Relentless Health Value

Exploring TPA and Health Plan Inertia with Elizabeth Mitchell: What Plan Sponsors Need to Know. In this Take 2 of episode 436 of Relentless Health Value, host Stacey Richter speaks with Elizabeth Mitchell, President and CEO of the Purchaser Business Group on Health, about the challenges third-party administrators (TPAs) face, the issues around hidden fees, and the problems with health plan inertia.  They discuss how self-insured employers can find reliable TPA partners, the impact of anti-competitive contracts, and the importance of transparency in healthcare procurement. Mitchell emphasizes the need for direct contracting between employers and providers to reduce costs and improve quality.  The episode covers the implications of the Consolidated Appropriations Act, the role of brokers, and how employers can achieve better value for their healthcare spend. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP436-Take2 ✉️  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/ 08:06 What is the overarching context for health plans in healthcare purchasing? 11:31 Why is it important to reestablish a connection between the people paying for care and people providing care? 13:47 What are the needs of a self-insured employer when managing employee benefits? 19:00 Is it doable for employers to set their own contracts? 21:24 Is transparency presumed? 22:39 Will the new transparency upon us actually expose wasted expense? 24:23 EP408 [https://relentlesshealthvalue.com/episode/ep408-whos-suing-who-an-overview-of-healthcare-legal-goings-on-with-chris-deacon] with Chris Deacon. 25:58 “This is not about individual bad actors. … The systems … that is not aligned.” 27:39 Are there providers who want to work directly with employers? 30:53 Why is it important that incentives need to be aligned? 32:42 EP427 [https://relentlesshealthvalue.com/episode/ep427-how-do-digital-health-vendors-deliver-patient-outcomes-and-experiences-with-rik-renard] with Rik Renard. 33:51 What’s missing from the conversation on changing health plans?

In Episode 484 of Relentless Health Value, host Stacey Richter talks with Dave Chase from Health Rosetta about the three most pressing questions faced by self-insured employers today.  The discussion covers how to verify if a benefits advisor truly protects employer interests, avoiding personal liability when third-party administrator contracts have hidden conflicts, and identifying if employers are being systematically overcharged on pharmacy costs despite PBM guarantees.  The episode emphasizes the importance of accessing comprehensive data to identify conflicts and transparency in reporting, and it highlights open source resources available to create high-performance health plans. The conversation also mentions noteworthy related episodes and cases to provide further context and insights. === 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/ 06:36 What questions does a plan sponsor need to ask their consultant, EBC, or broker to ensure they are protecting the interest of the plan sponsor? 07:59 EP478 [https://relentlesshealthvalue.com/episode/ep478-stop-loss-coverage-part-1-how-it-goes-right-and-how-it-can-go-horribly-wrong-with-andreas-mang-and-jon-camire] with Andreas Mang and Jon Camire. 08:49 EP453 [https://relentlesshealthvalue.com/episode/ep453-running-a-tpa-third-party-administrator-rfp-process-that-is-less-of-a-wild-west-fiduciary-shootout-with-claire-brockbank] with Claire Brockbank. 09:51 EP433 [https://relentlesshealthvalue.com/episode/take-two-ep433-the-mystery-of-the-weekly-claims-wire-with-justin-leader] with Justin Leader. 09:53 EP436 [https://relentlesshealthvalue.com/episode/ep436-lets-talk-about-tpa-and-health-plan-inertia-instead-of-jumbo-employer-inertia-with-elizabeth-mitchell] with Elizabeth Mitchell. 11:03 How can plan sponsors avoid personal liability when their TPA has hidden conflicts of interest? 11:40 Tiara Yachts v. Blue Cross Blue Shield of Michigan lawsuit [https://law.justia.com/cases/federal/appellate-courts/ca6/24-1223/24-1223-2025-05-21.html]. 13:48 EP483 (Part 1) [https://relentlesshealthvalue.com/episode/ep483-part-1-to-contain-skyrocketing-healthcare-costs-or-renewals-you-gotta-understand-how-the-flywheel-works-with-jonathan-baran] with Jonathan Baran. 14:18 EP457 [https://relentlesshealthvalue.com/episode/ep457-its-a-big-thing-medical-spread-pricing-so-lets-talk-about-contract-transparency-with-cynthia-fisher] with Cynthia Fisher. 16:18 The Marshall-Hickenlooper bill called the Price Tags Act [https://www.hickenlooper.senate.gov/press_releases/hickenlooper-marshall-introduce-bipartisan-bill-to-make-health-care-costs-transparent/]. 16:50 Summer Short [https://relentlesshealthvalue.com/episode/the-euphemism-that-has-become-value-based-care-with-elizabeth-mitchell-summer-shorts-9] with Elizabeth Mitchell. 17:36 How do plan sponsors figure out if they are being overcharged for pharmacy benefits? 18:09 EP365 [https://relentlesshealthvalue.com/episode/encore-ep365-the-real-deal-with-pbm-contracts-and-drug-rebates-with-scott-haas] with Scott Haas. 20:18 EP397 [https://relentlesshealthvalue.com/episode/encore-ep397-the-minefield-that-is-a-pbm-contract-and-also-some-advice-for-ebcs-who-are-taking-money-under-the-table-with-paul-holmes] with Paul Holmes. 20:22 EP465 [https://relentlesshealthvalue.com/episode/ep465-the-not-super-effective-contracting-industry-norm-where-jumbo-plans-and-others-wind-up-paying-10000-for-50-drugs-with-chris-crawford] with Chris Crawford. 20:37 EP429 [https://relentlesshealthvalue.com/episode/ep429-following-the-dollar-through-pharmacy-acronyms-like-wac-awp-and-nadac-with-luke-slindee-pharmd] with Luke Slindee, PharmD. 22:56 EP476 [https://relentlesshealthvalue.com/episode/ep476-talking-whistleblowing-and-the-pharma-rebates-whistleblower-case-with-an-actual-whistleblower-with-ann-lewandowski] with Ann Lewandowski. 28:38 Where to find open-source resources to help guide plan sponsors with making better health plan decisions. 29:47 How the open-source trend is growing for health transparency. 30:48 What to look forward to at RosettaFest.

