Relentless Health Value
American Healthcare Entrepreneurs and Execs you might want to know. Talking. Relentless Health Value is a weekly interview podcast hosted by Stacey Richter, a healthcare entrepreneur celebrating fifteen years in the business side of healthcare. This show is for leaders in pharma, devices, payers, providers, patient advocacy and healthcare business. It's for health industry innovators, entrepreneurs or wantrepreneurs or intrapreneurs. Relentless Healthcare Value is the show for you if you want to connect with others trying to manage the triple play: to provide healthcare value while being personally and professionally fulfilled.
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Insights to Outwit the Hot Mess of the Non-Healthcare Market
<p>In this Inbetweenisode, Stacey shares listener feedback and reflects on making better decisions in employer-sponsored healthcare, spotlighting LinkedIn posts by Ken Wosczyna and Michelle Bernabe. </p> <p>Ken argues Relentless Health Value moves from theory to practical transformation by sharpening judgment, which Stacey ties to how millions of workplace decisions shape the healthcare system and how actuaries and executives can align choices with values. </p> <p>Stacey emphasizes that good decisions require both transparency and understanding, previewing an upcoming episode with Jerry DiMaso about using transparency files to compare what peer companies pay, and citing examples of misleading "transparency"...
EP503: Smart Collaboration With Direct-to-Employer Specialty Care, With Ryan Wells; Leo Spector, MD, MBA; and Adam Stavisky
<p>Episode 503 of Relentless Health Value features Stacey Richter with Adam Stavisky, Dr. Leo Spector (OrthoCarolina), and Ryan Wells (Health Here) discussing how self-insured employers and specialists rarely connect directly due to intermediaries and fee-for-service "rails." </p> <p>They outline three common pitfalls when bridging this gap: defining and measuring quality and appropriateness (limits of claims data and missing patient-reported outcomes), achieving scale across geographies and specialties, and ensuring benefit design and incentives so members actually use direct-contracting programs. The conversation frames the evolution of Centers of Excellence from 1.0 (travel to brand-name hospitals) to 2.0 (more local but administratively manual) to 3.0...
EP502: How Some Pretty Wild Medicare Fraud Sabotages ACOs and Also Independent Practices and Could Cost Plan Sponsors Such as Self-insured Employers a Lot of Zeros Downstream, With Brian Machut
<p>Episode 502 features Stacey's conversation with Brian Machut (Alliant Health) on how widespread Medicare fee-for-service fraud is inflating costs and undermining ACO shared savings in MSSP and ACO REACH. ACOs uncovered major urinary catheter fraud in 2023 tied to codes A4352/A4353, totaling about $3.5B, with some beneficiaries billed for items never received (including a case shared by Dr. Tara Lagu). </p> <p>CMS created a "SAHS" (significant, anomalous, highly suspect) process to remove certain suspect costs, but benchmark effects can unevenly impact ACOs; catheter fraud is still projected at $3–$3.5B in 2025. The episode also highlights rapidly growing "skin substitute" spending pr...
EP501: Speaking of Infusions, Do You Want to Pay $135 or Do You Want to Pay $13,560 for the Exact Same Drug? With Ivana Krajcinovic, PhD
<p>Episode 501 of Relentless Health Value features Stacey Richter interviewing Ivana Krajcinovic, outgoing Vice President of Healthcare Delivery at Unite Here Health, about extreme and persistent price variation for medical infusions as evidence of a "no market" in healthcare. They cite examples where the same chemotherapy drug (Oxaliplatin), long off patent, cost Medicare about $35 (or $185 for a series), an independent practice about $135, but a hospital in Chicago charged $13,560 and a hospital in Monterey billed $90,000 for a series—markups described as up to nearly 500x and far beyond Medicare. </p> <p>The discussion highlights how these prices create major member affordability pr...
