Podcast appearances and mentions of Chris Crawford

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 ===

All LA teams are out of the postseason across the NBA and NHL. You hate to see it. The Mariners keep winning, apparently against all odds. While we might have issues with the team's ownership, it shouldn't take away from enjoying how well the team is playing right now. Mollywhop Monday! Chris Crawford and Nathan Bishop help us make sense of why the Mariners are playing so well right now. We keep asking if the offense is sustainable - is it? The AL West is looking bad and the guys tell us how we can measure the M's success in a weak division. We have a touch of breaking news, and finally we celebrate a new endeavor for Chris and Anders. We continue with Chris and Nathan and get an update on George Kirby. Plus, how can we evaluate Julio Rodriguez at this point? Seahawks rookie minicamp took place over the weekend and we hear from head coach Mike Macdonald for his first evaluation of the new rookie draft picks and undrafted free agent signings. Ian tells us what we can learn in a short time so far. It's quite interesting to think about how the Seahawks might use Jalen Milroe. We check in on the text line and finally, crosstalk with Softy.

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 ===

From a bedroom coder to Game Developer's Conference OG to the creator of one of the greatest one-on-one action strategy games of the 8 bit era, Jeff Johannigman worked for some of the most legendary companies of the 80s, Epyx, Electronic Arts, and Origin.   In Part 1, we talk about those early days, including the making of games such as G.I. Joe and Savage Empire and working with important figures like Ihor Wolosenko, Dani Bunten, Chris Crawford, Warren Spector, and Richard Garriot. Jeff's insight and storytelling skill make this a wonderful chat. Recorded: September 2024 Video version: https://www.patreon.com/posts/jeff-johannigman-125624209 Get us on your mobile device: Android: https://www.google.com/podcasts?feed=aHR0cHM6Ly92aWRlb2dhbWVuZXdzcm9vbXRpbWVtYWNoaW5lLmxpYnN5bi5jb20vcnNz iOS: https://podcasts.apple.com/de/podcast/video-game-newsroom-time-machine And if you like what we are doing here at the podcast, don't forget to like us on your podcasting app of choice, YouTube, and/or support us on patreon! https://www.patreon.com/VGNRTM Send comments on  Mastodon @videogamenewsroomtimemachine@oldbytes.space Or twitter @videogamenewsr2 Or Instagram https://www.instagram.com/vgnrtm Or https://bsky.app/profile/vgnrtm.bsky.social Or videogamenewsroomtimemachine@gmail.com Links: https://www.linkedin.com/in/johannigman/ https://en.wikipedia.org/wiki/Atari_Program_Exchange https://www.mobygames.com/person/2821/jeff-johannigman/credits/ https://www.mobygames.com/company/14/br%C3%B8derbund-software-inc/ Jerry Wolosenko - Synapse - https://www.patreon.com/posts/42014024 The Video Game Crash 40th Anniversary - Part 2: Everyone Else - https://www.patreon.com/posts/video-game-crash-76259421 The Video Game Crash 40th Anniversary - Part 1: Atari - https://www.patreon.com/posts/video-game-crash-75643983 https://en.wikipedia.org/wiki/Relax_(video_game) https://en.wikipedia.org/wiki/Epyx Michael Katz Part 1 - Coleco - Epyx - Mattel - https://www.patreon.com/posts/35169258 https://www.mobygames.com/game/10151/gi-joe-a-real-american-hero/ https://en.wikipedia.org/wiki/Barbie_(1984_video_game) https://www.gamesthatwerent.com/2013/07/g-i-joe-c64-early-glimpse/ https://www.mobygames.com/person/962/dennis-caswell/ https://www.mobygames.com/game/115/starflight/ Don Daglow Part 1 - PDP - Mattel - Intellivision - EA https://www.patreon.com/posts/38445119 https://www.mobygames.com/game/1353/demon-stalkers/ https://www.mobygames.com/person/8515/danielle-berry/ https://boardgamegeek.com/boardgame/182619/mule-the-board-game https://www.reddit.com/r/amiga/comments/pbj1qp/why_electronic_arts_is_committed_to_the_amiga_1985/?rdt=32890 https://www.mobygames.com/game/company:2/platform:genesis/sort:-date/page:1/ https://www.mobygames.com/game/1837/gauntlet/screenshots/macintosh/ https://www.mobygames.com/game/1837/gauntlet/screenshots/macintosh/586818/ https://www.mobygames.com/person/127/warren-spector/ https://www.wcnews.com/wcpedia/Blueprints https://www.mobygames.com/game/823/wing-commander-ii-vengeance-of-the-kilrathi/ https://wiki.ultimacodex.com/wiki/File:Savage_empire_large.jpg https://gdconf.com/about-gdc  Recommended Links: The History of How We Play: https://thehistoryofhowweplay.wordpress.com/ Gaming Alexandria: https://www.gamingalexandria.com/wp/ They Create Worlds: https://tcwpodcast.podbean.com/ Digital Antiquarian: https://www.filfre.net/ The Arcade Blogger: https://arcadeblogger.com/ Retro Asylum: http://retroasylum.com/category/all-posts/ Retro Game Squad: http://retrogamesquad.libsyn.com/ Playthrough Podcast: https://playthroughpod.com/ Retromags.com: https://www.retromags.com/ Games That Weren't - https://www.gamesthatwerent.com/ Copyright Karl Kuras

The draft is in the books and the Seahawks got quite a haul. Ian reflects on the picks.   MollyWhop Monday! Chris Crawford and Nathan Bishop join Ian to talk about the Mariners SIX straight series wins, Jorge Polanco as the AL player of the week and Seattle playing fun baseball. The bottom half of the lineup has been outperforming and JP Crawford deserves a ton of credit.   The Daily Power Play!   Nick Sheridan, Alabama QB Coach and Co-Offensive Coordinator joined Ian over the weekend to talk about Jalen Milroe and what the Seahawks are getting in their new quarterback selected in the 3rd round on Friday. We get a feel for Milroe, plus some new Seahawks Coach went up against.   Checking in on the Text Line!   Crosstalk with Softy, live from the EQC!

The Mariners have been clutch lately, and it's not too early to recognize that. The NFL Draft is days away and there's not much more we can speculate on - Ian just wants it to be here already! Mollywhop Monday! Chris Crawford and Nathan Bishop join us to give a realistic view of the excitement we're feeling about the Mariners right now. Are we allowed to be pumped? How real is Rowdy Tellez right now? The Daily Power Play! We have breaking news as the Kraken are parting ways with Dan Bylsma. The Seahawks are days away from the NFL Draft and we take a listen to John Schneider and Mike Macdonald's press conference regarding the way it's set up for the team. We Check in on the Text Line! Listeners react to the Kraken decision to part ways with Dan Bylsma. Finally, we crosstalk with Softy!

Mollywhop Monday! Chris Crawford and Nathan Bishop have to be happy about the 5-1 Mariners over the last two series, especially the weekend sweep. Ian and the guys break down what they saw.   Mollywhop Monday continues as we just can't get enough of the Mariners who succeeded back to .500.   The Daily Power Play!   Bobby Casper, Real Golf Radio tells Ian why this may have been the best Masters he's ever witnessed. What made it so special and where does Rory rank all time now?   Checking in on the Text Line!   Crosstalk with Softy!

This week on Tales From a Luxury Yacht Chef with Lisa Mead, I catch up with Chris Crawford, a commercial photographer originally from South Africa. He talks about his career starting off in advertising before making a life changing move overseas.Contact Information:Insta: @chriscrawfoWebsite: chriscrawfordphotography.com.au

Bummer for Robles yesterday after a fault weekend of loss for the Mariners. Seattle is lacking 'everyday guys' in the infield. They're just running out last year's roster and hoping for something different. Also, what is the NHL doing with their schedule?   Mollywhop Monday! Chris Crawford and Nathan Bishop join Ian to break down the Mariners three game loss on the road over the weekend. Things aren't looking great right now and there have been some questionable decisions. Is Dan Wilson really an upgrade over Scott Servais?   Mollywhop part 2 as the boys discuss how to replace Victor Robles and more.   Mariners are enduring their worst start to the season since 2008, but the most frustrating thing is it is just every issue that everyone was concerned about coming into the season.  The NCAA Men's basketball national championship is tonight...do we need Cinderella stories in the tournament?   Checking in on the Text Line!   Crosstalk with Softy!

The Mariners split the weekend - so can we judge them already? We dive into the group chat.   MollyWhop Monday! Chris Crawford and Nathan Bishop join Ian to react to opening weekend and the Mariners splitting with the A's. They also ponder the fan reaction to Julio Rodgriguez and why it's so negative.   The Daily Power Play!    The women's NCAA Tournament is lesser without JuJu Watkins in it. Ian dives into the stats for the men's brackets, which proves that chalk is king this year. We delve into the perception of Julio Rodriguez in this market and the reasons why fans seemingly aren't willing to support him.   Checking in on the Text Line! Mariners fans weigh in on the team's opening series and Julio Rodriguez.   Crosstalk with Softy!

Climate Pledge kicked ass this weekend and showed out this weekend.  Mitch Haniger got released over the weekend.   Molly Whop Monday with Chris Crawford and Nathan Bishop as MLB Opening Week is here! We talk about the new Mariners streaming deal and more.   Molly Whop part 2: how does this roster look, specifically the infield.   What were the biggest takeaways from the games at Climate Pledge Arena over the weekend? Are we done seeing Cinderella stories?   Checking the Tullamore Dew Textline.   Softy joins for cross talk.

NCAA brackets are set and the Seahawks have a new look. Ian thinks they're a better team after the moves they made.   Mollywhop Monday with Chris Crawford and Nathan Bishop! Chris and Nathan react to the news that Logan Gibert will get the first pitch on opening day, what the back end of the rotation might look like and look ahead to opening day.   The Daily Power Play! Despite the overtime loss, the Kraken played extremely well yesterday. Is Jani Nyman the real deal?   We pay tribute to Slick Watts as he passed away over the weekend at the age of 73. The NCAA brackets are set and we have games in Seattle! Ian tells you what you need to know. Plus, North Carolina sets a bad precedent for college sports.   Checking in on the Text Line!   Crosstalk with Softy!

Why are people so focused on the potential DK Metcalf trade? Ian tries to make sense of it. If they traded him, we're talking about taking a step back.   Mollywhop Monday! Chris Crawford and Nathan Bishop join Ian for a lively discussion about Cactus League and what we can actually ascertain from what's going on right now.   Mollywhop continues! Chris and Nathan discuss exactly what the Mariners have in their arsenal this year and what Dan Wilson needs to do to keep things on track.   Jordan Eberle, Kraken Captain joins Ian to talk about his recovery from a rare injury, his family and the state of the team right now.   Checking in on the Tullamore Dew Text Line!   Crosstalk with Softy!

