Podcast appearances and mentions of Vivian Ho

On Thursday's show: Despite federal and state regulations, hospitals in Texas are failing to provide real transparency in pricing for medical services they provide. We discuss a new report from health economist Vivian Ho.And we remember our colleague, longtime Texas radio newsman Matt Thomas, who died on Wednesday after a brief illness.Also this hour: We talk about efforts to deal with what's known as the “corridor of cruelty,” an area in Houston that has become a dumping ground for abandoned stray dogs and cats.Then, with Cinco de Mayo coming up next week, we revisit a 2024 conversation about how many holidays get co-opted, and how we can turn cultural appropriation into appreciation. (But also drink. And sell mattresses).And Kenny Wayne Shepherd became a star blues guitarist as a teenager, drawing comparisons to another three-named performer, the legendary Stevie Ray Vaughn. We learn why Shepherd's choice to go by three names had nothing to do with emulating Vaughn and discuss the lessons he's learned from touring with another blues legend, 91-year-old Bobby Rush ahead of their Sunday concert at House of Blues.

This episode of Relentless Health Value features Dr. Kenny Cole from Ochsner Health System. The discussion emphasizes the critical role of trusted relationships and excellent primary care teams in keeping patients out of the emergency room, thus reducing healthcare costs. Stacey Richter revisits this conversation to highlight the importance of care teams building trust with patients and the concept of primary care as an investment in health and wellness. The episode outlines four key points for delivering great primary care, including accountability for outcomes, belief in clinical goals, standardized care flows, and building patient trust. Dr. Cole also discusses the real-world challenges and strategies for achieving clinical and financial success in primary care. The episode serves as a guide for plan sponsors, clinicians, and healthcare executives looking to improve primary care delivery and align it with financial viability. The discussion is further enriched with insights on digitizing care pathways and the importance of measuring and sharing best practices to achieve high standards of care.I Stacey revisits, in a take two, this episode with Dr. Kenny Cole because she's listening to it this time with a new focus. That focus is the theme that keeps coming up over and over and over again on Relentless Health Value these past few months. === LINKS ===

Recently on Relentless Health Value, we've been tinkering around with a few recurring themes—recurring through lines—that are just true about American healthcare these days. In this episode of Relentless Health Value, host Stacey Richter speaks with Dr. Christine Hale about high cost claimants and the implications for healthcare plans in 2025 and beyond. They discuss the importance of trust in patient care, the financial incentives behind patient steering, and the critical role of timely and comprehensive data analysis. Dr. Hale emphasizes the need for an integrated approach to medical and pharmacy claims data to avoid expensive consequences and improve patient outcomes. She also shares strategies for plan sponsors to effectively manage high cost claimants through evidence-based care, appropriate treatment settings, and creative problem-solving, while underlining the importance of patient engagement and satisfaction. Don't miss next week's episode with Dr. Eric Bricker for a deeper dive into these topics. === LINKS ===

