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.

To read the full show notes with links mentioned, be sure to visit our episode page and consider signing up for our free weekly newsletter.

Episode 443 of Relentless Health Value pays tribute to the late Marshall Allen, an investigative journalist dedicated to exposing injustices within the American healthcare system. Hosted by Stacey Richter, the episode features Dave Chase, founder of Health Rosetta, who shares memories and insights into Marshall's tireless work in investigative reporting.

The episode highlights Marshall's impact on healthcare legislation, his significant contributions to ProPublica, and his book 'Never Pay the First Bill,' which empowers patients and employers to fight back against corrupt billing practices.

The episode also includes an earlier interview with Marshall, focusing on his perspective as an investigative reporter, the exploitation within the healthcare system, and the importance of patients and employers demanding transparency and fairness. The episode encourages listeners to continue Marshall's legacy by subscribing to the Marshall Health Academy and purchasing access for employees.

09:28 What’s the point of view that Marshall is coming from with his investigative reporting?

09:57 “How does this affect the people who are paying for it and the people who are undergoing the care?”

10:49 “There’s a lot of good people working within this very messed up system.”

11:03 Why are patients considered outsiders in the healthcare system?

11:45 “What’s happened in healthcare is that the stakeholders treat each other more as the customer.”

13:45 What is upcoding?

17:18 “These are schemes that have been created within the industry to increase revenue.”

17:46 “This system is not set up for the benefit of the patient.”

18:13 “On the financial side, the industry is actually oppressing the American people.”

19:14 “We have been expected to pay whatever aggregate sum is thrown at us.”

20:21 Why have patients been so passive toward this crooked healthcare system so far?

22:05 What’s the difference between making a profit and profiteering?

29:45 What are the first-order and second-order consequences of what’s happening in health care right now, and which of these consequences will actually drive change?

30:45 “When you tell the truth about what’s going on … they become so ashamed … that they change their behavior.”

32:00 “The patient … is not their most important customer.”

32:50 “The sleeping giant is the employers.”

In Episode 442 of 'Relentless Health Value,' host Stacey Richter shares an intriguing outtake from a previous episode featuring Andreas Mang, senior managing director at Blackstone, discussing the critical issue of cost management in oncology side effect treatment.

The conversation delves into the inefficiencies and patient harms caused by inadequate side effect management, particularly dehydration due to chemotherapy, and the resulting financial burdens on employers, taxpayers, and patients.

Stacey explores the importance of a value-based mindset in drug purchasing, integrating oncology care, and the potential financial and health benefits of better side effect management. She highlights various expert opinions and studies supporting these points, encouraging listeners to reconsider their approach to healthcare cost structures and patient care protocols.

If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe.

01:12 Andreas Mang on oncology medication side effect management.

03:12 Mark Lewis, MD’s Tweet.

03:39 Celena Latham’s response.

04:22 How integrative oncology can save money and what it looks like.

04:47 EP157 with Ethan Basch, MD.

06:20 Why PBMs saving money doesn’t necessarily mean savings for employers and payers.

07:36 EP435 with Dan Mendelson.

08:20 EP372 with Cora Opsahl.

08:40 EP331 with Al Lewis.

09:50 Stacey’s second rumination.

10:19 Why having a value mindset when purchasing is a thing.

10:42 Stacey’s third rumination.

12:03 EP370 with Erik Davis and Autumn Yongchu.

13:07 Why FFS does not pay or pay adequately for side effect management.

14:31 Stacey’s final rumination.

17:08 Summarizing Stacey’s four ruminations on this topic.

To read the full article with show notes, mentioned links and a full transcript, visit relentlesshealthvalue.com

In this episode, Abby Burns from Radio Advisory interviews Stacey Richter, host of the Relentless Health Value podcast, during the Raising the Bar Value Summit. They discuss the complexities of defining and creating value in healthcare, focusing on the roles of various stakeholders including patients, providers, and payers. Stacey shares insights on the challenges and tensions in the healthcare system, such as the fragmentation of care, financial toxicity, and the cultural norms that inhibit progress. The conversation also highlights practical examples and potential strategies to drive value and sustain positive changes within the industry.

03:33 Stacey’s journey and mission.

04:16 The story of Scott Conard, MD (EP391).