The Hidden Costs of PBMs: How Aggregate Discount Guarantees Inflate Drug Prices. In episode 465 of Relentlessly Seeking Value, host Stacey Richter interviews Chris Crawford, CEO of RxSaveCard, about the inflated costs within the pharmacy benefits industry. The discussion centers around a lawsuit involving J&J, highlighting how large PBMs can significantly overcharge for drugs that are available much cheaper through cash-pay options like Mark Cuban's Cost Plus Drugs. Crawford explains how Aggregate Discount Guarantees, a common contracting mechanism, often fail to control spread pricing effectively and instead may lead to higher costs for plan sponsors and employees. The episode also covers how RxSaveCard can help employers and employees access these lower cash prices, circumventing the inflated costs from traditional PBMs. === LINKS ===

What can we really tell about players at the NFL Combine? Ian has one strong take on Shedeur Sanders opting out of workouts. Mollywhop Monday! Chris Crawford and Nathan Bishop tell us what we can truly learn from the Cactus League and what's exciting about this time of year. Mollywhop continues with what Chris and Nathan took from Jerry Dipoto's interview with Chuck and Bucky last week. Seattle sports have had a rough go of late - and that's why all of our eggs are in the Mariners' basket. Finally, Crosstalk with Softy!

Emergency room costs now make up 6% of total healthcare plan spending—why? In this episode, host Stacey Richter welcomes Al Lewis to break down the data behind rising ER expenses, separating fact from fiction. They discuss whether increased patient acuity or widespread upcoding is driving costs, the impact of the No Surprises Act, and why plan sponsors struggle to negotiate fair ER rates. Plus, Al shares actionable strategies for employers to push back against inflated charges. If you want to understand the hidden forces behind escalating ER bills, this is a must-listen. You can find the charts and links mentioned in the show notes in the link below. === LINKS ===

How are we feeling heading into Spring Training about your Seattle Mariners?  Nathan Bishop joins for a Molly Whop session to talk about the threats of the other teams in the division and if the Mariners have a shot to win it.   Vice President and Assistant General Manager of the Mariners Andy McKay joins the show to talk about the player development process, Spring Training, and much more.   Thoughts on the Andy McKay interview.  Best Athlete actors of all time.  Thoughts on the 4 nations Face off.   Checking the Tullamore Dew Textline.   Softy joins for cross talk.

Chris Crawford is in for Ian today and, in honor of Valentine's Day,  we discuss what you romanticize in sports. RJ Anderson, CBS Sports tells us why he truly believes the Mariners are the favorite in the AL West this year. The Daily Power Play invites us into the Four Nations Face-Off. Danny O'Neil, The Dang Apostrophe! joins Chris to talk about his outlook on the Mariners season as spring training is right around the corner. Plus, how much better can Klint Kubiak make the Seahawks offense this season? Finally, what to expect out of Pete Carroll in Las Vegas? We check in on the Tullamore Dew Text Line and talk with Softy!

Every Gen X'er listening to this is gonna be singing that Clash song in your head for the rest of the day. So, let's turn our attention to Medicare Advantage policy. And on the show today, I grill the one and only Betsy Seals to find out which policies she thinks are going to stay and which are going to go. 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. Obviously, this is very much in the context of a new administration and also just other things that are going on. But today we talk about the following four “stay or go” policy areas. Here's the first policy area we talk about: changes and activities within the Stars program. How will the Medicare Advantage Stars program change or not? Not only with this new administration, but also there are lawsuits and how they will impact the goings-on moving forward. Second policy, will it stay or will it go, that we talk about is risk adjustment and all of the activity in government oversight and focus on recoupment of improper payments as kind of the overarching bucket and what will be the incoming administration's method around risk adjustment. This is certainly on many people's minds. The third “will it stay or will it go” policy that we discuss is the use of AI (artificial intelligence) by Medicare Advantage plans. What does the appropriate oversight of the use in AI look like? Lots of talk about those prior auth AI algorithms and the high levels of denied care. A big topic of everybody's collective mind is looking at how to ensure that oversight is appropriate and that we're using AI for good and that it's not having any adverse impact. So that's the third will it stay or will it go. Fourth, and lastly, the whole agent broker realm—additional CMS and government oversight over misleading or inaccurate information coming from the marketing or the agent broker marketing world. How will that look in 2025 and moving forward? This last one, I'm kind of all over the nuance there after reading posts and comments by Samantha George, and I would recommend following her on LinkedIn would be my suggestion. I am reflecting back on the Ann Kempski episode (EP444), where we talk about the whole, really consider the downstream impact when making any policy changes, because there can be unintended consequences. Now, in a show about carriers—in this case, Medicare Advantage carriers—I'd be pretty tone deaf not to mention the nation's ire at carriers at this exact moment in time, some of it extremely well earned and some of it reflective of an extremely dysfunctional healthcare system. I'd also be tone deaf not to mention the MedPAC (Medicare Payment Advisory Commission) report, which states that Medicare Advantage plans receive payments from CMS that are 122% of spending for similar beneficiaries in traditional Medicare. This translates to an estimated $83 billion in higher spending in 2024. And I would lastly be remiss not to mention how Medicare Advantage plans are most carriers' most profitable service lines, with average earnings of around $1800 per enrollee. All of what I said is not some kind of grand revelation, of course, to most listeners of this show. And it's also not the topic of the conversation today, although some of this did get asked and answered in the earlier shows (EP387, EP375, EP291) with Betsy Seals. One thing I will remind everyone about is that there are regional carriers that are not the big five who may or may not be doing big five types of things. And also, it is actually really difficult to run a Medicare Advantage plan successfully. They call it risk for a reason. One thing I really appreciated about the conversation with Betsy Seals that follows is her advice to contemplate value to the patient and make sure that anybody working on the carrier side, you have enough of a bead on what's actually happening to be able to identify when things are going off the rails, which does not seem to be the case in some instances. This also, by the way, having a bead on what's actually happening on the ground, helps to ensure compliance and that's piece of advice two. Last piece of advice is to learn how to be proactive and not reactive. And this is eminently more possible vis-à-vis data that's available and learning how to use it well. Betsy Seals, my guest today, has had a very busy last couple of years since she was on Relentless Health Value the last time. Betsy is CEO and co-founder of Rebellis Group, a managed care consulting firm focused specifically in Medicare Advantage. Rebellis was actually acquired in February of 2024 and joined as a family of a couple of other consulting firms that now Betsy heads up. So, in short, she's really busy. Also mentioned in this episode are Samantha George; Ann Kempski; Rebellis Group; and Vivian Ho, PhD.   You can learn more at rebellisgroup.com and alerionadvisors.com and by following Betsy on LinkedIn.   Betsy Seals is the CEO of Alerion Advisors, a family of companies dedicated to delivering unparalleled consulting services across the healthcare spectrum. As a parent organization, Alerion Advisors unites three specialized firms—Rebellis Group, Advent Advisory, and Toney Healthcare—to provide health plans and their partners with comprehensive, innovative, and results-driven solutions. With over 25 years of experience in the managed care industry, Betsy is a nationally recognized leader known for her regulatory expertise and strategic insights. Betsy brings to the table a solid mix of leadership and business acumen, as well as regulatory and strategic knowledge within the managed care landscape. Betsy's expertise is focused in the areas of mergers and acquisitions, compliance, sales and marketing, strategy, supplemental benefit landscape, innovative benefit design that address social determinants of health (SDoH), and health plan operations.   05:09 Will the Star Ratings program stay in this new administration? 08:08 How will the lawsuits against CMS policies play out with this new administration? 10:24 Why is it hard for Medicare Advantage plans to survive, let alone thrive? 16:22 How does AI directly impact beneficiary lives? 21:38 What's going on now with the override payments? 27:08 How is non-collaboration going to impact Medicare beneficiaries moving forward? 31:45 Why is it important to become more technologically savvy in compliance?   You can learn more at rebellisgroup.com and alerionadvisors.com and by following Betsy on LinkedIn.   @betsyseals discusses #medicareadvantage policies on our #healthcarepodcast. #healthcare #podcast #changemanagement #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Wendell Potter (Encore! EP384), Dr Scott Conard, Stacey Richter (INBW42), Chris Crawford, Dr Rushika Fernandopulle, Bill Sarraille, Stacey Richter (INBW41), Andreas Mang (Encore! EP419), Dr Komal Bajaj, Cynthia Fisher    

When things happen with the Mariners we have to talk about it. It's becoming exhausting to criticize the front office and there is some validity to what Jerry had to say. Can the team depend on what Jerry was championing yesterday?   Which of the big three teams in Seattle are closest to a title? Seahawks, Mariners or Kraken?   Coach Holmgren should be rubber stamped for the NFL HOF, but we are still on pins and needles about it.   Mollywhop with Chris Crawford and Nathan Bishop! Following Jerry Dipoto's media availability, the guys react from a fan perspective. What jumped out on the article diving into the hitting disparities at T-Mobile Park?   We take listener reactions to our question, who is closest to a title: Seahawks, Mariners or Kraken?   The Daily Power Play!   John Lund joins Ian to talk Super Bowl and all things sports. He and Ian relive some fun memories.  Crosstalk with Softy!

The Mariners have some high-level prospects in the minor leagues - but how 'big league' ready are they? What would the elimination of auto-bids in the NCAA Tournament look like in college basketball?   Chris Crawford, My oh Why! Chris is extremely high on the Mariners farm talent and gives his thoughts on the spring training invitees. It's time to move the young talent to capitalize on the rotation and team you have now.   Which prospects would you move in a Mariners trade and who would you be upset about losing?   Corbin Smith, Locked on Seahawks gives his thoughts on the Klint Kubiak hire as we await his official introduction in Seattle. He also gives his thoughts on Geno Smith's future and where the Seahawks could hit in this year's NFL Draft.   What do you want to see the Seahawks do in this quarterback deficient NFL draft? The team is somewhat in no-man's land and it's hard to know how they're going to rebuild without being in a 'rebuild'.   The Daily Power Play!   Gary Parrish, CBS Sports joins Ian to give the latest on the college basketball scene as we inch closer to March. What would the elimination of automatic bids do to the NCAA Tournament and how close are we to seeing that happen? Don't fix what's not broken!   Crosstalk with Softy!