So, the show today, it's sort of an encore but not really an encore because I recorded this whole new introduction that you are currently listening to. And I also did a few inserts that we popped into the show itself. Inserts from the future, you might say. 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. But why did I pull this episode from 2021, you might be wondering, as an immediate follow-on to the show from last week (EP469) about possible Medicaid cuts? Well, for one thing, the show last week about Medicaid cuts was about how the cuts might impact plan sponsors. And it left me feeling a little bit like part of the story was going unsaid. So much of what happens in healthcare, we see numbers on a spreadsheet but can easily lose track of human beings. I was reading something the other day. It reminded me of the people behind these numbers. I don't know if this happened in rural America, but it easily could have. Here's the link. Someone could not get a needed surgery. This surgery had all of the medical necessity boxes checked, except the hospital would not perform the needed surgery without cash up front in prepayment. This patient, he did not have enough money to cover the prepayment. So, somebody in the hospital finance department gave him a solution: Just wait until the situation becomes life-threatening, and then I guess you can go to the ER with your newly life-threatening condition, and they will have to perform the surgery without the money up front. And here we have the theme of people not being able to afford or not being able to access primary care or, in this case, I guess something more than that—a surgery—and they wind up in the emergency room. As John Lee, MD, put it, the healthcare system in this country is like a balloon. And the way we are currently squeezing it, everybody is getting squeezed into the emergency room—which is the very most expensive place to obtain care, of course, especially when that care is non-emergent. In rural America, this is particularly true. Now, by no means am I suggesting any kind of magic bullet to this Medicaid situation. As we all know, health and healthcare are not the same thing as health insurance; and we all know enough about the issues with Medicaid. That is not what the show is about. The episode that follows with Nikki King, who is my guest today, offers some great advice when there's just such a scarcity of clinicians available; and she does a great job of it. So, I am going to spend my time with you in this intro talking about rural hospitals in rural areas—the place where many patients wind up when they cannot get primary care in their community, just exacerbating all of the issues we have with Medicaid and affording Medicaid. But yeah, even if there is adequate or even great primary care, you still kind of need a hospital. The thing is, if an economic situation emerges where, say, for example—and this is the case in a lot of rural places—let's just say a factory or two or a mine or whatever closes down. It might mean the local hospital also closes down if that local hospital was dependent on commercial lives and cost shifting to those commercial lives. Like, this is not higher math or anything. It's easy to see how a doom loop immediately gets triggered. Recall that one big reason—and Cynthia Fisher (EP457) talked about this in an episode from a few months ago—one reason why employers in rural areas are choosing to move facilities somewhere else or overseas is that hospital costs are too high in the USA in these rural areas. So, they are closing their factory down because the hospital is charging too much. The lower the volume of commercial lives, the higher the hospital winds up raising their prices for the other employers in the area. Now, there's a point that comes up a lot in 2025 in conversations about rural hospital financials or just hospital financials in general, I guess. I had a conversation with Brad Brockbank about this a while back, and I've been mulling over it ever since. There are many who strongly suggest the reason why rural and other hospitals are in trouble is squarely because they don't have enough patients with commercial insurance in their payer mix. As Nathan Kaufman wrote on LinkedIn the other day, he wrote, “The ‘tipping point' is the percent of commercial gross revenues. When most hospitals hit 25%, if they don't have commercial rates in the high 300% [over Medicare] range, things begin to unravel.” And look, I'm not gonna argue any of the points here. How would I know? For any given hospital, it could be a financial imperative to try to get 300% over Medicare out of the local employers. I don't doubt it. The question I would ask, if someone knows that hospital finances are currently dependent on cost shifting, especially in a rural area with unstable industry, what are the choices that are made by hospital boards or leadership? Is this current dependency used as a justification to level up the cost shifting to local employers just as volume diminishes keep charging more, which is ultimately going to cause even more employers to leave the area? Which seems to be kind of a default. It's like the safety valve is, charge the local employers more. The point I'm making here is not all that profound, actually. It's just to point out that safety valve, taking advantage of it, comes with downstream impact that actually worsens a situation. So, what do we do now? And similar to the Medicaid, what I just said about Medicaid, I'm not showing up with any silver bullet here. And running a hospital is ridiculously hard. So, I do not wanna minimize that. And I certainly do not wanna minimize Medicare advantage paying less than Medicare going on and the mental health crisis and the just crippling issues that a lot of rural hospitals face. Here's a link to a really interesting report by the Center for Healthcare Quality & Payment Reform (CHQPR) about the ways hospitals can restructure and rethink how they deliver services, but I will take a moment to point out some case studies of success for what happens when people crossed off go get more money from the local employers off the list. Then there's also FQHCs (Federally Qualified Health Centers) doing some amazing things even in rural areas. Listen to the episode a while back with Doug Eby, MD, MPH, CPE (EP312) about the Nuka System of Care in Alaska, serving areas so rural, you need to take a prop plane to get to them. Their patients, their members have some of the best outcomes in the entire country. Their secret: yeah … great primary care teams that include behavioral health, the doctor, the nurse, a whole crew. And look at us. We've come full circle. Primary care (good primary care, I mean) is an investment. Everything else is a cost. Lastly, let me just offer a very large update: Today, you cannot just say rural hospital anymore and automatically mean a hospital in dire financial straits struggling to, like, make the rent. Large consolidated hospital systems have bought up so many rural hospitals for all kinds of reasons that may (or maybe not) have less to do with mission and more to do with all the things I discussed with Brennan Bilberry (EP395) in the episode entitled “Consolidated Hospital Systems and Cunning Anticompetitive Contracts.” Here is the original episode with Nikki King. Nikki, let me just mention, has gotten a new job since she was on the pod. She is now the CEO of Alliance Health Centers in Indiana. Also mentioned in this episode are Alliance Health Centers; John Lee, MD; Cynthia Fisher; Patient Rights Advocate; Brad Brockbank; Nathan Kaufman; Doug Eby, MD, MPH, CPE; Nuka System of Care; and Brennan Bilberry.   You can learn more at Alliance Health Centers and by following Nikki on LinkedIn.   Nikki King, MHSA, DHA, is the chief executive officer for Alliance Health Centers, Inc. Her work serves both urban and rural populations and is focused on substance abuse, communities underserved in healthcare, affordable housing, and economic development. Before working in the healthcare industry, she worked for the Center of Business and Economic Research studying models of sustainability in rural communities. Growing up as a first-generation college student in Appalachia, she brings lived experience of rural communities and approaches her work in healthcare as pivotal in breaking the cycle of poverty. Nikki completed her DHA at the Medical University of South Carolina and her MHSA from Xavier University.   08:14 How dire is the rural hospital situation right now? 08:33 How could freestanding ERs be a potential solution for rural hospitals? 09:56 Advice from CHQPR: Rural hospitals should not be forced to eliminate inpatient care. 11:22 Why is broadband a roadblock to telehealth as a solution for rural health access? 14:52 What are other potential rural health access solutions? 15:37 The “hot potato” of nurse practitioners in the healthcare world. 16:34 “The number of residencies for physicians each year is not increasing, but the population … is increasing.” 20:28 EP312 with Douglas Eby, MD, MPH, CPE, of the Nuka System of Care. 22:00 What's the issue with maternity care in rural America? 24:09 “As healthcare becomes more and more specialized, [the] ability to treat high-risk cases is better, but access gets worse.” 27:57 How is mental health care affected in rural communities? 28:29 “Rural communities are trying very hard to hang on to what they have.” 29:52 “When you look at the one market plan that's available in a rural community, you probably can't afford it.” 31:37 What's the single biggest challenge to moving to a model that incentivizes keeping people healthy? 32:32 “The easiest low-hanging fruit … is having national Medicaid and have that put under the same hood as Medicare.”   You can learn more at Alliance Health Centers and by following Nikki on LinkedIn.   Nikki King, MHSA, DHA, discusses #ruralhospitals and #ruralprimarycare. #healthcare #podcast #changemanagement #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! James Gelfand (Part 2), James Gelfand (Part 1), Matt McQuide, Stacey Richter (EP467), Vivian Ho, Chris Crawford (EP465), Al Lewis, Betsy Seals, Wendell Potter (Encore! EP384), Dr Scott Conard, Stacey Richter (INBW42)