In the second part of this conversation with Jonathan Baran, CEO of Self Fund Health, the focus is on reversing the negative cycle of skyrocketing healthcare costs by shifting from buying discounts to investing in primary care and better benefit designs.  The discussion highlights the current issues with the healthcare flywheel, driven by employers buying discounts, and offers solutions such as investing in direct primary care, incentivizing proper healthcare utilization, and improving patient navigation.  The conversation also explores the potential for direct contracting between employers and health systems, aiming for a paradigm shift where employers, brokers, and health plans work collaboratively to improve member health and reduce costs. === 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/ 05:23 Where to start in reversing the flywheel. 06:57 Why investing in primary care is pivotal to containing healthcare costs. 10:02 EP453 [https://relentlesshealthvalue.com/episode/ep453-running-a-tpa-third-party-administrator-rfp-process-that-is-less-of-a-wild-west-fiduciary-shootout-with-claire-brockbank] with Claire Brockbank. 10:04 EP452 [https://relentlesshealthvalue.com/episode/ep452-fiduciary-duty-vs-the-healthcare-status-quo-with-cora-opsahl] with Cora Opsahl. 10:07 EP457 [https://relentlesshealthvalue.com/episode/ep457-its-a-big-thing-medical-spread-pricing-so-lets-talk-about-contract-transparency-with-cynthia-fisher] with Cynthia Fisher. 10:12 EP365 [https://relentlesshealthvalue.com/episode/encore-ep365-the-real-deal-with-pbm-contracts-and-drug-rebates-with-scott-haas] with Scott Haas. 10:13 EP465 [https://relentlesshealthvalue.com/episode/ep465-the-not-super-effective-contracting-industry-norm-where-jumbo-plans-and-others-wind-up-paying-10000-for-50-drugs-with-chris-crawford] with Chris Crawford. 10:14 EP475 [https://relentlesshealthvalue.com/episode/ep475-is-this-a-moment-or-a-movement-with-peter-hayes] with Peter Hayes. 11:11 EP468 [https://relentlesshealthvalue.com/episode/ep468-very-common-assumptions-that-arent-actually-true-about-member-engagement-and-the-healthcare-industry-with-matt-mcquide] with Matt McQuide. 11:13 EP472 [https://relentlesshealthvalue.com/episode/ep472-the-well-honed-three-prong-hospital-playbook-to-maximize-revenue-from-high-cost-claimants-with-eric-bricker-md] with Eric Bricker, MD. 12:14 “The most expensive thing in healthcare is the pen of the primary care doctor.” 13:04 How the role of the broker has to fundamentally change. 16:16 What will the single most challenging aspect of this restructuring become? 20:20 How self-funded employers can be amazing customers in containing the rising cost flywheel in healthcare. 22:56 How do EHRs and other medical record systems play into reversing the flywheel of rising healthcare costs? 23:57 Ramy Khalil, MD’s post [https://www.linkedin.com/posts/ramy-khalil-md_clinicalinformatics-healthit-interoperability-activity-7323656628409397248-5l43/] on interoperability. 24:59 Why is it important for employers to drive volume differently? 25:38 How Self Fund Health is helping in this regard.