There have been two episodes lately that have sent me down a rabbit hole that I wanted to bring to your attention. Now, disclaimer: I know you people; you're busy. You listen on average to, like, 26 minutes of any given episode. So, yeah … look at me being self-aware. I say all this to say welcome to this inbetweenisode, otherwise known as The Rabbit Hole. But it's like a 20-something-minute rabbit hole, not a day-and-a-half retreat; so just be kind if you email me and tell me I forgot something or failed to dredge into a nuance or a background point. It might be that I just could not manage to pack it in. 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. This rabbit hole really, really matters for anybody creating benefit design. It really matters for anybody trying to optimize the health that can be derived from said benefit design. It also probably matters for a whole lot of operational decisions involving patients or members, nothing for nothing. But it really matters for anybody trying not to, by accident, as an unintended consequence, hammer plan members or patients with some really blunt-force cost containment measures that do a lot of harm in the process of containing costs or, flip side, accidentally cost a whole lot but don't actually improve member health. Nina Lathia, RPh, MSc, PhD, kind of summed up this whole point or gave an adjacent thought really eloquently in episode 426. She said there's better or worse ways to do things and doing the worst kinds of cost containment may not actually contain costs. You squeeze a balloon, and that works great for some, like pharmacy vendors who don't really have any skin in the game. (See me using the “skin in the game” term for other people besides plan members? That's some really good foreshadowing right there, by the way.) So, squeezing the balloon works for some when they don't have skin in the game, in the place where the air goes when you squeeze the balloon—like a pharmacy vendor who makes it super unaffordable for patients to get meds so the patient doesn't take their meds and winds up in the ICU, or the patient's formerly controlled with meds condition that is now newly uncontrolled and requires all kinds of medical interventions to get said condition back under control. Like, these are the reasons and the why behind why some cost containment efforts don't actually contain costs at the plan level. But not at the vendor level. You see what I mean? Most pharmacy vendors don't get penalized if medical costs wind up going up. And I'm picking on pharmacy vendors a little bit here, but it's true for a lot of siloed entities. But, you know, balloon squeezing can also work, actually, at the plan level if where the air goes, it's to a place where the member or the patient has to pay themselves. Like, if there's a huge, I don't know, max out of pocket or deductible, does it really matter to a very mercenary plan that's running on a very short time horizon? Do they really care, that plan, if the patient's formerly controlled condition gets uncontrolled? Maybe not, I guess, as long as it doesn't cost more than the max out of pocket that the patient is on the hook for, for any given plan year. So, yeah … again, there are better or worse ways to do things; and a lot of questions kind of add up to, What kind of plan do we want to be? What are our values, and does the plan align with them? But that's not the rabbit hole I wanted to go down today—the aligning with our values rabbit hole—so let us move on. The Relentless Health Value episode that kicked off the rabbit hole for me on multiple levels was the show with Bill Sarraille (EP459) about co-pay maximizers and accumulators. And don't get me wrong, that is a complicated topic with lots of pros, lots of cons; and I am not weighing in on the inherent lawfulness or value of any of this. I am also not weighing in on the fact that there are forthright and well-run maximizers and really not good ones, which cause patients financial, for sure, and possibly clinical harm. But not talking about that right now at all. Go back and listen to the show with Bill Sarraille if you are interested. Where my “down the rabbit hole” spiral started was when I started noticing the very, very common main plan pushback that was given right out of the gate so often when talking about the problems that any given plan sponsor has with these pharma co-pay programs—that if these pharmacopeia card dollars count toward the plan deductibles, then the patient's deductible gets met and the plan member will then often overuse healthcare and cost the plan excessive dollars from that point forward. So again, if you ask any given plan sponsor what I was gonna say their main issue but a main issue that they have with these pharma co-pay programs, that's gonna be it—that if these pharma dollars count toward the plan deductible, then the patient's deductible is met and from that point henceforth, the patient goes nuts and overuses healthcare services and it costs the plan a lot of money. The second episode causing this rabbit hole to open up is the one coming up actually with Scott Conard, MD. So, check back in a couple of weeks for that one. But in the show with Dr. Conard, we get into the impact of high-deductible health plans or just big out of pockets, however they transpire in the benefit design. Both of these scenarios, by the way, the maximizer meets the deductible scenario and the very, very high-deductible plan scenario are to blame, in other words, for this rabbit hole of an inbetweenisode. So, let's do this thing. Let's talk about the moral hazard of insurance to start us off. In the context of health insurance, if you haven't heard that term moral hazard before, it's an economics term; and it is used to capture the idea that insurance coverage, by lowering the cost of care to the individual, because their plan is paying for part of said care, by lowering the cost of care to the individual, it increases healthcare use. So, you could see why this may be related to having a deductible fully paid or not. Pre-deductible, the plan is not paying for a part of said care or paying a much smaller part. And after the deductible is paid for, then the plan is paying for a much larger percentage of care. So, moral hazard kicks in bigger after the deductible is fully paid, when the plan is paying for a bigger percentage or a bigger part of the care. So, before I proceed, let me just offer again a disclaimer to the many economists who listen to this show that this is a short inbetweenisode; so I am 100% glossing over some of the points that, for sure, have a lot of nuance. For anyone who wants a thick pack of pages for background reading, I have included some links below. Because you see, a few weeks ago, my Sunday did not go as planned. And instead of running errands, I wound up reading eight papers on moral hazard. So, my lack of groceries is your gain. You're welcome. I am happy to send you these links if you really want to dig in hard on this. Okay … so, moral hazard is the concept that individuals have incentives to offer their behavior when their risk or cost is borne by others. That's the why with deductibles, actually. We gotta give patients skin in the game because once a member has their deductible paid, it's like member gone wild and they will get all manner of excessive care. Again, I hear that a lot from plan sponsors—a lot, in all kinds of contexts but almost always, again, whenever the conversation has anything to do with manufacturer co-pay card programs and a lot when it has to do with just, you know, high-deductible plans and what happens when the patient meets their deductible. Once a patient or family has a fully paid deductible, their medical trend is like a spike, I hear over and over again. And again, this is the reason why many insist—and again, no judgment here, maybe they're right, I'm just rehashing the conversation—but this is why many insist the moral hazard of letting people have their deductible paid for them by Pharma or whatever is the reason why some believe it is imperative to have maximizers or accumulators where pharma dollars can absolutely not apply to patient deductibles. Because then we have sick patients who now have their deductibles reached, who have very few financial disincentives to go seek whatever care they want. Right. Moral hazard has entered the building. I've beaten this point to death, so let's move on. One time, I asked a plan sponsor, What exactly is it that these plan members are going wild spending plan money on once their deductible gets paid off? And he said, well, you know, they go get their suspicious-looking moles checked. Did you hear that silence just now? Yeah, that was my reaction. I don't know. I would consider getting suspicious moles checked kind of high-value care. There are posters all over the place saying if you have a suspicious-looking mole, it might be melanoma. Cancer. So, you should get ahead of that before you have a metastasized cancer. I'm no doctor, but yeah, this feels like high-value care. So, let's just, in arguendo, say it is high-value care and follow this thread for a sec. Once members reach their deductible, let's say they run around and get high-value care, care they actually need but haven't gotten before because they couldn't afford it earlier or were putting it off until they saved up enough, right? Like, this is the other side of the moral hazard coin. If patients delay or abandon care—and, by the way, there was a survey (it's in the Wayne Jenkins, MD, show from a while ago [EP358])—but 46% of patients with commercial insurance these days have delayed or abandoned care due to cost. But if they delay or abandon care that is high value and medically actually necessary and they put it off or abandon that high-value care because they cannot afford said care, then yeah, we have, again, the opposite of the moral hazard problem. We have members paying a whole lot for insurance that they cannot afford to use, they're functionally uninsured, and it's not gonna end healthfully if they need high-value care and they're not getting it. It's not. Functionally uninsured patients who have chronic conditions that really should be managed will, as per evidence, wind up with health problems if those chronic conditions are not managed. I read another study about this just recently. This is why members with chronic diseases on high-deductible health plans tend to have worse health, by the way. Now, I need to say, same rules do not always apply for healthy patients who, at least at this point, don't need regular healthcare. But do keep in mind, as it comes up in the Dr. Scott Conard show, 30% of patients who think they're healthy, they feel fine—actually they are not fine and will become sick and costly in the coming years. So, yeah … tune back in for that discussion if you are interested, but you get the gist of this whole thing, right? So, that's scenario 1 as to what patients may choose to buy once they're in the moral hazard zone and have met their deductible. They go get high-value care. So, let's move on from the high-value care case study where patients reach their deductible and get high-value care or they haven't met their deductible and fail to get care they actually need. I want to circle over to the other moral hazard potential situation: patients who meet their deductible. And in this scenario, they again embark on a health system jamboree; but they don't get a whole lot of high-value care in this scenario. They run around getting all manner of all kinds of stuff that is well outside of any evidence-based pathway. Like, weird example, I went to a doctor recently asking a question about something that everyone ultimately agreed was nothing. At which point, the doctor asked if I wanted an MRI. I was like, “What?” We and everyone else just agreed this was a big nothing burger. Why would I want an MRI? Is there something else that we didn't discuss to indicate that I need imaging? Like, why are we going there? And the doc said, “Oh, well, everyone in New York City has an anxiety problem. So, I thought you might just want to get an MRI.” Yeah, low-value stuff like that is now not financially prohibitive. So, someone who had met their deductible, in a similar situation to my example, might have shrugged and said, “Sure, I do have some anxiety. Let's go get that MRI.” Or if they hadn't met their deductible, then the whole skin-in-the-game, market-driven approach may work, I guess, to prevent them from getting low-value care that was clearly excessive and pretty wasteful. So, summing up these two scenarios, the implications of the moral hazard issue are, if it's expensive, people don't do it. If it's free or cheap, they will overutilize. And the issue with both of these patient choices is, patients are not good at discerning low-value care from high-value care. And because patients are not good at discerning high-value from low-value care, moral hazard is not mitigated with any sort of binary kind of vote for moral hazard or against moral hazard types of brute-force, broad-stroke tactics. Like, say I'm a moral hazard full-on believer. I assume all or most of the care a patient will go for is low value, right? Because if I try to prevent moral hazard from happening, then by default, what I'm effectively saying is, whatever they choose to buy on the basis of moral hazard is low value. So, I make basically everything I can pretty unaffordable so as not to invoke any moral hazard. But right, the problem with that is that some of the care is actually high value. And it's also expensive for the patient, so they don't get it. And patients are harmed, and balloons might get squeezed. Or the opposite, against moral hazard, right? Like, I'm against the concept of moral hazard. I don't believe in it, so I don't set up absolutely anything to combat it. Maybe because I assume all care that a patient might want to get is actually high value and totally worth it. That's gonna be a problem for the opposite reason. Plans can waste a lot of money this way. Random example, in 2014, the Commonwealth of Virginia reported spending $586 million on unnecessary costs from low-value care. I mean, they say something like a third of all care is waste and unnecessary, so … yeah. Plan sponsors can waste a lot of money on low-value care, and a bunch of that may happen when patients have less skin in the game because they reach their deductible, as one example, and the care is not financially prohibitive and moral hazard is realized. So, yeah … as I said, a couple of weeks ago, I did not spend my Sunday as planned. I spent my Sunday reading papers about moral hazard in insurance and how financial incentives impact patient decision making. And I'm gonna repeat the grand