『Relentless Health Value』のカバーアート

Relentless Health Value

Relentless Health Value

著者： Stacey Richter
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概要

 American Healthcare Entrepreneurs and Execs you might want to know. Talking. Relentless Health Value is a weekly interview podcast hosted by Stacey Richter, a healthcare entrepreneur celebrating fifteen years in the business side of healthcare. This show is for leaders in pharma, devices, payers, providers, patient advocacy and healthcare business. It's for health industry innovators, entrepreneurs or wantrepreneurs or intrapreneurs. Relentless Healthcare Value is the show for you if you want to connect with others trying to manage the triple play: to provide healthcare value while being personally and professionally fulfilled.©BD Bridges LLC, All Rights Reserved. 政治・政府 衛生・健康的な生活 身体的病い・疾患
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  • EP501: Speaking of Infusions, Do You Want to Pay $135 or Do You Want to Pay $13,560 for the Exact Same Drug? With Ivana Krajcinovic, PhD

    EP501: Speaking of Infusions, Do You Want to Pay $135 or Do You Want to Pay $13,560 for the Exact Same Drug? With Ivana Krajcinovic, PhD
    2026/02/26
    Let us chat about today the inches all around us and also about how there is no market in healthcare all at once in this show. Today I am talking with Ivana Krajcinovic. And let me give you some examples of the inches. Two members of a plan get infusions at a hospital. And if these two members had gone down the street to get their infusions, the total cost of the two of them would have been $1 million less … $1 million less! How many inches is a million dollars? 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. Or the examples Ivana Krajcinovic talks about coming up where an independent practice was charging $135 for a chemo infusion and the hospital down the street was charging for the same exact drug, by the way—the same exact infusion—$13,560 … $135 versus $13,560! We talk about affordability in this country? Member's paying coinsurance off that 13K, by the way. And if you're doing the math at home, that is a 10,000% markup. Or if we start from the Medicare price, it was a 40,000% markup. Then there's another example that Ivana talks about where a plan member went to a hospital and got a $90,000 bill for a series of infusions that, again, down the street would have been $185—all in. Inches much? So, it's pretty clear why the show is part of "The Inches Are All Around Us" series. Why do I say this is part of the "No Market" series? Because look, functioning markets rationalize prices. That's just what they do. So, if you have two places in the exact same geography and one of them is charging 500 times or whatever the other one, you don't have a market if they're both still in business a year later. Ongoing wild price variations is a big tell that there's no market to be had. Another tell, though, is that carrier networks, who are supposed to be the demand curve here—or at least that's what their marketing says or what we are all kind of led to believe—they advertise as high-value networks, right? The fact that any given network experiences essentially no business repercussions for spending a million dollars extra of its plan sponsors' (its customers') money—because that's who's paying for this, the self-insured employer or union, at the end of the day—and the network, the carrier network doesn't lose business as a result … Right? Listen to the show from last week with Jacob Asher, MD (Take Two: EP398) about the carrier nonmarket and why this is the case. But bottom line, if anyone is waiting on a market to constrain prices for them, that is very magical thinking. Where this whole thing is gonna wind up, by the way, is with my guest today, Ivana Krajcinovic, suggesting a roadmap to make a whole lot more likely that you'll pay $135 for an infusion instead of 13 grand. For more on this, do go back and listen to the show with Keith Hartman, RPh, by the way. We teed this off a couple of years ago. That was episode 369. But in Ivana's upcoming roadmap that you're gonna hear about (just doubling down on the spoilers—if I'm gonna do something, I might as well do it well), but in that roadmap, direct contracts with indie practices will feature a starring role. I'm telling you this because if you're one of those folks that listens to like 23 minutes of any given podcast and then bails, make sure you make it to around the 30-minute mark of the show. As I have said several times already, my guest today is the incomparable Ivana Krajcinovic, the outgoing vice president of healthcare delivery at UNITE HERE HEALTH. Ivana has just retired, but she spent over three decades with her team protecting the health and the hard-earned wages of 230,000 hospitality workers. She is exactly the kind of "dangerous expert" that we love to have on the show—someone with the wisdom about how the system actually works and the articulate willingness to talk about it. Okay … so, this conversation about the inches and the nonmarket for infusions specifically in this country, for more information, do go back and read the really excellent Bloomberg News exposé by John Tozzi. It's a really good article, and you'll see everything that we talk about today in writing with all the fact-checking that one would expect from Bloomberg News. So, okay … what we'll do in this episode is, first, we're gonna talk about the infusion nonmarket, the inches and its implications, such as an infusion costing 500 times Medicare when there are 1.5x Medicare options in the same exact health system. Sometimes I just can't even with some of this stuff. But another nonmarket tell, again, is that carrier networks are still in business. We talk all about that. What happens next in this episode is we deconstruct the roadmap that Ivana used to fight back, which starts with (no surprises) drilling into data and ends with direct contracting with independent doctors. And how that happens is by carving out utilization ...
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    40 分
  • Take Two: EP398: Why Are Commercial Carrier Marketplaces Completely Boring? Maybe Because There Isn't a Marketplace, With Jacob Asher, MD

