I wanted to talk with Dr. Lee because so many RHV (Relentless Health Value) listeners are trying to figure out how to sustain primary care as a stand-alone entity when the most obvious and most common way to make enough money in primary care is to drive and maximize the dollars from downstream volume of high-priced service lines, which, if you think about it, undermines the entire point of primary care.

To read the full article, show notes as well as the links mentioned visit our episode page. While there, consider signing up for our free weekly newsletter.

In Episode 445 of Relentless Health Value, Stacey Richter interviews Dr. Tom Lee, founder of One Medical and Galileo, about the sustainability of standalone primary care practices in 2024. Dr. Lee also was a founder at Epocrates

They discuss the paradox of primary care, the economic challenges of running an independent practice, and the importance of enlightened leadership with a value-focused mindset.

Dr. Lee emphasizes innovative service operations, cutting hidden waste, and balancing human-centered care with efficient processes. The conversation explores various facets of primary care, including access, longitudinal patient care, and the role of technology.

Tune in to understand how primary care can thrive amidst economic and systemic challenges.

07:02 What is the paradox of primary care?

09:19 Why is it hard to run an independent primary care practice?

10:01 What are the barriers to running an independent primary care practice?

10:41 Can you have fee for service and value?

12:25 “Value is more about a mindset.”

13:22 What hidden waste is there in a primary care practice?

15:11 What do you need to have a value-focused mindset?

17:14 Why does access precede quality?

18:20 Why have retail clinics failed in being longitudinal primary care destinations?

20:29 What is a longitudinal primary care destination and why does it matter?

23:48 What are the nuances of a service business that make them challenging for managers?

24:35 How do you find the balance between fee for service and value?

31:17 EP438 with John Lee, MD.

32:14 How can you invest in quality without a value-based contract?

34:19 How do you address the trade-off between fee-for-service finances and investing in value-based care?

35:36 Where is the “productive middle”?

36:27 Dr. Tom Lee’s message to payers.

39:55 Dr. Tom Lee’s message for policymakers.

In this encore episode of 'Relentlessly Seeking Value,' host Stacey Richter revisits a critically important conversation with ERISA attorney Paul Holmes about the complexities and hidden pitfalls in Pharmacy Benefit Manager (PBM) contracts.

Aimed at CFOs and employer plan sponsors, Holmes highlights how poorly reviewed PBM contracts can lead to companies paying 30-40% over market for pharmacy benefits, discusses the potential legal exposures under the Consolidated Appropriations Act (CAA), and suggests the essential need for independent reviews.

Holmes also delves into issues with Employee Benefit Consultants (EBCs) taking indirect compensation from PBMs and offers actionable advice for employers on how to mitigate these risks.

To read the full article, show notes as well as the links mentioned visit our episode page. While there, consider signing up for our free weekly newsletter.

07:41 What are Paul’s usual observations when a PBM contract crosses his desk?

08:34 “If you just sign … one of their model contracts …, you’re probably gonna pay 30% to 40% above market on your drug spend.”

12:11 What is a PBM lawyer? And why is it important to find an ERISA PBM lawyer?

17:12 EP379 with AJ Loiacono.

17:40 Who is on the hook for the cost of the PBM contracts?

21:05 What’s the problem with most ERISA lawyers today?

22:56 Lawsuit about PBM contract.

27:43 What’s Paul’s advice for benefits consultants?

31:40 How much might a plan sponsor be paying their consultant versus what a consultant might be making from a PBM?

In Episode 444 of Relentless Health Value, Stacey Richter speaks with healthcare consultant Ann Kempski about two state healthcare laws with unintended consequences: the Certificate of Need (CON) and the Certificate of Public Advantage (COPA) laws. They delve into the original intentions behind these laws, the ways in which they have often failed, and their impact on the competitive landscape.

The discussion also explores how CON laws have led to increased costs and market consolidation, while COPA laws have allowed potentially monopolistic mergers under state oversight. The episode sheds light on complex regulatory terrain and highlights the importance of vigilant oversight and diverse stakeholder involvement.

To read the full article with the links mentioned during the epsiode and a full transcript, visit the episode page. While on the site, please consider signing up for the free weekly newsletter.

00:00 Introduction

02:08 Understanding Certificate of Need (CON) Laws

02:57 Problems with CON Laws

04:02 Exploring Certificate of Public Advantage (COPA) Laws

05:25 Guest Introduction: Ann Kempski

06:05 In Memoriam: Suzanne Delbanco

06:20 Ann remembers Suzanne Delbanco.

06:55 EP224 with Suzanne Delbanco.

07:40 What are state Certificate of Need laws?

08:44 Why are states getting rid of these CON laws?

13:26 Why CON laws are created.

15:43 EP437 with Brian Klepper, PhD.

16:09 What are the conflicts of interest and problems that arise when CON laws are created?

20:55 What happens when states get rid of these CON laws?

24:10 How are Certificate of Public Advantage laws different from CON laws?

27:58 Why does the research show that COPAs don’t usually accomplish their goals?

31:34 What encouraging current events are happening in the realm of COPA laws?

32:08 Gloria Sachdev, PharmD, of Employers’ Forum of Indiana.