employers

EP436: Let’s Talk About TPA and Health Plan Inertia Instead of Jumbo Employer Inertia, With Elizabeth Mitchell
Relentless Health ValueMay 16, 2024
436
41:3338.03 MB

EP436: Let’s Talk About TPA and Health Plan Inertia Instead of Jumbo Employer Inertia, With Elizabeth Mitchell

Listen On Your Favorite App The episode today is somewhat of a follow-on to the show with Lauren Vela, which was episode 406 about employer inertia. If we’re talking about inertia, though, we’d be remiss not to get a little circumspect about the whole affair and subject some other stakeholders to ou...

EP433: The Mystery of the Weekly Claims Wire: What Are Plan Sponsors Actually Paying For Each Week? With Justin Leader
Relentless Health ValueApril 18, 2024
433
40:0036.61 MB

EP433: The Mystery of the Weekly Claims Wire: What Are Plan Sponsors Actually Paying For Each Week? With Justin Leader

On the show today, I am going to use the term TPA (third-party administrator) and ASO (administrative services only) vendor kind of interchangeably here. But these are the entities that a plan sponsor—for example, a self-insured employer is a plan sponsor—but these plan sponsors will use to administ...

Encore! EP391: A Case Study for Anyone Trying to Level Up Primary Care That I’m Gonna Call “How Margin Shoves Mission Off the Bus,” With Scott Conard, MD
Relentless Health ValueApril 11, 202436:5333.77 MB

Encore! EP391: A Case Study for Anyone Trying to Level Up Primary Care That I’m Gonna Call “How Margin Shoves Mission Off the Bus,” With Scott Conard, MD

Here’s a great musing that I read on LinkedIn : How will alternative primary care models fare when growth mode gets balanced with profitability and VC-supported burn rate is transformed to Big Retail bottom-line expectations? Mission v. margin. I’m gonna add to this: How will alternative primary car...

EP430: Advice for Digital Health Vendors Selling to Employers, With Barbara Wachsman
Relentless Health ValueMarch 14, 2024
430
38:4535.47 MB

EP430: Advice for Digital Health Vendors Selling to Employers, With Barbara Wachsman

We have been spending a bunch of time here on Relentless Health Value talking about PBMs (pharmacy benefit managers) lately and pharmacy benefits, but we are moving into a new topic area. It sort of kicked off three weeks ago with the pod with Rik Renard ( EP427 ) on the importance of care flows if ...

EP429: Following the Dollar Through Pharmacy Acronyms Like WAC, AWP, and NADAC, With Luke Slindee, PharmD
Relentless Health ValueMarch 07, 2024
429
38:2052.64 MB

EP429: Following the Dollar Through Pharmacy Acronyms Like WAC, AWP, and NADAC, With Luke Slindee, PharmD

Listen On Your Favorite App In this healthcare podcast we’re talking about pharmacy acronyms or terms like AWP and WAC, and, not really an acronym, but we’ll also talk pharmacy list prices, rebates, discounts. We also have NADAC, but that’s slightly off to the side for reasons we’ll get to in a sec....

EP428: Do-It-Now Advice From the J&J and the DOL v BCBS Lawsuits, With Julie Selesnick
Relentless Health ValueFebruary 29, 2024
428
41:5257.49 MB

EP428: Do-It-Now Advice From the J&J and the DOL v BCBS Lawsuits, With Julie Selesnick

This show is different, so if you’ve already listened to or read all about the gory details of the J&J and/or the DOL v BCBS lawsuits, this is not gonna be a repeat of that information. Julie Selesnick, my guest today, does cover the very, very top line about these two cases. But after that, we ...

Encore! EP379: How Much Money, Really, Are Employee Benefit Consultants and/or Brokers Making From Plan Sponsors? With AJ Loiacono
Relentless Health ValueFebruary 15, 202435:1348.35 MB

Encore! EP379: How Much Money, Really, Are Employee Benefit Consultants and/or Brokers Making From Plan Sponsors? With AJ Loiacono

For a full transcript of this episode, click here . Here on Relentless Health Value, we have done a bunch of shows lately on how some weird PBM (pharmacy benefit manager) and pharmacy goings-on impact plan members, patients, and also independent pharmacies. During the conversation with Benjamin Jo...

