Podcasts about cost of care

Right up front here, let me just state loudly that there are some amazing independent TPAs (third-party administrators) out there who have the expertise, the scrappy willfulness, and the deep desire to do right by their clients, their self-insured employer clients. 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. And look, they may be facing some of the same headwinds that plan sponsors themselves face, like anticompetitive contracts, brokers who are up to no good, etc. So, just keep that in mind as you listen. And the main point of all of this if you are a plan sponsor is, find a good TPA partner, which, as Bryce Platt has said about consultants but same rules apply about TPAs here, the difficulty is being informed enough to tell the difference. So, the goal of this show is to help with that, the “be informed enough to tell the difference.” All of this being said, this is technically a Take Two; but we trimmed it down and welcome to a whole new intro. So, call this a refresher and an update about a really, really important topic from last year that is becoming extremely (maybe even more) relevant this year. Really relevant. Consider, for example, the show with Claire Brockbank (EP453) about carrier/TPA RFPs (requests for proposal) and all of the landmines that are really expensive, that are buried in some of these contracts. Then there was the Cynthia Fisher show (EP457) from last year about the millions, maybe billions of dollars in aggregate going missing in medical (ie, TPA or ASO [administrative services only]) spread pricing. We had “The Mystery of the Weekly Claims Wire” show with Justin Leader (EP433), again, revealing money that's being disappeared when the TPA is withdrawing dollars from plan sponsor checking accounts. And then there's the payment integrity episode with Kimberly Carleson (EP480) from a few weeks ago with just another wrinkle on this, namely TPAs or ASOs who insist on auditing themselves and how that turns out for members and plan sponsors. Oh, and last, but certainly not least, is the whistleblower show with Ann Lewandowski (EP476) on how a TPA arm of an EBC (employee benefit consultant) allegedly pocketed $20 million—$20 million of their client's pharma rebates—and used that $20 million to fund their executive bonus pool. What a time to be alive! All of this just highlights the huge stakes for plan sponsors to really understand what their TPA is all about. And when I say high stakes, I mean from both a legal standpoint and also just vast dollars in play here. But this episode with Elizabeth Mitchell is also, I'm gonna say, extremely relevant given just a few ripped from the headlines and news articles such as these. I'm gonna start actually with a post from Kimberly Carleson, and I like the comment by Jeff Evans, who wrote, “How does $8,710 equal $104,266?” Spoiler alert, it doesn't. Lots of missing dollars there. Someone's hands are in the cookie jar. Oh, look, the TPA has entered the chat. In a nutshell, and I'm quoting something Peter Hayes wrote, he wrote, “TPAs have received relatively little public attention. [There's an article in Health Affairs] that describes how TPAs impose hidden fees, benefit from their own form of spread pricing, and otherwise prioritize their own financial interests over those of their plan clients.” Also, here's a totally other issue. Let me quote Luke Prettol highlighting something Jason Shafrin had written about a paper by Jeff Marr, Daniel Polsky, and Mark Meiselbach. Let me slightly rephrase what Luke said. He wrote, “Employers pay, on average, a 4.7% [so almost 5%] price markup when hospitals are in their TPA's [Medicare Advantage] network.” Right? Dr. Eric Bricker talked about this in that episode (EP472) just how TPAs with MA (Medicare Advantage) business negotiate their commercial clients to pay higher rates so that then they can pay lower rates for their own MA members. As Luke wrote, “On its face, this overpayment does not appear to be solely in the interest of participants.” No kidding. Now, let's spin the wheel here. There are barriers for TPAs themselves, even the ones who have a deep desire to do the right thing. As Patrick Moore wrote, “Most TPAs still can't do [many of the things that employers might want because there are] PPO contracts.” So, is it a rock in a hard place situation? I mean, if the TPA has no other options than using a carrier's PPO (preferred provider organization) network with all its attendant contractual issues, then yeah, that is one definite challenge. Along these lines, let me read a post by Rina Tikia, because I think she sums up this really well. “When independent TPAs … push for transparency, they're blocked under the banner of ‘fiduciary risk.' “Meanwhile, the largest carriers and PBMs, with Cayman shell subsidiaries, DOJ kickback probes, [huge] hedge fund ties, [$10 million-plus] lobbying budgets, and antitrust violations continue unchecked. They are not only allowed to operate but celebrated as mainstream options. “Why the double standard? Political donations? Foundation smokescreens? Nonprofit status as a PR