Cash Pay From the Pharma Manufacturer Point of View, With Ophelia Johnson
In this episode, host Stacey Richter and pharma veteran Ophelia Johnson explore cash‑pay (self‑pay) models from the perspective of pharmaceutical manufacturers, especially in the booming GLP‑1 market. They explain how legislative pressures, PBM reforms, and low formulary approval rates have driven manufacturers to offer direct discounts via coupons, telehealth channels, and other bypass routes, and they break down the complex money flow behind GoodRx‑style coupons and pharmacy reimbursements. Johnson highlights the operational challenges of managing new channel partners, gross‑to‑net calculations, and ensuring pharmacies are made whole, while also noting the potential for transparent, fixed‑fee pricing. The conversation offers practical insights for pharma executives looking to build cash‑pay channels without jeopardizing profitability.
EP515: SNF (Skilled Nursing Facility) Fraud—Or Is It Fraud? With Michelle Cera, PhD
In this episode, host Stacey Richter talks with investigative reporter Michelle Serra of Hunterbrook Media about their latest deep‑dive into skilled nursing facilities (SNFs) and the systemic under‑staffing that turns Medicare reimbursements into profit. The investigation reveals that large SNF...
EP513: Revisiting Cunning Anticompetitive Hospital Contracts, With Brennan Bilberry
In this episode, host Stacey Richter talks with Brennan Bilberry, a founding partner at Fairmark Partners, about the anti‑competitive tactics hospitals use after consolidating, such as "all‑or‑nothing" contracting, anti‑steering clauses, and leveraging rural monopoly facilities to force higher prices across...
EP511: The Tension When Clinical Teams Take On Risk for Policymakers and Others Looking to Rustle Up Future Perverse Incentives,...
In this episode, Dr. Siva and Dr. Monica Lypson discuss the perverse incentives created when clinical teams assume financial risk in value‑based contracts, especially around upcoding, downcoding, and the resulting cherry‑picking or "lemon‑dropping" of patients. They argue that without transparent,...
EP510: The Impact on You of Medicare Advantage Goings-On (2026 Edition), With Betsy Seals
In this episode, host Stacey Richter talks with Medicare Advantage expert Betsy Seals about the current stabilization phase of the MA market, highlighting profit versus profiteering, cost‑shifting to commercial employers, and the impact of vertical integration on provider payments. Seals...
EP506: How Other Employers, Shareholders, and Clinics Are Using Price Transparency Data—And It's an Arms Race, With Jerry DiMaso
In this episode, Stacey Richter talks with Jerry DeMasso, CEO of Payerset, about how price‑transparency data is reshaping the healthcare market for self‑insured employers, plan sponsors, and clinical organizations. DeMasso explains three key insights employers can gain: benchmarking against competitors,...
Insights to Outwit the Hot Mess of the Non-Healthcare Market
In this in‑between episode, host Stacey reflects on listener feedback and highlights LinkedIn posts from community members Ken Woosina and Michelle Burnaby, emphasizing that better healthcare decisions stem from transparent, actionable insights rather than theory. She discusses how transparency data,...
EP503: Let's Go From Lazy PPO Networks to Smart Collaboration With Direct-to-Employer Specialty Care, With Ryan Wells; Leo Spector, MD,...
In this episode, host Stacey Richter talks with Ryan Wells (founder of Health Here), Dr. Leo Spector (CEO of OrthoCarolina), and Adam Stavisky (benefits consultant) about the need for direct, data‑driven collaboration between self‑insured employers and specialty physicians. They explore...
Take Two: EP398: Why Are Commercial Carrier Marketplaces Completely Boring? Maybe Because There Isn't a Marketplace, With Jacob Asher, MD
In this episode of the "No Market" series, host Stacey Richter talks with Dr. Jacob Asher, a former chief medical officer for major health plans, about why commercial carrier marketplaces—especially in California—are stagnant and lack true competition. They identify six...
EP500: This Is Episode 500, and It's All About You, Tribe
In episode 500 of the Relentless Health Value podcast, host Stacey Richter celebrates the community of healthcare entrepreneurs, executives, and change‑makers she calls the "tribe," highlighting how the show has moved listeners from theory to real‑world transformation. Listener clips illustrate...