EP422: Some Indie Pharmacy Upshots That Surprised Me—and I Thought I Was Pretty in the Know, With Benjamin Jolley, PharmD
Relentless Health ValueJanuary 04, 2024
422
36:4350.42 MB

EP422: Some Indie Pharmacy Upshots That Surprised Me—and I Thought I Was Pretty in the Know, With Benjamin Jolley, PharmD

For a full transcript of this episode, click here . Listen to this show as either a follow-on or a prequel to the shows with Mark Cuban and Ferrin Williams, PharmD, MBA ( EP418 ) and Ge Bai, PhD, CPA ( EP420 ). And if you’re interested in this “what’s going on in the world of PBM...

EP418: Mark Cuban With Some Advice for CEOs and CFOs of Self-insured Employers, With Mark Cuban and Ferrin Williams, PharmD, MBA, From Scripta
Relentless Health ValueNovember 16, 2023
418
54:4275.11 MB

EP418: Mark Cuban With Some Advice for CEOs and CFOs of Self-insured Employers, With Mark Cuban and Ferrin Williams, PharmD, MBA, From Scripta

For a full transcript of this episode, click here . CEOs and CFOs … hey, this show is for you. Let’s start here: 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 pu...

EP408: Who’s Suing Who? An Overview of Healthcare Legal Goings-on, With Chris Deacon
Relentless Health ValueJune 15, 2023
408
39:4354.53 MB

EP408: Who’s Suing Who? An Overview of Healthcare Legal Goings-on, With Chris Deacon

I couldn’t resist the “who’s suing who” because, yeah, you can’t go wrong with Aretha Franklin references. Back on the pod we have Chris Deacon, who is going to give us a rundown of the legal goings-on going on right now that impact self-insured employers, carriers, h...

EP406: The Inertia Show: 5 Excellent Reasons for the “Why” With the Inertia in Benefits Departments, With Lauren Vela
Relentless Health ValueJune 01, 2023
406
32:1144.19 MB

EP406: The Inertia Show: 5 Excellent Reasons for the “Why” With the Inertia in Benefits Departments, With Lauren Vela

Listen On Your Favorite App I’m gonna run through the five reasons Lauren Vela talks about in this healthcare podcast for the “why” with the inertia in benefits departments of self-insured employers. But before I do, let me report that, in sum, they add up to … in many cases, benefits folks sit betw...

EP397: The Minefield That Is a PBM Contract and Also Some Advice for EBCs Who Are Taking Money Under the Table, With Paul Holmes

EP397: The Minefield That Is a PBM Contract and Also Some Advice for EBCs Who Are Taking Money Under the Table, With Paul Holmes

Listen on Your Favorite App If this were a video show, I would stare into the camera with steely eyeballs right now and say that I have a special message for employer CFOs. If you aren’t a CFO, pretend that you are so that you get the full effect here. So, now that we’re all CFOs, let’s pull up the ...

EP149: Overpaying for Healthcare vs Full-Day Kindergarten & Raises for Teachers, with Richard Steinhart, Former School Board Officer
Relentless Health ValueAugust 24, 201732:4244.89 MB

EP149: Overpaying for Healthcare vs Full-Day Kindergarten & Raises for Teachers, with Richard Steinhart, Former School Board Officer

Mr. Steinhart has had a distinguished career as an entrepreneur, investor and executive in the healthcare industry. He has been instrumental in starting or investing in many technology-based companies, several of which have developed products that have become the standard of care in their respective...

