PODCAST · health
Relentless Health Value
by Stacey Richter
Welcome to Relentless Health Value, the podcast for those working in the belly of the beast to fix our fundamentally broken healthcare system. If you are a self-insured employer, plan sponsor, benefits consultant, clinician, a C-suite executive or anyone in the business of healthcare tired of the "transformational theater" and marketing fluff, you have found your tribe. The U.S. healthcare system isn't a rational market; it's a game of Pachinko where perverse incentives reign, and as we always say, where there's mystery, there's margin.Hosted by Stacey Richter, we relentlessly hunt down the administrative "inches" of waste and expose the hidden fees draining the $5.6 trillion healthcare sector. We transform wonky healthcare theory into ruthlessly practical, actionable insights. Whether it's demanding radical transparency, navigating complex PBM contracts, or buying actual healthcare instead of illusory discounts, our mandate is simple: If it results in a net positive for patients, w
Episodes
-
The One Question to Test if a TPA Is Actually Independent, With Kimberly Carleson
Is Your TPA Truly Independent? The One Claims Audit Question to Ask, With Kimberly Carleson (EP534) The Red Flag Question That Reveals Whether a TPA Works for Your Plan or for the Network. Episode 534. What's a practical, speedy way to assess whether a TPA (third-party administrator) is truly...
-
Level Funding Is Self-funding: 5 Avoidable Contract Risks, With Frank Pennachio
Level-Funded Health Plan Risks: ERISA Contract Traps, Stop-Loss Gaps, and Surplus Fine Print. Episode 533. An employer with a fully insured plan told Stacey Richter his renewal this year was 69% — his broker negotiated it down to 50%, which she's not sure she'd classify as a victory. Level…
more -
Why Avoidable ER Visits Aren't the Real Cost Problem: Revisiting Our Interview With HHS Nominee Chris Klomp
Emergency Department High Utilizers and Real-Time Care Coordination, With Chris Klomp (Episode 532) Today we are dipping into the archives for an essential replay from 2016, one decade ago, featuring Chris Klomp back when he served as CEO of Collective Medical, and now nominated to serve as…
more -
Slaying the Three-Headed Monster of Health Plan Networks, With Evan Anderson
Discount Illusions, Billing Errors, and Site-of-Care Markups: A Carrier Network Primer for Employers with Evan Anderson of Handl Health. Episode 531. Whatever the plan was at the very beginning, the big status quo carrier networks have evolved into what Stacey Richter calls a three-headed…
more -
A Wildly Underappreciated Point: Overpaying for Infusions Means Overpaying for Stop-Loss Coverage, With Jake Velie and Keith Hartman, RPh
The Hidden Link Between Expensive Infusions and Rising Stop-Loss Renewal Premiums. Episode 530. When an infusion claim lands on a self-insured plan's high-cost claims report, it's tempting to treat the price tag as fixed — but the exact same infusion drug can cost 10 times more depending on where…
more -
How Stark Law, Stipends, and Noncompetes Drive Hospital Consolidation, With Eric Bricker, MD
The Chain Reactions Wrecking Healthcare Affordability: Facility Fees, Stark Law, and Noncompetes. Episode 529. Why do hospital facility fees keep pace with inflation while professional fees fall behind—and how did a law meant to stop kickbacks end up fueling a stipend economy instead? Stacey...
-
Private Equity in Primary Care: What the Data Actually Shows, With Yashaswini Singh, PhD. Episode 528.
Private Equity in Primary Care: Just Another Inflationary Business Model? What Does the Data Actually Show, With Yashaswini Singh, PhD (EP528) Private equity has been buying up primary care practices for years, promising the capital that chronically underfunded clinicians badly need. But does the...
-
Why Should a Plan Sponsor Care About the 340B Charity Program? With Shawn Gremminger
How the 340B Drug Discount Program Quietly Raises Costs for Self-Insured Employers. Episode 527. Why should a self-insured employer care about the 340B charity program? That's the single question Stacey Richter puts to Shawn Gremminger, president and CEO of the National Alliance of Healthcare...
