Episodios

  • EP477: Through Line Show: What the Tribe Thinks You Need to Know About Trust or It’s Gonna Be a Problem. Also, Why You Are Smart, With Stacey Richter
    May 22 2025
    A couple months ago, I did my very first episode (EP467) that locked down a very clear through line, a theme tying together a bunch of RHV (Relentless Health Value) episodes from earlier this year. That earlier through line was a lack of good primary care means higher emergency room spend. 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. Let’s talk about another emerging (in hindsight) through line. And to be clear, just like that last show, this through line emerged because of you lot who listen every week. You all wrote great, really insightful comments and reposts that excavated underlying themes tying a bunch of the episodes together. So, this show is going to be about one of these underlying themes: the very real impact of trust or lack of trust, which may come from too little antitrust. I’ll pause for a sec for you to appreciate that little poetic gem I copied from Mick Connors, MD, and I’ll tell you where we’re gonna finish up. Spoiler alert: It’s with me telling you, Relentless Health Value listener, this whole thing is gonna wrap up with me telling you how smart you are. Because you’re ultimately going to be the happiest, probably the longest living, and also most successful. So, stick with me here because we’re gonna go down before we go up. I also wanna mention the bonus clip that you will find released on the exact same day as this show. It’s from one of the first Relentless Health Value episodes from literally 10 years ago that I did with Charles Green, who is an expert on trust. Most of that original and ancient episode is kind of terribly embarrassing for me to revisit. Don’t get me wrong, Charles Green is amazing and totally carries the interview; but I listened to myself and realized that, yeah, 10 years of practice makes not perfect, for sure in my case, but at least better. This is likely TMI, so let me move on and say that the 10-minute bonus clip of that original show covers how to earn trust and to be worthy of trust IRL and thus really apropos to this conversation. So, you will find this clip for your convenience back in the pod feed also released today. Okay … so, trust, the impact of trust. Just two weeks ago, my guest, Peter Hayes (EP475), talked about a pervasive lack of trust that has developed among patients and also Americans scared to become patients as well as clinicians. Enrico Cullen also called out on LinkedIn the other day. He was talking about the show with Kenny Cole, MD (EP473), and he wrote, “If a patient is not taking the statin that you prescribe them because their neighbor’s uncle developed bad muscle aches while taking it … all it means is they trust their neighbor more than they trust their doctor.” So, that was something that Kenny Cole had said during the show. Or as Denise Wiseman, PhD, MBA, CPXP, wrote the other day (again about the Kenny Cole episode from a few weeks ago), she said, “One key message that stood out: Building trusted relationships isn’t soft or secondary—it’s a critical lever for better health outcomes and smarter system design. As Dr. Cole says, ‘It’s our job to earn their trust and go on a journey with [patients].’” Also, along these same exact lines (ie, the impact trust can have when it exists or the problems a lack of trust creates), Julie Siemers, DNP, MSN, RN, wrote, “It’s fascinating how trust shapes patient choices. Strengthening those connections with various providers is essential for better healthcare outcomes.” And, right? Let me paraphrase Enrico and Denise and Julie with some additional context. If trust isn’t built with patients and then if some clinical or pop health or navigator/coordinator somebody pops up on the scene and tries to close care gaps or navigate members away from a low-quality or ridiculously high-cost care setting, or tries to get a member/patient to not show up in the ER as a default … Look, anybody trying to do any of these things without a foundation of member or patient trust will be mopping up the floor while the faucet’s still running. Listen to the show with Matt McQuide (EP468) for this point with five underlines. Listen to the show with Christine Hale, MD, MBA (EP471) on high-cost claimants. The TLDR on that one: You cannot spreadsheet your way out of high-cost claims. You need trust. You gotta, with all of these things, start with a step one: Build trust. And if you hop over that part, yeah, good luck with pretty much anything that you’re gonna try to do, as many find out the hard way. So, what I just said there, starting with a foundation of trust to make almost anything happen as the step two, is this a popular but just kind of rando theory based on nothing much as far as evidence goes? Oh, very much no. So much evidence. Listen to the pod with Rebecca Etz, PhD (EP295) from a while back that covers a few of the ...
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    19 m
  • Bonus Add-on to EP477: How to Earn Trust, With Charles Green
    May 22 2025
    Welcome to this bonus add-on. I’m not gonna give much of an intro here except to say, we’ve come a long way, baby. And also, this short clip from the original show about trust is really a master class on what trust means and how to earn it. 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. My guest in the show is Charlie Green from Trusted Advisor Associates. Ten years ago, when this episode originally aired, he’d been doing his, as he calls it, trust thing for about 15 years. This means being focused on speaking. He’s written a lot about trust consulting, doing workshops, and training for corporate accounts on the subject of trust and trusted relationships in business. He has also written three books on trust, the best-known one called The Trusted Advisor. Also mentioned in this episode are Trusted Advisor Associates; James Gelfand, JD; and The ERISA Industry Committee. You can learn more at trustedadvisor.com and by emailing cgreen@trustedadvisor.com. You can also follow Charles on LinkedIn. Charles H. Green is an author, speaker, and world expert on trust-based relationships and sales in complex businesses. Founder and former CEO of Trusted Advisor Associates, he is author of Trust-Based Selling and co-author of The Trusted Advisor and The Trusted Advisor Fieldbook. He has worked with a wide range of industries and functions globally. Charles works with complex organizations to improve trust in sales, internal trust between organizations, and trusted advisor relationships with external clients and customers. Charles spent 20 years in management consulting. He has a bachelor’s degree in philosophy from Columbia and an MBA from Harvard Business School. A widely sought-after speaker, he has published articles in Harvard Business Review, Directorship Magazine, Management Consulting News, CPA Journal, American Lawyer, Investments and Wealth Monitor, and Commercial Lending Review. 