takeaway because this is a podcast and you might be multitasking. So, once again, here's the sum of it all: If it's expensive, people tend not to do it. If it's free or cheap, they will overutilize. And the issue with both of these patient choices is, patients are simply quite bad at distinguishing high-value care from low-value care. Once their deductibles are met, most patients will—due to moral hazard—they will, in fact, go on a spending spree; and part of what they will get done will be really, really important and necessary stuff, like getting their unusual moles looked at or their heart pain checked out or going for that follow-up visit or lab work that their doctor told them they need to come in for. And the other part of what they will do will be things that are outside the best-practice, evidence-based pathway guidelines by the length of the Appalachian Trail—you know, doing what appears to be a tour of specialty medicine physicians for unclear reasons but which lead to a cascade of testing and who knows what else. Why do they do this, these members? Do they do this on purpose? No. There is study after study that shows, again, members/patients do not, most of the time, have the chops to figure out if some medical service is high-value or low-value care. And no kidding. Most members and patients have no clinical training. They're not doctors. They're not nurses. They're not physician assistants. They're humans whose uncle died of cancer, and now they have a pain in their foot and they're convinced it's a tumor. Right? Like, do we blame them when they finally go see a doctor because they crushed their budget that particular year paying thousands and thousands of dollars out of pocket for whatever earlier in the year, and now they've made it to their deductible—do we blame them for taking the very rational step of getting the most out of those thousands of dollars of sunk costs? At that point, it's a “let me get my money's worth” situation because they can't afford to do this again next year. I mean, we hire employees because they're smart and rational, and this is really actually a pretty smart and rational thing to do. It's not somebody trying to commit fraud. Okay, sure … some people are. There's always bad apples. But the vast majority are just trying to live their life and not spend all of their vacation money next year on medical services like they did this year. I'm saying all this because it's actionable, by the way. And I'm getting to that, but indulge me for like 60 more seconds because I want to acknowledge you, listeners of this show, are probably nodding along to this whole thing this whole time and thinking all of this is pretty obvious. Well, yeah … maybe. Except here's the reason I decided to do an inbetweenisode about this rabbit hole instead of doing my normal thing, which is just ranting about it over dinner for three days straight—and God bless my husband for sitting through it—is the bottom line. But the reason we are here together today is the number of emails and posts and et cetera that cross my desk where it doesn't seem like these dots have been connected on all of this or at least connected in magic marker. Like fat, indelible magic marker, which is what I think is necessary for these dots to be connected with the ones between moral hazard and patients not being able to discern high- and low-value care. There are so many ways and places these dots will show up. Like, here's another moral hazard issue with those maximizers or accumulators, which apparently are on my mind right now—the not good ones I'm talking about now, where patients find themselves on the hook for hundreds or thousands of dollars midyear if they want to pick up the meds that they've been prescribed. If you need more details on how that might happen to understand what I'm saying fully, listen to the show again a couple of weeks ago with Bill Sarraille (EP459). But even if you're a little confused, it doesn't matter because the question is this: Do we justify having programs that make drugs really expensive for patients? Do we put in place one of these pretty darn punitive types of accumulators or maximizers, right? Like, there's different kinds, and I'm talking about the punitive ones of accumulators or maximizers. Do we justify putting one of those into place and figure that if a patient really wants the med, they'll pay a whole lot of money for it? Because if they're willing to pay a whole lot of money for it, then, right? It must be high-value care, so they'll figure out how to pay for it. Keep in mind, as I said earlier, if it's expensive, people don't do it. If it's free or cheap, they will overutilize. And the issue with both of these patient choices is, patients are not good at discerning low-value care or meds from high-value care or meds. So, look, Pharma can be up to all kinds of crap, and list prices are really expensive. No arguments here. That isn't the point. The point is, What is the actual problem that we're trying to solve for, for our plan and our patients and our members? And if that problem is making sure that the right patients get the right high-value meds or care, then not letting members get co-pay assistance such that all drugs—the good ones and the too-expensive ones and the ones that we don't really want our members to take for whatever reason—if we make all of them way too expensive with a maximizer or accumulator designed to make all the drugs really expensive … dots connected. We wind up with the all-in to prevent moral hazard issue we just talked about, where patients could easily be harmed and the plan can easily get into a balloon squeezing situation. All I'm saying is that there's a big-picture view of moral hazard here that we need to be looking at and over-indexing into binary, moral hazard black and white, where we attribute malice to members, some of whom, some of the time, may actually be trying to get high-value care, or the flip side, the plan's paying too much for low-value care and causing financial difficulties and not understanding the root cause. Going black and white or over-indexing to prevent outlier kind of stuff is probably not gonna end well. Not seeking a middle way can easily result in a solution that is possibly worse than the problem. So, look, moral hazard is actually a thing. There are lots of implications to patients not being able to distinguish high-value and low-value care. But if we know this, then, philosophically at least, how do we conceptualize a solve? What should we be doing? If we're not doing black and white, what does the gray in the middle look like? Alright, we don't want to be a solution looking around for a problem. So, let's think about the problems that we want to solve for. I would start with, What's the goal? The goal of plan sponsors providing insurance most of the time is attract and retain talent. Also, I was at the HBCH (Houston Business Coalition on Health) Conference at the beginning of December 2024. And there was a poll question. There was a bunch of employers in the audience, and the poll question asked the audience, “What's your biggest plan goal this year?” Main answer by a mile: Cut costs. Okay … so, we want to attract and retain, and we want to control costs. Obviously, you can go about achieving these three things a bunch of different ways, and they will all be tradeoffs. As Luke Prettol reminded me of the other day, there are no solutions, only tradeoffs. And so, with that, right now, I want to introduce the second concept that I have been ruminating over in my rabbit hole lately, that I've kind of been hinting at for this whole time. But here's a word we've been waiting for to solve all of our problems in a good kind of way, not the bad black-and-white ways that are so often either financially a problem or deploying brute force and harming patients in the name of solving something else: Pareto optimality. Pareto optimality is the state where resources are allocated as efficiently as possible so that improving one criterion will not worsen other criteria. It's essential to consider this, that Pareto optimality is the ideal we should at least be striving for when attempting to overcome any challenge but, in particular, the moral hazard issue, when we know that patients do not know what care is high value and what care is low value. Because if we don't try to at least Pareto optimize (if that's a word), if we try to fix the moral hazard problem and wind up with a new problem or new problems that might be worse than the old problem, that's not optimal. We have improved one criterion and worsened another. So, fixing the members going wild after they meet their deductible by slamming the lid on the fingers of members trying to get high-value care as well as low-value care, well … not sure about this, but I'd assume if not the attract but at least the retain criterion might be compromised by member dissatisfaction. But also, as I've said nine times, we might not actually cut costs. We might be doing a squeeze of the balloon. Especially that could be true when, as we all probably know or suspect, what's driving costs at the plan level is rising hospital prices. There's a show coming up on rising hospital prices as a primary driver of rising plan costs, and it's pretty hard to argue with. So, it's financially pretty advantageous to keep patients from needing to go to the hospital. So, yeah … I'd strongly suggest not squeezing balloons when hospitalizations are where the air goes. I'm not gonna belabor this. My only suggestion is, do the Pareto optimality math. A lot of you already are, I'm sure, and do a great job. But just for any given policy plan change, or decision, keep in mind moral hazard and then really go through the whole cascade of likely impact on other factors based on likely member/patient behavior. It's so easy to get sucked into kind of these philosophical, “those are my enemies” kinds of conversations that are actually philosophically sort of interesting, but they aren't the goal. I mean, there's always unintended consequences; but not all unintended consequences should come as some kind of, like, wild-ass surprise. They were pretty predictable, actually. Let me also mention that when considering Pareto optimal solutions, advanced primary care starts to get really compelling. It's because having a PCP team with data and a relationship to the patient helps patients stay on the high-value care bus. And that can minimize the bad that comes from lowering the barrier to care and inviting in a little bit of moral hazard. Just saying. Okay, so this has been going on a little bit longer than I had originally intended, but I do want to remind you of the so-called theory of second best. It's probably really appropriate here, and one of the reasons why I'm mentioning this and not finishing the show right now is that, in a very synchronistic moment, I was writing up my outline for this inbetweenisode and—how random is this?—Steve Schutzer, MD, wrote an email that included something about the theory of second best. Great minds and all of that. Anyway, the theory of second best is really aligned with Pareto optimality. It's just that sometimes you gotta be really practical. You gotta be a little scrappy. If you cannot achieve the best option, either because you just can't or because the best option for one thing results in too many negative consequences elsewhere, then don't do the best option. Forget it. Do the second best (ie, the theory of second best). There is nothing wrong with that. Don't be a hero. Okay, so in summary, moral hazard is actually a thing and so is the opposite; and it's even more of an impactful thing because most people cannot distinguish high-value from low-value care. And if they meet their deductible that they have paid a lot of money to reach, of course, they are going to want to try to get through their checklist of medical appointments that they have been putting off. This is not a surprise. And it's not all bad, as long as the care that they are trying to go get is high value; and that matters if we're trying to cut costs. Because to cut costs for real and not in a squeezing of the balloon way, we need to direct or limit somehow what gets done to high-value care. And we got to do that without accidentally causing other problems, meaning think through Pareto optimality and possibly consider the theory of second best. I hope this has been helpful at some level. It's helped me. I feel better having vented. Also mentioned in this episode are Nina Lathia, RPh, MSc, PhD; Bill Sarraille; Scott Conard, MD; Wayne Jenkins, MD; Houston Business Coalition on Health (HBCH); Luke Prettol; and Steve Schutzer, MD. Additional studies mentioned: Moral Hazard in Health Insurance: What We Know and How We Know It Do People Choose Wisely After Satisfying Health Plan Deductibles? Evidence From the Use of Low-Value Health Care Services Healthcare and the Moral Hazard Problem Distinguishing Moral Hazard From Access for High-Cost Healthcare Under Insurance   For more information, go to aventriahealth.com.   Each week on Relentless Health Value, Stacey uses her voice and thought leadership to provide insights for healthcare industry decision makers trying to do the right thing. Each show features expert guests who break down the twists and tricks in the medical field to help improve outcomes and lower costs across the care continuum. Relentless Health Value is a top 100 podcast on iTunes in the medicine category and reaches tens of thousands of engaged listeners across the healthcare industry. In addition to hosting Relentless Health Value, Stacey is co-president of QC-Health, a benefit corporation finding cost-effective ways to improve the health of Americans. She is also co-president of Aventria Health Group, a consultancy working with clients who endeavor to form collaborations with payers, providers, Pharma, employer organizations, or patient advocacy groups.   04:05 Where did Stacey's rabbit hole spiral start? 05:40 What is the moral hazard of insurance? 09:31 EP358 with Wayne Jenkins, MD. 12:49 Why isn't moral hazard mitigated in insurance? 18:16 EP459 with Bill Sarraille. 20:51 “How do we conceptualize a solve?” 22:24 Why should we be striving for Pareto optimality? 25:20 What is the theory of second best?   For more information, go to aventriahealth.com.   Our host, Stacey Richter, discusses considerations for #plansponsors and others. #healthcare #podcast #changemanagement #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Chris Crawford, Dr Rushika Fernandopulle, Bill Sarraille, Stacey Richter (INBW41), Andreas Mang (Encore! EP419), Dr Komal Bajaj, Cynthia Fisher, Stacey Richter (INBW40), Mark Cuban and Ferrin Williams (Encore! EP418), Rob Andrews (Encore! EP415)  

