Hello, all you Relentless Tribe members. Before we dive in today, I just wanted to give a quick but massive thank you to Alex Sommers, MD, ABEM, DipABLM, from Astia Health for his generous gift, which we are going to use to help fund a camera for the podcast here to level up our video game. We're trying to do some video. It may or may not be going so well so far. Check us out on Spotify or YouTube and, yeah, judge for yourself.
For a full transcript of this episode, click here.
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I was absolutely fascinated by a recent article in the New England Journal of Medicine written by today's guest, Dr. Suhas Gondi. The article is entitled "A Sleeping Giant of Health Care Affordability—Self-Insured Employers."
Now, Dr. Gondi wrote this article with his coauthor, Zirui Song, MD, PhD, for doctors. And one of the reasons he told me he wrote it is because, let's face it, a lot of doctors do not listen to this podcast. And it seems that many physicians are largely actually unaware that there is a self-insured employer or other plan sponsor that sits behind that carrier ASO or network card with some big carrier's name on it that the patient walks into the clinic with.
And, I don't know, maybe this is unsurprising because for decades people have referred to employers, as aforementioned, the Sleeping Giant (three points for whoever came up with that nickname) if so many physicians and/or New England Journal of Medicine readers are in fact unaware, warranting an article that, again, it's not the carrier or the payer who many times with private insurance is paying the bill.
But here's another possible sleeping giant (and I know I'm gonna get some heat for saying this): physicians. And I know many doctors will immediately be offended by being called a sleeping giant and touché, because most employers are, too. And fair enough, really, for both parties.
First, speaking on behalf of employers, listen to the show with Lauren Vela (EP406) for a whole bunch of great reasons for employer inertia, as they call it. One of them is: Many employer teams in charge of the health plan actually have a day job, which is not running a health plan off the side of their desks, which actually kind of runs parallel to what many doctors or other clinicians would say.
Every clinician also has a day job that might not be patient financials and access barriers. And it's also called med school, not "deal with the financial fallout from a whole lot of compounding policy and coverage decisions that turned out to be not so great for patients" school.
And look, employers and physicians both share actually another similarity. There are many in both groups who are very, very dissatisfied by current status quo goings-on for different but complementary reasons.
So, there's a lot of parallels here, and sort of in all of them, I am spying in a weird way the complement, frankly, the sleeping giant term recognizes the latent power for both employers and clinicians/physicians alike.
Lisa Rosenbaum, MD, put it this way (EP519): She said that if we all blame all of our problems on some kind of, like, intractable, inevitable structural constraints, we lose our own agency.
How interesting would it be if both the ultimate purchasers and the ultimate purveyors of healthcare arose and started really trying to figure out how to work together at scale?
This general theme has already started with some of the advanced primary care stuff that's going on. Listen to the episode with Patrick Nelli (EP509) or the myriad of shows about direct contracting between doctor practices, physician-led practices, and employers, compressing again the distance between the ultimate purchasers, the ones actually shelling out the shekel for the care, and clinicians actually buying healthcare in a very awake fashion.
My guest today, Dr. Suhas Gondi, recently finished his internal medicine residency at Brigham and Women's Hospital in Boston. And Dr. Gondi is currently an attending physician at Mass General. Additionally, he serves as chief medical officer at Health Strategy, an independent pharmacy benefits consulting firm.
This is Relentless Health Value. This podcast is sponsored by Aventria Health Group. I also want to thank Payerset, who is our series underwriter in 2026.
And I also very, very much would like to thank Patient Rights Advocate, who gave us a super nice donation to help further our work around here.
Thank you so much also to everyone who has offered up some financial support. We really appreciate it. It actually is weirdly expensive to keep this podcast running and as ad-free as we possibly can make it. So, the financial support is super appreciated. Thank you so much.
And here is my conversation with Dr. Suhas Gondi.
Also mentioned in this episode are Health Strategy; Alex Sommers, MD, ABEM, DipABLM; Astia Health; Zirui Song, MD, PhD; Arielle Bose; Lauren Vela; Lisa Rosenbaum, MD; Patrick Nelli; Aventria Health Group; Payerset; Patient Rights Advocate; Mark Cuban; Sarah Emond; Ivana Krajcinovic, PhD; Matt McQuide; and Cristin Dickerson, MD.
For a list of healthcare industry acronyms and terms that may be unfamiliar to you, click here.
You can learn more at healthstrategyllc.com and by following Dr. Gondi on LinkedIn.
Suhas Gondi, MD, MBA, is an associate physician at Massachusetts General Hospital, instructor at Harvard Medical School, and chief medical officer at Health Strategy, a consulting firm that helps health plans, employers, and health systems manage pharmacy benefits and rising prescription drug spending. In his role, he oversees clinical strategy and leads a team of physicians, pharmacists, and data scientists in evidence review, formulary management, and value-based purchasing. He serves as a trusted advisor to employers, health plans, and government agencies on clinical evidence, medication access, and affordability.
His research has spanned value-based care, private equity, and other topics in health policy. His work has been published in the New England Journal of Medicine, JAMA, and The Lancet; cited in Congressional testimony and by the Medicare Payment Advisory Commission; and featured by the New York Times, Washington Post, New Yorker, Politico, and Axios. He completed his residency in internal medicine and primary care at Brigham and Women's Hospital after earning an MD with honors from Harvard Medical School and an MBA with distinction from Harvard Business School.
00:00 Introduction to this episode.
00:35 A big thank you.
01:00 New England Journal of Medicine article by Zirui Song, MD, PhD, and Suhas Gondi, MD, MBA.
04:28 EP519 with Lisa Rosenbaum, MD.
04:58 EP509 with Patrick Nelli.
06:22 The conversation with Dr. Suhas Gondi.
07:08 Why Dr. Suhas Gondi and his coauthor wrote their article.
09:24 Why the affordability of care and the decisions self-employers are making about coverage matter to clinicians.
12:12 What the term "sleeping giants" implies and how that reflects the reality of healthcare.
14:31 A case study.
21:24 How the patient can still get lost even when both the employer and clinician think they're doing the right thing.
22:52 An example from the oncology space.
25:23 EP501 with Ivana Krajcinovic, PhD.
26:54 EP468 with Matt McQuide.
27:01 Acquired's show on how Epic quietly powers American healthcare.
28:47 Dr. Suhas Gondi's advice to clinicians.
30:55 The communication gap between clinicians and employers.
33:30 Why the presence of middlemen should not prevent communication between clinicians and employers.
Recent past interviews:
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Ge Bai, Andrew Tsang, Stacey Richter (EP520), Dr Lisa Rosenbaum, Claire Brockbank, Stacey Richter (EP517), Ophelia Johnson, Michelle Cera