In this episode Stacey Richter speaks with Jonathan Baran, CEO of Self Fund Health in a detailed exploration of what they term the 'Flywheel Downward Spiral' of American healthcare costs. The conversation delves into how electronic health records (EHR) and the incentives driving insurers, brokers, and hospital systems contribute to consistently rising healthcare premiums.  Key points include how insurers profit from high premiums, the misleading marketing focus on discounts rather than actual costs, and the role of EHR systems in maximizing hospital profits rather than improving patient care. The episode sets the stage for a subsequent discussion on reversing these trends, aiming to align healthcare outcomes with cost reductions. Self Fund Health, I am so pleased to tell you, as I am always so pleased to tell you, did make such a kind offer to help out Relentless Health Value financially. You and the tribe here are really, really great folks who I truly appreciate. Please support Self Fund Health if you are in Wisconsin. This episode is sponsored by Self Fund Health. === LINKS === 🔗  Self Fund Health: https://selffundhealth.com [https://selffundhealth.com] 🔗  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/ 08:46 Entering the health system “flywheel” at the renewal phase. 09:46 What goes on in the renewal season that contributes to the health system “flywheel”? 12:28 Why is the standard 9% increase in healthcare costs during renewal season actually problematic? 13:22 How does the purchase of discounts contribute to the skyrocketing cost of healthcare and distract from discussing the actually underlying cost of healthcare? 16:07 EP465 [https://relentlesshealthvalue.com/episode/ep465-the-not-super-effective-contracting-industry-norm-where-jumbo-plans-and-others-wind-up-paying-10000-for-50-drugs-with-chris-crawford] with Chris Crawford. 17:01 Why do employers need to learn to buy healthcare and not insurance? 20:32 Rina Tikia’s post [https://www.linkedin.com/feed/update/urn:li:activity:7336421474179715072?commentUrn=urn%3Ali%3Acomment%3A%28activity%3A7336421474179715072%2C7336826305222455296%29&dashCommentUrn=urn%3Ali%3Afsd_comment%3A%287336826305222455296%2Curn%3Ali%3Aactivity%3A7336421474179715072%29] on self-funded plans. 23:18 Why are hospital executives incentivized to buy and own all of the primary care in a market? 26:35 How big electronic medical record systems play into this increase in healthcare costs. 28:27 Acquired podcast [https://www.acquired.fm/episodes/epic-systems-mychart] on one EHR system. 31:09 What needs to happen to reverse this flywheel of increasing healthcare costs?

In this bonus clip from Episode 483 of Relentless Health Value, host Stacey Richter discusses the efforts of individuals working within large healthcare organizations to improve patient outcomes despite systemic challenges.  Guest Jonathan Baran, co-founder and CEO of Self Fund Health, highlights how incentives within the healthcare system drive behaviors that often conflict with patient and member interests.  The discussion emphasizes the importance of not generalizing the intentions of all employees based on organizational actions and encourages a deeper understanding of underlying incentive structures to foster meaningful changes.  Self Fund Health, I am so pleased to tell you, as I am always so pleased to tell you, did make such a kind offer to help out Relentless Health Value financially. You and the tribe here are really, really great folks who I truly appreciate. Please support Self Fund Health if you are in Wisconsin. This episode is sponsored by Self Fund Health. === LINKS === 🔗  Self Fund Health:   https://selffundhealth.com [https://selffundhealth.com] 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP483-BONUS ✉️  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/ 03:11 A brief background on Jonathan and Self Fund Health. 04:24 Why is it imperative that individuals stop identifying wholly with the organization that they work with? 05:48 Why is it important to be direct and call out the behavior without calling out the individual? 07:14 EP483 (Part 1) [https://cc-lnk.com/EP483-Part1] with Jonathan Baran.