『Relentless Health Value』のカバーアート

Relentless Health Value

Relentless Health Value

著者： Stacey Richter
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Welcome to Relentless Health Value, the podcast for those working in the belly of the beast to fix our fundamentally broken healthcare system. If you are a self-insured employer, plan sponsor, benefits consultant, clinician, a C-suite executive or anyone in the business of healthcare tired of the "transformational theater" and marketing fluff, you have found your tribe. The U.S. healthcare system isn't a rational market; it's a game of Pachinko where perverse incentives reign, and as we always say, where there's mystery, there's margin. Hosted by Stacey Richter, we relentlessly hunt down the administrative "inches" of waste and expose the hidden fees draining the $5.6 trillion healthcare sector. We transform wonky healthcare theory into ruthlessly practical, actionable insights. Whether it's demanding radical transparency, navigating complex PBM contracts, or buying actual healthcare instead of illusory discounts, our mandate is simple: If it results in a net positive for patients, we do it. Join the Relentless Health Value Tribe to equip yourself with the fiduciary armor needed to outwit the status quo, demand accountability, and drive real change.©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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  • Slaying the Three-Headed Monster of Health Plan Networks, With Evan Anderson

    Slaying the Three-Headed Monster of Health Plan Networks, With Evan Anderson
    2026/09/30
    Discount Illusions, Billing Errors, and Site-of-Care Markups: A Carrier Network Primer for Employers with Evan Anderson of Handl Health. Episode 531. Whatever the plan was at the very beginning, the big status quo carrier networks have evolved into what Stacey Richter calls a three-headed monster: the contractual illusion of discounts, payment integrity nobody with skin in the game is allowed to check, and wild site-of-care price swings inside the very same network. Stacey talks with Evan Anderson of Handl Health, where he works on product strategy, general strategy, and operations, about how fee-for-service networks got here and what self-insured employers, brokers, and TPAs can do around the edges right now. Consider it a primer — a survey of the general map of the landscape, with breadcrumbs to many past episodes for anyone ready to take a deep dive. WHAT YOU'LL LEARN ✅ Why a discount off a chargemaster price is "an optical illusion" — including the 2023 Health Affairs finding that at roughly half of hospitals, the discounted cash price is lower than the insurer-negotiated rate ✅ How old mainframe adjudication systems, obtuse contracts, and double-digit billing error rates make payment integrity nearly impossible to verify — because where there's mystery, there's margin ✅ How site-of-care differentials drive runaway spend, from hospital multipliers as high as 13X to $135 vs. $13,560 for the exact same infusion drug — both in-network ✅ Why switching carrier networks, even with your own claims file and transparency data, is a shrinking lever as prices regress toward the mean ✅ Three around-the-edges moves: direct contracting for advanced primary care and Centers of Excellence, steerage and tiering that include site-of-care tiers, and bundled episodes of care aggregated into alternative health plans ✅ How the broker/EBC role is shifting from network shopper to plan orchestrator WHY THIS MATTERS These networks are, lest we forget, built on a fee-for-service model that structurally aligns incentives in ways that are a lot of times misaligned with members and plan sponsors. As Evan puts it, cut one head off and the body grows it back — that body being decades of opacity (gag clauses were only banned by the CAA in 2021) and intermediaries paid in ways indifferent or positively correlated to higher spend. For plan sponsors facing extreme increases, knowing the real price, the quality, and what was actually billed is how you start chipping away at the status quo. MENTIONED IN THIS EPISODE EP505 with Ahilan Sivaganesan, MD: Apple Podcasts | Spotify | Other Apps EP434 with Benjamin Schwartz, MD, MBA: Apple Podcasts | Spotify | Other Apps Website: Handl Health Handl Health on LinkedIn Evan Anderson on LinkedIn Article: Katy Talento, ND, ScM, on a post-network world LinkedIn Post by Mark Cuban LinkedIn Post by Craig Gottwals Study: Health Affairs, hospital cash prices vs. negotiated prices EP482 with Preston Alexander: Apple Podcasts | Spotify | Other Apps EP480 with Kimberly Carleson: Apple Podcasts | Spotify | Other Apps EP521 with Andrew Tsang: Apple Podcasts | Spotify | Other Apps Article: Jim Jusko, JD, on healthcare provider networks (Medical Economics) EP529 with Eric Bricker, MD: Apple Podcasts | Spotify | Other Apps EP501 with Ivana Krajcinovic, PhD: Apple Podcasts | Spotify | Other Apps EP472 with Eric Bricker, MD: Apple Podcasts | Spotify | Other Apps EP398 with Jacob Asher, MD: Apple Podcasts | Spotify | Other Apps LinkedIn Post by Mike Hopkins EP528 with Yashaswini Singh, PhD: Apple Podcasts | Spotify | Other Apps LinkedIn Comment by Lori Smith Guliano LinkedIn Comment by Patrick Nelli EP509 with Patrick Nelli: Apple Podcasts | Spotify | Other Apps EP504 with Ryan Jacobs: Apple Podcasts | Spotify | Other Apps EP530 with Jake Velie and Keith Hartman, RPh: Apple Podcasts | Spotify | Other Apps EP523 with Suhas Gondi, MD, MBA: Apple Podcasts | Spotify | Other Apps EP503 with Ryan Wells; Leo Spector, MD, MBA; and Adam Stavisky: Apple Podcasts | Spotify | Other Apps EP294 with Steve Schutzer, MD: Apple Podcasts | Spotify | Other Apps === LINKS === 🔗 Show Notes with all mentioned links ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 🎤 Follow us on Apple Podcasts 🎤 Follow us on Spotify 📺 Subscribe to our YouTube channel === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 00:00 Introduction to this episode. 02:21 An overview of today's conversation. 06:31 The conversation with Evan Anderson. 06:40 What is a network? 08:15 The reality of contracts and care networks. 13:19 The contractual illusion of discounts. 21:17 What does a good solution look like right now? 24:35 How incentivizing providers can open opportunities. 26:44 How COE and steerage architecture plays into this. 34:02 The different role of the broker and EBC in this ...
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    38 分
  • EP533: Level Funding Is Self-funding: 5 Avoidable Contract Risks, With Frank Pennachio