Take Two: EP398: Why Are Commercial Carrier Marketplaces Completely Boring? Maybe Because There Isn't a Marketplace, With Jacob Asher, MD
<p>The Non-Market Reality of Healthcare Carrier Marketplaces with Dr. Jacob Asher. In this episode of Relentlessly Seeking Value, host Stacey Richter introduces the 'No Market' series focused on the healthcare sector's lack of competitive market dynamics, which affects cost and quality. </p> <p>The episode features a conversation with Dr. Jacob Asher, who has extensive experience as a Chief Medical Officer at major healthcare plans. They discuss the stagnant nature of commercial carrier marketplaces, particularly in California, and the various factors contributing to this stasis, including employer inertia, the influence of employee benefit consultants, and the strategic focus of...
EP500: This Is Episode 500, and It's All About You, Tribe
<p>In the milestone Episode 500 of the 'Relentless Health Value' podcast, Stacey Richter reflects on the significant influence and community formed around the platform. Initiated by a conversation with Cora Opsahl, the episode transforms into a heartfelt ode to the listeners — healthcare entrepreneurs, executives, and change-makers, whom Stacey refers to as 'the tribe.'</p> <p>Featured contributions from several listeners highlight themes such as moving from theory to practical transformation, the power of collective momentum, and 'unplugging from the Matrix' of opaque healthcare practices. </p> <p>Notable testimonials underline how the podcast has guided real-world decisions, fostered community connections, and...
EP499: Self-insured Employers and Other Plan Sponsors Are Paying Millions for MSK (Musculoskeletal) Injuries That Would Have Healed Themselves, With Jay Kimmel, MD
<p>In this episode of Relentless Health Value, host Stacey Richter talks with Dr. Jay Kimmel, an orthopedic surgeon and co-founder of Upswing Health, about the significant costs associated with musculoskeletal (MSK) injuries and conditions for self-insured employers and other plan sponsors. </p> <p>They explore how a large portion of MSK-related expenses are for low-acuity injuries that often heal on their own without the need for emergency room visits or unnecessary treatments. Dr. Kimmel discusses the importance of addressing the 'white space'—the critical initial moments when a patient decides whether or not to seek emergency care. </p> <p>He...
EP498: The Payment Integrity Arms Race—RCM (Revenue Cycle Management) and Plan Sponsors, With Mark Noel
<p>In Episode 498, host Stacey Richter converses with Mark Noel of ClaimInsight about the critical aspects of payment integrity within self-insured employers and plan sponsors, focusing on the arms race with revenue cycle management (RCM). </p> <p>The discussion reveals three main insights: the substantial impact of small claim errors, the inherent flaws and conflicts within prepayment analysis by TPAs, and the problematic financial incentives influencing claim processing. Noel emphasizes the importance of prepayment integrity for both plan savings and protecting members, underscoring the need for meticulous oversight and proactive management in payment processes.</p> <p>=== LINKS === 🔗 Show Notes with all...
Take Two: EP341: The "Just Spend Everything You're Given" Trap—Lessons in True Provider Fiscal Discipline, With Gary Campbell
<p>In this Take Two episode of Relentlessly Seeking Value, host Stacey Richter speaks with Gary Campbell, CEO of Johnson Health Center, an FQHC in Virginia. The discussion centers around the importance of fiscal discipline in healthcare, especially in federally qualified health centers where there's no opportunity to cost-shift inefficiencies. </p> <p>This episode also revisits the notable experience and practices of Nikki King, CEO of Alliance Health Centers, focusing on her innovative methods to overcome operational challenges without additional funding.</p> <p>The conversation highlights the importance of visionary leadership, cultural alignment, and operational efficiency to deliver high-quality patient...
EP497: What You Don't Know About Healthcare Transactions and Clearinghouses Could Cost You, With Zack Kanter
<p>In Episode 497 of Relentless Health Value, Stacey Richter engages in a detailed conversation with Zack Kanter, CEO of Stedi about the complexities and inefficiencies inherent in healthcare transactions and clearinghouses. They discuss how non-standardized processes and legacy systems result in exorbitant costs and delays in claims processing and eligibility checks, which are significantly higher compared to other industries. </p> <p>Despite HIPAA's standardized rules, the lack of competitive pressure and outdated technology contribute to these issues, ultimately impacting patient care and administrative costs. Zack offers insights on how modernizing the clearinghouse infrastructure can lead to substantial cost savings and b...
