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Relentless Health Value

Relentless Health Value

By: Stacey Richter
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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.©BD Bridges LLC, All Rights Reserved. Hygiene & Healthy Living Physical Illness & Disease Politics & Government
Episodes
  • EP507: 4 Core Concepts to Buy or Deliver the Highest-Value Healthcare—A Review

    EP507: 4 Core Concepts to Buy or Deliver the Highest-Value Healthcare—A Review
    Apr 16 2026
    Look, we wonks, meaning you and me, you're listening to this, so I am on to you. But we wonks in the Relentless Tribe, we move like lightning on Relentless Health Value. We tend to cover lots of ground pretty fast. So, sometimes I like to, with great intention, sum up what's been said—really lock into the big revelations, the big points made, the through lines. 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 like to do this so that points stick in my mind and I remember them and can build on them later. I am thinking you like this, too, because actually our through line shows in the past have been pretty popular. But this, today, is not your average through line show. I am trying something new and actually playing clips of earlier episodes so that you can recall what a guest may have said exactly and specifically and also really see the ways that episodes may interlock. So, to that end, let me just get to it and tell you the four core concepts to buy or deliver the highest-value healthcare that we will cover today. Core Concept 1: Buy healthcare. And by the way, health insurance is not healthcare. Jonathan Baran talks about that, and then Cynthia Fisher, Mark Newman, and Justin Leader cover the why, which is billions of dollars. Core Concept 2: When buying said healthcare, avoid the myth of less expensive healthcare. What is the myth of less expensive healthcare? Well, there's a lot of them, actually. One myth is that low price means low quality. Wrong. Most of the time there is actually no correlation between price and quality, but sometimes less expensive is higher quality. Also, low quality can be the most expensive care irrespective of the cost. Also, the same exact healthcare service or product can cost wildly different prices. Just keep that in mind. You'll hear Elizabeth Mitchell; Sam Flanders, MD; Shane Cerone; Jerry DiMaso; Ivana Krajcinovic, PhD, talk about this, this whole idea of when buying healthcare, avoid the myth of less expensive healthcare. Core Concept 3: So, of course, at this point, direct contracting enters the building. Because direct contracting between ultimate buyers of healthcare (meaning plan sponsors like self-insured employers etc.) and the actual purveyors of healthcare (meaning clinicians) is a fairly obvious strategy if we're going to try to get high quality at a fair price. I mean, get the beginning and the end of the road together. When you do that, it not only can spotlight—and thereby help eliminate—who might be low value that's sitting in the middle of the road collecting tolls like a toll booth, but it also enables collaboration in other ways, really, between the ultimate purchasers and the ultimate deliverers of care. Because there can be conversations about integration. There can be goals and then work out issues together, right? Collaboration is the next breakthrough innovation. So, that's our Core Concept 3: Consider direct contracting or even just, you know, as a start, go talk to, if you're a self-insured employer or you're a purveyor of care, go just find somebody to have a conversation with. Go talk to each other. Just have a chat. And I might include pharmacies, actually, in that mix. It's amazing what can happen, actually, when those buying care and selling care sit in the same room. In this number three core concept, consider direct contracting, we hear again from Ivana Krajcinovic but then also from Ryan Jacobs, Adam Stavisky, and then lastly, we have a quote from Ryan Wells. Core Concept 4: When direct contracting, or otherwise purchasing healthcare, buy the highest-value healthcare. How is that for an aspirational goal? But really, what do you want a direct contract for? What do you want your partners to be accountable to deliver? And what's rolled up into all of that? What is value? What is value, right? We go there, and when I say we, I mean we hear from Mick Connors, MD; Dr. Siva, otherwise known as Ahilan Sivaganesan, MD; and then we have Kenny Cole, MD, to bring us home. We finish up really at a very human level for why all of this matters. So, in summary, here's our four concepts. When you buy healthcare, buy healthcare. Focus on what you're actually getting for your money and how you are buying it. When you do that, direct contracting starts to make some sense. Just make sure the care that you are buying is truly high value. That's the whole shebang in a nutshell. One more thing before we kick into this. So, yeah, while I was quietly contemplating the vast universe of things gone wrong and right in the healthcare sector, Tom Nash, our producer extraordinaire, wandered in and asked me to try out his new Relentless Health Value Chatbot that he's been working on possibly 18 hours a day, including weekends ever since the incident with Michelle Bernabe and the AI futurist philanthropist, which you can hear all about ...
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    34 mins
  • EP506: How Other Employers, Shareholders, and Clinics Are Using Price Transparency Data—And It's an Arms Race, With Jerry DiMaso

