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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, we do it. Join the Relentless Health Value Tribe to equip yourself with the fiduciary armor needed to outwit the status quo, demand accountability, and drive real change.
Unknown Host hosts Relentless Health Value.
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, th
RCM: Why Revenue Cycle Management Is Healthcare's $200B Hot Potato, With Andrew Tsang (EP521) Revenue cycle management (RCM) sounds like the least sexy phrase in healthcare — a back-office spreadsheet problem. It isn't.
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 po
Cognitive Atrophy, Referral Incentives, Fragmented Care: Is Primary Care Inevitable or Fixable? Episode 519. Primary care physicians are leaving traditional practice for concierge medicine in visible numbers—and the ques
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 e
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 O
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.
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
How the Sutter Health Antitrust Case Opened the Door for Employers and Members to Recover Hospital Overcharge Damages. What happens when a self-insured employer or health plan member finally says enough is enough and tak
The Hospital Contract Playbook: Four Clauses That Turn Market Power Into Higher Prices This is Episode 513 (EP513) of Relentless Health Value. Across the country, hospital systems have used their growing market power to
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 disclos
When Risk-Based Payment Becomes Its Own Upcoding Arms Race This is Episode 511 (EP511) of Relentless Health Value. Medicare Advantage plans get paid more for sicker patients, which is why upcoding became a problem — and
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 ar
The Seven-Step Roadmap That Gets CFOs to Stop Being Passive Price Takers on Health Benefits. As a companion to last week's CEO-focused episode, Stacey Richter talks with Patrick Nelli — CEO of Aligned Marketplace and a f
The Three False Dogmas Keeping CEOs From Fixing Their Health Plan. In the show's first-ever Ask Me Anything episode, Stacey Richter puts a listener's question to Lee Lewis, chief strategy officer and GM medical solutions
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 for buying or deliv
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 becoming a competitive weap
Time-Driven Costing and the Operative Value Index for Surgical Care, With Ahilan Sivaganesan, MD. Why "Value Equals Outcomes Over Cost" Doesn't Work Until You Can Actually Measure Both. Episode 505. What if the only way
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? Stacey Richter talks with R
Why "Insight Is Common, Execution Is Rare" Is the Whole Game in Fixing Healthcare. Listener Insights on Better Decisions, Price Transparency, and PBM Spread Pricing Tricks Episode INBW46. In this inbetweenisode, Stacey R
Lisa Rosenbaum
Beth Israel Deaconess Medical Center
1 appearance on this show
Matthew Cantor
Shinder Cantor Le
1 appearance on this show
Brennan Bilberry
Fairmark Partners
1 appearance on this show
Ahilan Sivaganesan
Mishe Health
1 appearance on this show
Patrick Nelli
Aligned Marketplace
1 appearance on this show
Lee Lewis
Health Transformation Alliance
1 appearance on this show
Jerry DiMaso
Payerset
1 appearance on this show
Ahilan Sivaganesan, MD
Hospital for Special Surgery
1 appearance on this show
Ryan Jacobs
Marathon Health
1 appearance on this show
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