospital system. If we were to come up with a motto for the show today with Dr. Eric Bricker, it’s that all costs are somebody else’s revenue. And when it’s revenue and profit of the magnitude that we’re talking about with many high-cost claimants, it starts to be less of an accidental “Oh, wow! How did that CABG patient wind up in our clinic? What are the odds?” and more of a “Whoever is not steering patients is letting someone else with a big profit incentive lock down that steerage in deeply embedded ways.”

    === LINKS ===
    🔗 Show Notes with all mentioned links:
    https://cc-lnk.com/EP472

    📺 Dr. Bricker's AhealthcareZ Channel
    www.youtube.com/@ahealthcarez

    ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter:
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    🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1

    🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b

    📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue

    === CONNECT WITH THE RHV TEAM ===
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    05:06 From a hospital revenue perspective, where do high-cost claimants fall?

    08:45 How do hospitals structure their stop-loss provisions so that they ensure they’re always maximizing their revenue?

    12:15 How hospitals acquire providers to steer as many patients as possible through specific service lines.

    20:21 Why do carriers let hospitals get away with these rates and stop-loss negotiations?

    21:06 How do Medicare Advantage and Medicare rates play into all of this?

    22:00 What should a benefit consultant be doing here?

    23:37 What are the keys to direct contracting?

    27:21 Why is it important to get trusted relationships set up ahead of time?

    28:04 The Company That Solved Health Care by John Torinus Jr.

    29:23 What needs to be the clinical consideration for specialists?

    30:46 What is the advantage that employers have in all of this?

    33:06 Dr. Bricker’s video on 32 examples of healthcare deception.
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    35 m
  • EP471: High-Cost Claimants in 2025 and Beyond—What Is Really Expensive Not to Know? With Christine Hale, MD, MBA

    EP471: High-Cost Claimants in 2025 and Beyond—What Is Really Expensive Not to Know? With Christine Hale, MD, MBA
    Apr 10 2025
    Recently on Relentless Health Value, we’ve been tinkering around with a few recurring themes—recurring through lines—that are just true about American healthcare these days. In this episode of Relentless Health Value, host Stacey Richter speaks with Dr. Christine Hale about high cost claimants and the implications for healthcare plans in 2025 and beyond. They discuss the importance of trust in patient care, the financial incentives behind patient steering, and the critical role of timely and comprehensive data analysis. Dr. Hale emphasizes the need for an integrated approach to medical and pharmacy claims data to avoid expensive consequences and improve patient outcomes. She also shares strategies for plan sponsors to effectively manage high cost claimants through evidence-based care, appropriate treatment settings, and creative problem-solving, while underlining the importance of patient engagement and satisfaction. Don't miss next week's episode with Dr. Eric Bricker for a deeper dive into these topics. === LINKS === 🔗 Show Notes with all mentioned links: https://relentlesshealthvalue.com/episodes ✉️ 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 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 05:22 What is a high-cost claimant, and how is the definition changing? 07:42 Why buy-and-bill pharmaceuticals can be so costly for plan sponsors. 10:19 What are plan sponsors getting wrong about this situation? 11:28 What do you need as an employer to understand your plan data fully? 13:41 EP462 with Scott Conard, MD. 17:35 What are plan sponsors currently doing that they should not being doing? 19:54 Why starting small is important. 23:02 EP468 with Matt McQuide. 25:37 What are the steps employers should take to improve their high-cost claimant spend? 31:02 EP371 with Erik Davis and Autumn Yongchu. 33:46 EP467 with Stacey. Recent past interviews: Click a guest’s name for their latest RHV episode! Nikki King, James Gelfand (Part 2), James Gelfand (Part 1), Matt McQuide, Stacey Richter (EP467), Vivian Ho, Chris Crawford (EP465), Al Lewis, Betsy Seals, Wendell Potter (Encore! EP384), Dr Scott Conard
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    35 m
  • EP470: Continuing the ER and Primary Care Through Line Over to Rural Hospitals and Healthcare, With Nikki King, DHA

    EP470: Continuing the ER and Primary Care Through Line Over to Rural Hospitals and Healthcare, With Nikki King, DHA
    Apr 3 2025

    In this episode, host Stacey Richter revisits a conversation with Nikki King, CEO of Alliance Health Centers, discussing the critical issues facing rural hospitals and healthcare systems. They delve into the impacts of Medicaid cuts, the financial struggles of rural hospitals reliant on commercial insurance, and potential solutions like freestanding emergency rooms, telehealth, and the expanded roles of nurse practitioners.

    The conversation also covers the complexities of maternity care and mental health services in rural areas, emphasizing the urgent need for systemic reforms to ensure equitable access to healthcare.

    === LINKS ===
    🔗 Show Notes with all mentioned links:
    https://cc-lnk.com/EP470

    ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter:
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    📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue

    🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1

    🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b

    === CONNECT WITH THE RHV TEAM ===
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    08:14 How dire is the rural hospital situation right now?

