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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

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    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
  • EP499: Self-insured Employers and Other Plan Sponsors Are Paying Millions for MSK (Musculoskeletal) Injuries That Would Have Healed Themselves, With Jay Kimmel, MD

    EP499: Self-insured Employers and Other Plan Sponsors Are Paying Millions for MSK (Musculoskeletal) Injuries That Would Have Healed Themselves, With Jay Kimmel, MD
    2026/02/05

    In this episode of Relentless Health Value, host Stacey Richter talks with Dr. Jay Kimmel, an orthopedic surgeon and co-founder of Upswing Health, about the significant costs associated with musculoskeletal (MSK) injuries and conditions for self-insured employers and other plan sponsors.

    They explore how a large portion of MSK-related expenses are for low-acuity injuries that often heal on their own without the need for emergency room visits or unnecessary treatments. Dr. Kimmel discusses the importance of addressing the 'white space'—the critical initial moments when a patient decides whether or not to seek emergency care.

    He emphasizes the value of immediate access to knowledgeable professionals to help guide these decisions and prevent avoidable high-cost care. They also touch on historical practices where physicians would consult each other informally, suggesting that modern solutions like Upswing Health can replicate those beneficial spontaneous interactions to improve patient care and reduce costs.

    === LINKS ===
    🔗 Show Notes with all mentioned links:
    https://cc-lnk.com/EP499

    🔗 Visit Upswing Health:
    https://upswinghealth.com

    ✉️ 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/

    07:49 EP472 with Eric Bricker, MD, on high-cost claimants.

    08:01 What is the "white space" in MSK spend?

    10:43 Statistics on Connecticut's spending on plan members with low-acuity MSK injuries.

    13:30 How back pain also easily transitions from a low-acuity issue to a high-acuity problem.

    15:11 How plan sponsors can detect their white space downstream spend.

    16:58 EP464 with Al Lewis.

    17:02 EP470 with Nikki King, DHA.

    18:15 Why where patients start their journey often dictates where they wind up and how costly that medical pathway is.

    20:48 Where PCPs fit into this MSK spend issue.

    25:26 EP468 with Matt McQuide.

    25:34 EP471 with Christine Hale, MD, MBA.

    25:39 Why access is key.
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    28 分
  • EP498: The Payment Integrity Arms Race—RCM (Revenue Cycle Management) and Plan Sponsors, With Mark Noel