09:28 Why it’s important not just to drive change but to sustain it.

12:23 Heart Failure: A Case Study in Value.

14:13 EP438 with John Lee, MD.

15:07 Why patient positive value often fails instead of succeeds.

18:07 How financial toxicity has become clinical toxicity in healthcare.

19:44 How cultural norms have evolved into healthcare challenges.

23:38 The story of Mike Tuggy, MD, in Washington.

25:13 Looking at the four tensions in measuring value as continuums.

25:37 Why timeline is important in creative value in healthcare.

27:52 Finding Allies by Michael Leavitt.

28:34 What are the four ways to measure value in healthcare?

29:27 How do payers and providers collaborate to align on value metrics?

31:26 Why will proven versus experimental treatments become more important in the next few years?

34:54 Stacey’s manifesto (EP400) and values for personal integrity in healthcare.

38:55 Stacey’s parting advice.

For more information, go to Radio Advisory or Aventria Health Group.

In Episode 440 of 'Relentless Health Value,' host Stacey Richter engages with David Muhlestein to explore the optimal size for a medical practice, concluding that 10 to 20 physicians supported by a capable team provide the best balance of economies of scale and community integration. The conversation transitions into the challenges large healthcare systems face, particularly the Diversification Discount.

This diversification often impedes patient care and operational efficiency by misaligning values with business practices. The episode delves into the paradox of optimizing primary care while still supporting specialty care, reflecting on how organizational values impact healthcare outcomes. Muhlestein suggests implementing business units or decentralized models to realign with patient care values and efficiencies.

To read the full article and show notes with links mentioned as well as a full transcript, click here.

08:12 From a business and patient/better outcomes standpoint, what does an optimal provider practice look like?

11:48 EP412 with Robert Pearl, MD.

13:06 Why isn’t the current landscape what David considers optimal?

14:53 What leads to the “crisis of autonomy”?

15:13 How do medical practices get to the phase of delegation?

17:39 EP438 with John Lee, MD.

18:55 EP437 with Brian Klepper, PhD.

20:53 EP432 with Kate Wolin, ScD.

20:55 EP421 with Jodilyn Owen.

23:48 Medicare Meet-Up podcast with Mai Pham, MD.

24:45 What metrics should boards of directors also be held accountable for?

28:48 Why is an efficiency-focused business not necessarily the best at managing population care?

31:13 What is the “diversification discount”?

32:49 Pivot podcast with Kara Swisher and Scott Galloway, MBA.

35:53 What can primary care doctors do to optimize their practices?

36:48 Why do we need to shift the mindset from “bigger” and “more”?

In Episode 439 of 'Relentlessly Seeking Value,' host Stacey Richter discusses the convoluted issues surrounding generic drug pricing with pharmacy consultant Luke Slindee.

To read the full article and show notes with links mentioned as well as a full transcript, click here.

They delve into the ways traditional Pharmacy Benefit Managers (PBMs) exploit the system to make immense profits, often leading patients to pay more even with insurance. The conversation explores various solutions, such as the removal of "Usual and Customary Prices" from PBM contracts, the advantages of bypassing insurance, and giving patients direct payment tools like health savings accounts.

Luke Slindee, with his extensive background in pharmacy and consulting, provides valuable insights into rebalancing the generic drug market to benefit patients, pharmacies, and plan sponsors alike. Additionally, the broader implications of these dysfunctional systems on pharmacy operations and staff conditions are discussed.

Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe.

08:12 Where do cash prices fall when pharmacies have contracts with PBMs?

08:39 What is a usual and customary price?

12:14 How is the usual and customary price affected by PBMs?

16:49 Should pharmacies be allowed to have two sets of cash prices?

17:14 Where does GoodRx fit into this because of the pharmacy/PBM dilemma?

19:06 What’s happening with Amazon and the anticompetitive contract lawsuit, and how does it relate back to pharmacy contracts with PBMs?

20:38 EP395 with Brennan Bilberry.

21:05 EP420 with Ge Bai, PhD, CPA.

23:27 Why is there a new wave of cash-only pharmacies?

24:02 EP418 with Mark Cuban and Ferrin Williams, PharmD, MBA, from Scripta.

25:41 What would allow the generic market to return to normal competitive pricing?

26:39 How does this dysfunction create a negative downstream effect?