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EP457: It’s a Big Thing: Medical Spread Pricing. So, Let’s Talk About Contract Transparency, With Cynthia Fisher
I’m putting a meme in the show notes. It’s my second meme ever, so I’m clearly on a roll. As you can see, it’s a picture of two kids taking a test; and the one kid is cheating off the other kid. It’s a How to Do Spread Pricing test, and the kid with carrier has his eyes all over the PBM kid’s test....
Encore! EP418: Mark Cuban With a PSA for CEOs and CFOs of Self-insured Employers, With Mark Cuban and Ferrin Williams, PharmD, MBA, From Scripta
This show from last year was one of the most popular episodes of the past year. And it’s also extremely relevant right now, given all of the PBM (pharmacy benefit manager) goings-on, as well as ongoing litigation like the J&J lawsuit , etc. Listen to the show with Julie Selesnick ( EP428 ) for ...
Encore! EP415: Some Jumbo Employers Buying Better Healthcare Outcomes While Saving 15% on Total Cost of Care, With Rob Andrews
This encore is very relevant after the shows with Cora Opsahl ( EP452 ), Claire Brockbank ( EP453 ), and Marilyn Bartlett ( EP450 ). Getting better health for the 160 million Americans covered by commercial insurance is all about rates, rights, and power. For a full transcript of this episode, clic...
EP453: Running a TPA (Third-Party Administrator) RFP Process That Is Less of a Wild West Fiduciary Shootout, With Claire Brockbank
TPA stands for third-party administrator. RFP stands for request for proposal. I’m kicking off the show today with a review that we got recently on Apple Podcasts, and not just because it’s a really nice review. It’s because it’s relevant on about nine levels to the show today with Claire Brockbank...
EP452: Fiduciary Duty vs the Healthcare Status Quo, With Cora Opsahl
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 group of very relentless peop...
The Euphemism That Has Become Value-Based Care, With Elizabeth Mitchell—Summer Shorts 9
I was talking to one health plan sponsor, and she told me if she sees any charges for value-based care anything on any one of the contracts that get handed to her, she crosses them off so fast it’s like her superpower. For a full transcript of this episode, click here . If you enjoy this podcast, b...
EP445: Can a Primary-Care-Only Practice Survive in 2024? With Tom X. Lee, MD
In this healthcare podcast, I am talking with Tom X. Lee, MD, who has a long history in primary care. He founded One Medical and then also, most recently, Galileo. Dr. Lee also was a founder at Epocrates (tossing that in for context). For a full transcript of this episode, click here . If you enjoy...
Encore! EP397: The Minefield That Is a PBM Contract and Also Some Advice for EBCs Who Are Taking Money Under the Table, With Paul Holmes
Today is an encore because I am going on vacation next week. It always feels a little bit like a time warp because by the time this show will air, I will be back from vacation. This show with Paul Holmes was one of the most popular episodes of 2023 and definitely is just as relevant now. A lot of t...
EP442: A Short Rumination on Saving Money, Except Not Saving Money. Oncology Side Effect Management as a Case Study, With Andreas Mang
This week, I’m gonna play an outtake, I guess it could be called, from the show with Andreas Mang from Blackstone that we wound up cutting for reasons of time and topic; but it’s been on my mind ever since. So, here’s this clip; and then I’m gonna invite you to partake in my ruminations because the...
EP436: Let’s Talk About TPA and Health Plan Inertia Instead of Jumbo Employer Inertia, With Elizabeth Mitchell
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 our microscope. For a full tr...
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 adminis...
EP431: How Accountability for Outcomes Works in the Real World With Kenny Cole, MD
There’s this meme that’s going around on the interwebs with the caption, “Sometimes the shortest distance in between two places isn’t a straight line.” What? Yeah, because actually there’s three dimensions in the real world. So, when we all consider the real world, understanding the contours of rea...
EP421: Wildly Improving Outcomes When the Patient Is, for Reals, in the Center—For Maternity and Beyond, With Jodilyn Owen
For a full transcript of this episode, click here . I want to kick off this show with a clip from episode 415 with Rob Andrews, wherein he so very eloquently sets the stage here: We think that one of the core problems here is that too many intermediaries and providers in the system, their compe...
EP419: The Financialization of Health Benefits for Boards of Directors and C-Suites of Self-Insured Employers, With Andreas Mang
Are you on the board of directors of a company? Or are you a shareholder of a publicly traded company? Or are you a CEO or a CFO who reports to a board of directors or these shareholders? Well, this show is for you. And it’s about how the healthcare industry has become financialized at the same tim...
Encore! EP365: The Real Deal With PBM Contracts and Drug Rebates, With Scott Haas
I hope you enjoy this encore episode of one of the most popular shows in the last 12 months. One of my mentors often said price is irrelevant. He said he would sell anything for any price as long as he could define the terms of the deal. During this conversation today with Scott Haas about PBMs (...
EP390: What Legislators Need to Know About Hospital Prices, With Gloria Sachdev, PharmD, and Chris Skisak, PhD
If you go to the Sage Transparency dashboard Web site , you get a really graphical representation of the prices that any given hospital actually needs to charge so that they break even. You can see precisely which hospitals are operating on thin margins and which ones are not. You might be thinki...