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Recent Episodes

EP514: Successfully Suing a Health System for Their Anticompetitive Contracts and Also Collecting Damages for Plan Sponsors and Members, With Matt Cantor
Relentless Health ValueJune 03, 2026
514
43:4340.02 MB

EP514: Successfully Suing a Health System for Their Anticompetitive Contracts and Also Collecting Damages for Plan Sponsors and Members, With Matt Cantor

Listen on Your Favorite App Hello, all you Relentless Tribe members. This is the third episode in our legal goings-on trifecta, starting with Doug Aldeen in episode 512 covering what amounts to the main reasons plan sponsors wind up suing their brokers or employee benefit consultants. For a full tra...

EP513: Revisiting Cunning Anticompetitive Hospital Contracts, With Brennan Bilberry

EP513: Revisiting Cunning Anticompetitive Hospital Contracts, With Brennan Bilberry

Listen on Your Favorite App If you are a large employer, union funds broker, fiduciary, or anyone responsible for a health plan that spends half of its dollars on hospital care (which most do), or if you have anything to do with policy or enforcement of policy, yeah … listen this week and next week....

EP512: 3 Kinds of Broker/EBC Rent-Seeking Payment Models—A Lawyer’s Perspective, With Doug Aldeen

EP512: 3 Kinds of Broker/EBC Rent-Seeking Payment Models—A Lawyer’s Perspective, With Doug Aldeen

Listen on Your Favorite App I wanted to talk to a lawyer ’cause, yeah, lawyers are the ones that see stuff that falls the whole way down to the level of legal action. But I wanted to find out what are the main categories of things that wind up in legal land when it comes to broker or EBC (employee b...

EP511: The Tension When Clinical Teams Take On Risk for Policymakers and Others Looking to Rustle Up Future Perverse Incentives, With Dr. Siva and Monica Lypson, MD, MHPE
Relentless Health ValueMay 14, 2026
511
29:3727.1 MB

EP511: The Tension When Clinical Teams Take On Risk for Policymakers and Others Looking to Rustle Up Future Perverse Incentives, With Dr. Siva and Monica Lypson, MD, MHPE

Listen on Your Favorite App Last week, we talked Medicare Advantage with Betsy Seals ( EP510 ), and we talked about finding members who a plan can serve well. This makes sense because Medicare Advantage is a capitated program. In other words, Medicare Advantage plans get paid by CMS a per member per...

EP510: The Impact on You of Medicare Advantage Goings-on (2026 Edition), With Betsy Seals
Relentless Health ValueMay 07, 2026
510
35:3032.5 MB

EP510: The Impact on You of Medicare Advantage Goings-on (2026 Edition), With Betsy Seals

Listen on Your Favorite App I came up with at least one way to tell the difference between making a fair profit and profiteering. If someone makes more money when the patients or members they serve are worse off, yeah, call that profiteering. For a full transcript of this episode, click here . If yo...

EP509: The 7.7% Wake-Up Call: A Roadmap to Align Finance Teams With Non-complacent Benefit Design, With Patrick Nelli
Relentless Health ValueApril 30, 2026
509
37:4834.6 MB

EP509: The 7.7% Wake-Up Call: A Roadmap to Align Finance Teams With Non-complacent Benefit Design, With Patrick Nelli

Listen on Your Favorite App Sarah Monroe: Hi. This is Sarah Monroe in Chicago, and I'm a benefits procurement leader. And I'm curious why you think so few executives take proactive bold action in health benefits strategy given the magnitude of opportunity. Stacey: Isn't that a great question? For a ...

EP508: Why Don't More Self-insured CEOs Take Bold Action in Health Benefits Strategy? With Lee Lewis
Relentless Health ValueApril 23, 2026
508
44:0240.31 MB

EP508: Why Don't More Self-insured CEOs Take Bold Action in Health Benefits Strategy? With Lee Lewis

Listen on Your Favorite App This episode is the very first episode that we have done that is an AMA—an Ask Me Anything—and here is our very first question. Sarah Monroe: Hi. This is Sarah Monroe in Chicago, and I'm a benefits procurement leader. And I'm curious why you think so few executives take p...

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