shield?” These are excellent questions. And here's another challenge: brokers. Ramesh Kumar Budhani wrote about this one, just how hard it is sometimes to find—for TPA, an independent TPA, trying to do the right thing—to find brokers who prioritize doing the right thing for employers and helping their clients save money. The summary of all of this: There are TPAs and there are ASOs who aren't even trying. They are going to ride the flywheel, the gravy train, and catch all of the dollars flying off of it for as long as they can manage to cling to it with all 10 of their fingers. Then there are TPAs, mostly indies, trying super hard to do the right thing. But how successful they are is going to depend on how boxed in they are by the PPO networks or the carriers that the brokers or even plan sponsors may insist on. Just how courageous they are and just how smart they are and experienced they are about the market and how it actually operates. So, the show that follows is about all of this, including how we can inspire TPAs, which, in the show that follows, subsumes ASOs kind of into it. But in the show that follows, I hope it's inspiring to create an environment so that the market demands TPAs that do all of the things, and we make inertia not a viable business strategy. Elizabeth Mitchell, my guest today, currently serves as the president and CEO of the Purchaser Business Group on Health. Also mentioned in this episode are Purchaser Business Group on Health; Bryce Platt; Claire Brockbank; Cynthia Fisher; Justin Leader; Kimberly Carleson; Ann Lewandowski; Jeff Evans; Peter Hayes; Luke Prettol; Jason Shafrin; Jeff Marr; Daniel Polsky; Mark Meiselbach; Eric Bricker, MD; Tom Nash; Patrick Moore; Rina Tikia; Ramesh Kumar Budhani; Mark Cuban; Harold Miller; Chris Deacon; Moby Parsons, MD; Benjamin Schwartz, MD, MBA; Mishe Health; Rik Renard; and Cora Opsahl. You can learn more at PBGH and by connecting with Elizabeth on LinkedIn.   Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health (PBGH), advances its strategic focus areas of advanced primary care, functional markets, and purchasing value. She leads PBGH in mobilizing health care purchasers, elevating the role and impact of primary care, and creating functional healthcare markets to support high-quality affordable care, achieving measurable impacts on outcomes and affordability. At PBGH, Elizabeth leverages her extensive experience in working with healthcare purchasers, providers, policymakers, and payers to improve healthcare quality and cost. She previously served as senior vice president for healthcare and community health transformation at Blue Shield of California, during which time she designed Blue Shield's strategy for transforming practice, payment, and community health. Elizabeth served as the president and CEO of the Network for Regional Healthcare Improvement (NRHI), a network of regional quality improvement and measurement organizations. She also served as CEO of Maine's business coalition on health (the Maine Health Management Coalition), worked within an integrated delivery system (MaineHealth), and was elected to the Maine State Legislature, serving as a State Representative. Elizabeth served as vice chairperson of the U.S. Department of Health and Human Services Physician-Focused Payment Model Technical Advisory Committee, board and executive committee member of the National Quality Forum (NQF), member of the National Academy of Medicine's “Vital Signs” Study Committee on core metrics, and a guiding committee member for the Health Care Payment Learning & Action Network. Elizabeth holds a degree in religion from Reed College and studied social policy at the London School of Economics.   08:06 What is the overarching context for health plans in healthcare purchasing? 11:31 Why is it important to reestablish a connection between the people paying for care and people providing care? 13:47 What are the needs of a self-insured employer when managing employee benefits? 19:00 Is it doable for employers to set their own contracts? 21:24 Is transparency presumed? 22:39 Will the new transparency upon us actually expose wasted expense? 24:23 EP408 with Chris Deacon. 25:58 “This is not about individual bad actors. … The systems … that is not aligned.” 27:39 Are there providers who want to work directly with employers? 30:53 Why is it important that incentives need to be aligned? 32:42 EP427 with Rik Renard. 33:51 What's missing from the conversation on changing health plans?   You can learn more at PBGH and by connecting with Elizabeth on LinkedIn.   @lizzymitch2 of @PBGHealth discusses #TPA and #healthplan vs. #jumboemployer inertia on our #healthcarepodcast. #healthcare #podcast #financialhealth #patientoutcomes #primarycare #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Dave Chase, Jonathan Baran (Part 2), Jonathan Baran (Part 1), Jonathan Baran (Bonus Episode), Dr Stan Schwartz (Summer Shorts), Preston Alexander, Dr Tom X Lee (Take Two: EP445), Dr Tom X Lee (Bonus Episode), Dr Benjamin Schwartz, Dr John Lee (Take Two: EP438), Kimberly Carleson, Ann Lewandowski (Summer Shorts)  