Here's my new idea for an episode. Welcome to it. I want to talk about a major theme running through the last few episodes of Relentless Health Value. And this theme is, heads up, going to continue through a few upcoming shows as well. 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. We have Matt McQuide coming up, talking about patient engagement, and Christine Hale, MD, MBA, talking about high-cost claimants. And we also have an encore coming up with Kenny Cole, MD, talking about a lot of things; but patient trust is one of them. But before I get to the main theme to ponder here, let me talk about what gets selected to talk about on Relentless Health Value. I will freely admit, how topics for shows get picked, it's not exactly a linear sort of affair. And furthermore, even if it were, I can't always get the stars to align to get a specific cluster of guests to all come on like one after the other. So, for sure, it might be less than obvious at times where my head is at—and sometimes, admittedly, I don't even know. This may sound incredibly scattershot (and it probably is), but in my defense, this whole healthcare thing, in case you didn't know, it's really complicated. Every time I get a chance to chat with an expert, I learn something new. I feel like it's almost impossible to sit in a vacuum and mastermind some kind of grand insight. Very, very fortunately, I don't need to sit in a cave and do all this heavy thinking all by myself. We got ourselves a tribe here of like-minded, really smart folks between the guests and you lot, all of you in the tribe of listeners who are here every week. Yeah, you rock! And I can always count on you to start teasing out the themes and the through lines and the really key actionable points. You email me. You write great posts and comments on LinkedIn and elsewhere. Even if I am a little bit behind the eight ball translating my instinct into an actual trend line, it doesn't slow this bus down. It's you who keeps it moving, which is why I can confidently say it's you all who are to blame for this new idea I came up with the other day after the podcast with Al Lewis (EP464) triggered so much amazing and really deep insight and dot connecting back and forth that hooked together the past six, I'm gonna say, or so shows. Let's just start at the beginning. Let's start with the topics that have been discussed in the past several episodes of the pod. Here I go. Emergency room visits are now costing about 6% of total plan sponsor spend on average. That was the holy crap moment from the episode with Al Lewis (EP464). Emergency room volume is up, and also prices are up. In that show with Al Lewis, I did quote John Lee, MD, who is an emergency room doctor, by the way. I quoted him because he told a story about a patient who came into the ER, winds up getting a big workup in his ER. Dr. Lee says he sees this situation a lot where the patient comes in, they've had something going on for a while, they've tried to make an appointment with their PCP or even urgent care, they could not get in. It's also really hard to coordinate and get all the blood work or the scans and have that all looked at that's needed for the workup to even happen. I've spoken with multiple ER doctors at this point, and they all say pretty much the same thing. They see the same scenario happen often enough, maybe even multiple times a day. Patient comes in with something that may or may not be emergent, and they are now in the ER because they've been worried about it for weeks or months. And the ER is like the only place where they can get to the bottom of what is going on with their body. And then the patient, you know, they spend the whole day in the ER getting what amounts to weeks' worth of outpatient workup accomplished and scans and imaging and labs. And there's no prior authing anything down. It's also incredibly expensive. Moving on from the Al Lewis show, earlier than that I had had on Rushika Fernandopulle, MD (EP460) and then also Scott Conard, MD (EP462). Both are PCPs, both talking about primary care and what makes good primary care and what makes bad primary care and how our current “healthcare marketplace,” as Dr. Conard puts it, incentivizes either no primary care and/or primary care where volume driven throughput is the name of the game—you know, like seeing 25 patients a day. These visits or episodes of care are often pretty transactional. If relationships are formed, it's because the doctor and/or the patient are rising above the system, not the other way around. And none of that is good for primary care doctors, nurses, or other clinicians. It's also not good for patients, and it's not good for plan sponsors or any of the ultimate purchasers here (taxpayers, patients themselves) because while all of this is going on, those patients getting no or not good primary care are somebody's next high-cost claimant. Okay, so those were the shows with Rushika Fernandopulle and Scott Conard. Then this past week was the show with Vivian Ho, PhD (EP466), who discusses the incentives that hospital leadership often has. And these incentives may actually sound great on paper, but IRL, they wind up actually jacking up prices and set up some weird incentives to increase the number of beds and the heads in them. There was also two shows, one of them with Betsy Seals (EP463) and then another one with Wendell Potter (EP384), about Medicare Advantage and what payers are up to. Alright, so let's dig in. What's the big theme? What's the big through line here? Let's take it from the top. Theme 1 is largely this (and Scott Conard actually said this flat out in his show): Primary care—good primary care, I mean—is an investment. Everything else is a cost. And those skyrocketing ER costs are pure evidence of this. Again, listen to that show with Al Lewis earlier (EP464) for a lot of details about this. But total plan costs … 6% are ER visits. Tim Denman from Premise Health wrote, “That is an insane number! Anything over 2% warrants concern.” But yeah, these days we have, on average across the country, 200 plan members out of 1000 every single year dipping into their local ER. That