Relentless Health Value Podcast

If you want to understand why hospital prices are climbing, look at the hospital boards. Board decisions drive executive incentives → Those incentives drive pricing strategies → Those pricing strategies determine what patients and employers pay. And the numbers don’t lie: 🏥 Hospital costs have increased more than double the amount premiums have. 📈 Some “nonprofit” hospitals are boasting 15%+ EBITDA margins. 💰 Many major hospitals are charging way more than their costs justify. Not all hospitals are the same, but consolidated hospital networks are playing a major role in the healthcare affordability crisis. Want to dig deeper into how hospital boards influence pricing? Listen to this episode with Dr. Vivian Ho. 🔗https://cc-lnk.com/EP466 #HealthcareReform #HospitalPricing #HealthPolicy #RelentlessHealth Also mentioned in this #healthcarepodcast: Vivian Ho; Rice University's Baker Institute for Public Policy; Baker Institute Center for Health Policy; Suhas Gondi; Salpy Kanimian; Derek Jenkins; Byron Hugley; Michael Strain; Dave Chase, Health Rosetta-discovering archaeologist; Zack Cooper; Houston Business Coalition on Health (HBCH); Marilyn Bartlett; Cora Opsahl; Claire Brockbank; Shawn Gremminger; Autumn Yongchu; Erik Davis; Ge Bai; Community Health Choice; Mark Cuban; Ferrin Williams, PharmD MBA

Hospitals often claim their price hikes are due to rising costs—higher nurse salaries, expensive equipment, charity care, etc. 🚨 Spoiler alert: That’s NOT what’s happening. 📊 Hospital prices are skyrocketing, but their underlying costs are NOT rising at the same rate. In this episode, Dr. Vivian Ho explains how many major hospitals—especially consolidated ones—are structuring executive incentives in ways that prioritize revenue growth over affordability. One nonprofit hospital even bragged about a 15.1% EBITDA in 2024 at JP Morgan. Not exactly razor-thin margins. So what’s the real story behind rising premiums? And what role do hospital boards play in all of this? We dig deep into the data on this can’t-miss episode. 🔗https://cc-lnk.com/EP466 #HealthcareFinance #HospitalCosts #HealthInsurance #RelentlessHealth Also mentioned in this #healthcarepodcast: Vivian Ho; Rice University's Baker Institute for Public Policy; Baker Institute Center for Health Policy; Suhas Gondi; Salpy Kanimian; Derek Jenkins; Byron Hugley; Michael Strain; Dave Chase, Health Rosetta-discovering archaeologist; Zack Cooper; Houston Business Coalition on Health (HBCH); Marilyn Bartlett; Cora Opsahl; Claire Brockbank; Shawn Gremminger; Autumn Yongchu; Erik Davis; Ge Bai; Community Health Choice; Mark Cuban; Ferrin Williams, PharmD MBA

💰 Are your health insurance premiums rising faster than inflation? Yes. 💸 Are employees paying an even bigger portion of those rising premiums? Also yes. That’s the double whammy hitting employees right now—higher absolute costs AND a bigger slice of the burden. But why? What’s driving this relentless increase? The biggest culprit isn’t what you might think. It’s not new medical tech, pharma, or even administrative bloat. It’s hospital prices. Hospitals are charging way more—and their revenue from services has soared beyond inflation. In fact, hospital costs have gone up over double the amount that premiums have. We break it all down in this episode with Dr. Vivian Ho. If you care about healthcare costs (and let’s be honest—who doesn’t?), this one’s for you. 🔗https://cc-lnk.com/EP466 #HealthcareCosts #HealthInsurance #HospitalPrices #RelentlessHealth Also mentioned in this #healthcarepodcast: Vivian Ho; Rice University's Baker Institute for Public Policy; Baker Institute Center for Health Policy; Suhas Gondi; Salpy Kanimian; Derek Jenkins; Byron Hugley; Michael Strain; Dave Chase, Health Rosetta-discovering archaeologist; Zack Cooper; Houston Business Coalition on Health (HBCH); Marilyn Bartlett; Cora Opsahl; Claire Brockbank; Shawn Gremminger; Autumn Yongchu; Erik Davis; Ge Bai; Community Health Choice; Mark Cuban; Ferrin Williams, PharmD MBA