This episode with Chris Crawford, CEO of RxSaveCard, is not about the when, why, or how of GLP-1s for weight loss or best-practice prescribing. This episode very, very specifically is about the how and why of the pickle plan sponsors get themselves into often enough where if they impose formulary restrictions to limit the volume of meds that they are paying for, then unit prices go up, which is a thing for GLP-1s. And this is critical just given how the costs associated with GLP-1s for weight loss contribute to some pretty significant increases in pharmacy trend for plan sponsors who choose to cover the GLP-1s for weight loss. Chris Crawford and Stacey Richter discuss the challenges plan sponsors face with the rising costs of GLP-1 medications for weight loss. They explore how plan sponsors' efforts to manage pharmacy trends often result in a tradeoff: lowering unit costs by increasing volume or vice versa. Chris also introduces a potential solution leveraging the growing cash marketplace, where employers can bypass traditional PBM contracts to achieve cost savings. Tune in for actionable insights into the perverse incentives in the pharmacy supply chain and innovative ways to navigate them. (Continued below the links) === LINKS ===

The Mariners still aren't doing much - so what could they do to win you back as a fan? Ron Francis took it upon himself to address rumors about the Kraken front office in a live television interview. That's a rarity in sports these days. Ian finds himself in a position to give Jerry Dipoto a break right now. Ownership is more responsible for the woes. What could the Mariners do to win you back as a fan? We listen back to Chris Crawford and Nathan Bishop, who tell us what it would take for them. Plus, Harold Reynolds had a striking perspective from a former player when talking to Chuck and Buck this morning. He sees it from the fan's point of view. Listeners weigh in on the Mariners and tell us what it would take to take the negativity away from the perception of the Mariners. The bar for being beloved as a Seattle sports franchise isn't high and the Mariners have it right at their fingertips. Steve Palazzolo, The 33rd Team previews the divisional round in the NFL playoffs after a fairly lopsided wild card weekend. What's next for Tomlin and Russell Wilson in Pittsburgh? He also takes a look at the various quarterback situations around the league.  We take more feedback from listeners regarding their feelings toward the Mariners. The Daily Power Play! Mike Holmgren joins us in studio and discusses coaching moves around the league, infused with his own experience. Coach shares some stories about Deion Sanders and his time coaching against him. How much say will John Schneider have in the next offensive coordinator? He also talks about how much he loved the chess match in coaching.Coach Holmgren tells us what it's like to play and coach in cold weather in the NFL. How much of an impact will it have on this weekend's games?

After watching last night's game between the Rams and Vikings, Ian ponders how far away the Seahawks really were from the postseason. Hugh Millen had an in-depth breakdown of Geno Smith yesterday and it tells us a little more about what the Seahawks might do. Between that and what we saw from Sam Darnold last night, it shows how much of a quarterback starved league this is.The Daily Power Play takes us through the latest with the Kraken. Mollywhop Time! Chris Crawford and Nathan Bishop join us and avoid talking Mariners by begrudgingly talking Notre Dame football for a minute. We get to the nothingness that has been the Mariners' winter. They're not surprised Seattle wasn't a finalist, but it raises an eyebrow that the didn't even have a seat at the table. Chris doesn't want people to look down on Donovan Solano, despite the disappointment over the lack of a bigger move. Nathan thinks it's cool that he's here in Seattle and that the Mariners are better with him than without him. The only downside is that this likely means Justin Turner isn't coming back.

If you have zero clue what co-pay maximizers and/or co-pay accumulators are and the financial incentives involved for PBMs (pharmacy benefit managers) and plan sponsors here, after you're done listening to this episode, go back and listen to the show with Joey Dizenhouse (EP423). Also, the episode called “Game Theory Gone Wild” with Dea Belazi, PharmD, MPH (EP293). Both these shows could fill in some blanks. 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. Here's the micro mini of the co-pay maximizer/accumulator deal. These are vehicles that are designed by vendors who are also sometimes called maximizers or sometimes they're also PBMs. But these programs are designed to get as much money out of Pharma as possible in the form of co-pay support. So, here's how the maximizers are supposed to maximize plan sponsors getting pharma money. Say, for some drug, the pharma company has, I don't know, $12,000 max in co-pay support available to patients in total per year. Pharma does always cap the dollars that are available for patients. So, in this hypothetical, $12k a year is available. What a forthright or well-run maximizer will do is figure out, you know, if there's $12k max available, then they'll set a co-pay—so there's variable co-pays for patients—so they'll set a patient co-pay of, like, $1000 a month, which adds up to $12k over 12 months of the year. Get it? Every single month, the patient has a $0 co-pay, but the plan maximizes the dollars that the plan gets. Or, you know, maybe they'll charge $1,025 a month so the patient has some small “skin in the game,” and the plan sponsor just banked $12k. Sounds great, right? Well, sure, when it works as promised … and we'll get to this in a moment. Accumulators, on the other hand, have no such “Hey, let's make sure the patient actually gets their meds” guardrails. They hear that the Pharma is offering $12k, and the accumulator vendor and their plan sponsor clients also are like, “Cool, let's get that money as fast as possible.” So, they make the co-pay for that drug, I don't know, like hypothetically $3000. Great, now the patient runs out of that co-pay money in May. And don't forget and/or let me inform you, for both maximizers and accumulators, dollars paid by the Pharma generally don't count to the plan deductible for the patient. So now, the patient walks into the pharmacy, if in an accumulator or in a poorly run maximizer program, they walk into the pharmacy in May and are told that if they want their drug, they're gonna need to pay the $3000 co-pay that was set out of pocket every month until they reach their deductible. With some of these co-pay maximizer/accumulator plans, the plan sponsor may be a little bit out of the loop relative to what is actually going on here. The plan sponsor may think that members are doing fine—you know, they're getting their drug every month—so they may be surprised to learn about this running out of money in May issue. And what is true more often than it's not true, this $3000 or whatever—hundreds or thousands of dollars—payment due co-pay, the patient learns about it at the pharmacy counter or while trying to get chemo. It comes as a complete surprise, the fact that they owe three grand or whatever. What patient just shrugs and pays up in that moment because they happen to have their entire deductible or thousands of dollars lying around and at the ready? What a shock to find this out at the pharmacy counter or at the infusion clinic. Some of these maximizer programs are also starting to veer back into accumulator zones, like they're doing things such as saying that the member must pay their out-of-pocket max or their deductible or 30% of the cost of the drug, right, like some number before the plan will allow the patient to use the co-pay reimbursement program to begin with. So, there's other things that are emerging right now, which, again, cause the patient to have a very, very large out of pocket in order for them to get a drug which they have been prescribed and—ostensibly, at least—need. Allegedly, and sometimes for sure, dollars raked in from Pharma make it across the PBM/maximizer, vendor, middleman trench all the way over to the plan sponsor. For sure, especially for the administrative only maximizer vendors … yeah, you're gonna have the dollars actually making it to the plan sponsor. But sometimes the vendor running these programs is paid spread, right? So, the more expensive the drug and the richer the co-pay card program, the more the vendor will make because they take a percentage of savings. So, the more expensive, the more savings, therefore, the more the vendor is gonna make. In these cases where the vendor is paid a spread, can I take Perverse Incentives for $600, Alex? Right? But in sum, again, there's a lot to this conversation with Bill Sarraille, so please do listen to the whole thing. Bill offers five main pieces of advice, so I'm just gonna cover them right here up front—spoiler alert, I guess, but just to keep them all in one place. 1. Look into what is going on with a maximizer and/or accumulator program. First of all, is the plan sponsor paying spread? And also, how are these programs being marketed to members and how aggressively? Because there are a lot of plan sponsors having way more negative impact than they suspect they are. So, that's point of advice #1: Really look into actually what is happening on the grounds with some of these programs. 2. Eliminate surprise. Any plan sponsor listening, and Brian Reid also says this very crisply in an episode a month or so ago (EP456). If a plan sponsor wants to do stuff like this—like force a patient to pay hundreds or thousands of dollars out of pocket—if at any point during the year they are gonna wind up with thousands of dollars in co-pay or coinsurance to get their Crohn's disease med or cancer med or whatever, be really up front about this at least. It's really important if we really want to make sure that patients are taking maintenance meds and getting the medications that they're prepared for the reality that, at a certain point during the year, they are going to have a really big bill. 3. There is legal risk here. So also, Bill's advice is check into whether accumulators and/or maximizers are unlawful under the ACA (Affordable Care Act) and/or by deceptive practices rules when maximizers or accumulators are teed up as a benefit. And it, again (reference point of advice #2), it's not explained that dollars they get from Pharma will be taken by the plan and not applied to the patient deductible. I was just reading about the crazy aggressive marketing tactics that some of these vendors are using to get members to sign up and … yeah, definitely look into deceptive practice rules. 4. If it's utilization management that we're trying to achieve here, then your utilization manager should be utilization managing. These maximizers are not meant to impact utilization management. Patients really cannot differentiate, as per study after study, it's very difficult for patients to differentiate high-value from low-value care or meds. So, pretty much the impact of having a patient with thousands or hundreds of dollars of out-of-pocket spend to get a med isn't going to be to ensure that the right people are taking the right med. Point is, use the right tool for the right job. So, if we're trying to keep patients away from low-value meds, the tool for that is utilization management. Also be aware, if the PBM says it cannot do utilization management or you'll lose your rebates and/or is pushing into a maximizer accumulator program to do this instead, that's kind of a clue that they cannot do it because they are taking money from Pharma to not have any restrictions on a drug. Read the article in the New York Times (you're welcome) about how PBMs took secret payments for the free flow of opioids, and Chris Crawford also talks about this sort of same-ish thing in an upcoming show relative to GLP-1s. But if you're trying to do utilization management, then do utilization management. 5. Use our understanding of this whole goings-on as a rationale or a way to tamp down perverse incentives. We want to wind up with patients getting charged a percentage of net prices, not a percentage of some wildly inflated list price with this whole accumulator maximizer contributing to, you know, just more wildly inflated list prices so the co-pay programs can be bigger and someone can make even more money off of the percentage of savings. And plan sponsors addicted to rebates now have another bucket of cash. Like, this is just another example of how perverse incentives pervade the system. And we should certainly be aware of that. Bill Sarraille was a healthcare attorney for many years. He retired from his law firm on the first of last year, and now he's doing the things he wanted to do before but couldn't because his billable rate was too high. Bill is teaching at the University of Maryland Law School and doing some regulatory consulting, etc. He's working with a variety of patient groups. Also mentioned in this episode are University of Maryland Francis King Carey School of Law; Joey Dizenhouse; Dea Belazi, PharmD, MPH; Brian Reid; Chris Crawford; Marilyn Bartlett; Scott Haas; Paul Holmes; and Tom Nash. You can learn more at University of Maryland Francis King Carey School of Law and by following Bill on LinkedIn. You can also sign up for his Substack.   Bill Sarraille is a professor of practice at the University of Maryland Francis King Carey School of Law, a regulatory consultant, and a retired senior member of the Healthcare Practice group at Sidley Austin LLP. Bill is a nationally recognized expert in healthcare, life sciences, drugs, medical devices, and patient access to treatments. He is widely known for his expertise in a broad array of healthcare matters, including rare disease treatment access barriers, pharmaceutical pricing, Anti-Kickback Law compliance, the 340B program, and managed care and PBM issues. During his years practicing law, Bill was recognized repeatedly by The Best Lawyers in America in both healthcare law and administrative law. He was also consistently listed as a leader in the field of healthcare law in Chambers USA: America's Leading Lawyers for Business. Bill also serves as the general counsel of the charity the Pharmaceutical Coalition for Patient Access, as an advisor to multiple patient advocacy groups on patient access issues, a compliance advisor to a coinsurance patient assistance foundation, and as the director of a rare disease society and Kalderos, Inc., a health IT firm with a focus on effectuating pharmaceutical discounts and rebates.   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? 38:38 EP365 with Scott Haas. 38:45 EP397 with Paul Holmes.   You can learn more at University of Maryland Francis King Carey School of Law and by following Bill on LinkedIn. You can also sign up for his Substack.   @HCLAWComment discusses #costcontainment on our #healthcarepodcast. #healthcare #podcast #pharma #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Stacey Richter (INBW41), Andreas Mang (Encore! EP419), Dr Komal Bajaj, Cynthia Fisher, Stacey Richter (INBW40), Mark Cuban and Ferrin Williams (Encore! EP418), Rob Andrews (Encore! EP415), Brian Reid, Dr Beau Raymond, Brendan Keeler  