    EP498: The Payment Integrity Arms Race—RCM (Revenue Cycle Management) and Plan Sponsors, With Mark Noel
    2026/01/29
    This episode is part of the "Inches Are All Around Us" series because … yeah, you'll see why fast enough. So, last week or two weeks ago, if you listened to that episode about clearinghouses with Zack Kanter (EP497), you may or may not recall. And if you didn't listen to that episode, no worries. Just go back and soak it in when you have a sec. 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. But in that episode about clearinghouses, I said something about how self-insured employers are bringing a knife to a gunfight if they do not have real programmatic, integrated payment integrity programs. Because an arms race is afoot whether or not the self-insured employer or other plan sponsors recognize they're in one. The arms race, by the way, is with revenue cycle management (RCM). Here's a quotable quote that my guest today, Mark Noel, says in the conversation that follows. Spoiler alert, I suppose, but around the 27-minute mark or something he says (and some light editing by me), but he says: It's an arms race. It's a tug-of-war. It's a zero-sum game. Because you have the RCM folks on the front trying to maximize revenue, and you have the self-insured employers and plan sponsors on the back end trying to pay as little as they need to. And so, it is imperative that the payment integrity vendor is keeping their policies up-to-date as of the minute because these things change all the time, and the rev cycle management side is gonna be up-to-date. So, right … on one side you have RCM, the RCM industry—a $140 billion behemoth, by the way, that is already larger than the U.S. auto industry and growing five times faster. These RCM vendors are using programmatic clearinghouses as discussed two weeks ago. Plus, they're ever more sophisticated with automatic tools to maximize every cent of revenue they can squeeze out of a claim. That is their job. On the other side sits the self-insured employer, often relying on less sophisticated processes and/or maybe even vendors who are effectively phoning it in. Because they have an incentive to not do a great job here because … right: perverse incentives. Who is surprised? No one is surprised. Listen to the show with Justin Leader (EP433) on the mystery of the weekly claims wire. So, prepayment integrity is what I talk about today with Mark Noel, my aforementioned guest today. Mark is from ClaimInsight, who I do need to thank, by the way. I need to thank ClaimInsight for donating some financial support to help Relentless Health Value here cover expenses. But here's gonna be the three prepayment integrity revelations that Mark Noel brings up in the conversation that follows. Revelation 1: The small-claim gold mine, I'm gonna call it. We often obsess over the—for good reason, don't get me wrong—but we obsess over the million-dollar babies or the cancer case, right? These high-cost claimants. But 80% of claims volume is actually small claims, right? Not 80% of the spend but 80% of the volume. Overpaying or double billing on thousands of, like, $200 claims adds up to millions of dollars in wasteful inches very quickly. Stan Schwartz, MD, talked about this on an earlier episode (EP486) from a little bit of a different angle, but same result applies. Revelation 2: The "conflict of interest" trap. It is a fundamental business mistake to hire the same company to do the work as you do to check the work. Asking a TPA (third-party administrator) or an ASO (administrative services only) to report on their own errors is like asking for a tax penalty audit from the same person who filed your return, right? It is just an inherent conflict of interest. It's almost not fair to either party. Just … yeah. So, that was Revelation 2. Revelation 3: The perverse incentives of many things, but one of them is shared savings that we talk about today. Many carrier contracts allow them to earn shared savings on the back end for fixing errors that they didn't catch on the front end, right? So, this means that they actually have a perverse incentive to let errors through initially so that they can get paid a second time to recover money that they should never have spent in the first place. Maybe I'm saying the quiet part out loud now. I do not know, but in the light of day, these revelations are kind of stark and fairly unimpeachable. And this matters because ultimately prepayment integrity, maybe just payment integrity in general, isn't just a financial issue for the plan. It is a bulwark for members. We live in a world where 41% of Americans have medical debt. Ensuring that a claim isn't wrongly expensive, which the member's paying a part of here in a lot of cases, it's a fiduciary and probably moral imperative, just like has been said 50,000 times on this podcast. Plan sponsors must demand unconflicted expertise at the table—transparency, trust that can be ...
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    35 分
  • Take Two: EP341: The "Just Spend Everything You're Given" Trap—Lessons in True Provider Fiscal Discipline, With Gary Campbell

    Take Two: EP341: The "Just Spend Everything You're Given" Trap—Lessons in True Provider Fiscal Discipline, With Gary Campbell
    2026/01/22
    In this Take Two episode of Relentlessly Seeking Value, host Stacey Richter speaks with Gary Campbell, CEO of Johnson Health Center, an FQHC in Virginia. The discussion centers around the importance of fiscal discipline in healthcare, especially in federally qualified health centers where there's no opportunity to cost-shift inefficiencies. This episode also revisits the notable experience and practices of Nikki King, CEO of Alliance Health Centers, focusing on her innovative methods to overcome operational challenges without additional funding. The conversation highlights the importance of visionary leadership, cultural alignment, and operational efficiency to deliver high-quality patient care and maintain financial health. Gary Campbell emphasizes the necessity of strategic planning, involving clinicians in decision-making, and standardizing processes to create a better work environment and optimize patient care. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/TakeTwo-EP341 ✉️ 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/ 09:03 Why is there no opportunity to cost shift in an FQHC? 09:34 What happens when an FQHC is operating inefficiently? 10:00 "Have you workflowed it out? … You can overstaff yourself in a way that your cost per patient goes way up." 10:23 Why is taking a lean approach not an excuse to cut staff? 11:27 EP490 and EP492 with Shane Cerone and Sam Flanders, MD. 11:35 EP438 with John Lee, MD. 11:38 EP455 with Beau Raymond, MD. 11:40 EP402 with Amy Scanlan, MD. 11:42 EP405 with Eric Gallagher. 12:48 "The nurses are linchpins to everything." 13:44 LinkedIn post from Eve Cunningham, MD, MBA. 15:10 How does standardizing care lead to personalization of care? 16:34 "Our clinical teams see that we care." 16:53 "If you don't have a vision for where you want to be two and three years down the road, you're struggling." 17:09 "I want everybody to understand, What is their why?" 19:45 Lean & Meaningful by Roger E. Herman and Joyce L. Gioia. 24:44 "You have to project plan things out that you want." 25:51 "They don't teach leadership in most medical schools."—Dr. Robert Pearl 26:46 Outlive by Peter Attia, MD. 27:55 "Get to know these clinicians." 29:39 "From a core values perspective, you can make every single decision … on core values." 30:03 "We always start with those values. … They're embedded in everything we do." 30:20 How does an FQHC or private practices that are patient-oriented attract talent? 35:24 EP297 with Jerry Durham. 35:54 "First and foremost, be visible."
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    37 分
  • EP497: What You Don't Know About Healthcare Transactions and Clearinghouses Could Cost You, With Zack Kanter

