Employers and Hospital Prices

EP491: Incumbent TPAs and Consultants Getting Called to Jumbo Employer Client HQ to Answer Awkward Questions, With Elizabeth Mitchell

EP491: Incumbent TPAs and Consultants Getting Called to Jumbo Employer Client HQ to Answer Awkward Questions, With Elizabeth Mitchell

Listen On Your Favorite App Today, back on the pod, we have Elizabeth Mitchell, CEO of PBGH , the Purchaser Business Group on Health. Elizabeth Mitchell is talking about the why, as in why did PBGH embark on a big cost and quality safety transparency data demonstration project that they just finishe...

EP466: What Is Rising Faster, Insurance Premiums or Hospital Prices? With Vivian Ho, PhD

EP466: What Is Rising Faster, Insurance Premiums or Hospital Prices? With Vivian Ho, PhD

LIsten On Your Favorite App This episode has three chapters. Each one answers a key question, and, bottom line, it all adds up to action steps directly and indirectly for many, including plan sponsors probably, community leaders, and also hospital boards of directors. Here’s the three chapters in su...

EP452: Fiduciary Duty vs the Healthcare Status Quo, With Cora Opsahl

EP452: Fiduciary Duty vs the Healthcare Status Quo, With Cora Opsahl

Listen On Your Favorite App Last time Cora Opsahl was on the show, Michelle Bernabe, RN, KAT, wrote a comment on LinkedIn I thought encapsulated the gist of it all so well. She wrote, “[Cora] first became a mentor/ally through Relentless Health Value episode 372 . … It opened a doorway to a whole gr...

EP415: Some Jumbo Employers Buying Better Healthcare Outcomes While Saving 15% on Total Cost of Care, With Rob Andrews

EP415: Some Jumbo Employers Buying Better Healthcare Outcomes While Saving 15% on Total Cost of Care, With Rob Andrews

I just want to stop here and have a gratitude moment. I wanted to thank the Pittsburgh Business Group on Health for inviting me to do the keynote at their annual symposium. It was a big honor. But in doing so, I had the opportunity to play clips from both the podcast and also from people who helped ...

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Recent Episodes

EP517: The Business of Prior Auths: The 401-Level Financial Motive Behind Prior Auths
Relentless Health ValueJune 24, 2026
517
27:2325.07 MB

EP517: The Business of Prior Auths: The 401-Level Financial Motive Behind Prior Auths

Listen on Your Favorite App Hello, Relentless Health Value Tribe. Welcome to it. So, yeah … last week, I had a great conversation with Ophelia Johnson ( EP516 ) that is a companion show, I would say, to this one. So, listen to that one first. Listen to this one first. You do you. For a full transcri...

EP516: GLP-1s and Cash Pay From the Pharma Manufacturer Point of View, With Ophelia Johnson
Relentless Health ValueJune 17, 202644:0540.35 MB

EP516: GLP-1s and Cash Pay From the Pharma Manufacturer Point of View, With Ophelia Johnson

Listen on Your Favorite App Hello, all you Relentless Tribe members. Welcome to it. Today we have a show that will bend your mind in new directions. And yes, I have a head cold at a very weird time of year. I have trouble apparently doing things like normal people. Anyway, we talk a lot on this podc...

EP515: SNF (Skilled Nursing Facility) Fraud—Or Is It Fraud? With Michelle Cera, PhD
Relentless Health ValueJune 10, 202643:0739.47 MB

EP515: SNF (Skilled Nursing Facility) Fraud—Or Is It Fraud? With Michelle Cera, PhD

Listen on Your Favorite App Hello, all you Relentless Tribe members. Lately, I have been just obsessed with what's hiding in plain sight: the root cause glitches in how American healthcare is built. Not the symptoms now. Not the noise. The actual ground zero. I mean, what we call healthcare in this ...

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...

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