number, by the way, will rise and fall depending on the access and availability of primary care and/or good urgent cares. Here's from a Web site entitled ER Visit Statistics, Facts & Trends: “In the United States, emergency room visits often highlight gaps in healthcare accessibility. Many individuals turn to ERs for conditions that could have been managed through preventative or primary care. … This indicates that inadequate access to healthcare often leads to increased reliance on emergency departments. … “ED visits can entail significant costs, particularly when a considerable portion of these visits is classified as non-urgent. … [Non-urgent] visits—not requiring immediate medical intervention—often lead to unnecessary expenditures that could be better allocated in primary care settings.” And by the way, if you look at the total cost across the country of ER visits, it's billions and billions and billions of dollars. In 2017, ED visits (I don't have a stat right in front of me), but in 2017, ED visits were $76.3 billion in the United States. Alright, so, the Al Lewis show comes out, I see that, and then, like a bolt of lightning, François de Brantes, MBA, enters the chat. François de Brantes was on Relentless Health Value several years ago (EP220). I should have him come back on. But François de Brantes cemented with mortar the connectivity between runaway ER costs and the lack of primary care. He started out talking actually about a new study from the Milbank Memorial Fund. Only like 5% of our spend going to primary care is way lower than any other developed country in the world—all of whom, of course, have far higher life expectancies than us. So, yeah … they might be onto something. François de Brantes wrote (with some light editing), “Setting aside the impotence of policies, the real question we should ask ourselves is whether we're looking at the right numbers. The short answer is no, with all due respect to the researchers that crunched the numbers. That's probably because the lens they're using is incredibly narrow and misses everything else.” And he's talking now about, is that 5% primary care number actually accurate? François de Brantes continues, “Consider, for example, that in commercially insured plans, the total spend on … EDs is 6% or more.” And then he says, “Check out Stacey Richter's podcast on the subject, but 6% is essentially what researchers say is spent on, you know, ‘primary care.' Except … they don't count those costs, the ER costs. They don't count many other costs that are for primary care, meaning for the treatment of routine preventative and sick care, all the things that family practices used to manage but don't anymore. They don't count them because those services are rendered by clinicians other than those in primary care practice.” François concludes (and he wrote a great article) that if you add up all the dollars that are spent on things that amount to primary care but just didn't happen in a primary care office, it's conservatively around 17% of total dollars. So, yeah … it's not like anyone is saving money by not making sure that every plan member or patient across the country has a relationship with an actual primary care team—you know, a doctor or a nurse who they can get on the phone with who knows them. Listen to the show coming up with Matt McQuide. This theme will continue. But any plan not making sure that primary care happens in primary care offices is shelling out for the most expensive primary care money can buy, you know, because it's gonna happen either in the ER or elsewhere. Jeff Charles Goldsmith, PhD, put this really well. He wrote, “As others have said, [this surge in ER dollars is a] direct consequence of [a] worsening primary care shortage.” Then Dr. John Lee turned up. He, I had quoted on the Al Lewis show, but he wrote a great post on LinkedIn; and part of it was this: “Toward a systemic solution, [we gotta do some unsqueezing of the balloon]. Stacey and Al likened our system to a squeezed balloon, with pressure forcing patients into the [emergency room]. The true solution is to ‘unsqueeze' the system by improving access to care outside the [emergency room]. Addressing these upstream issues could prevent patients from ending up in the [emergency room]. … While the necessary changes are staring us in the face, unsqueezing the balloon is far more challenging than it sounds.” And speaking of ER docs weighing in, then we had Mick Connors, MD, who left a banger of a comment with a bunch of suggestions to untangle some of these challenges that are more challenging than they may sound at first glance that Dr. Lee mentions. And as I said, he's a 30-year pediatric emergency physician, so I'm inclined to take his suggestions seriously. You can find them on LinkedIn. But yeah, I can see why some communities are paying 40 bucks a month or something for patients without access to primary care to get it just like they pay fire departments or police departments. Here's a link to Primary Care for All Americans, who are trying to help local communities get their citizens primary care. And Dr. Conard talked about this a little bit in that episode (EP462). I can also see why plan sponsors have every incentive to change the incentives such that primary care teams can be all in on doing what they do. Dr. Fernandopulle (EP460) hits on this. This is truly vital, making sure that the incentives are right, because we can't forget, as Rob Andrews has said repeatedly, organizations do what you pay them to do. And unless a plan sponsor gets into the mix, it is super rare to encounter anybody paying anybody for amazing primary care in an actual primary care setting. At that point, Alex Sommers, MD, ABEM, DipABLM, arrived on the scene; and he wrote (again with light editing—sorry, I can't read), “This one is in my wheelhouse. There is a ton that could be done here. There just has to be strategy in any given market. It's a function of access, resources, and like-minded employers willing to invest in a direct relationship with providers. But not just any providers. Providers who are willing to solve a big X in this case. You certainly don't need a