College football is changing and we are seeing more news that changes our perspective on its future by the day. Ian peruses some headlines that took him by surprise. Jon Ryan, Former Seahawks Punter joins us for his weekly segment to talk about the Seahawks' disappointing loss to the Packers on Sunday night, raising the 12th man flag and what Seattle needs to do to be successful down the final stretch of the season. Plus, we relive the legendary fake field goal that led to an NFC Championship. Ian discusses an exciting Wednesday! Chris Crawford and Nathan Bishop join us for a mid-winter MollyWhop! What do we make of the lack of Mariners' activity during the winter meetings? Chris and Nathan continue with an outlook on how the Mariners look as they stand now. Who could be an impact player, and which additions make sense for the team? Finally, who would you rather see back on this roster as compared to others? In The Daily Power Play! we discuss Matty Beniers' 200th game and latest struggles. David Riley, WSU Head Basketball Coach joins Ian to talk about the upcoming Apple Cup of hoops, how his team has sustained success through injuries and the evolution of the talent on the roster thus far.

There were some serious implications derived from Monday Night Football last night, and none of it has to do with actual NFL. It's all fantasy football! Plus, we get a little insight on what the Mariners are not doing at the winter meetings. Jon Ryan, Former Seahawks Punter fills us in on his holiday plans, including some select local guests. Jon explains the mentality behind special teams in the NFL. What has changed for the Seahawks over the last few weeks? Jon gives his perspective in what's gone right.Tell Me Something Good! Jodi and Bender join Ian to talk about the great things they're doing at Seattle Children's today. Brandon Huffman, 247 Sports joins Ian to give us the latest on what's going on with 'portal-palooza'. What are some of the surprises we're seeing locally and are there really surprises anymore within the era we live? How significant is it that John Mateer hasn't entered the portal yet? Chris Crawford, My Oh Why joins us to give some perspective on what the Mariners are doing - or not - during the winter meetings. Where can we reasonably set our expectations? The Daily Power Play! What are the chances the Mariners do anything besides line ownership pockets this winter?

Chuck Powell hosts the 47th annual "Mariners havent been invited to the World Series" podcast as we recap the 2024 season with the Molly Whop boys: Nathan Bishop and Chris Crawford, and then the former players join as Bucky Jacobson and Steven Souza jump in.

Chuck Powell hosts the 47th annual "Mariners havent been invited to the World Series" podcast as we recap the 2024 season with the Molly Whop boys: Nathan Bishop and Chris Crawford, and then the former players join as Bucky Jacobson and Steven Souza jump in.

Chuck Powell hosts the 47th annual "Mariners havent been invited to the World Series" podcast as we recap the 2024 season with the Molly Whop boys: Nathan Bishop and Chris Crawford, and then the former players join as Bucky Jacobson and Steven Souza jump in.

The Mariners have an opportunity right now and it's difficult to predict what direction they'll go. Ian doesn't see 'huge' moves on the horizon, but is curious about this winter. There are a lot of transitions around this market that could open an opportunity for the Mariners to seize it. Jon Ryan, Former Seahawk tells Ian that it always hurts in the lockerroom when a teammate gets cut, but it's all a part  of the bus John Schneider cut him in  Green Bay AND Seatte, but they're still friends. He tells us what "Dinner on Delta" is all about. He thinks those who have questions about John Schneider need to be patient. Finally, he definitely feels as though the 49ers are still the Seahawks biggest rival, but doesn't feel as though it's a tough 'road challenge'. Shane Waldron was fired nine games into his tenure with the Bears. It's very reactionary, but something needed to happen. In football people tend to look for the 'next someone' but sometimes there's only one. MollyWhop! Chris Crawford and Nathan Bishop join Ian to discuss just what the Mariners should be doing this off-season. Just because the Mariners are off, the boys aren't. There is some anticipation on what the Mariners will do this year. Best moves, worst moves and more. Following the firing of Shane Waldron, Emmanuel Acho spoke to a former pro bowler for the Seahawks - and he didn't have kind things to say. We speculate on who that may have been.  Cougar Roundtablee! Alex Brink and Mkristo Bruce join Ian to break down the latest Cougar win, check out the portal and preview the final three games. Will John Mateer remain in Pullman? What should we expect in the postseason for Washington State?

Today, we have Chris Crawford on The Way Home Podcast! Chris Crawford is a policy strategist at Protect Democracy. Today on The Way Home Podcast, Dan and Chris discuss the institutional heritage of America, the importance of free and fair elections for religious freedom and Christian values, and how to defend and promote democracy moving […] The post The Way Home Podcast: Chris Crawford on Elections and Civic Duty appeared first on Daniel Darling.

Jack is in for some big big trouble as he begins climbing the beanstalk all the way up to the top! But what is a harder foe to avoid - Donkey Kong or the Golden Goose? We answer this question and ask even more in todays episode! Ben and Wes also take a look at Frenzy by Stern, Legionnaire by Chris Crawford, and Slither by Century II in today's special episode!Website -https://historyofvideogamespodcast.comTwitter - https://twitter.com/HistoryofVideo1Email - historyvgpodcast@gmail.comHosts - Ben & WesMusic - Arranged and recorded by Ben

The Seahawks are up against it in Detroit, and as comfortable as Geno Smith is there, the defensive lineup is decimated enough to worry about. Ian also has some things to say about the Mariners.   Greg Cosell, NFL Films joins us to preview the Seahawks in Detroit on Monday Night Football tonight. What pitfalls could Seattle encounter, especially considering the defensive players that are out?    The Mets and Braves are currently playing in an epic game that bitterly reminds us of what could have been with the Mariners.   Mollywhop Monday! Chris Crawford and Nathan Bishop break down the season that was. Nathan says he knows he'll get the baseball itch next spring, but also that people are burnt out from this season and those that preceded. Chris takes us through all of the games that could've made a difference this season. The guys weigh in on exactly what went wrong this year.   Chris and Nathan tell us where this season ranks among disappointment in Mariners' history.   We put a final wrap on the Mariners season and what to look for (or not) in the future.   Mike Sando, The Athletic gives us a preview of the Seahawks in Detroit tonight, plus a trip around the NFC and the trends we're seeing in the first four weeks of the season. Sando takes a deep dive into his research to tell us what we're seeing around the league in quarterback play. Also, there are some running backs (ahem, Derrick Henry) that have legs beyond their projected expectancy.

The Seahawks won in ugly, yet dominating fashion. Why is there such a lack of investment in running backs in the NFL right now? Seattle is extremely lucky to have Zach Charbonnet and Kenny McIntosh behind Ken Walker.  Hugh Millen, Hardcore Football takes us through the Seahawks win over the Dolphins and, despite how dominating the score was, there are still pieces to critique. The depth the Seahawks have at running back doesn't mask the fact the team is missing Ken Walker.  Hardcore Football continues with Hugh, who breaks down DK Metcalf's performance.  Mollywhop Monday! Chris Crawford and Nathan Bishop join Ian to tell us if the Mariners are dead, or just mostly dead. While it would be an immense pleasure to watch them play beyond the next week, we know enough about this team to not get too excited. Chris remains excited about the team, despite their uphill battle and the knowledge they're pretty much cooked. Nathan is less enthusiastic, stating we've been robbed of excitement throughout the latter half of this season.  Mollywhop continues as we all agree that the division is out of hand. The guys tell us what would have to happen for the wild card...which would have to be a minor miracle.  The Daily Power Play! Preseason games are fun, but the results truly don't matter. Also, Ian has something good.  Mike Sando, The Athletic joins us to break down the week that was in the NFL. Scoring was down across the board, the Seahawks won big, but it wasn't their cleanest game. Sando takes us around the league and tells us the early trends and tone.