    EP533: Level Funding Is Self-funding: 5 Avoidable Contract Risks, With Frank Pennachio
    2026/10/14
    Hello, all you Relentless Tribe members. Thanks for hanging with me today to talk about a bunch of things. One of them being what exactly are level-funded plans, and what are the upsides, and then what are the risks? Because here's the thing. I was talking to an employer the other day, an employer with a fully funded insured plan; and he told me his renewal this year: 69% … 69%! 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. Now, their broker managed to negotiate that increase down to 50%. I'm not entirely sure if I'd classify that as a victory. So, when Frank Pennachio says in the conversation with him that I'm gonna have today that there's a lot of desperation out there for a lifesaver for these plan sponsors, for employers out there, for just a way forward that may just even preserve the employer's ability to continue to provide coverage; to not actively be working insanely hard to try to replace the humans with, like, AI that doesn't need insurance; or to, like, offshore labor to a country, literally any other country, because any other country is going to have more affordable healthcare, like, at a certain point, one more double-digit increase, one more 50% increase becomes a really big corporate decision. So, right, we talk a lot about self-funding on Relentless Health Value because it can be a very empowering way to go if a plan sponsor chooses to embrace the entirety of the potential upsides while mitigating the inherent risks of becoming a fiduciary and, as Elizabeth Mitchell has said, running a small insurance business off the side of their desks. That's what you're doing when you become self-insured. Someone in the company is running a small insurance business off the side of their desk. What would be a problem for anyone to hear, though, is a message that self-funding or becoming a self-insured employer is, like, some kind of homogenous broad stroke. Like, all of these employer-sponsored insurance companies that have gotten stood up are the same or maybe even similar, kind of forgetting that there are many, many different flavors or models of self-insurance. So, coming up here, Frank Pennachio, my guest today, quotes economist Thomas Sowell, who famously said that in healthcare, "There are no solutions. There are only trade-offs." And you can see why, because all of this adds up to a key point: how plan sponsors can make intentional and intelligent decisions, trade-offs, pick which trade-off they want rather than desperate ones. So, right, my guest today is Frank Pennachio, who is the author of the book The Silent Danger. Frank brings nearly 40 years of experience in the health insurance industry. He started his career on the P&C (property casualty) side before evolving into employee benefits, owning an agency, consulting, and training with agencies and plan sponsors nationwide. Frank also has a couple of courses available on his Web site, so certainly do check them out. In the conversation coming up here, Frank walks us through the hidden contract risks that level-funded plan sponsors fall into regularly; and then we get into the critical takeaways to help plan sponsors, their advisors, navigate these waters with eyes wide open. If you are an employer considering, for example, level funding or trying to figure out other ways to be self-funded or an advisor or a policymaker or anybody thinking hard about healthcare affordability and where the dollars spent by taxpayers, members, and health plans are going, this episode is your essential field guide. This is Relentless Health Value. I want to first of all thank Frank for generously offering to sponsor the costs of producing this episode, which was really kind of him. That was a really nice gesture. Also, thanks to our founding sponsor, Aventria Health Group. And with that, here is my conversation with Frank Pennachio. Also mentioned in this episode are Elizabeth Mitchell; Aventria Health Group; Andreas Mang; Jon Camire; Kimberly Carleson; Justin Leader; Lori Guliano; David Goldfarb; Doug Aldeen; Cynthia Fisher; Claire Brockbank; Stan Schwartz, MD; and ZERO.health. For a list of healthcare industry acronyms and terms that may be unfamiliar to you, click here. You can learn more at thesilentdanger.com and by following Frank on LinkedIn. Frank Pennachio is a nationally recognized authority on fiduciary risk, ERISA compliance, and the governance of self-funded health plans. With more than four decades in the insurance and risk management industry, Frank has built a reputation for challenging conventional thinking and exposing hidden liabilities that often go undetected in employer-sponsored benefit programs. Frank is known for connecting silos that traditionally operate independently: employee benefits and property & casualty. Frank is the author of The Silent Danger, a book focused on the overlooked ...
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    37 分
  • EP532: Why Avoidable ER Visits Aren't the Real Cost Problem: Revisiting Our 2016 Interview With HHS Nominee Chris Klomp