trauma team on standby to remove a splinter or take off a wart. A great advanced primary care relationship is one way, but another thing is just access to care off-hours with the resources to make a difference in a cost-plus model. You can't help everybody at once. But you can help a lot of people if there is a collaborative opportunity.” And then Dr. Alex Sommers continues. He says, “We already have EKG, most procedures and supplies, X-ray, ultrasounds, and MRI in our clinics. All that's missing is a CT scanner. It just takes a feasible critical mass to invest in a given geography for that type of alternative care model to alter the course here. Six percent of plan spend going to the ER. My goodness.” So, then we have Ann Lewandowski, who just gets to the heart of the matter and the rate critical for primary care to become the investment that it could be: trust. Ann Lewandowski says, “I 100% agree with all of this, basically. I think strong primary care that promotes trust before things get so bad people think they need to go to the emergency room is the way to go.” This whole human concept of trust is a gigantic requirement for clinical and probably financial success. We need primary care to be an investment, but for it to be an investment, there's got to be relationships and there has to be trust between patients and their care teams. Now, neither relationships nor trust are super measurable constructs, so it's really easy for some finance pro to do things in the name of efficiency or optimization that undermine the entire spirit of the endeavor without even realizing it. Then we have a lot of primary care that doesn't happen in primary care offices. It happens in care settings like the ER. So, let's tug this theme along to the shows that concern carriers, meaning the shows with Wendell Potter (EP384) on how shareholders influence carrier behavior and with Betsy Seals (EP463) on Medicare Advantage plans and what they're up to. Here's where the primary care/ER through line starts to connect to carriers. Here's a LinkedIn post by the indomitable Steve Schutzer, MD. Dr. Schutzer wrote about the Betsy Seals conversation, and he said, “Stacey, you made a comment during this fabulous episode with Betsy that I really believe should be amplified from North to South, coast to coast—something that unfortunately is not top of mind for many in this industry. And that was ‘focus on the value that accrues to the patient'—period, end of story. That is the north star of the [value-based care] movement, lest we forget. Financial outcome measures are important in the value equation, but the numerator must be about the patient. As always, grateful for your insights and ongoing leadership.” Oh, thank you so much. And same to you. Grateful for yours. Betsy Seals in that podcast, though, she reminded carrier listeners about this “think about the value accruing to the patient” in that episode. And in the Wendell Potter encore that came out right before the show with Betsy, yeah, what Wendell said kind of made me realize why Betsy felt it important to remind carriers to think about the value accruing to patients. Wall Street rewards profit maximization in the short term. It does not reward value accruing to the patient. However—and here's me agreeing with Dr. Steve Schutzer, because I think this is what underlies his comment—if what we're doing gets so far removed from what is of value to the patient, then yeah, we're getting so removed from the human beings we're allegedly serving, that smart people can make smart decisions in theoretical model world. But what's being done lacks a fundamental grounding in actual reality. And that's dangerous for plan members, but it's also pretty treacherous from a business and legal perspective, as I think we're seeing here. Okay, so back to our theme of broken primary care and accelerating ER costs. Are carriers getting in there and putting a stop to it? I mean, as aforementioned about 8 to 10 times, if you have a broken primary care system, you're gonna pay for primary care, alright. It's just gonna be in really expensive care settings. You gotta figure carriers are wise to this and they're the ones that are supposed to be keeping healthcare costs under control for all America. Well, relative to keeping ER costs under control, here's a link to a study Vivian Ho, PhD, sent from Health Affairs showing how much ER prices have gone up. ER prices are way higher than they used to be. So, you'd think that carriers would have a huge incentive to get members primary care and do lots and lots of things to ensure that not only would members have access to primary care, but it'd be amazing primary care with doctors and nurses that were trusted and relationships that would be built. It'd be salad days for value. Except … they're not doing a whole lot at any scale that I could find. We have Iora and ChenMed and a few others aside. These are advanced primary care groups that are deployed by carriers, and these organizations can do great things. But I also think they serve—and this came up in the Dr. Fernandopulle show (EP460)—they serve like 1% of overall patient populations. Dr. Fernandopulle talked about this in the context of why these advanced primary care disruptors may have great impact on individual patients but they have very little overall impact at a national scale. They're just not scaled, and they're not nationwide. But why not? I mean, why aren't carriers all over this stuff? Well, first of all—and again, kind of like back to the Wendell show (EP384) now—if we're thinking short term, as a carrier, like Wall Street encourages, you know, quarter by quarter, and if only the outlier, mission-driven folks (the knights) in any given carrier organization are checking what's going on actually with plans, members, and patients like Betsy advised, keep in mind it's a whole lot cheaper and it's easier to just deny care. And you can do that at scale if you get yourself an AI engine and press Go. Or you can come up with, I don't know, exciting new ways to maximize your risk adjustment and upcoding. There's an article that was written by Sergei Polevikov, ABD, MBA, MS, MA