Seahawks won and proved that good coaching actually wins. Ryan Grubb proved he can adjust a gameplan on the fly. Cougs win the Apple Cup and victory is back on the Palouse. There's a lot of room for improvement, but playing below their capability, they still start the season 2-0.   Hardcore Football with Hugh Millen! Hugh starts things out with an in-depth breakdown of the final play call of the Apple Cup. The play was so bad already that Hugh can't believe Jedd Fisch took a timeout and still ended up with that play. Hugh has some very strong opinions on this.   Hugh continues with us and discusses what he saw from Geno Smith in the Seahawks win yesterday.   Mollywhop Monday! Chris Crawford and Nathan Bishop join Ian to give an honest assessment of the Mariners' chances at the postseason this year, which are looking slim to none. They have to either sweep the next to series or at least go 5-1. Plus, is Julio's season really as bad as people seem to complain about? Or does the blame of a season just fall on the superstar every time?   Hugh Millen gave us a very in-depth look at how Jedd Fisch was outcoached in the Apple Cup and we relive what happened in the Apple Cup.   The Daily Power Play! Eddie Olczyk joins us to talk about some new and exciting happenings with the Kraken. Ian's got a brand new role!   Mike Sando, The Athletic joins to explain how the Seahawks succeeded in New England as well as a look around the league and what the chaos in the NFL means as we get ready for week 3. We discuss his pick-6 column as well.

We are on our way when it comes to the NFL season! Something changed at halftime for the Seahawks. Also, Edgar Martinez is going old school when it comes to coaching hitting.    Hardcore Football with Hugh Millen! Hugh tells us whether yesterday's Seahawks game was a classic example of 'halftime adjustments', while breaking down the offensive performance comparatively by half. Where were the breakdowns and what worked that they need to continue to do? Hugh tells us where his concerns lie.   Hardcore Football continues as we turn to the defense. There were plenty of standouts, and a few things that could be cleaned up. Hugh explains what he saw.   Mollywhop Monday! Chris Crawford and Nathan Bishop react to the reports that Jerry Dipoto isn't going anywhere anytime soon. While the team is still very much alive, what kind of life can we expect to see down this final stretch of the season?   Mollywhop Monday continues as the guys discuss Edgar Martinez's approach to coaching    Tell me Something Good! The Mayor IPA has sold out! However, there's a party in store.   Mike Sando, The Athletic breaks down the weekend that set the table for the NFL season. What were the biggest surprises in week 1? Mike gives his first impressions of the Mike Macdonald era at the helm of the Seahawks. Offensively, shaky to start, but defensively - they played with purpose.

What a weekend for the Mariners - and not in the good way.   Fact or Fiction is back! As we prepare for the Seahawks season, we revisit Hugh Millen's breakdown of what the Ryan Grubb offense has to offer.    We continue with a preview of the Seahawks and listen into what Hugh thinks the defense will look like under Mike Macdonald. How much will it look like Baltimore's?   Mollywhop Monday! Chris Crawford and Nathan Bishop react to the weekend series and what we've seen of late. They're both exhausted by what we're seeing and tell us why.   Mollywhop continues and it's a special mix of anger and apathy. We give Mariners fans the therapy session they need.   The Astros aren't doing the Mariners any favors. And Detroit...is actually ahead of Seattle in the wild card.   Mike Sando, The Athletic gives Ian some insight on the Seahawks' strength of schedule. How might it benefit Seattle this season and what pitfalls could we see?

BREAKING: We have some updated injury news regarding Uchenna Nwosu and he'll miss several weeks after injuring his knee on Saturday.  The Mariners took two of three from the Giants over the weekend and while the games were positive and scrappy - they did the same thing under Servais.  Hugh Millen, Hard Core Football! Hugh joins us to break down the Seahawks final preseason game. He tells us Geno Smith is properly ranked as a 'median' level quarterback. Hugh tells us the complexity behind playing quarterback and why it's such a difficult position to play AND evaluate. Plus, changes in the red zone.  Hugh Millen continues to react to the news Uchenna Nwosu will miss several weeks. How impactful will his absence be?  Mollywhop Monday! Chris Crawford and Nathan Bishop join Ian to give their thoughts on the Mariners first series under Dan Wilson as a manager. While they succeeded over the weekend, was their style any different that it was under Servais?  Mollywhop continues.  What is the bigger issue with the Mariners between Jerry Dipoto and the Mariners?  Mike Sando, The Athletic joins us to break down his quarterback tiers, just released today. Where does Geno Smith rank? Sando takes us on a trip around the league to tell us what the quarterbacks look like in advance of this season. He also tells us where those facing off against the Seahawks rank.

EMERGENCY MOLLYWHOP! Chris Crawford and Nathan Bishop give their initial reactions to the Mariners' reported firing of Scott Servais. Crawford thinks they're replacing him with Dan Wilson to do everything they can to keep people coming to the ballpark, while failing. Nathan agrees and doesn't know how we can even fairly evaluate Servais in the circumstances in which he's operated. Chris and Nathan remain with us to react to Dan Wilson taking over for the Mariners, and Chris is surprised they didn't go with Manny Acta or Kristopher Negron. This just points to keeping butts in seats. Nathan is watching other moves being made, as in Edgar Martinez joining the staff. These moves are clearly being made over Jerry Dipoto's head. What makes a good manager? Scott Servais was put in an impossible position, in more than one way. Chris and Nathan continue the hour MollyWhop marathon to tell us what kind of team Dan Wilson is inheriting right now. Plus, how safe is Jerry's job right now? Corbin Smith, Locked on Seahawks gives his first reaction to the Seahawks trading cornerback Michael Jackson to the Panthers for linebacker Michael Barrett. The depth at linebacker is a good add, while the Seahawks had an embarrassment of riches in the defensive backfield, especially at corner. Chuck Powell joins Ian in studio, after having predicted the Servais firing if the Dodgers series went the way it did this week. Neither of the guys want anyone to lose a job, but this move just makes sense. How much blame should be put on Servais or Dipoto for the careers that came to Seattle to die? Chuck gives Jerry Dipoto a lot of credit for what he's done here - if you want him out, be careful what you wish for. An adequate offense should be enough for this team to be a perennial postseason contender. We begin the cavalcade of fans weighing in on the Mariners. Brandon Funston, The Athletic kicks off the unofficial start to the weekend. Today, we talk quarterbacks as you prepare for your fantasy draft. Listeners let loose on the firing of Scott Servais, and boy do we have a lot.

Mariners are four games back to the Astros in the AL West, but with the win yesterday we acknowledge it could've actually been worse. Hugh Millen, Hardcore Football! Hugh dissects the Seahawks offense for us as we have a new look under Ryan Grubb. Which bubble guys does he see making the team? We take a deep dive. Hugh gives some offensive comparisons to what Rome Odunze did under Ryan Grubb and the way DK Metcalf has been used. Nobody is happy with how little he was targeted. MollyWhop Monday with Chris Crawford and Nathan Bishop! How much is Scott Servais to blame for the Mariners' woes? While the guys would understand if the team parted ways with him, they don't find him ultimately at fault. MollyWhop continues with Chris and Nathan and we're approaching magic number territory. They're 20-30 since their high-water mark. What do the Mariners need to do the rest of this season? Finally, a preview of Seattle's series in LA facing the Dodgers. Mike Sando, The Athletic joins Ian to talk about the Seahawks preseason and gives his impressions of Mike Macdonald so far. Mike gives the pros and cons of the new kickoff rules and a preview of who will get into the NFL Hall of Fame this year.

The Trail Blazers are leaving ROOT Sports, and Ian sees a demise of sports consumption for the fan.  Corbin Smith, Locked on Seahawks joins us with the latest roster observations on the Seahawks. He has a new comparison for Byron Murphy and it's not one you've heard before. He's still surprised he dropped out of the top ten in the draft and marvels at how well it worked to John Schneider's benefit. Corbin takes us through the prospective depth chart. Next week is a big one for Abe Lucas.  The Mariners just got swept by the Tigers and fall three games behind the Astros in the AL West. Things are not looking good.  Chris Crawford, My Oh Why and Nathan Bishop of Dome and Bedlam join us and are simply exhausted by the ineptitude they've seen through this series - but also over the last nine years. They give us quite an honest review of the most recent performances. A sweep is a must for them heading into Pittsburgh.   We hear from Scott Servais following the crapfest we saw in Detroit.   We lighten things up with some fun audio from George Kittle, who takes some shots at the collective media. Brandon Funston, The Athletic Fantasy Guru joins us to kick off the unofficial start of the weekend! Today we run down the wide receiving group as you get ready to draft your roster!

We are back in studio! What was your weekend like? We share some fond memories of ours. Anders rode with Captain Benton on the course, Ian was with Ashley and Jess shared a cart with Softy.  Hardcore Football with Hugh Millen! The Seahawks played their first preseason game and we got our initial look at what a Mike Macdonald Seattle team looks like. Hugh takes us inside the huddle. Hugh is happy with the defensive backfield.  Ian shares what he got out of the Seahawks first preseason game. Communication is key with Mike Macdonald.  Mollywhop Monday! Chris Crawford and Nathan Bishop join us to react to the Mariners three game sweep of the Mets. MollyWhop continues as the guys discuss what's next for the Mariners as they head to Detroit - and into the end of summer.  The Olympics this year showed us a side of sports Ian hasn't seen in a long time. It brought back some pride with the emotion seen. What we've seen the last few weeks was the best of sports.

Happy Monday folks. Did you know we're giving away a grill? The Mariners took two of three from the Phillies and we are thrilled that they continue to fight, Saturday night being one of the biggest examples. We are live from the Virginia Mason Athletic Center and fill you in on what we're seeing.   As we watch DK Metcalf interact with the fans out here at training camp, Ian notes that he might be the most mis-characterized player on the current team. He's the only real 'superstar' right now, and his interactions on the field and off with the fans show us an amazing athlete and human. Brady Russell, Seahawks TE joins Ian to talk about his role with the Seahawks, why he loves Mike Macdonald and the versatility he maintains to remain 'uncuttable'.   The Olympics are underway and the athleticism of the athletes can't be overstated.   Mollywhop Monday! Chris Crawford and Nathan Bishop join to break down the week that was for the Mariners - and we are pretty happy about it, especially after seeing what they did to fight back in Saturday night's game.   Mollywhop continues as the guys react to what the Mariners did at the trade deadline.   Anders has a point of contention when it comes to a bit of the Mollywhop.   It's been a gorgeous day at the Virginia Mason Athletic Center, but Ian admits the weekend tired him out more than rested him. Totally worth it though. Jim Harbaugh responded to some allegations recently and it was classic. Finally, we hear from Mike Macdonald after practice today.