-
Mark Cuban and Cora Opsahl: The Truth About Pass-Through PBM Contracts and Generic Compliance Ratios
How Discount Theater and Generic Compliance Ratios Quietly Overcharge Patients and Employers. Episode 526. Mark Cuban, co-founder of Mark Cuban Cost Plus Drug Company, and Cora Opsahl, managing director of Peterson Health Analytics and former director of the 32BJ Health Fund, join Stacey Richter...
-
PMPM vs FFS—The Perverse Incentives Plan Sponsors Sometimes Miss, With Cristin Dickerson, MD
Four Questions Plan Sponsors Should Ask Before Choosing PMPM or Fee-for-Service. Episode 525. This episode is a tangent that never made it into the final cut of Stacey Richter's original conversation with Cristin Dickerson, MD, founding partner of Green Imaging, a physician-led radiology network...
-
Beating Provider Network Pricing Games by Thinking About Buying Healthcare Like a Manufacturer Supply Chain, With John Quinn
John Quinn, founder and CEO of Wellnecity, joins Stacey Richter in episode 524 for an outtake from their conversation last fall on rethinking how self-insured employers build their provider networks. Rather than treating the network as one big, undifferentiated system, Quinn argues employers…
more -
The Sleeping Giants of Healthcare—Why Self-insured Employers and Clinicians Keep Missing Each Other, With Suhas Gondi, MD, MBA. EP523
Why Self-Insured Employers and Clinicians Keep Missing Each Other, With Suhas Gondi, MD. The Sleeping Giants of Healthcare: Why Employers and Clinicians Keep Missing Each Other. Episode 523. Dr. Suhas Gondi, MD, MBA, chief medical officer at Health Strategy and an attending physician at...
-
How GoodRx Actually Makes Money: PBMs, Cash Prices, and Pharmacy Contracts, With Ge Bai, PhD, CPA (EP522)
Ask Me Anything: How Does GoodRx Actually Make Money, and Who Really Pays for the Discount? Episode 522. A listener asked Stacey Richter a deceptively simple question: how exactly does GoodRx make money? To answer it, this AMA episode revisits a 2021 conversation with Ge Bai, PhD, CPA, professor…
more -
How Revenue Cycle Management (RCM) Became an Over $200 Billion Healthcare Hot Potato, With Andrew Tsang. EP521
RCM: Why Revenue Cycle Management Is Healthcare's $200B Hot Potato, With Andrew Tsang (EP521) How Revenue Cycle Management (RCM) Became an Over $200 Billion Healthcare Hot Potato. Episode 521. Revenue cycle management (RCM) sounds like the least sexy phrase in healthcare — a back-office…
more -
Cash-Pay Generic Drugs Are a Functioning Market in Healthcare—Policymakers Beware and Be Careful. EP520
Cash-Pay Generic Drugs and the PBM Spread Pricing Problem (EP520) Cash-pay generic drugs are one of the few corners of US healthcare where a real, functioning market already exists — which is why Stacey Richter argues policymakers need to tread carefully when trying to "fix" drug affordability.…
more -
Cognitive Atrophy and Referral Incentives Breaking Primary Care, With Lisa Rosenbaum, MD (EP519)
Cognitive Atrophy and Referral Incentives Breaking Primary Care, With Lisa Rosenbaum, MD (EP519) Primary care physicians are leaving traditional practice for concierge medicine in visible numbers—and the question is whether that exodus is an unavoidable consequence of how the system is built, or...
-
How Do You Explain the Difference Between an ASO Vendor and a TPA? With Claire Brockbank. Episode 518
The ASO vs. TPA Decision That Quietly Costs Self-Funded Employers More What's the real difference between an ASO and a TPA — and why does it matter that self-insured employers working with an ASO pay, by one referenced estimate, about 4.7% more than the insured book of business for the same care?...