First week of June, what'd you miss in vet med?Hill's launches Microbiome Portal with HarvardOklahoma State OK's $250M for new hospitalChewy pledges $1M to LMUMars studies patient safety eventsA call for more independenceSynchrony reports on Lifetime Costs of PetsHelpful links:The Bird Bath substackFrontiers - Making the case for a resurgent U.S. independent veterinary practice segment: a SWOT analysisThe One Health Microbiome ResourceAVMA Journals - Patient safety events cause harm across a variety of veterinary care settings: a global retrospective analysisSynchrony - Pet Lifetime of Care 2025

This week on the podcast, Cate connects with Charlotte Jacobs — a parent and  childcare provider at Seedlings to Sunflowers Nonprofit Childcare and Family Center in Gorham — and Hazel Willow, a Maine parent who has utilized Head Start and now advocates for protecting childcare services and workers. “My child’s last day living in the… The post Podcast: ‘A Day Without Childcare' and the real cost of care gaps first appeared on Maine Beacon.

Long Island lawmakers denounce a law moving elections to even years. A Connecticut bill would give state control to town-run summer camps. New York homeland security officials warn parents about a dangerous new TikTok trend. Plus, WSHU heard from you about your climate concerns.

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

In the final AMA Update episode of 2024, American Medical Association CXO Todd Unger looks back on another year of stories about the work that physicians are doing across the country and how the AMA is fighting to support them.

Bill Kramer, senior advisor for health policy at the Purchaser Business Group on Health, talks about how the country's largest employers figure out how to keep the cost of health care sustainable for their employees. 

In this episode, Stacey Richter speaks with Rob Andrews, CEO of the Health Transformation Alliance (HTA) and former Congressman, about the strategic steps jumbo employers can take to achieve improved health outcomes while reducing cost. They delve into the importance of using data to discern effective practices, negotiate contracts, and hold intermediaries accountable. To Read The Show Notes With All Mentioned Links, Visit the Episode Page. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. The discussion highlights maternal health as a critical area of focus, with successful interventions shown to reduce NICU admissions and overall healthcare costs. Andrews emphasizes the role of self-insured employers in driving systemic changes that align financial incentives with health outcomes. This encore is very relevant after the shows with Cora Opsahl (EP452), Claire Brockbank (EP453), and Marilyn Bartlett (EP450). Getting better health for the 160 million Americans covered by commercial insurance is all about rates, rights, and power. 07:34 How did Rob get to his current role? 09:08 The problem of maternal health and mortality rate, and how self-insured employers wind up directly and indirectly paying for this. 10:27 Why economic consequences move the needle, and why sometimes they don't. 12:26 Why the best way to address costs isn't to re-shift costs but to address them directly. 13:22 Why compensation that isn't dependent on outcomes is a problem. 16:23 “Strategy's not what people say; it's what they do.” 18:21 How do you operationalize saving money with better outcomes? 26:26 How do employers turn conflict into collaboration? 28:20 What is the win-win-win structure among employers, payers, and providers in Rob's eyes? 30:53 To whom should the task of risk adjustment fall? 34:43 “Better contracts do improve outcomes.”  

Texas hospitals must ask patients starting Friday whether they are in the U.S. legally and track the cost of treating people without legal status.   Please Like, Comment and Follow 'The Ray Appleton Show' on all platforms:   ---    'The Ray Appleton Show' is available on the KMJNOW app, Apple Podcasts, Spotify, YouTube or wherever else you listen to podcasts.    --  'The Ray Appleton Show'   Weekdays 11 AM -2 PM Pacific on News/Talk 580 AM & 105.9 FM KMJ    | Website  | Facebook | Podcast |   -  Everything KMJ   KMJNOW App | Podcasts | Facebook | X | Instagram   See omnystudio.com/listener for privacy information.

In the latest episode of Medicine: The Truth, Dr. Robert Pearl and Jeremy Corr return with timely insights on some of the most pressing issues in healthcare today. From the ... The post MTT #88: Abortion restrictions, PBMs and the rising cost of care appeared first on Fixing Healthcare.

In the latest episode of Medicine: The Truth, Dr. Robert Pearl and Jeremy Corr return with timely insights on some of the most pressing issues in healthcare today. From the ... The post MTT #88: Abortion restrictions, PBMs and the rising cost of care appeared first on Fixing Healthcare.

In this Spotlight Episode host Stacey Richter discusses the management of oncology side effects with Dan Nardi, CEO of Reimagine Care. Highlighting the challenges cancer patients face, especially following chemotherapy which often leads to nausea and readmissions, the conversation delves into how Reimagine Care facilitates at-home integrative cancer care.   Their services focus on proactive and reactive support via AI-driven tools like 'Remy' to assist patients outside of clinical environments. This approach aims to reduce emergency visits and improve patient outcomes while easing the workload on healthcare providers. The discussion underscores the role of patient reported outcomes and the integration of technology with human care to improve the quality of oncology treatment pathways.   To Read the Full Article Notes with Mentioned Links, Visit Our Episode Page . If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. Note from Stacey Richter: Pulling off a show like this one is not cheap, and my Aventria business partner Dave Dierk and I are happy to fund the vast majority of it. But yeah, breath of fresh air, and thanks much to the team over at Reimagine Care for their sponsorship. My one disclaimer is that I have not personally vetted the solution, but there is a white paper available where you will also find some insights from Reimagine Care's work with Memorial Hermann Health System. 03:38 Why is it really important to keep track of oncology patients and their side effects? 04:27 Why is cancer treatment such a complex care journey? 05:57 Are there outcome and financial issues that compound when an oncology patient is left to navigate their care journey on their own? 08:53 What is difficult in navigating cancer treatment care pathways, and what does Reimagine Care tackle within that? 09:55 EP157 with Ethan Basch, MD. 10:17 How does Reimagine Care proactively check in with oncology patients to help them navigate their care pathways? 12:41 How does Reimagine Care measure their performance, and how did their work affect patient outcomes? 13:28 The Reimagine Care white paper. 14:57 How do providers feel about Reimagine Care services? 17:37 Where can technology really make a difference in cancer care?