This episode has three chapters. Each one answers a key question, and, bottom line, it all adds up to action steps directly and indirectly for many, including plan sponsors probably, community leaders, and also hospital boards of directors. Here's the three chapters in sum. 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. Chapter 1: Are commercial insurance premiums rising faster than the inflation rate? And if so, is the employee portion of those premiums also rising, meaning a double whammy for employees' paychecks (ie, premium costs are getting bigger and bigger in an absolute sense, and also employees' relative share of those bigger costs is also bigger)? Spoiler alert: yes and yes. Chapter 2: What is the biggest reason for these premium increases? Like, if you look at the drivers of cost that underpin those rising premiums, what costs a lot that is making these premiums cost a lot? Spoiler alert: It's hospitals and the price increases at hospitals. And just in case anyone is wondering, this isn't, “Oh, chargemasters went up” or some kind of other tangential factor. We're talking about the revenue that hospitals are taking on services delivered has gone up and gone up way higher than the inflation rate. In fact, hospital costs have gone up over double the amount that premiums have gone up. Wait, what? That's a fact that Dr. Vivian Ho said today that threw my brain for a loop: Hospital costs have gone up over double the amount that premiums have gone up. Chapter 3: Is the reason that hospital prices have rocketed up as they have because the underlying costs these hospitals face are also going up way higher than the inflation rate? Like, for example, are nurses' salaries skyrocketing and doctors are getting paid a lot more than the inflation rate? Stuff like this. Too many eggs in the cafeteria. Way more charity care. Bottom line, is an increase in underlying costs the reason for rising hospital prices? Spoiler alert: no. No to all of the above. And I get into this deeply with Dr. Vivian Ho today. But before I do, I do just want to state with three underlines not all hospitals are the same. But yeah, you have many major consolidated hospitals crying about their, you know, “razor-thin margins” who are, it turns out, incentivizing their C-suites to do things that ultimately wind up raising prices. I saw a PowerPoint flying around—you may have seen it, too—that was apparently presented by a nonprofit hospital at JP Morgan, and it showed this nonprofit hospital with a 15.1% EBITDA (earnings before interest, taxes, depreciation, and amortization) in 2024. Not razor thin in my book. It's a, the boards of directors are structuring C-suite incentives in ways that ultimately will raise prices. If you want to dig in a little deeper on hospital boards and what they may be up to, listen to the show with Suhas Gondi, MD, MBA (EP404). Vivian Ho, PhD, my guest today, is a professor and faculty member at Rice University and Baylor College of Medicine. Her most major role these days is working on health policy at Baker Institute at Rice University. Her work there is at the national, state, and local levels conducting objective research that informs policymakers on how to improve healthcare. Today on the show, Professor Vivian Ho mentions research with Salpy Kanimian and Derek Jenkins, PhD. Alright, so just one quick sidebar before we get into the show. There is a lot going on with hospitals right now. So, before we kick in, let me just make one really important point. A hospital's contribution to medical research, like doing cancer clinical trials, is not the same as how a hospital serves or overcharges their community or makes decisions that increase or reduce their ability to improve the health and well-being of patients and members who wind up in or about the hospital. Huge, consolidated hospital networks can be doing great things that have great value and also, at the exact same time, kind of harmful things clinically and financially that negatively impact lots of Americans and doing all of that simultaneously. This is inarguable. Also mentioned in this episode are Rice University's Baker Institute for Public Policy; Baker Institute Center for Health Policy; Suhas Gondi, MD, MBA; Salpy Kanimian; Derek Jenkins, PhD; Byron Hugley; Michael Strain; Dave Chase; Zack Cooper, PhD; Houston Business Coalition on Health (HBCH); Marilyn Bartlett, CPA, CGMA, CMA, CFM; Cora Opsahl; Claire Brockbank; Shawn Gremminger; Autumn Yongchu; Erik Davis; Ge Bai, PhD, CPA; Community Health Choice; Mark Cuban; and Ferrin Williams, PharmD, MBA. For further reading, check out this LinkedIn post.   You can learn more at Rice University's Center for Health Policy (LinkedIn) and Department of Economics and by following Vivian on LinkedIn.   Vivian Ho, PhD, is the James A. Baker III Institute Chair in Health Economics, a professor in the Department of Economics at Rice University, a professor in the Department of Medicine at Baylor College of Medicine, and a nonresident senior scholar in the USC Schaeffer Center for Health Policy and Economics. Ho's research examines the effects of economic incentives and regulations on the quality and costs of health care. Her research is widely published in economics, medical, and health services research journals. Ho's research has been funded by the National Institutes of Health (NIH), the Agency for Healthcare Research and Quality, the American Cancer Society, and Arnold Ventures. Ho has served on the Board of Scientific Counselors for the National Center for Health Statistics, as well as on the NIH Health Services, Outcomes, and Delivery study section. She was elected as a member of the National Academy of Medicine in 2020. Ho is also a founding board member of the American Society for Health Economists and a member of the Community Advisory Board at Blue Cross Blue Shield of Texas. Ho received her AB in economics from Harvard University, a graduate diploma in economics from The Australian National University, and a PhD in economics from Stanford University.   05:12 Are insurance premiums going up? 05:59 What is the disparity between cost of insurance and wage increases? 06:21 LinkedIn post by Byron Hugley. 06:25 Article by Michael Strain. 06:46 How much have insurance premiums gone up for employers versus employees? 09:06 Chart showing the cost to insure populations of employees and families. 10:17 What is causing hospital prices and insurance premiums to go up so exponentially? 12:53 Article by (and tribute to) Uwe Reinhardt. 13:49 EP450 with Marilyn Bartlett, CPA, CGMA, CMA, CFM. 14:01 EP452 with Cora Opsahl. 14:03 EP453 with Claire Brockbank. 14:37 EP371 with Erik Davis and Autumn Yongchu. 15:28 Are razor-thin operating margins for hospitals causing these rising hospital prices? 16:56 Collaboration with Marilyn Bartlett and the NASHP Hospital Cost Tool. 19:47 What is the explanation that hospitals give for justifying these profits? 23:16 How do these hospital cost increases actually happen? 27:06 Study by Zack Cooper, PhD. 27:35 EP404 with Suhas Gondi, MD, MBA. 27:50 Who typically makes up a hospital board, and why do these motivations incentivize hospital price increases? 30:12 EP418 with Mark Cuban and Ferrin Williams, PharmD, MBA. 33:17 Why is it vital that change start at the board level?   You can learn more at Rice University's Center for Health Policy (LinkedIn) and Department of Economics and by following Vivian on LinkedIn.   Vivian Ho discusses #healthinsurance #premiums and #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #changemanagement #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Chris Crawford (EP465), Al Lewis, Betsy Seals, Wendell Potter (Encore! EP384), Dr Scott Conard, Stacey Richter (INBW42), Chris Crawford (EP461), Dr Rushika Fernandopulle, Bill Sarraille, Stacey Richter (INBW41)  