    EP532: Why Avoidable ER Visits Aren't the Real Cost Problem: Revisiting Our 2016 Interview With HHS Nominee Chris Klomp
    2026/10/07
    Today we are dipping into the archives for an essential replay from 2016, one decade ago, featuring Chris Klomp back when he served as CEO of a company called Collective Medical. With the nomination of Chris Klomp to serve as deputy secretary of the Department of Health and Human Services (HHS), all eyes are kind of on how he plans to manage a nearly $2 trillion federal health apparatus. 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. Hey, turns out I have a semi-decent track record for finding the folks who are going to make a difference or who are making a difference and bringing them to you, Relentless Health Value tribe. Or it could be that—what do they say?—twice a day a blind squirrel finds a nut. I could edit out that metaphorical mess I just made, but I'm not going to so you can fully appreciate the work that our editor, Tom Nash, has cut out for him. Okay … so, a decade ago, Chris Klomp, as a CEO, was focused on one of the most stubborn bottlenecks in healthcare: frequent emergency department visits and systematic lack of care coordination therein. In this conversation that follows, in this earlier episode, he broke down how real-time insights and aligned incentives can prevent avoidable hospital utilization. Listening back today provides a kind of rare, candid preview of the operational philosophy which may now shape Chris Klomp's view on health policy. Now, you might consider this a very, very short introduction 'cause I'm wrapping up here. But never fear. Instead of chewing your ear off at the top of the show, like I normally do, I'm gonna spread my commentary inside the conversation with Chris Klomp that follows, just to kinda keep everything in context. Also, speaking of changes around here, we are experimenting with a new way to start the show that kinda jumps right in instead of trying to figure out a, like, one-sentence title for the entirety of the episode. Maybe I'm just terrible at titles (which might be fair enough), but it also seems like the main point or summary or takeaway of any given show, it only sorta starts to come out when the episode hits you lot, you Relentless Tribe, you listeners. You go on LinkedIn and pull out and parse and respond, and then all of a sudden, I wish the episode had a different name or a different title based on the sometimes really crystal-clear reflections and insights that I read or hear about later on and after the dust settles. So, if you have thoughts on this—seems like a big deal to us, but maybe it's not a big deal to you—if you have any thoughts, do share. This is Relentless Health Value. Thank you so much to Aventria Health Group, which is our founding sponsor. Thank you also so much to our series underwriter in 2026, Payerset. And I just wanna let you know that Payerset just posted about 129,000 self-funded employers' allowed amounts on their Web site for free. So, do go over to Payerset's Web site if you wanna check that out. Also, thank you very much to Patient Rights Advocate for a really, really nice donation this year. It's so important to helping keep this show on the air. Again, this is the show from 2016 with Chris Klomp. Also mentioned in this episode are Tom Nash; Arielle Bose; Aventria Health Group; Payerset; Patient Rights Advocate; Collective Medical Technologies; Mick Connors, MD; Al Lewis; Peter Smulowitz, MD, MPH; Leah Honigman, MD; Bruce Landon, MD, MBA; John Lee, MD; Monica Lypson, MD, MHPE; Kenny Cole, MD; Scott Conard, MD; and Jerry DiMaso. For a list of healthcare industry acronyms and terms that may be unfamiliar to you, click here. Chris Klomp is the chief counselor at the U.S. Department of Health and Human Services. He has driven healthcare reform at state and federal levels, focusing on value-based care and interoperability. He built Collective Medical; has co-founded, advised, and served on the board of many innovative start-ups and on the Utah Digital Health Services Commission; and worked at Bain Capital and Bain & Company. Chris holds a bachelor of arts degree with honors in economics and English from Brigham Young University and an MBA from Stanford. 00:00 Introduction to this episode. 04:38 Reducing wasteful spend in healthcare. 05:37 The percentage of total healthcare costs that goes to emergency medical spend in the U.S. 06:07 EP467 with Stacey. 07:09 Why ED spending is low-hanging fruit. 08:17 How EDs operate as choke points. 09:14 Impacting what happens in the emergency department. 17:34 What happens when a patient enters the ED. 20:57 Why it's important to have data available to everyone who might touch the patient. 23:44 EP495 with Mick Connors, MD. 23:51 EP464 with Al Lewis. 23:58 Research from Peter Smulowitz, MD, MPH; Leah Honigman, MD; and Bruce Landon, MD, MBA. 24:45 The need-to-know when it comes to managing data. 28:01 Thinking about risk and imminent ...
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    37 分
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