Your Employees Are Catching On… Are You? 🤯 Imagine this: ✅ A generic drug cost $7 five years ago. ✅ The insurance co-pay rose to $34 this year. ✅ The same drug on a cash-pay site? Still $7. Employees are figuring this out—and they’re frustrated. In this week’s Relentless Health Value, Chris Crawford and I expose how PBMs are profiting from this spread pricing game, and why plan sponsors need to rethink their approach before they lose employee trust and millions of dollars. Tune in to learn: 📉 Why pharmacy trend costs keep rising—when they shouldn’t 💰 How RxSaveCard clients cut 50% of total retail generic spend 🛠️ Actionable strategies to fix the system for your workforce Employers: Your employees are doing the math. It’s time for you to do it, too. Listen now! 🎙️👇 🔗 https://cc-lnk.com/EP465 #EmployerBenefits #PharmacyCosts #PBMReform #RelentlessHealthValue Also mentioned in this #healthcarepodcast: Chris Crawford; RxSaveCard; Mark Cuban Cost Plus Drug Company, PBC; Scott Haas; Paul Holmes; Luke Slindee, Pharm.D.; A. J. Loiacono; Robert Andrews; GoodRx; Ge Bai; Rob Marty, DBA, MHA

Remember Briar Rabbit? The tricky rabbit pretends to fear the briar patch—only to thrive when thrown in. Now, picture PBMs and the Aggregate Discount Guarantee. “Oh no! Whatever you do, don’t throw me into that Aggregate Discount Guarantee briar patch.” Sounds familiar? It should. Many plan sponsors think they're controlling costs with these PBM guarantees, but in reality, they’re playing right into the PBMs’ hands—paying massively inflated prices for generic drugs that cost a fraction in cash-pay models. This week on Relentless Health Value, Chris Crawford breaks down: 📌 The real impact of these so-called guarantees 📌 How plan sponsors end up paying way too much 📌 What employees are already doing to outsmart the system Don’t miss this one. It’s a must-listen for anyone involved in pharmacy benefits! 🎧👇 🔗 https://cc-lnk.com/EP465 #PBMs #PharmacySpending #CostTransparency #RelentlessHealthValue Also mentioned in this #healthcarepodcast: Chris Crawford; RxSaveCard; Mark Cuban Cost Plus Drug Company, PBC; Scott Haas; Paul Holmes; Luke Slindee, Pharm.D.; A. J. Loiacono; Robert Andrews; GoodRx; Ge Bai; Rob Marty, DBA, MHA

Ever heard of a $50 drug costing $10,000 through insurance? Sounds absurd, right? Yet, this exact scenario is at the center of a lawsuit involving J&J’s pharmacy benefits plan and a large PBM. In the latest Relentless Health Value episode, Chris Crawford and I dive into: ✅ Why large employers & plan sponsors unknowingly overpay ✅ The Aggregate Discount Guarantee – a fix that’s failing ✅ How employees are bypassing insurance & saving big The bottom line? The way PBMs structure pricing is driving up costs, even as cheaper options exist in plain sight. If you're responsible for pharmacy benefits or just curious about how we can fix this broken system, tune in! 🎧👇 🔗https://cc-lnk.com/EP465 #HealthcareCosts #PharmacyBenefits #PBMs #RelentlessHealthValue Also mentioned in this #healthcarepodcast: Chris Crawford; RxSaveCard; Mark Cuban Cost Plus Drug Company, PBC; Scott Haas; Paul Holmes; Luke Slindee, Pharm.D.; A. J. Loiacono; Robert Andrews; GoodRx; Ge Bai; Rob Marty, DBA, MHA