01:45 Four trust principles that can help you earn your clients trust and come off as more trustworthy from first impressions onward. 04:31 Charles’s words of wisdom for rebuilding lost trust. 05:46 Where does trusted leadership start? 06:38 Why trust in leadership is about embodying trust in actions, not words. 07:26 Why does personality have an outsized impact in leadership and trust? 08:21 “If we want to improve our trust, we just simply need to work on ourselves.” 08:56 Why listening with a sense of curiosity and respect drives reciprocal behavior and improves trust. 09:14 What is the best technique to immediately improve your trust relationship? You can learn more at trustedadvisor.com and by emailing cgreen@trustedadvisor.com. You can also follow Charles on LinkedIn. @CharlesHGreen of @trustedadvisors discusses trust in this bonus episode of our #healthcarepodcast. #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation Recent past interviews: Click a guest’s name for their latest RHV episode! Ann Lewandowski, Peter Hayes, Yashaswini Singh, Dr Kenny Cole, Dr Eric Bricker, Dr Christine Hale, Nikki King, James Gelfand (Part 2), James Gelfand (Part 1), Matt McQuide, Stacey Richter (EP467)
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    12 m
  • EP476: Talking Whistleblowing and the Pharma Rebates Whistleblower Case With an Actual Whistleblower, With Ann Lewandowski
    May 15 2025
    Alright, first off, let me calm down any attorneys right outta the gate here. We will not be talking about—at all—the legal activity that is currently ongoing that my guest today, Ann Lewandowski, is involved with. The suit mostly on our radar today is the one where an EBC (employee benefit consultant) allegedly had 61% of their revenue coming from pocketing their clients’ pharma rebates and using said clients’ pharma rebates to fund their executive bonus pool. Doing all this, not transparently (ie, none of their clients were aware that this was going on), it was not disclosed as per the Consolidated Appropriations Act of 2021. 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, these EBCs’ clients were (one would assume) plan sponsors, like self-insured employers, of course. This pocketing of the rebates amounted to allegedly $27 million. Nice executive bonus poll they got there, I guess, would be one comment. Anyway, allegedly when the whistleblower—who happened to be, at the time, this employee benefit consultant’s compliance officer—when he, you know, did his thing and sounded the alarm and said, “Hey, gang. Consolidated Appropriations Act. We gotta disclose this compensation we are earning from, you know, pocketing our clients’ pharma rebates and all that. It’s the law of the land.” Well, a couple things went down at that point, but yeah … EBC executive team winds up ultimately firing their compliance officer (ie, the whistleblower). We gotta be opaque as hell, I believe is the alleged quote. So, this case has all the things. It’s a violation allegedly of the CAA (Consolidated Appropriations Act) legislation. It’s got retaliation. It’s got self-dealing. It’s got a lot of WTHs per mile, as they say … allegedly. Right about now, I am going to mention that Peter Hayes last week on this podcast (EP475) talked about how regulations like the CAA are a major force colliding with two other major forces: transparency and public outrage. So, three major forces combining to shake up the status quo. And maybe this whole pharma rebates getting disappeared case is a great example of this actually allegedly happening. We got all three of these forces—outrage, transparency, and regulations—revealing (allegedly) one giant swirl cone of cluster f’ery that could certainly inspire even the most uninspired plan sponsor to take a serious look into their brokers or PBMs (pharmacy benefit managers) or TPAs (third-party administrators) or other vendors. At least do some level of auditing there. So, there’s that. But also, to me, the big takeaway circles back once again to this trust touchstone that, again, keeps coming up in lots of Relentless Health Value episodes lately. And it’s just a really big reminder that trust isn’t just for patients and their doctors, and it’s not just for clinicians and their administrators or leadership. It’s also for plan sponsors and their advisors. Although distrust is the problem with everybody else I just mentioned, in this particular instance, the problem isn’t a lack of trust. It’s often too much of it. Plan sponsors often really trust their longtime EBCs or TPAs, and yeah … sometimes it’s warranted. Sometimes it’s not. Brutally not. Kimberly Carleson the other day, she wrote, “$14.5 million is being returned to self-funded health plans after the Department of Labor found that … the TPA had been pocketing undisclosed markups.” She continues, “But your premiums are still rising today because behavior like this hasn’t stopped. This isn’t just about one TPA [or one EBC]. It’s a warning shot.” So, yeah, this whole goings-on with this pharma rebates disappearing lawsuit is a warning shot on several levels. One is just how many millions of dollars can go missing on its way from point A to members’ wallets. But another level of warning shot is more personally self-interested in nature because the thing about whistleblowing is that it’s only possible when there is a scent of illegal activity wafting in the air. And if that bad smell turns out to be verifiable by the DOJ or DOL or courts of law, at that point, personally, you can either be the whistleblower or be on the other side of the table. And being on the other side of the table could mean millions of dollars in fines or even jail time. We talk about that generic drug manufacturer collusion whistleblower case a little bit later on in the show today, where the CEOs are facing possible prison and there’s millions of dollars in fines also, just BTW. So, all of this and more comes up today in my conversation with Ann Lewandowski. I mean, if you had the chance to talk about whistleblowing with a whistleblower, you would’ve done the same thing in my shoes, right? Talk about whistleblowing with someone who has made the decision to be one ...
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    36 m
  • EP475: Is This a Moment or a Movement? With Peter Hayes
    May 8 2025