-
Prior Authorizations & Pharma Rebate Contracts — How Financial Motives Keep Generics Off Formularies (EP517)
What if a prior authorization has less to do with your medical need than with how big a rebate check a PBM is collecting on a competing drug? In this solo deep dive — a direct follow-up to last week's conversation with Ophelia Johnson on GLP-1s and cash pay (EP516 link below) — host Stacey…
more -
Cash Pay From the Pharma Manufacturer Point of View, With Ophelia Johnson (EP516)
Only about half of new GLP-1 prescriptions got approved for coverage in 2023 — a gap Ophelia Johnson says is why pharma manufacturers started building cash-pay and direct-to-employer channels instead of waiting on PBMs. Johnson, who built new channels for the manufacturer behind the GLP-1 boom…
more -
Self-Insured Employers: SNF Fraud or Perverse Incentives? Understaffing, Gamed STAR Ratings, and Medicare Dollars at Skilled Nursing Facilities with Michelle Cera. EP515
Is it fraud — or is it just a perverse incentive? That question sits at the center of Hunterbrook Media's latest investigation into skilled nursing facilities (SNFs), and the answer, as Stacey Richter puts it, matters to self-insured employers and anyone else paying for healthcare. In this…
more -
Successfully Suing a Health System for Their Anticompetitive Contracts and Also Collecting Damages for Plan Sponsors and Members, With Matt Cantor. EP514
How the Sutter Health Antitrust Case Opened the Door for Employers and Members to Recover Hospital Overcharge Damages This is Episode 514 (EP514) of Relentless Health Value. What happens when a self-insured employer or health plan member finally says enough is enough and takes a consolidated...
-
Revisiting Cunning Anticompetitive Hospital Contracts, With Brennan Bilberry - EP513
The Hospital Contract Playbook: Four Clauses That Turn Market Power Into Higher Prices Across the country, hospital systems have used their growing market power to write four specific contract terms into their deals with insurers — terms that all but guarantee higher prices for employers, unions,...
-
3 Kinds of Broker/EBC Rent-Seeking Payment Models—A Lawyer's Perspective, With Doug Aldeen. EP512
A Lawyer's Field Guide to Rent-Seeking Broker and EBC Payment Models Brokers and employee benefit consultants often get compensated in ways health plans never fully see — and even when the dollars are technically disclosed, the math can hide an enormous overcharge. In this episode, Stacey Richter...
-
The Perverse Incentive Trap Hidden Inside Value-Based Care — and What to Do About It. EP511
When Risk-Based Payment Becomes Its Own Upcoding Arms Race Medicare Advantage plans get paid more for sicker patients, which is why upcoding became a problem — and now health systems are upcoding visit complexity right back, with MA plans automatically downcoding in response. In this episode,...
-
Why Employers Pay More Because of Vertically Integrated Medicare Advantage Carriers with Betsy Seals. EP510
The Line Between Fair Profit and Profiteering in Medicare Advantage There's a simple test for telling a fair profit from profiteering in Medicare Advantage: does the carrier make more money when the patients it serves are worse off? In this episode, Stacey Richter talks with Betsy Seals…
more -
The 7.7% Wake-Up Call: A Roadmap to Align Finance Teams With Non-complacent Benefit Design, With Patrick Nelli. EP509
The 7.7% Wake-Up Call: A Roadmap to Align Finance Teams With Benefit Design, With Patrick Nelli (EP509) The Seven-Step Roadmap That Gets CFOs to Stop Being Passive Price Takers on Health Benefits. Episode 509. As a companion to last week's CEO-focused episode, Stacey Richter talks with Patrick...