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    

The brazen murder of UnitedHealthcare CEO Brian Thompson in broad daylight in midtown Manhattan last year has open the floodgates to an outpouring of anger and frustration with the health insurance industry. Across the country, whether it's about skyrocketing financial costs or access to care, there seems to be a wide agreement that health insurance in America is broken. The question is how to fix it. How can policy incentivize the industry to be better stewards of the health of its members without fueling unsustainable costs or incentivizing waste? What solutions are on the table and how might they shape the future of healthcare in America? Here to help us dig into the details is Vivian Ho, the James A. Baker III Institute Chair in Health Economics at Rice University.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Vivian Ho of Rice University joins Chad to provide some insight and information about why Americans pay more for healthcare than anyone else in the world.

The hour begins with Susie Jones joining Chad and Dave for Overrated, Underrated or Properly Rated before an interview with Vivian Ho of Rice University about the high cost of healthcare in America.

On Friday's show: The state-appointed board overseeing Houston ISD has approved placing a record $4.4 billion bond proposal on the November ballot. We learn what the money would do. And a new school year begins for the district on Monday. We learn about high employee turnover there.Also this hour: Health economist Vivian Ho discusses a pair of recent studies she co-authored looking at how high hospital prices are driving up insurance premiums and how increased salaries for nonprofit hospital CEOs may be driving consolidation for health care systems.Then, from a revised hurricane season storm prediction, to Simone Biles headlining a concert-style athletic performance at Toyota Center this fall, our “non-expert panel” weighs in on The Good, The Bad, and The Ugly of it all,And a new Native American-owned restaurant opens in Kemah. We visit Th_Prsrv and talk with Chef David Skinner.

On Monday's show: The Texas Medical Board on Friday published what it sees as guidance for doctors about how to define what constitutes a medical exception under the state's strict abortion ban. We learn what that guidance entails and some of the legal questions it raises. Also this hour: A recent report from Rice University examines cost and quality at Houston hospitals and found, among other things, there's a wide range of costs for customers with Blue Cross Blue Shield of Texas depending on which hospital they go to for care. Then, columnist Dwight Silverman discusses some recent developments in consumer technology. And we discuss the University of Houston's overtime win against Texas A&M in the NCAA tournament. And dramatic off-field developments involving Shohei Ohtani and his now former translator once again raise the specter of how sports and gambling are more intertwined than ever. And will MLB investigate it as aggressively as it did the Astros' sign-stealing scandal? We talk it over with Jeff Balke, who writes for Houston Press and co-hosts the Bleav in Astros podcast.

  On Monday's show: At the end March, people on Medicaid will have to start signing up for the program again to renew their coverage, instead of the “continuous enrollment” method, which rolled enrollment over from year to year and was part of the federal government's COVID-19 health emergency policy. As a consequence, the federal Department of Health and Human Services expects 6.8 million people to lose their coverage even though they are still eligible. We discuss what this could mean for Texas, a state with so many uninsured and relying on Medicaid. Also this hour: We learn about the Biden administration's immigration policies and their potential impact on Houston and Texas. Then, columnist Dwight Silverman discusses some of the latest developments in consumer technology And we get an update on Houston sports from Jeff Balke, who writes for Houston Press and co-hosts the Bleav in Astros podcast.

Award-winning journalist Vivian Ho exposes a shattering true-crime story, shedding light on America's new lost generation and investigating two murders that are connected to a troubled trio. Written, researched, and hosted by Kate Winkler Dawson/producer Alexis Amorosi/mixer Ryo Baum/composer Curtis Heath/web designer Ilsa Brink Buy my books: katewinklerdawson.com    If you have suggestions for historical crimes that could use some attention, email me: info@tenfoldmorewicked.com    Follow me on social: @tenfoldmore (Twitter) / @tenfoldmorewicked (Facebook and Instagram)    2022 All Rights ReservedSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

On Friday's show: We learn how inflation is making it hard for rural hospitals in Texas to stay open. Also this hour: With the recent return of NASA's Artemis 1 mission to the moon, Houstonians share their memories of the first moon landing in 1969. Then, we revisit a conversation with scientists at Johnson Space Center about the process of carefully opening a vacuum sealed tube filled with rocks and soil that was collected on the moon 50 years ago. And we break down The Good, The Bad, and The Ugly of the week.

On Thursday's show: A new report from Rice University's Baker Institute for Public Policy compared prices at three of Houston's biggest hospital systems. Also this hour: We learn more about the area's high pollen counts recently and how people can get relief from their allergies. Dr. Dat Tran from Innovative Allergy answers your questions. And, with recent news that The Orange Show will be getting a facelift in the near future, we visit the unique monument to one man's love of oranges.

