Relentless Health Value™

By: Stacey Richter
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  • Summary

  • 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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Episodes
  • EP455: A Leadership Blueprint for Measurably Better Care, With Beau Raymond, MD

    EP455: A Leadership Blueprint for Measurably Better Care, With Beau Raymond, MD
    Oct 31 2024
    A rate critical to attain better care for patients, I’m gonna say, is enlightened leadership—maybe dyad leadership—at a clinical organization. I am saying this because without enlightened leaders, it’d be harder to build from the blueprint that Beau Raymond, MD, talks about today on the show. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. I’d say an enlightened leader is someone—and this is my definition, but it’s a term that Tom Lee, MD, brought up first in an earlier episode (EP445)—an enlightened leader really cares about providing better patient care at an affordable price. They have a manifesto to that end, if you will. They also have studied, likely, and understand how change management works because every improvement requires change. They get the bit about people, processes, and technology being intertwined and what operational excellence means. Further, they are probably doing or considering many of the things that Robert Pearl, MD, talked about in episode 412. On the opposite end of the spectrum, there’s a new term floating around called administrative harm. There’s a study. Admin harm refers as much to what administrators—who I refuse to call leaders at this context because I’m talking about the not good administrators, so let’s be clear—but I’d say administrative harm results from what the administrators choose not to do as much as what they choose to do. It is actually a thing to be an enlightened leader, especially in these profit-driven times. It’s really tough, actually, and nothing anyone should take for granted. So, maybe this whole show is kind of a shout-out to the enlightened leaders out there. Thanks for doing what you do. Okay, so this said, and it needed to be said, let’s talk blueprint for better care in the conversation that follows. Dr. Beau Raymond says, step 1, right out of the gate, set clear goals. Then step 2, engage others throughout the organization to together build the framework needed to achieve said goals. Engaging frontline folks and others is really the only way that any proposed framework will actually work in the real world. Listen to the shows with Karen Root (EP381) and Ashleigh Gunter (EP447) for just one proof point after another that what I say is based in fact. Step 3 of the blueprint to better outcomes that Beau Raymond, MD, talks about today is get your data. We talk a lot about plan sponsors and the getting of data, but same thing applies to clinical organizations. For clinical organizations, the getting of data means longitudinal data. The need for longitudinal data has come up in multiple shows, most recently the one with Dan Nardi (Spotlight Episode), and this is just one example of why getting the whole bag of data really matters. Dan said on that earlier show, it’s often a thing that oncologists are unaware of how many of their patients are winding up in the ER for nausea after chemo, which, by the way, is the most common cause for readmission. And the reason for this is lots of patients travel to their oncologist but go to a local ER in a different health system. The show with Brendan Keeler (EP454) about the Particle v Epic lawsuit in general dustup over who gets the data is super relevant here. That’s what I was thinking when I was talking with Dr. Raymond, and maybe it just popped in your head, too. Or just continuing this topic of the importance of longitudinal data, how many specialists, in almost any specialty, see a patient and then don’t know what happened to that patient subsequently? Or even primary care in transactional models? So, step 3 here is get your data and also, as part of that, figure out how to make sure everybody understands the data and also understands that it is fair. Eric Gallagher (EP405), Dr. Raymond’s dyad counterpart over at Ochsner, talked about this some in that episode. So did Kenny Cole, MD (EP431), interestingly, also from Ochsner. Amy Scanlan, MD (EP402) mentions it as well. Step 4 in the blueprint to measurably better outcomes that I discuss with Dr. Beau Raymond, data collection and data management probably need to be system-wide because … yeah, longitudinal and etc. But the “What are you gonna do now with the insights that you derived from the data?” is pretty local. The obstacles and enablers are going to be different depending on the geography. For example, an area with a large Vietnamese population and a big variation in colorectal screening rates as a priority, just logically, is gonna have a program that is in no way suited to roll out in an area with, say, a large Black or African American population with high hypertension rates. Priorities and programs are just different depending on the geography. So, step 4 here is, ask each region, based on the data, what fixes they’re going to own. What will they take ownership on and commit to...
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    39 mins
  • EP454: How the Particle v Epic Lawsuit Impacts Plan Sponsors and Public Health Trying to Get Data, With Brendan Keeler