-
Why Don't More Self-insured CEOs Take Bold Action in Health Benefits Strategy? With Lee Lewis. (EP508)
Why Self-Insured CEOs Won't Take Bold Action on Health Benefits, With Lee Lewis (EP508) The Three False Dogmas Keeping CEOs From Fixing Their Health Plan. Episode 508. In the show's first-ever Ask Me Anything episode, Stacey Richter puts a listener's question to Lee Lewis, chief strategy officer...
-
4 Core Concepts to Buy or Deliver the Highest Value Healthcare — A Review With 14 Expert Voices (EP507)
4 Core Concepts to Buy or Deliver the Highest-Value Healthcare, A Review With 15 Experts (EP507) Buy Healthcare, Not Insurance: A Through-Line Review of the Four Concepts Behind High-Value Care. Episode 507. Stacey Richter pulls together clips from 15 past guests to lay out the four core concepts...
-
Price Transparency Data: How Employers, Shareholders, and Clinics Use It, With Jerry DiMaso (EP506)
Price Transparency Data: How Employers, Shareholders, and Clinics Use It, With Jerry DiMaso (EP506) The Price Transparency Arms Race: What Self-Insured Employers and Clinics Can Both Do With the Data. Episode 506. Health price transparency data isn't just a compliance exercise anymore — it's...
-
The Death of the "What Is Value" Guessing Game for Clinical and Plan Decision-Makers Ready to Move On, With Ahilan Sivaganesan, MD (EP505)
Time-Driven Costing and the Operative Value Index for Surgical Care, With Ahilan Sivaganesan, MD (EP505) Why "Value Equals Outcomes Over Cost" Doesn't Work Until You Can Actually Measure Both. Episode 505. What if the only way to know who's delivering high-value surgical care is to actually...
-
A Back-to-Basics Roadmap Through the Perverse Incentives to Advanced Primary Care, With Ryan Jacobs (EP504)
A Roadmap Through the Perverse Incentives Blocking Advanced Primary Care, With Ryan Jacobs (EP504) Why Evidence-Backed Primary Care Still Can't Scale, and a 3-Step Roadmap to Get Around It. Episode 504. Why isn't advanced primary care (APC) everywhere, if the evidence for it is this strong?…
more -
Insights to Outwit the Hot Mess of the Non-Healthcare Market (INBW46)
Listener Insights on Better Decisions, Price Transparency, and PBM Spread Pricing Tricks (INBW46) Why "Insight Is Common, Execution Is Rare" Is the Whole Game in Fixing Healthcare. Episode INBW46. In this inbetweenisode, Stacey Richter spotlights two Relentless Tribe members whose LinkedIn posts...
-
From Lazy PPO Networks to Smart Collaboration — A Roadmap for Direct-to-Employer Specialty Care. EP503
Direct-to-Employer Specialty Care and Centers of Excellence 3.0, With Ryan Wells, Leo Spector, MD, and Adam Stavisky (EP503) Why Self-Insured Employers and Specialists Need to Start Talking Directly Instead of Through a Lazy Middle. Episode 503. Self-insured employers and the specialists who...
-
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. (EP502)
How Medicare Fraud in Catheters and Skin Substitutes Sabotages ACO Shared Savings and Cost-Shifts to Self-Insured Employers, With Brian Machut (EP502) Why $3.5 Billion in Fake Catheters and an Even Bigger Skin Substitute Grift End Up Costing Self-Insured Employers Too. Episode 502. Hackers are...
-
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. EP501
Why the Same Infusion Costs $135 or $13,560, With Ivana Krajcinovic, PhD (EP501) How a $135 Infusion Becomes a $13,560 Bill—and the Direct-Contracting Fix for It. Episode 501. Ivana Krajcinovic, PhD, recently retired vice president for healthcare delivery at UNITE HERE HEALTH, a Taft-Hartley fund...
-
Why the Commercial Carrier Market Never Changes — Six Reasons There Is No Market. Take 2 of EP398
Six Reasons California's Health Plan Market Share Never Changes, Year After Year. Take Two Episode 398. In this Take Two rebroadcast, Stacey Richter revisits a conversation with Jacob Asher, MD, who spent 14 years as a health plan chief medical officer in California—first at Anthem, then Blue...