    EP497: What You Don't Know About Healthcare Transactions and Clearinghouses Could Cost You, With Zack Kanter
    2026/01/15

    In Episode 497 of Relentless Health Value, Stacey Richter engages in a detailed conversation with Zack Kanter, CEO of Stedi about the complexities and inefficiencies inherent in healthcare transactions and clearinghouses. They discuss how non-standardized processes and legacy systems result in exorbitant costs and delays in claims processing and eligibility checks, which are significantly higher compared to other industries.

    Despite HIPAA's standardized rules, the lack of competitive pressure and outdated technology contribute to these issues, ultimately impacting patient care and administrative costs. Zack offers insights on how modernizing the clearinghouse infrastructure can lead to substantial cost savings and better patient outcomes.

    === LINKS ===
    🔗 Show Notes with all mentioned links:
    https://cc-lnk.com/EP497

    🔗 Visit Stedi:
    https://www.stedi.com

    ✉️ 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/

    09:47 What things are being paid for that we might not be aware we're paying for in healthcare?

    12:09 Why HIPAA actually makes healthcare more standardized than other industries.

    15:35 How healthcare is ahead in some ways and behind in others.

    18:03 Where do the 4 to 5 days come from in healthcare transaction processing?

    20:39 Why these transaction delays affect care delay.

    23:14 EP482 with Preston Alexander.

    23:18 EP472 with Eric Bricker, MD.

    27:10 How should the process work from the time a provider clicks "validate"?

    30:19 Why is the clearinghouse the right place to solve all these issues?

    31:41 Why are we where we are in terms of these issues?

    35:28 Why people should be looking at their clearinghouse costs.

    36:59 What to know about Stedi.
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    38 分
  • EP496: Plan Sponsors Spend About $1.20 to Buy $1 of Healthcare, and Clinical Organizations Receive 80¢ for Every $1.20 Spent, With Mark Newman

    EP496: Plan Sponsors Spend About $1.20 to Buy $1 of Healthcare, and Clinical Organizations Receive 80¢ for Every $1.20 Spent, With Mark Newman
    2026/01/08
    In this episode of Relentless Health Value, Stacey Richter engages with Mark Newman, CEO and founder of Nomi Health, in a deep dive into the administrative and transactional inefficiencies plaguing the American healthcare system. The conversation highlights how plan sponsors often spend more than a dollar to purchase healthcare, yet healthcare providers receive only a fraction of that amount due to data fragmentation and varied accounting practices. Mark Newman reveals two main issues: 'data isn't data' and 'a dollar isn't a dollar,' explaining how inconsistencies and misalignments in data and accounting methods lead to significant waste. The discussion also explores innovative solutions Nomi Health is piloting to streamline payments, reduce friction, and ultimately lower healthcare costs while improving care. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP496 🔗 Visit our sponsor Nomi Health: https://www.nomihealth.com/ ✉️ 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/ 06:48 What is actionable to know about the life of a claim? 08:14 How data can change as it moves through the claims process. 11:45 Why a dollar isn't a dollar in healthcare. 18:50 Why employers are actually paying more than a dollar to access a dollar of healthcare (the medical loss ratio). 21:54 Why cutting out the "friction" is actually better for employees and members. 22:48 EP482 with Preston Alexander. 22:50 EP472 with Eric Bricker, MD. 23:36 EP490 and EP492 with Sam Flanders, MD, and Shane Cerone. 23:53 Infographic by Andrew Tsang showing 27 streams of income. 26:53 How do we fix these issues? 28:05 LinkedIn comment from Sandra Raup. 28:59 How Nomi Health is experimenting with a no co-payment, no deductible model. 31:29 INBW42 with Stacey on moral hazard. 32:26 EP486 with Stan Schwartz, MD. 32:31 EP485 with Cristin Dickerson, MD. 32:56 The Innovator's Dilemma by Clayton M. Christensen. 34:55 How does Nomi Health work with and help employers?
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    37 分