Relentless Health Value
Stacey Richter
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Recent Episodes
EP515: SNF (Skilled Nursing Facility) Fraud—Or Is It Fraud? With Michelle Cera, PhD
SNF Fraud or Perverse Incentives? Hunterbrook Investigates Understaffing, Self-Reported STAR Ratings, and Medicare Dollars at Skilled Nursing Facilities Is it fraud — or is it just a perverse…
EP514: Successfully Suing a Health System for Their Anticompetitive Contracts and Also Collecting Damages for Plan Sponsors and Members, With Matt Cantor
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…
EP513: Revisiting Cunning Anticompetitive Hospital Contracts, With Brennan Bilberry
Stacey Richter introduces Episode 513 of Relentless Health Value as a primer on anti-competitive hospital contracting with Brennan Bilberry of Fairmark Partners, setting up next week's interview with…
3 Kinds of Broker/EBC Rent-Seeking Payment Models—A Lawyer's Perspective, With Doug Aldeen
What does it look like when a broker or employee benefit consultant is circling your plan like it's a gold mine? Doug Aldeen, a well-known attorney who has spent many years in the self-insured space,…
The Perverse Incentive Trap Hidden Inside Value-Based Care — and What to Do About It
If we want clinical teams to take on risk, we have to reckon with what that risk-taking actually incentivizes. In this episode, Stacey Richter weaves together conversations with two physicians to…
The Impact on You of Medicare Advantage Goings-on (2026 Edition), With Betsy Seals
If someone makes more money when the patients or members they serve are worse off, call that profiteering. That's Stacey Richter's working definition heading into this conversation — and it's exactly…
The 7.7% Wake-Up Call: A Roadmap to Align Finance Teams With Non-complacent Benefit Design, With Patrick Nelli
Employer medical inflation has averaged 7.7% annually over the last 20 years — and that was in a historically low inflation environment, so the near-term number is likely closer to 8.5%. If your…
Why Don't More Self-insured CEOs Take Bold Action in Health Benefits Strategy? With Lee Lewis
One company at the Health Transformation Alliance managed their health benefits well enough that when they were acquired, the acquiring company looked at the plans and found $2,300 less expense per…
4 Core Concepts to Buy or Deliver the Highest Value Healthcare — A Review With 14 Expert Voices
Employers pay roughly $1.20 to $1.30 for every dollar of actual healthcare their members receive. In one documented California lawsuit, a carrier charged a plan $4 million for a single inpatient stay…
How Other Employers, Shareholders, and Clinics Are Using Price Transparency Data—And It's an Arms Race, With Jerry DiMaso
Hospital price transparency mandates took effect in 2019. Carrier transparency mandates followed in 2022. That means plan sponsors have had access to negotiated rate data for every billing code,…
The Death of the "What Is Value" Guessing Game for Clinical and Plan Decision-Makers Ready to Move On, With Ahilan Sivaganesan, MD
Most hospitals cannot tell you the true internal cost of a single care episode. Not the medical device costs, not the personnel, not the consumables — the actual cost. And yet we operate a $5.6…
A Back-to-Basics Roadmap Through the Perverse Incentives to Advanced Primary Care, With Ryan Jacobs
Advanced primary care has a robust evidence base. It manages risk, improves outcomes, and lowers costs. So why isn't it everywhere? Because in a healthcare non-market where health systems drive…
Insights to Outwit the Hot Mess of the Non-Healthcare Market
Knowledge Is Fiduciary Armor — On Making Better Decisions in a Healthcare System Built on Mystery and Margin The US healthcare system is a massive aggregation of millions of decisions made by…
From Lazy PPO Networks to Smart Collaboration — A Roadmap for Direct-to-Employer Specialty Care
One Madison hospital charges $219,000 for a surgery that Johns Hopkins — one of the best cardiac programs on earth — does for $80,000 door to door. That's Centers of Excellence 1.0. The question this…
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
Here is what hackers are doing with stolen medical data: billing CMS for urinary catheters at $8,000–$9,000 each — items costing $10–$50 that were never sent to the seniors billed for them. In 2023…
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
Two members of a plan received infusions at a hospital. If they had gone down the street, the plan would have spent $1 million less — for the same drug. That is the infusion nonmarket in 2026. In…
Why the Commercial Carrier Market Never Changes — Six Reasons There Is No Market
If you rank California's commercial health plans by member count and check back every year for 14 years, the ranking barely moves. Kaiser at the top. The big blues plans close behind. Everyone else…
EP500: This Is Episode 500, and It's All About You, Tribe
Ten years ago, Stacey Richter started Relentless Health Value because the healthcare industry felt like a Pachinko machine — you drop a program or a policy in, it bounces around a black box, and…
Self-insured Employers and Other Plan Sponsors Are Paying Millions for MSK (Musculoskeletal) Injuries That Would Have Healed Themselves, With Jay Kimmel, MD
Plan Sponsors Are Paying Millions for MSK Injuries That Would Have Healed Themselves — Here's Why Musculoskeletal spend runs roughly $16 PMPM and accounts for 20–30% of total plan costs depending on…
The Payment Integrity Arms Race—RCM (Revenue Cycle Management) and Plan Sponsors, With Mark Noel
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…
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Relentless Health Value has published 647 episodes since June 2014, covering topics in Business News, Health & Fitness.
Relentless Health Value is currently highly active with new episodes weekly. Average episode length is 33m.
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