    EP454: How the Particle v Epic Lawsuit Impacts Plan Sponsors and Public Health Trying to Get Data, With Brendan Keeler
    Oct 24 2024
    You know why I’m interested in the Particle v Epic EHR (electronic health record) systems lawsuit? It’s because … data. Say I’m thinking about this like, say, a plan sponsor and I want data so I can do better population health or do care navigation to help my members avoid downstream bad things or steer and tier to high-quality docs and point solutions and, and, and … For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. To do anything that has anything to do with population health, I need data. And when I say data, we often think claims data as plan sponsors; and we think about getting it from carriers. But where does the claims data originate? Oh, right … the gleam in the eye of a lot of claims data is EHR data. Someone typed something into an EHR system that metamorphosized, ultimately, into a claim that wound up in a carrier’s dataset. Plan sponsors want the claims part of the claims data, obviously, to see prices; but they also want those underlying data elements that indicate the health of their members. Said another way, they want the insights gleaned from some clinician somewhere who typed something into an EHR system that turned into codes that drove claims. So, yeah … Particle v Epic. Particle was getting EHR data and passing it on to other parties, and we get into the what’s and the who’s and the commentary. But bottom line, what I wanted to get into today is this: Will this lawsuit result in more access to data for downstream entities who need it, or less? What are the implications here of Epic shutting down access to its EHR data to Particle and Particle filing an antitrust lawsuit saying Epic did this because Epic wanted to use their monopoly power here to advantage their own payer platform business? Oh, the plot thickens. Payer platform business? For an EHR system. What is that exactly? More intrigue. What’s going on there? Because, yeah, probably a lot of plan sponsors and patients are, I’m gonna say, unaware of this part of the equation as to what data the carriers seem to have and where are they getting it from and what things they may be doing with it that plan sponsors and/or members who are their customers may or may not be aware of. Knowledge is power here, especially in the fight over trying to get data out of carriers who won’t hand it over when the carriers themselves are getting that data through interoperability networks that potentially plan sponsors also qualify for. Chucking that in there as a point to ponder. This whole “I’m intrigued” bit here, though, was not rhetorical. I really am/was intrigued—so intrigued, as a matter of fact, that I called Brendan Keeler to come on the pod and talk this out with me. Brendan, by the way, has written a very detailed account of the Epic/Particle dustup. There is a part one and a part two. Before we kick in here, though, I did just want to make at least one point on background. First, so many, many people want to get their mitts on EHR data for good reasons and maybe not-so-good reasons from the standpoint of the patients whose personal health information is being fought over here. The basic rule is that to get EHR data, you have to be involved in the treatment of the patient. So, this is the current governance as it stands. You have to be involved in the treatment of the patient if you want EHR data. So involved in the treatment, actually, that you have to have your own treatment data to share back. This is called reciprocity, right? Like, how can you say that you’re treating a patient if then you don’t have any data as to that treatment? On-site clinics, by the way, are providing treatment—just saying, in case anybody is thinking the same thing I’m thinking right now. Okay, back to the lawsuit. The real kicker of this whole Particle v Epic and Epic cutting off Particle thing, as far as I’m concerned, is over the secondary use of said treatment data once someone gets it (ie, someone gets EHR data transmitted to them because they are doing something or other to treat the patient, but now they have that data). And at that point, is it a free-for-all what they do with it? Can they, I don’t know, sell it to anyone they want? Said another way, what if I realize I need EHR data for, I don’t know, I’m a lawyer trying to do lawyer things or I’m public health entity or whatever. It doesn’t matter. If I throw a medical professional in a room and cook up something this person is doing, that could be considered treatment if you squint at it. Tricky, right? Now I can get EHR data. So, yeah … there’s that motto “If you ain’t cheatin’, you ain’t tryin’,” which Pryce Ancona said, ironically, on Health Tech Nerds the other day; and I cracked up. But it’s so not funny. Because you have some people—maybe or maybe not—kind of violating, let’s just say, the spirit...
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    35 mins
  • EP453: Running a TPA (Third-Party Administrator) RFP Process That Is Less of a Wild West Fiduciary Shootout, With Claire Brockbank

    EP453: Running a TPA (Third-Party Administrator) RFP Process That Is Less of a Wild West Fiduciary Shootout, With Claire Brockbank
    Oct 17 2024
    In this episode, host Stacey Richter delves into the complexities of the Third Party Administrator (TPA) Request for Proposal (RFP) process with guest Claire Brockbank from 32BJUnion. The discussion highlights the critical role of contracts in managing health plans effectively and the potential pitfalls of accepting contracts crafted by TPAs without thorough review. Drawing from Claire's experience, they explore tactics like starting with your own contract paper in RFP processes to gain negotiation leverage, and the benefits of employer coalitions in navigating health care complexities. To Read the full article which includes mentioned links visit the episode page. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to become a member of the Relentless Tribe. Real-world examples underscore the financial impacts of poorly negotiated contracts and highlight successful strategies for health plan sponsors to optimize costs and services. The episode aims to empower employers with tools and insights to negotiate effectively and ensure their health plan contracts align with their strategic goals, ultimately paving the way for better population health management and cost-effective care delivery. As but one example—and Cora Opshal spoke about this last week and Claire talked about this today—it’s about how allowing upside-down payments, for example, that are in a lot of ASO contracts, this allowing of upside-down payments. I mean, it turns out that 32BJ spent around $10 million paying more than the bill was for one year. If somebody signs that contract as handed to them by the carrier, then the plan is now contractually obligating themselves to pay more than the price the clinical practice was charging. So, doc sends bill for $100, and the carrier pays that practice $200 on behalf of the plan sponsor. So now the plan sponsor is paying $200 for a $100 bill. Is this conflict of interest? Is it imprudent? Is it not reasonable? Said another way, is that a bit of a fiduciary breach on the plan sponsor? So it's understandable why the team at 32BJ pushed back and pushed back hard. We all can see why the leading edge of plan sponsors and more and more C-suites are hotfooting it into conference rooms to plan their RFP process and doing it in the way that Claire Brockbank talks about today. For an open-source contract and some other free tools, please do head over to the 32BJ Insights Web site. 05:36 How does the initial contract writing affect how events in your healthcare plan will go? 06:56 What happens if a plan sponsor or employer doesn’t do the contracting right? 10:42 How much could be saved by doing contracting right? 11:01 EP433 with Justin Leader. 12:22 How do you start an RFP process with your own contract? 14:06 What Claire Brockbank recommends doing to do a TPA RFP process in a way that’s best for you. 19:46 What factors do carriers need to get an ASO or TPA to respond to using your contract? 21:11 Open-source contract available from 32BJ. 21:57 Why it’s important to really probe brokers, despite loyalty to your broker/consultant. 24:30 Who are the reliable agents and experts when carriers are looking to start this process? 26:24 EP428 with Julie Selesnick. 27:56 What’s the silver lining to this effort? 29:17 Why is it important to make it clear why you’re doing what you’re doing for your lawyers and any other support team you need? 31:39 What does “good” look like in this process? 34:15 Why is it important to continue to hold your ASO accountable?
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    37 mins

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