Episodes
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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
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
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
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
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
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
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
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
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
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...