-
EP500: This Is Episode 500, and It's All About You, Tribe
10 Years and 500 Episodes: What Listeners Say Actually Changed in Healthcare (EP500) Ten Years, 500 Episodes, and the Listener Stories Proving Healthcare Can Change. Episode 500. To mark 10 years and 500 episodes, Stacey Richter turns the mic over to the Relentless Health Value Tribe itself,...
-
Self-insured Employers and Other Plan Sponsors Are Paying Millions for MSK (Musculoskeletal) Injuries That Would Have Healed Themselves, With Jay Kimmel, MD. EP499
Why Twisted Ankles Cost Plan Sponsors Millions, With Jay Kimmel, MD (EP499) The MSK "White Space": How Triage-Before-the-Triage Could Cut Unnecessary Orthopedic Spend. Episode 499. Jay Kimmel, MD, an orthopedic surgeon with over 35 years in practice and co-founder of Upswing Health, joins Stacey...
-
The Payment Integrity Arms Race—RCM (Revenue Cycle Management) and Plan Sponsors, With Mark Noel (EP498)
Revenue cycle management is a $140 billion industry — already larger than the US auto industry and growing five times faster. RCM vendors use programmatic clearinghouses and increasingly sophisticated tools to maximize every cent of revenue from a claim. That is their job. On the other side sits...
-
The "Just Spend Everything You're Given" Trap—Lessons in True Provider Fiscal Discipline, With Gary Campbell
What FQHCs Can Teach Every Healthcare Leader About True Fiscal Discipline. There are two very different ways to end up with no profit. One is genuine struggle. The other is simply being very good at spending every dollar you are given. In healthcare, we have no functioning market to tell the...
-
What You Don't Know About Healthcare Transactions and Clearinghouses Could Cost You, With Zack Kanter
Healthcare Transactions Cost 1,000 Times More Than They Should — Here's Why Clearinghouses Are Part of the Problem Sending a claim through a healthcare clearinghouse costs 10 to 15 cents per transaction. Sending a thousand business emails at scale costs about 15 cents total. That is a...
-
Plan Sponsors Spend About $1.20 to Buy $1 of Healthcare, and Clinical Organizations Receive 80¢ for Every $1.20 Spent, With Mark Newman
Plan Sponsors Pay $1.20 to Buy $1 of Healthcare — and Providers Collect 80 Cents of That A self-insured employer pays $1.20–$1.30 to access a dollar of negotiated healthcare. Providers budget their business around collecting 70 to 80 cents of what they are contractually owed — because denial…
more -
2025 Year-End Themes, Part 2: The Two Things That Have to Change for Any of the Rest of It to Work
This is Part 2 of Stacey's year-end synthesis of the most actionable themes from 2025. Last week covered Themes 1–3. This week covers 4 and 5 — which are, if you squint, really two sides of the same problem: plan sponsors can't buy value when they can't see what they're buying, and they can't see...
-
INBW44: The Relentless Health Value Themes That We Covered Throughout 2025—A Recap, Part 1
As Stacey Richter reflects on a year of Relentless Health Value episodes, three themes kept surfacing in nearly every conversation: the foundational role of trusted relationships, the cost of underinvesting in primary care, and the dominance of perverse financial incentives and profiteering. This...
-
Encore! EP450: When Your Health Plan Is $9 Million in the Hole, Who Are You Going to Call? A CPA. And Tell Them to Bring Their Spreadsheets, With Marilyn Bartlett, CPA, CMA, CFM, CGMA
From $9 Million in the Hole to $112 Million in the Black: How Marilyn Bartlett Turned Around Montana's State Employee Health Plan. What happens when a self-funded health plan is headed for bankruptcy and a CPA with a spreadsheet and her eye on the target gets to work? In roughly three years,...