ANTIC Episode 109 - Host Wars In this episode of ANTIC The Atari 8-Bit Computer Podcast… Brad and Randy cover VCFSE, Kay finishes archiving the Famous Computer Cafe and gets some great material from Dan Kramer and Larry Summers, and the hosts trade barbs… READY! Links for Items Mentioned in Show: What we've been up to Larry Summers:  Excalibur - https://archive.org/details/excalibur-2nd-manual-type-apx  https://archive.org/details/Functional_Specification_for_The_Arabian_Adventures_Packet_Technologies  https://archive.org/details/Out_of_Ataris_Game_San_Jose_Mercury_News_1982-06  https://archive.org/details/Chris_Crawford_recommendation_letter_for_Larry_Summers  https://archive.org/details/Atari_81_v1n4_1981-05  Superboots business plan - https://archive.org/details/superboots-business-plan  Dan Kramer:  https://archive.org/details/atari-management-recognition-award  https://archive.org/details/atari-controller-design-focus-groups-report-1981  https://archive.org/details/a-qualitative-investigation-of-programmable-videogame-controllers  https://archive.org/details/atari_silvia  https://archive.org/details/cx2800  https://archive.org/details/cx2800-notes  https://archive.org/details/atari-direct-video-pcb  https://archive.org/details/atari-5200-controller-schematics-kramer-dan  Famous Computer Cafe - https://archive.org/details/famous-computer-cafe?sort=-addeddate  Book “Best of SoftSide - Atari Edition” - https://archive.org/details/ataribooks-best-of-softside-atari-edition  https://gameatl.com/vintage-computing-festival-southeast/  News Atari Insights newsletter V1#1 - John Zielke - http://www.ataribasics.com  Atari Opens Enrollment for its 2024 Summer Camp Program: https://finance.yahoo.com/news/atari-opens-enrollment-2024-summer-171700449.html  https://atari.com/collections/summer-camp  New drop-in replacement mechanical keyboard for the Atari 800 - https://forums.atariage.com/topic/368661-new-drop-in-replacement-mechanical-keyboard-for-the-atari-800/  Article on how to repair the split collars on an Atari 800 - https://atari.timhinds.com/atari-800-keyboard-restoration/  AtariProjects - http://atariprojects.org - Jason Moore  Inverse ATASCII Podcast - https://inverseatascii.info/ - Wade Ripkowski  The content presented at the Atari Last Party 2024 (the oldest demo party in Poland) has been added to the atarionline.eu Fujinet server  ABBUC #157 magazine - German edition - http://abbuc.de  A8Pico to win from ABBUC: Send the answer to the question: "What is the chorus in the Atari song?" You can find the answer on Wolfgang's YouTube channel: (https://www.youtube.com/@RetroWK ) Send answer by e-mail to a8pico2024@abbuc.de  Enhanced 600XL PCB by kveldulfur - https://forums.atariage.com/topic/367934-enhanced-600xl-pcb-by-kveldulfur/  Atari FastBASIC - https://github.com/dmsc/fastbasic  Upcoming Shows Atari Expo 2024 in Santiago Chile— Aug 3rd&4th.—http://www.expoatari.cl  Vintage Computer Festival West - August 2-3 - Computer History Museum, Mountain View, CA - https://vcfed.org/events/vintage-computer-festival-west/   Silly Venture SE (Summer Edition) - Aug. 15-18 - Gdansk, Poland - https://www.demoparty.net/silly-venture/silly-venture-2024-se   VCF Midwest - September 7-8 - Renaissance Schaumburg Convention Center in Schaumburg, IL - http://vcfmw.org/  VCF Europe - September 7-8 - Munich, Germany - https://vcfe.org/E/  World of Retrocomputing 2024 Expo - September 14-15 - Kitchener, ON, Canada - https://www.facebook.com/events/s/world-of-retro-computing-2024-/1493036588265072/  Portland Retro Gaming Expo - September 27-29 - Oregon Convention Center, Portland, OR - https://retrogamingexpo.com/  Retro Computer Festival 2024 - November 9-10 - Centre for Computing History, Cambridge, England - https://www.computinghistory.org.uk/det/72253/Retro-Computer-Festival-2024-Saturday-9th-November/  Silly Venture WE (Winter Edition) - Dec. 5-8 - Gdansk, Poland - https://www.demoparty.net/silly-venture/silly-venture-2024-we  YouTube Videos FlashJazzCat SIDE3 Video - https://www.youtube.com/watch?v=hoXGLvUAs84  Lotharek SIDE3 Video - https://www.youtube.com/watch?v=EVFxVjqLbQk  MAC/65 Assembler Editor and Atari 8-bit Machine Language Programming - Part 1 - David Arlington - https://www.youtube.com/watch?v=7WdSPvqSIME  MAC/65 Assembler Editor and Atari 8-bit Machine Language Programming - Part 2 - David Arlington - https://www.youtube.com/watch?v=bQPw1myNLb4  The Atari 2024 Expo Preview - CmosGames (in Spanish) - https://www.youtube.com/watch?v=Fx-3S8UzdDs  Rewind 2 - a demo for Atari XL/XE by New Generation, Zelax & Radiance - VoyAtari - https://www.youtube.com/watch?v=UuWEEms1IX4  Now there's a Decent keyboard for each Atari 8-bit computer - Screaming at the Radio - https://www.youtube.com/watch?v=BiBLV-qH9To  New at Archive.org  Bluegrass Region Atari Computer Enthusiasts newsletters https://archive.org/details/brace-bits-vol-3-no-1/ https://archive.org/details/computer-shopper-march-1987-vol-7-num-3-atari-articles https://archive.org/details/computer-shopper-december-1986-vol-6-num-12-atari-articles https://archive.org/details/computer-shopper-october-1988-vol-8-num-10-atari-articles https://archive.org/details/computer-shopper-august-1986-vol-6-num-8-atari-articles https://archive.org/details/computer-shopper-february-1989-vol-9-num-2-atari-articles https://archive.org/details/alog-displaymaker-alog-computing https://archive.org/details/alog-maillist-alog-computing  

Headlines!Michael Jackson, Seahawks CB sits down with Ian to discuss new training camp under Mike Macdonald, what motivates him and why he doesn't mind a full cornerback room, despite the competition. He gives us an evaluation of Geno Smith this season so far, as well as why he thinks he looks so comfortable right now.We're hearing a lot more from Marshawn Lynch these days than we ever did during his playing days. Ian misses the air of mystery that used to surround him. It's not fair to compare Sam Howell to Geno Smith, mostly because the offense is built around Geno.Following the Ty France move, we dive into some potential scenarios at first base for the Mariners the rest of this season. With just over a day to go for the trade deadline, what moved should we expect?Mollywhop Monday! Chris Crawford and Nathan Bishop join Ian as we JUST learned the Mariners have made another move in trading for Justin Turner. What are our reasonable expectations for Turner when he joins the team? Why are the Blue Jays dealing with the Mariners so much?Mollywhop Continues! The Mariners haven't moved any headliners in their most recent deals - is a blockbuster on the horizon? Randy Arozarena certainly has the potential to be an impact player, but the guys want to see it on the field. Finally, who are the untouchables?Ian Rapoport, NFL Network joins Ian for a live sit down at the Virginia Mason Athletic Center. He wasn't surprised Mike Macdonald got a head coaching job and gives his thoughts on the end of the Pete Carroll era. Macdonald inherited a very talented roster as well.Tyler Lockett spoke at Seahawks camp today and we take a listen into the veteran's press conference. He discusses the differences we'll see in the offense, as well as the defense. He also talks about his tenth year in the league and what he expects from himself.

Kenny McIntosh, Seahawks RB sits down with Ian to talk about his comeback from injury, what Ryan Grubb brings and where he sees himself on the field this season. Some trickery might be in play with this offense.  Was the Angels' sweep of the Mariners the best thing to happen to them? Ian likes the sense of urgency it created to potentially force Seattle to make a move. We are extremely excited about the signing of Randy Arozarena. We hear from Mark Tomkin who told Gregg Bell all about him earlier today.  The Seahawks reacquired Marquis Blair, who embodies the type of player with whom Seattle wants to set the tone.  Emergency MollyWhop! The Mariners made a move! Chris Crawford and Nathan Bishop join Ian to talk about the acquisition of Randy Arozarena. All signs point to positivity right now, which is a new tone for this segment. Despite his slow start to this season, he's proven himself late in seasons. Nate and Chris are both thrilled right now.  Brian Nemhauser, HawkBlogger sits down with Ian to talk about what he's seeing under Mike Macdonald, what resigning Marquis Blair tells him and the ceiling for this team.  Brian stays around to tell us what he sees the defense looks like under Macdonald, as well as one standout player who might be flying under the radar.  Danny O'Neil, The Dang Apostrophe joins Ian to talk about everything from Seahawks training camp to the Mariners latest moves. He also gives his take on what it looks like for Washington in the Big 10 this year. Given the choice, Danny would choose the Pac-12.

The gang is all back together! Jess and Ian are back from time off and we thank Anders and Chris Crawford for holding down the fort. We discuss the travel fiascos and wedding happiness. Ian went to the Mariners game yesterday and noticed how many Astros fans were in the stands. Happy for the win!   The Mariners host the Angels tonight and the Astros play the A's. The Mariners have what looks like an easy schedule over the next two series, so what's an acceptable outcome?   The CW has it's new broadcast crew and Ian sees it as a retread of the Pac-12 Network.   Mollywhop Monday! Chris Crawford and Nathan Bishop join Ian to discuss the Mariners' standings right now. Jorge Polanco has been on the upswing, will that continue? What is reasonable for an expectation for the next two series?   Mollywhop Monday continues with Chris Crawford and Nathan Bishop! What do we make of the Ty France move?   The Mariners did make a move, bringing up Jason Vosler - so what does this tell us about potential moves?   What's next for the TNT basketball broadcast and will fans be deprived of the best show on earth? Plus, who is actually a starter on the Seahawks of the young group next season?

In the third hour, Dave Softy Mahler and Dick Fain chat with Larry Stone about the All Star Game, uniforms, Teoscar Hernandez, and the Mariners trading, then listen and react to Chris Crawford's interview with M's General Manager Justin Hollander today.