    08:33 How could freestanding ERs be a potential solution for rural hospitals?

    09:56 Advice from CHQPR: Rural hospitals should not be forced to eliminate inpatient care.

    11:22 Why is broadband a roadblock to telehealth as a solution for rural health access?

    14:52 What are other potential rural health access solutions?

    15:37 The “hot potato” of nurse practitioners in the healthcare world.

    16:34 “The number of residencies for physicians each year is not increasing, but the population … is increasing.”

    20:28 EP312 with Douglas Eby, MD, MPH, CPE, of the Nuka System of Care.

    22:00 What’s the issue with maternity care in rural America?

    24:09 “As healthcare becomes more and more specialized, [the] ability to treat high-risk cases is better, but access gets worse.”

    27:57 How is mental health care affected in rural communities?

    28:29 “Rural communities are trying very hard to hang on to what they have.”

    29:52 “When you look at the one market plan that’s available in a rural community, you probably can’t afford it.”

    31:37 What’s the single biggest challenge to moving to a model that incentivizes keeping people healthy?

    32:32 “The easiest low-hanging fruit … is having national Medicaid and have that put under the same hood as Medicare.”
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    35 m
  • EP469 (Part 2): The Impact on Plan Sponsors of Medicare Site-Neutral Payments and HSA Reforms, With James Gelfand, JD

    EP469 (Part 2): The Impact on Plan Sponsors of Medicare Site-Neutral Payments and HSA Reforms, With James Gelfand, JD
    Mar 27 2025

    In part 2 of episode 469, host Stacey Richter discusses the implications of Medicare site neutral payments and Health Savings Account (HSA) reforms with James Gelfand, president and CEO of the ERISA Industry Committee (ERIC).

    The episode details how plan sponsors should adapt to Medicare's site neutral payment policies aimed at curbing hospital consolidation and inflated prices through facility fees and markups. Gelfand provides insights into how HSA reforms currently in Congress could expand the scope of preventive care covered before deductibles are met, benefitting both employers and employees.

    The conversation also touches on the challenges high deductible health plans pose and the potential benefits of codifying recent IRS guidance to allow greater flexibility in pre-deductible coverage. The discussion underscores the importance of plan sponsors staying ahead of Medicare policies to avoid higher costs.

    === LINKS ===

    🔗 Show Notes with all mentioned links:
    https://relentlesshealthvalue.com/episodes

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

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    🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1

    🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b

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    === CONNECT WITH THE RHV TEAM ===

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    05:42 What does Medicare site-neutral payments mean?

    08:59 How do markups play into the dynamics here?

    09:52 Upcoming episode with Christine Hale, MD, MBA.

    10:36 What does the “narrow” start for these changes mean?

    11:42 What action steps should plan sponsors be taking?

    13:01 What options do plan sponsors have in highly consolidated markets?

    14:27 EP371 with Erik Davis and Autumn Yongchu.

    14:53 EP448 (Part 1 and Part 2) with Shawn Gremminger.

    15:46 Will this bill potentially make changes to HSA plans?

    17:40 Why has the thinking behind healthcare usage changed since the inception of HSAs?

    18:42 INBW41 with Stacey.

    23:24 How are preventive care and first-dollar coverage connected within the context of HSAs?

    25:48 Why would it be difficult to completely get rid of a high-deductible health plan and offer HSAs without them?
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    31 m
  • EP469 (Part 1): The Impact on Plan Sponsors of Medicaid Cuts, With James Gelfand, JD

    EP469 (Part 1): The Impact on Plan Sponsors of Medicaid Cuts, With James Gelfand, JD
    Mar 27 2025

    In part 1 of this two part episode, Stacey Richter speaks with James Gelfand, President and CEO of the ERISA Industry Committee (ERIC), about the potential effects of proposed Medicaid cuts on plan sponsors and their members.

    They explore ways plan sponsors can prepare for the changes, including Medicaid's four major areas of possible cuts: reducing waste, fraud, and abuse; implementing work requirements; reeling in provider taxes; and addressing the 'Cornhusker Kickback' from the ACA.

    The conversation also delves into how state governments and hospitals might respond to these cuts and suggests actions for plan sponsors to mitigate potential impacts. The episode is part one of a two-part series, with the second episode covering Medicare site neutral payments and HSA reforms.

    === LINKS ===

    🔗 Show Notes with all mentioned links:
    https://relentlesshealthvalue.com/episodes

    ✉️ 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:
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    🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1

    🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b

    📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue

    === CONNECT WITH THE RHV TEAM ===

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

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    05:22 What’s happening with Medicaid cuts?

    06:47 What are the four main things congress is actually looking at in cutting Medicaid?

    09:12 What is the Cornhusker Kickback?

    16:46 What should plan sponsors be doing right now to prepare for these potential Medicaid cuts?

    20:04 What’s going to happen to hospitals with these proposed Medicaid cuts?

    20:48 EP464 with Al Lewis.

    23:41 How does hospital consolidation affect the potential future with these Medicaid cuts?
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    26 m
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