On World Alzheimer's Day, On Your Behalf looks at everything from ageing well to advice around planning for your care.Should older drivers have to re sit their test once they reach a certain age? Presenter Anna Curran has been meeting some older drivers to get their take on the matter.She chats to road safety expert, Rob Heard from the Older Drivers Forum about older drivers' safety.Jonathan Furphy from the Driver Vehicle Agency shares information about how to check your eligibility to drive when you reach an older age. Solicitor Rachael McKee answers questions about power or attorney and planning your care. Paschal McKeown from AGE NI and Ruth Barry from the Alzheimers Society join Anna to discuss issues around getting a diagnosis, planning care and where to get help.

Dave Roberts, chief human resources officer for the West Ada School District, talks about the innovative way his district, with help from Regence and moves from the Idaho Legislature, cut the cost of premiums for employees, and what we can all do to ensure we're getting effective, affordable health care. 

Dr. Emily Tincher joins us to discuss the rising costs of veterinary care and how they impact pet families. Dr. Andy Roark and Dr. Tincher dive into her co-authored book chapter on cost, access to care, and payment options, highlighting key factors driving price increases, such as staffing costs, practice economics, and the cost of consumables and drugs. Dr. Tincher also shares insights on effectively communicating with pet owners about these costs and the importance of understanding their preferences. LINKS: Nationwide's Most Common Claims: https://news.nationwide.com/041824-dermatitis-gastroenteritis-most-common-conditions-prompt-vet-visits/ Cost of Care, Access to Care, and Payment Options in Veterinary Practice: https://www.vetsmall.theclinics.com/article/S0195-5616(23)00156-0/abstract Spectrum of Care: www.spectrum-of-care.com Open Door Veterinary Collective: https://opendoorconsults.org/ Pyometra Peer Reviewed Article Referenced: https://avmajournals.avma.org/view/journals/javma/260/S2/javma.20.12.0713.xml ABOUT OUR GUEST Emily M. Tincher, DVM, is Senior Director of Pet Health at Nationwide. A second-generation veterinarian, she is co-author of a chapter in Veterinary Clinics of North America: Small Animal Practice, "Cost of Care, Access to Care, and Payment Options in Veterinary Practice.” Dr. Tincher is a member of the Board of Directors for the Veterinary Leadership Institute and has become a sought-after speaker, most recently on spectrum of care topics, presenting at major veterinary conferences across North America.

To read the full article with show notes, mentioned links and a full transcript, visit relentlesshealthvalue.com In this episode, Abby Burns from Radio Advisory interviews Stacey Richter, host of the Relentless Health Value podcast, during the Raising the Bar Value Summit. They discuss the complexities of defining and creating value in healthcare, focusing on the roles of various stakeholders including patients, providers, and payers. Stacey shares insights on the challenges and tensions in the healthcare system, such as the fragmentation of care, financial toxicity, and the cultural norms that inhibit progress. The conversation also highlights practical examples and potential strategies to drive value and sustain positive changes within the industry. 03:33 Stacey's journey and mission. 04:16 The story of Scott Conard, MD (EP391). 09:28 Why it's important not just to drive change but to sustain it. 12:23 Heart Failure: A Case Study in Value. 14:13 EP438 with John Lee, MD. 15:07 Why patient positive value often fails instead of succeeds. 18:07 How financial toxicity has become clinical toxicity in healthcare. 19:44 How cultural norms have evolved into healthcare challenges. 23:38 The story of Mike Tuggy, MD, in Washington. 25:13 Looking at the four tensions in measuring value as continuums. 25:37 Why timeline is important in creative value in healthcare. 27:52 Finding Allies by Michael Leavitt. 28:34 What are the four ways to measure value in healthcare? 29:27 How do payers and providers collaborate to align on value metrics? 31:26 Why will proven versus experimental treatments become more important in the next few years? 34:54 Stacey's manifesto (EP400) and values for personal integrity in healthcare. 38:55 Stacey's parting advice. For more information, go to Radio Advisory or Aventria Health Group.