    In this episode of Relentless Health Value, host Stacey Richter sits down with Peter Hayes to discuss the major forces driving change in the healthcare industry. Hayes outlines three critical factors: changing public opinion, heightened transparency, and new regulations such as the Consolidated Appropriations Act.

    He emphasizes the unprecedented convergence of these elements, creating a pivotal moment for healthcare transformation. The discussion delves into the erosion of trust within the healthcare system and the growing public unrest over high costs and inefficiencies.

    Hayes also highlights the role of state-level initiatives as experimental laboratories for potential national solutions. The episode concludes with a call to focus on root causes and collaborative approaches to restore trust and improve healthcare affordability and quality.

    === LINKS ===
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    05:28 What things are adding to the urgency in this moment of healthcare?

    05:55 The three things that have brought us to a tipping point in healthcare.

    07:05 Why is now the real moment for this tipping point?

    10:35 EP458 with Komal Bajaj, MD.

    13:01 Article by (and tribute to) Uwe Reinhardt.

    13:27 Hospital ratings by The Leapfrog Group.

    14:08 EP358 with Wayne Jenkins, MD.

    15:07 EP474 with Yashaswini Singh, PhD.

    16:29 How is regulation changing in healthcare?

    21:48 How the “trifecta” of change is working together to create this movement of change in healthcare.

    23:54 What do we need to look at to address the problems pushing this change in healthcare?

    25:44 EP465 with Chris Crawford.

    30:04 Why is federal and state collaboration going to be important to this healthcare change?

    31:51 EP455 with Beau Raymond, MD.