Employers and plan sponsors are getting hit hard with rising ER costs. But you’re not powerless. On this week’s Relentless Health Value, Al Lewis shares three ways to fight back against out-of-control ER charges: 1️⃣ Support employees suing for egregious hospital bills. You’re on the same side—help them fight unfair charges. 2️⃣ Educate employees on consent forms. Many people unknowingly sign away protections against surprise billing. 3️⃣ Be proactive about negotiating ER rates. Don’t just accept the charges—there are ways to push back. With ER volume rising and coding practices driving costs up, now is the time for employers to take action. 💡 Want the full breakdown from Al? Listen to the episode here: https://cc-lnk.com/EP464 #EmployeeBenefits #ERBilling #HealthcareNegotiation #PlanSponsors #CostContainment Also mentioned in this #healthcarepodcast: Al Lewis 🇺🇦; Quizzify; Brian Cotter; John Lee; J. Michael Connors MD; Robert Andrews; Vivian Ho

Primary care is the front line of healthcare. But when it’s underfunded and under-resourced, where do patients go? The ER. 💡 A powerful insight from this week’s Relentless Health Value podcast with Al Lewis: The biggest driver of rising ER costs isn’t just more patients—it’s fewer alternatives. 🔹 Many primary care offices lack resources like X-rays, labs, or mental health support. 🔹 Patients often can’t get timely appointments, leading them to the ER instead. 🔹 ERs end up handling weeks’ worth of diagnostic work in a single visit. And here’s the kicker: The fee-for-service system rewards this model—there’s no financial incentive to keep patients out of the ER. How do we fix this? Al Lewis shares insights on what plan sponsors can do to mitigate rising ER costs and advocate for employees. 💡 If you’re responsible for managing healthcare spend, this episode is a must-listen. 🎧 https://cc-lnk.com/EP464 #HealthCareSpending #PrimaryCare #ERCosts #HealthBenefits #EmployerHealth Also mentioned in this #healthcarepodcast: Al Lewis 🇺🇦; Quizzify; Brian Cotter; John Lee; J. Michael Connors MD; Robert Andrews; Vivian Ho

🚨 6% of total plan spend is now going to ER visits. That’s a huge number. On the latest episode of Relentless Health Value, Al Lewis discusses why ER costs are skyrocketing. Here’s what we unpack: 🔹 More people are going to the ER. 🔹 The average cost per visit has increased 15% in 2023. 🔹 ER coding is shifting towards higher-intensity levels. 🔹 Plan sponsors struggle to negotiate ER rates. A key question we tackle: Are ER visits being upcoded, or are patients actually sicker? 🤔 Al and I break down the data, revealing that while upcoding is happening, hospital admissions aren’t rising alongside these higher-acuity codes. In other words—billing practices, not patient severity, may be driving costs up. Want to know what employers and plan sponsors can do about it? 🎧 Tune in to the full conversation here: https://cc-lnk.com/EP464 #HealthcareCosts #EmergencyRoom #Upcoding #HealthBenefits #PlanSponsors Also mentioned in this #healthcarepodcast: Al Lewis 🇺🇦; Quizzify; Brian Cotter; John Lee; J. Michael Connors MD; Robert Andrews; Vivian Ho

💡 3 Key Takeaways from Betsy Seals on Medicare Advantage 💡 In a shifting policy landscape, staying ahead isn’t optional—it’s critical. On this week’s Relentless Health Value episode, Betsy Seals shares three must-know strategies for anyone in the Medicare Advantage space: 📊 1. Know what’s really happening on the ground. If you’re making policy decisions but don’t have a pulse on real patient experiences, you might be missing key warning signs. ⚖️ 2. Compliance isn’t just about rules—it’s about impact. Oversight on AI, risk adjustment, and broker marketing is intensifying. Being proactive ensures compliance AND better outcomes. 📈 3. Use data wisely. The future belongs to those who can leverage insights to predict trends and act before issues explode. As Betsy shares, “Value to the patient” should always be the North Star. And with new policies rolling out, understanding the stay-or-go landscape has never been more important. 🎧 Don’t miss this episode: https://cc-lnk.com/EP463 #HealthcareStrategy #MedicareAdvantage #ValueBasedCare #Leadership Also mentioned in this #healthcarepodcast: Betsy Seals, Alerion Advisors, Samantha George, Ann Kempski, Rebellis Group, Vivian Ho