    Take Two: EP398: Why Are Commercial Carrier Marketplaces Completely Boring? Maybe Because There Isn't a Marketplace, With Jacob Asher, MD
    2026/02/19

    The Non-Market Reality of Healthcare Carrier Marketplaces with Dr. Jacob Asher. In this episode of Relentlessly Seeking Value, host Stacey Richter introduces the 'No Market' series focused on the healthcare sector's lack of competitive market dynamics, which affects cost and quality.

    The episode features a conversation with Dr. Jacob Asher, who has extensive experience as a Chief Medical Officer at major healthcare plans. They discuss the stagnant nature of commercial carrier marketplaces, particularly in California, and the various factors contributing to this stasis, including employer inertia, the influence of employee benefit consultants, and the strategic focus of carriers on Medicare Advantage over commercial business.

    They also explore how carriers' dependence on existing provider networks and contractual negotiations based on member volumes contribute to a lack of meaningful competition. The episode highlights the challenges faced by plans attempting to innovate or differentiate on quality and the systemic issues that perpetuate the current equilibrium.

    === LINKS ===
    🔗 Show Notes with all mentioned links:
    https://cc-lnk.com/Take2-EP398

    ✉️ 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/

    00:00 Introduction to the episode.

    00:42 The "No Market" series.

    01:51 Why is the carrier market boring?

    04:26 A breakdown of what follows.

    05:48 Six reasons why a marketplace doesn't actually exist.

    10:04 Upcoming episodes in the "No Market" series.

    10:41 The conversation with Dr. Jacob Asher.

    11:01 What is the competitive picture of California's health plans?

    11:03 Understanding the California health plan market.

    12:28 What the competitive landscape looks like to get market share in California.

    12:55 Challenges in market competition.

    13:14 What are micro markets and market drivers?

    15:14 How brokers and consultants shape the marketplace.

    15:49 Why is it difficult to take market share?

    16:56 Who was Dr. Asher pitching to and why?

    18:56 How is Kaiser's position in the marketplace unique?

    19:29 Did employers ever buy plans for quality?

    23:23 What does this look like from the payer perspective?

    27:42 What improvements have there been to engagement in health plans?

    29:47 Have plans gotten better at communicating with employers?

    31:19 Why is it hard to compare the Kaiser world to the non-Kaiser world?

    31:19 Dr. Asher's final thoughts and reflections.