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    34 m
  • EP474: Private Equity in Healthcare—The Big Data Points You Really Need to Know, All Together in One Episode, With Yashaswini Singh, PhD
    May 1 2025
    In Episode 474 of 'Relentless Health Value', host Stacey Richter interviews Dr. Yashaswini Singh, an economist and assistant professor at Brown University, about the growing influence of private equity (PE) in healthcare. The conversation delves into the corporate transformation of medicine, highlighting the potential misalignment between business interests and patient care. Dr. Singh discusses the diverse strategies PE firms use to drive profitability, such as increasing negotiated prices, consolidating market share, employing real estate leasebacks, and emphasizing performance metrics that may not align with patient benefits. The episode also examines the significant impacts these strategies have on physicians, including increased turnover and changes in practice patterns, as well as the broader implications for patients and communities. Dr. Singh stresses the importance of informed leadership, education, policy enforcement, and transparency to ensure that private investments ultimately benefit healthcare systems without compromising patient care. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP474 ✉️ 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=1 🎤 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/ 05:53 What is the tension between business and medicine? 07:05 What is the impact of private equity on healthcare? 08:46 How does healthcare change when private equity invests in medical facilities? 10:54 What are the intuitive impacts of private equity in healthcare? 12:28 What are the less intuitive effects of private equity on healthcare? 13:36 EP472 with Eric Bricker, MD. 14:15 What are the misconceptions about private equity investors acquiring healthcare facilities? 16:17 The Steward saga. 16:24 The death of Hahnemann Hospital in Philadelphia. 19:27 Are there any positive outcomes to private equity investment in healthcare? 21:17 EP445 with Tom X. Lee, MD. 22:45 EP420 with Ge Bai, PhD, CPA. 22:47 EP465 with Chris Crawford. 22:49 EP460 with Rushika Fernandopulle, MD. 22:55 Is there ever a need for private investment in healthcare? 25:40 How do the changes private equity firms create affect patients? 27:20 Study in Health Affairs on physician turnover rates following private equity acquisitions. 29:30 How can private equity disrupt physician employment as well? 34:13 What remedies might there be for consolidation in healthcare and private equity investing in medicine?
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    41 m
  • EP473: Keeping Patients out of the ER: How Trusted Relationships in Primary Care Should Work. A Take 2 With Kenny Cole, MD
    Apr 24 2025
    This episode of Relentless Health Value features Dr. Kenny Cole from Ochsner Health System. The discussion emphasizes the critical role of trusted relationships and excellent primary care teams in keeping patients out of the emergency room, thus reducing healthcare costs. Stacey Richter revisits this conversation to highlight the importance of care teams building trust with patients and the concept of primary care as an investment in health and wellness. The episode outlines four key points for delivering great primary care, including accountability for outcomes, belief in clinical goals, standardized care flows, and building patient trust. Dr. Cole also discusses the real-world challenges and strategies for achieving clinical and financial success in primary care. The episode serves as a guide for plan sponsors, clinicians, and healthcare executives looking to improve primary care delivery and align it with financial viability. The discussion is further enriched with insights on digitizing care pathways and the importance of measuring and sharing best practices to achieve high standards of care.I Stacey revisits, in a take two, this episode with Dr. Kenny Cole because she's listening to it this time with a new focus. That focus is the theme that keeps coming up over and over and over again on Relentless Health Value these past few months. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP473 ✉️ 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=1 🎤 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/ 07:35 Is there an optimal care pathway where there might be a lot of treatment variability? 10:52 EP412 with Robert Pearl, MD. 12:32 Why is it important to start with the end in mind? 15:44 How do you scale clinical excellence? 18:18 EP315 with Bob Matthews. 19:12 EP242 with Marty Makary, MD. 21:29 Why is it important simply to demonstrate what’s possible for better health outcomes? 22:33 EP427 with Rik Renard. 23:18 How do we reinvent the business model of healthcare? 24:51 EP466 with Vivian Ho, PhD. 25:06 EP415 with Rob Andrews. 26:51 EP391 with Scott Conard, MD. 30:14 EP455 with Beau Raymond, MD. 34:22 Dr. Cole is published in various healthcare journals; check out his most recent article.
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    35 m
  • EP472: The Well-Honed, Three-Prong Hospital Playbook to Maximize Revenue From High-Cost Claimants, With Eric Bricker, MD
    Apr 17 2025

    In Episode 472, Stacey Richter speaks with Dr. Eric Bricker about the impactful strategies hospital systems use to maximize revenue from high-cost patients. They explore the financial complexities and contracting tactics that enable hospitals to profit significantly from a small percentage of high-cost claimants.