    EP506: How Other Employers, Shareholders, and Clinics Are Using Price Transparency Data—And It's an Arms Race, With Jerry DiMaso
    Apr 9 2026
    So, we have a few miniseries afoot here on Relentless Health Value right now, and one of them is "The Inches That Are All Around Us"—finding the hidden fees, the hidden friction for plans and members and clinics themselves a lot of times in those inches. 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. So, how does transparent pricing data fit in here? Well, you can use it to find inches. They are all around us. You can see it in this data. So, we talk about self-insured employers, plan sponsors, and their perspective on this price transparency data first in the conversation that follows. And then we get into the perspective of the provider organization or the clinic. Let's take this from the top. Plan sponsors such as self-insured employers or unions can gain three very interesting and maybe underappreciated insights from this price transparency data. Not limited, of course, to these three insights, but these were the three that Jerry DiMaso talked about; and I lasered in on them with very single-minded ambition. Okay … so, here's the three insights of interest to plan sponsors. (1) Benchmarking against a plan sponsor's competitors. We often forget about this, that every self-insured employer is actually a company trying to sell something, probably with competitors. You can search for your own plan or a competitor's plan using an EIN to compare rates, specific carve-outs, and identify if there are other companies in the same industry that are receiving better pricing. Considering that paying for health benefits is often the second-biggest line item on many corporate balance sheets, I wonder how long it's going to take for some activist shareholder group to figure out that they can find evidence of avoidable overspending. Especially because of our number two insight here, which is (2) you can use this data to identify high-cost codes. Plan sponsors can pinpoint specific billing codes where they are paying way too much. And right now (maybe you are, too) but I am thinking about the examples of infusions given in the recent episode with Ivana Krajcinovic, PhD (EP501) and that Brian Cotter talks about all the time. Also Nate Walker. Plans paying a million dollars too much for some infusion. That would be a crazy thing for a corporate shareholder to figure out and bring up at some, I don't know, shareholder meeting or earnings call, right? (3) Exposing the, I'm gonna call it, "discount shell game." This data allows plan sponsors to see through stuff like gross aggregated discounts. They can verify if a TPA's, I don't know, 90% discount is actually real savings. Okay … so, what does one then do with these insights once found? Jerry DiMaso, again, my guest today in the conversation that follows, talks through these at some length; but here's the very top line. First thing a plan sponsor can do is use this information to direct TPA negotiations. Plan sponsors can get their TPA to go back to providers and negotiate better rates. I did not know that. Number two thing that a plan sponsor can do with this information: Implement service carve-outs and direct contracts. Employers can identify expensive outliers and then steer and tier and maybe direct contract with specialized providers or Centers of Excellence as a result of that knowledge. As a second bit to this, not to be underestimated, this data allows for objective calculation of savings a lot of times from, you know, direct contracts or other initiatives so that plan sponsors don't have to rely on vendors to grade their own homework, as they say. Plan sponsors can start to do their own math. And here's the last thing that we discuss in the episode that follows that a plan sponsor can do with this price data: Model alternative plan types. Right? You can analyze whether switching from a PPO to an HMO or some other alternative model would save money while actually maintaining access to the same providers that employees are already using. Okay … so, now and in the conversation that follows, at this moment, we pivot to clinical organizations and how they can use this information. And by the way, although what we talk about next is of great interest to clinical organizations, lots of this is also still relevant to self-insured employers because, right, any ultimate purchaser does not want the independent practices to go outta business. So, helping them make sure that they can stay in business is in everyone's best interest. I talk about this coming up with Patrick Nelli from Aligned Marketplace, and I talked about it with Dan Greenleaf from Duly in an episode. Indie practices are just cheaper than consolidated health systems. If they go out of business, now all of the volume goes to consolidated health systems who now well and truly have a monopoly and all the glorious, unchecked pricing opportunities that go along with that. Anyway. ...
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    36 mins
  • EP505: The Death of the "What Is Value" Guessing Game for Clinical and Plan Decision-Makers Ready to Move On, With Ahilan Sivaganesan, MD

    EP505: The Death of the "What Is Value" Guessing Game for Clinical and Plan Decision-Makers Ready to Move On, With Ahilan Sivaganesan, MD
    Apr 2 2026
    Stacey Richter interviews neurosurgeon Dr. Ahilan Sivaganesan (Dr. Siva) about replacing vague healthcare "value" claims with quantified outcomes and unit-level costs, introducing his Operative Value Index (OVI). They discuss how hospitals often lack true internal episode costs and how common quality metrics miss patient-reported outcomes and appropriateness across the full care journey. Using time-driven activity-based costing (TDABC) and condition- or procedure-specific patient-reported outcomes, OVI creates a common mathematical language to compare surgeons, practices, or health systems, risk-adjust for confounders, and support steering/tiering and direct contracting for self-funded employers. Siva describes transparency via bubble charts that spur clinician behavior change without new incentives and argues this infrastructure is essential as bundled payments and risk-based arrangements expand, framing a "Yahoo vs Google" shift from fee-for-service volume to measurable value. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP505 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls= 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 00:00 Introduction to this episode. 00:38 The goal of this episode. 01:28 What the Operative Value Index (OVI) is. 02:04 A quick episode overview. 04:23 EP434 with Benjamin Schwartz, MD, MBA. 04:44 How this episode came about. 09:24 How Dr. Siva got involved in the research around outcomes and costs. 11:51 How the value equation doesn't add up to true quality. 14:12 What measuring quality across the entire care journey means. 15:00 EP326 with Rishi Wadhera, MD, MPP. 15:08 EP295 with Rebecca Etz, PhD. 16:07 Why appropriateness is the foundation of quality. 19:08 Why practicing clinicians need to be thinking about the true costs of delivering care. 21:20 Time-driven activity-based costing (TDABC). 23:44 The two things that must be known for value-based care to succeed. 24:06 Article by Dana Prommel Strauss. 27:09 A quick summary of the conversation thus far. 30:42 The power of transparency in Dr. Siva's bubble plots. 32:39 EP449 with Marty Makary, MD, MPH. 34:05 Why these bubble plots work not just at the procedural level but at the diagnosis level, too. 36:13 EP503 with Ryan Wells; Leo Spector, MD, MBA; and Adam Stavisky. 36:21 EP501 with Ivana Krajcinovic, PhD. 36:30 EP398 with Jacob Asher, MD. 37:28 The "big blue ocean" opportunity for forward-looking providers. 38:52 Substack post by John Lee, MD. 40:37 The incredible opportunity for entities and groups that can help provide the infrastructure needed for this value index. 41:42 Essay written by Dr. Siva. 43:19 Last thoughts by Dr. Siva on TDABC and competition on value.
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    44 mins
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