-
The Measurement Trap: Why We Track Healthcare Costs and Outcomes Exactly Backwards with Dr. Mick Connors. EP495
The value equation in healthcare is outcomes divided by cost — but here's the revelation Stacey Richter had in this conversation: we've been measuring it exactly backwards. In American healthcare, costs are tracked at the macro aggregate level while outcomes are measured at the narrow individual...
-
Six Tensions of Pharmaceutical Drug Pricing, With Sarah Emond of ICER. EP494
If a drug keeps a patient out of the hospital — and hospital spend is 50% of most plan sponsors' total costs — why do we design benefits that make patients less able to afford that drug? That's the martini-fueled question Stacey Richter started with, and it threads through this entire…
more -
Bonus Add-on for EP494: ICER and the Pharma Pricing Arms Race, With Sarah Emond
Pharma raises list prices to maximize rebates. Higher list prices blow up patient coinsurance. Pharma responds with copay cards. PBMs fight back with maximizers and accumulators. Prior auths ramp up. Premiums rise. Deductibles climb. And at no point in this cycle does anyone stop to ask: is this...
-
INBW43: Five Baskets of Thank Yous to Hand Out, Along With a Plug for Big Demand Curve Energy
It will take a village to transform healthcare. Stacey Richter says this so often it is taped to her wall on a Post-It. This Thanksgiving Inbetweenisode is her chance to say thank you to the people actually building that village — and to make the case, with a detour through a drunk blacksmith...
-
Direct Contracts and the ECEN High-Value Network Model, Take Two EP240: With Olivia Ross
Direct contracts between employers and clinical organizations perform way better than what most third parties negotiate — and the Employers Centers of Excellence Network (ECEN), built by the Purchaser Business Group on Health (PBGH), proved exactly that. This Take Two episode revisits that work…
more
We're indexing this podcast's transcripts for the first time — this can take a minute or two. We'll show results as soon as they're ready.
No matches for "" in this podcast's transcripts.
No topics indexed yet for this podcast.
Loading reviews...
ABOUT THIS SHOW
Welcome to Relentless Health Value, the podcast for those working in the belly of the beast to fix our fundamentally broken healthcare system. If you are a self-insured employer, plan sponsor, benefits consultant, clinician, a C-suite executive or anyone in the business of healthcare tired of the "transformational theater" and marketing fluff, you have found your tribe. The U.S. healthcare system isn't a rational market; it's a game of Pachinko where perverse incentives reign, and as we always say, where there's mystery, there's margin.Hosted by Stacey Richter, we relentlessly hunt down the administrative "inches" of waste and expose the hidden fees draining the $5.6 trillion healthcare sector. We transform wonky healthcare theory into ruthlessly practical, actionable insights. Whether it's demanding radical transparency, navigating complex PBM contracts, or buying actual healthcare instead of illusory discounts, our mandate is simple: If it results in a net positive for patients, w
HOSTED BY
Stacey Richter
Loading similar podcasts...
Frequently Asked Questions
How many episodes does Relentless Health Value have?
Relentless Health Value currently has 400 episodes available on PodParley. New episodes are automatically indexed when they're published to the podcast feed.
What is Relentless Health Value about?
Welcome to Relentless Health Value, the podcast for those working in the belly of the beast to fix our fundamentally broken healthcare system. If you are a self-insured employer, plan sponsor, benefits consultant, clinician, a C-suite executive or anyone in the business of healthcare tired of the...
How often does Relentless Health Value release new episodes?
Relentless Health Value publishes regularly with 400 episodes available. Check the episode list for the typical release schedule.
Where can I listen to Relentless Health Value?
You can listen to Relentless Health Value on PodParley by clicking any episode. We provide an embedded audio player for direct listening, and you can also subscribe via your preferred podcast app using the RSS feed.
Who hosts Relentless Health Value?
Relentless Health Value is created and hosted by Stacey Richter.
URL copied to clipboard!