    Key points include the negotiation of provider stop-loss contract provisions, strategic adjustment of charge masters, and the intentional steerage of patients to high-revenue service lines. This episode highlights the intricacies of hospital finance and the hidden mechanisms that drive healthcare costs for self-insured employers and other plan sponsors.

    We could have 0.5% to 1% of total plan members costing upwards of 40% of total plan dollars. And I bring this up just to highlight the magnitude of the money here. In that show from last week, we take the issue of high-cost claimants from the standpoint of the plan sponsor.

    Today, however, we’re gonna be looking at this from the standpoint of the hospital system. If we were to come up with a motto for the show today with Dr. Eric Bricker, it’s that all costs are somebody else’s revenue. And when it’s revenue and profit of the magnitude that we’re talking about with many high-cost claimants, it starts to be less of an accidental “Oh, wow! How did that CABG patient wind up in our clinic? What are the odds?” and more of a “Whoever is not steering patients is letting someone else with a big profit incentive lock down that steerage in deeply embedded ways.”

    === LINKS ===
    🔗 Show Notes with all mentioned links:
    https://cc-lnk.com/EP472

    📺 Dr. Bricker's AhealthcareZ Channel
    www.youtube.com/@ahealthcarez

    ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter:
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    05:06 From a hospital revenue perspective, where do high-cost claimants fall?

    08:45 How do hospitals structure their stop-loss provisions so that they ensure they’re always maximizing their revenue?

    12:15 How hospitals acquire providers to steer as many patients as possible through specific service lines.

    20:21 Why do carriers let hospitals get away with these rates and stop-loss negotiations?

    21:06 How do Medicare Advantage and Medicare rates play into all of this?

    22:00 What should a benefit consultant be doing here?

    23:37 What are the keys to direct contracting?

    27:21 Why is it important to get trusted relationships set up ahead of time?

    28:04 The Company That Solved Health Care by John Torinus Jr.

    29:23 What needs to be the clinical consideration for specialists?

    30:46 What is the advantage that employers have in all of this?

    33:06 Dr. Bricker’s video on 32 examples of healthcare deception.

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    35 m
  • EP471: High-Cost Claimants in 2025 and Beyond—What Is Really Expensive Not to Know? With Christine Hale, MD, MBA
    Apr 10 2025
    Recently on Relentless Health Value, we’ve been tinkering around with a few recurring themes—recurring through lines—that are just true about American healthcare these days. In this episode of Relentless Health Value, host Stacey Richter speaks with Dr. Christine Hale about high cost claimants and the implications for healthcare plans in 2025 and beyond. They discuss the importance of trust in patient care, the financial incentives behind patient steering, and the critical role of timely and comprehensive data analysis. Dr. Hale emphasizes the need for an integrated approach to medical and pharmacy claims data to avoid expensive consequences and improve patient outcomes. She also shares strategies for plan sponsors to effectively manage high cost claimants through evidence-based care, appropriate treatment settings, and creative problem-solving, while underlining the importance of patient engagement and satisfaction. Don't miss next week's episode with Dr. Eric Bricker for a deeper dive into these topics. === LINKS === 🔗 Show Notes with all mentioned links: https://relentlesshealthvalue.com/episodes ✉️ 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=1 🎤 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/ 05:22 What is a high-cost claimant, and how is the definition changing? 07:42 Why buy-and-bill pharmaceuticals can be so costly for plan sponsors. 10:19 What are plan sponsors getting wrong about this situation? 11:28 What do you need as an employer to understand your plan data fully? 13:41 EP462 with Scott Conard, MD. 17:35 What are plan sponsors currently doing that they should not being doing? 19:54 Why starting small is important. 23:02 EP468 with Matt McQuide. 25:37 What are the steps employers should take to improve their high-cost claimant spend? 31:02 EP371 with Erik Davis and Autumn Yongchu. 33:46 EP467 with Stacey. Recent past interviews: Click a guest’s name for their latest RHV episode! Nikki King, James Gelfand (Part 2), James Gelfand (Part 1), Matt McQuide, Stacey Richter (EP467), Vivian Ho, Chris Crawford (EP465), Al Lewis, Betsy Seals, Wendell Potter (Encore! EP384), Dr Scott Conard
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    35 m
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