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
  • EP460: Rushika Fernandopulle, MD’s Theory of Change Starts With Status Quo Healthcare

    EP460: Rushika Fernandopulle, MD’s Theory of Change Starts With Status Quo Healthcare
    Jan 9 2025
    In this Relentless Health Value episode, Dr. Rushika Fernandopulle discusses with Stacey Richter his four-prong theory of change for transforming the American healthcare system. Key topics include the necessity of new payment models, process innovation, employing a relational technology infrastructure, shifting the cultural mindset towards team-based care, and emphasizing the importance of long-term partnerships. The conversation underscores the urgent need to move away from the current status quo to ensure better health outcomes and affordable care for all Americans. This is one of those episodes where we consider top-line strategic imperatives and key drivers. There was no better person to do this with than Rushika Fernandopulle, MD, who, in case you were unaware, was the founder of Iora Health, an advanced primary care group that was sold to One Medical and then to Amazon. They discusses his four-prong theory and as Stacey says, "I can’t leave well enough alone, so I plucked one more prong from our conversation and stuck it on the end." For a summary of this 5 prong approach, visit the show notes page where we also list all of the links mentioned in the episode. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP460 ✉️ 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/ ✭ X https://twitter.com/relentleshealth/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social 06:39 How Dr. Rushika Fernandopulle found himself where he is now. 08:06 Dr. Fernandopulle’s conversation with Kenny Cole, MD. 10:33 Why is it important to have new payment models? 12:21 EP453 with Claire Brockbank. 14:50 EP455 with Beau Raymond, MD. 16:19 Why it makes sense to change as quickly as possible. 19:55 How to be proactive and not be reactive and achieve value-based reimbursement for good care. 21:41 Why team-based care is so important for change. 23:37 Why is it important to have a different set of technology tools? 24:38 EP391 with Scott Conard, MD. 25:24 Why changing the culture is important. 27:01 “Getting doctors to do things they don’t like is a waste of time.” 33:22 “Healthcare is local.” 35:31 EP364 with David Muhlestein, PhD, JD. 35:43 Study by Zack Cooper, PhD. 36:53 EP404 with Suhas Gondi, MD, MBA. 39:04 Why long-term partnerships are the only way to make things better.
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    41 mins
  • EP459: Cost Containment by Co-Pay Maximizer or Co-Pay Accumulator: Points to Ponder, With Bill Sarraille

    EP459: Cost Containment by Co-Pay Maximizer or Co-Pay Accumulator: Points to Ponder, With Bill Sarraille
    Jan 2 2025

    In Episode 459, host Stacey Richter speaks with healthcare attorney Bill Sarraille about co-pay maximizers and accumulators, mechanisms designed to extract maximum co-pay support dollars from pharmaceutical companies.

    They discuss the financial implications for patients, plan sponsors, and pharmacy benefit managers (PBMs), emphasizing the legal and ethical issues and potential patient harm due to high out-of-pocket costs and surprise expenses.

    Sarraille provides five key pieces of advice for plan sponsors and highlights the importance of transparency and proper utilization management to minimize patient access problems and legal risks. Listen or read the show notes on our site for the full list.

    (continued below the links)

    === LINKS ===

    🔗 Show Notes with all mentioned links:
    https://cc-lnk.com/EP459

    ✉️ 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

    ===CONNECT WITH THE RHV TEAM ===

    ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/

    ✭ Threads https://www.threads.net/@relentlesshealthvalue/

    ✭ X https://twitter.com/relentleshealth/

    ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social

    Co-pay maximizers and accumulators are programs designed to capture maximum co-pay assistance from phara. Maximizers spread pharma co-pay support evenly throughout the year, ensuring plan sponsors benefit while, in theory, patients face minimal costs. More on how that can go wrong in the episode.

    Accumulators, however, design their plan to deplete pharma dollar support quickly, surprising patients with significant out-of-pocket expenses mid-year when they go visit the pharmacy.

    These programs usually exclude pharma assistance dollars from deductibles, potentially causing financial hardship because when pharma is paying your co-pay, those payments don't count against your deductible.

    09:31 What should plan sponsors be aware of right now?

    14:01 What is the justification for maximizers, and why is this at odds with the purpose of insurance?

    18:05 Where does the issue of “fairness” land within cost containment?

    20:00 Brian Reid’s LinkedIn post on insurance company access challenges.

    21:30 What are the real legal issues presented by some of these co-pay maximizers and co-pay accumulator programs?

    27:06 How are these programs creating perverse incentives?

    29:28 EP450 with Marilyn Bartlett, CPA, CGMA, CMA, CFM.

    32:16 “If you’re covered by the ACA, I think this is unlawful.”

    32:57 What advice does Bill have in regard to these programs?

    33:49 What potential litigations does Bill see coming in the near future in regard to these co-pay maximizers and co-pay accumulator programs?
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    40 mins
  • INBW41: End-of-Year Wrap-Up and My Personal Charter Encore: Where the Rubber Hits the Road

    INBW41: End-of-Year Wrap-Up and My Personal Charter Encore: Where the Rubber Hits the Road
    Dec 26 2024

    In this Inbetweenisode titled 'End of Year Wrap Up and My Personal Charter Encore,' Stacey Richter extends heartfelt thanks to listeners and healthcare workers for their dedication.

    She reflects on the challenges of maintaining personal integrity in a profit-driven healthcare system and introduces her personal charter. This charter, focused on ensuring net positive outcomes for patients, acknowledges that achieving transformational change in healthcare requires a collective effort.

    Stacey discusses the complexities of balancing ethical decisions, financial constraints, and the broader impact on patient care, urging others to reflect on their own guiding principles.

    Here's her manifesto which she is now calling her Personal Charter below which she breaks down in this podcast episode:

    "If the thing results in a net positive for patients, then I will do it. The timeframe is short-term or medium-term. And the assumption is that it will take a village and I am not alone in my efforts to transform healthcare or do right by patients."

    === LINKS ===

    🔗 Show Notes with all mentioned links: https://cc-lnk.com/INBW41

    ✉️ 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

    === CONNECT WITH THE RHV TEAM ===

    ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/
    ✭ Threads https://www.threads.net/@relentlesshealthvalue/
    ✭ X https://twitter.com/relentleshealth/
    ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social

    06:52 “It’s a zero-sum game.”

    07:02 Is the amount of profit fair?

    07:13 What is an inescapable fact of the healthcare industry?

    07:30 What does the financialization of healthcare mean?

    07:55 Why does the self-interest in healthcare matter?

    09:54 “It’s basically up to us as individuals to do the right thing.”

    13:39 What is the first part of Stacey’s personal charter?

    13:54 How does Stacey calculate the net positive of an impact?

    14:17 What are two major upsides/downsides that Stacey contemplates?

    17:08 Why are incremental change and disruptive change not mutually exclusive?

    21:16 “I always try to keep in mind that it will take a village.”

    22:55 Why finger pointing is killing innovation in healthcare.
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    26 mins

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