    33:40 EP390 with Gloria Sachdev, PharmD, and Chris Skisak, PhD.
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    35 分
  • EP500: This Is Episode 500, and It's All About You, Tribe

    EP500: This Is Episode 500, and It's All About You, Tribe
    2026/02/12
    This episode would not be happening, to be frank, if Cora Opsahl hadn't asked me what my plans were for episode 500. A few weeks ago, we were in the lobby bar at the legendary Hotel Chelsea—Sid Vicious, Patti Smith, you know the place. In our defense, the Hotel Chelsea is, in fact, probably about the halfway point between our two places of business. They are known for their martinis. The show just started, and it's already off the rails. 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. Anyway, Cora said (casually, mind you), "Whatcha you gonna do for episode 500?" I said, "Oh, I have that all figured out. I'm gonna do episode 499, and then I'm gonna do episode 501, and then I'm gonna figure out episode 500 when I have a little bit more time to think about it. Because right now I'm really, really busy at my day job." As I've said many times, I used to crastinate, then I went pro. Cora just stared at me, gathering her thoughts maybe. Finally, Cora goes in response to my do episode 499 and then do episode 501 and then do episode 500 sometime later on when I get around to it. Cora goes, "Yeah, well, that is a truly terrible idea." Then she helped me figure out a good plan. So, welcome to episode 500. This podcast is sponsored by Aventria Health Group. While I'm talking about sponsored by, and I know I covered this in the Thanksgiving Show (INBW43), but I really, really wanna thank all of the individuals who have contributed moral and/or financial support. Back to how episode 500 came to be. The plan I concocted with Cora started out as a LinkedIn post. Here's the post: "Ten years ago and 500 episodes ago, I started Relentless Health Value because the healthcare industry felt like a game of pachinko. You drop a program or a policy or a technology in. It bounces around a black box. And sometimes the result is the opposite of what you intended or what you wanted." I keenly felt my lack of not just essential knowledge but just how to actually deploy that knowledge to move the needle and secure a really patient-centric system. But then I met the Relentless Health Tribe. You lot. "You are the alchemists of this industry. You take the words [that] you hear here and turn them into [tangible programs and solutions]," things that actually work in this hot mess that we call the healthcare sector. So, look, the whole reason for Relentless Health Value continuing for all of these years is the impact that you have. Some of this impact I hear about, but a lot of it, frankly, I don't. So, this is what I asked for on that LinkedIn post. I wrote, "I want to hear from you." And then I asked everyone reading to write their own accountings for how Relentless Health Value and its guests may have influenced their own trajectories toward a better way forward. Because here's the thing, and how do I wanna say this? Not everyone listens to the show. We are not everyone's cup of tea. We meaning, for sure, me; but yeah, if you're here listening, you, too. So, don't try to claim otherwise. I'm onto you. We are not only worried about patients/members, but we are also a bunch of deeply knowledgeable wonks who understand—because we need to—how the pipes have been laid and how the dollars flow through them. Because we get that you cannot actually manage to do the right thing by patients and members a lot of times, unless you have a handle on how this deeply opaque and often wildly counterintuitive world actually works that functions, in many ways, the opposite of what the press release says or the first three pages of the contract, as the case may be. So, I'm proud of you, and I'm proud that you are listening because if I added up the number of lives that you lot serve—like when you make decisions, how many are impacted by your choices—it's, I don't know, if I had to add it all up, I'd say back of envelope over 80 million people in this country, 100 million. Not sure how to count, because some of you work upstairs at health systems and provider organizations. Some of you are self-insured employers or TPAs (third-party administrators) or consultancies or solution providers, legislative folks, policymakers. Or maybe you just work with one patient at a time trying to figure out how to do that as best you can. You're here, and I appreciate that from the bottom of my heart, and I would certainly encourage you to look around because there's real power in this village that you are a part of and that can and will matter. So, again, this show, not for everyone by a long stretch. But who gravitates here are those with a strong desire to find their own North Star, their own beacon, as Alex Sommers, MD, put it. And we're all looking for actionable insights so we can manage to succeed doing something. We are not here to stare at our belly buttons. And this is often uncomfortable, right? It's sometimes really, really ...
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    38 分
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