If you're into water and accountability, you freak, this one's for you. From Jackson, Mississippi to Flint, Michigan and every dam in between. Works used in the making of this podcast: "Flint Water Crisis" at https://en.wikipedia.org/wiki/Flint_water_crisis. "The Biden Plan: The Most Awaited Infrastructure Plan for US."  https://www.dlapiper.com/en/us/insights/publications/2022/04/projects-global-insight-issue-5/the-biden-plan/. 4/1/2022. "Living in a city with no water: ‘This is unbearable'."  By Emmanuel Felton. 9/3/2022 https://www.washingtonpost.com/nation/2022/09/03/jackson-mississippi-water-crisis/. "Permanent water solution for Las Vegas residents could take 4-5 years."  Spencer Schacht.  9/7/2022.  https://www.kob.com/new-mexico/clean-water-shortage-continues-for-las-vegas-residents/. https://www.theguardian.com/environment/2020/jun/23/full-report-read-in-depth-water-poverty-investigation.  6/23/2020.   "The Affordability of Water and Wastewater Service In Twelve U.S. Cities: A Social, Business and Environmental Concern." A study prepared for The Guardian by Roger D. Colton of Fisher, Sheehan & Colton Public Finance and General Economic.  5/2020.  https://www.scribd.com/document/465846248/Water-Report?secret_password=T6F6aUH8JqAPtTg5J1aW#fullscreen&from_embed.   "EPA Announces $26 Million in Funding for New Mexico Water Infrastructure Improvements."  https://www.epa.gov/newsreleases/epa-announces-26-million-funding-new-mexico-water-infrastructure-improvements. 9/30/2022. "More than 25m drink from the worst US water systems, with Latinos most exposed."  Emily Holden, Caty Enders, Niko Kommenda, and Vivian Ho.  https://www.theguardian.com/us-news/2021/feb/26/worst-us-water-systems-latinos-most-exposed. 2/26/2021. "Reeves claims Miss. gave Jackson $200M for infrastructure. Where did that money come from?"  Anthony Warren.  https://www.wlbt.com/2022/09/08/reeves-claims-miss-gave-jackson-200m-infrastructure-where-did-that-money-come/.  9/8/2022. "A Growing Drinking Water Crisis Threatens American Cities and Towns."  Robin Lloyd.  https://www.scientificamerican.com/article/a-growing-drinking-water-crisis-threatens-american-cities-and-towns/.   9/9/2022. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

On Thursday's show: A new report finds that 16 percent of Texas hospitals are still not complying with federal price transparency rules. We discuss why these rules were put in place and what can be done to get hospitals to comply with them. Also this hour: We learn what's being done to address the state's teacher shortage. Then, Dwight Silverman answers your technology questions. And we learn how therapy helped Saturday Night Live cast member Chris Redd be a better comedian and how rap helped him get over a debilitating stutter. Redd's on stage at Houston Improv for four shows tonight through Sunday.

On Monday's show: The Harris Health System announced the release of its only COVID-19 patient this past Friday, leaving zero COVID-19 patients for the first time since March of 2020. And Memorial Hermann also announced Friday that they would be easing several of their COVID guidelines – health screenings won't be required from employees and patients and masks will be optional in non-patient areas. Visitation will also return to pre-pandemic rules. While some things may be looking better for hospitals they're still assessing the full scope of the financial damage the pandemic caused over the last two years. Also this hour: You still have until the end of the day to file your federal income taxes. We discuss why the deadline was extended to today and what you should do if you can't get yours filed on time. Plus, veterinarian Dr. Lori Teller answers your pet care questions. And we get an update on Houston sports from Jeff Balke.

  On Friday's show: Could power generated from solar panels have prevented the outages caused by last February's winter storm? Environment Texas seems to think so. Plus: A new state law requires hospitals to be transparent about their pricing. What does this look like? Also this hour: We discuss the challenges 3D printed guns (sometimes referred to as "ghost guns" because they have no serial numbers) present law enforcement. Then, we discuss The Good, The Bad, and The Ugly of the week. And we talk with Lee David Zlotoff, the creator of the TV show MacGyver, about MacGyver the Musical, which is making its world premeire at Stages Houston now  through March 4.

An article authored by Vivian Ho on the life and influence of Tom Morey.

COVID-19 has decimated hospitals in many ways – including financially. Vivian Ho is James A. Baker III Institute Chair in Health Economics and director of the Center for Health and Biosciences at Rice University, and she joins host Krys Boyd to talk about the knock-on effects of the pandemic, from possible health-care bankruptcies to staffing issues, that hospitals are bracing for after the storm.

Health policy is always a matter of life and death — and even more so during a pandemic. This week, health economist Vivian Ho grapples with some of our moment's big questions: How is Texas doing with its vaccine rollout? What's baked into our state's unusual choice to prioritize people over 65 or with underlying conditions, rather than teachers and other frontline workers? How fair has it been so far? And what does it mean that even the Centers for Disease Control and Protection's data isn't good enough to answer basic questions about reopening safely? At Rice University, Ho is the James A. Baker III Institute Chair in Health Economics, and she directs the Baker Institute's Center for Health and Biosciences. She is also a professor at Baylor College of Medicine, and was recently elected to the National Academy of Medicine, one of the highest honors in the field. Question or comment? Connect with Lisa on Facebook or Twitter. See omnystudio.com/listener for privacy information.

Vivian Ho, health economist at Rice University, says there's a relationship between a state's decision to issue strict lockdown measures early in the pandemic and how many COVID-19 deaths ultimately occurred there. More here: https://www.bakerinstitute.org/research/state-restrictions-and-covid-19-death-rate/

This week, The Guardian published the first in a series of reports on why COVID-19 cases have surged in the Central Valley. Valley Public Radio Host Kathleen Schock spoke with reporter Vivian Ho about her investigation into how the virus spread among agricultural workers. Also joining the conversation is UC Merced Associate Professor of Sociology Edward Flores, who recently co-published a study on the connection between low-wage employment and the coronavirus.

Our special edition of Houston Matters weekdays at 3 p.m. addresses your questions and concerns about important issues affecting the community. In the first segment, host Ernie Manouse is joined by Dr. Vivian Ho with Rice University’s James A. Baker III Institute to talk about the latest news surrounding COVID-19. She co-writes a blog detailing the latest updates on the pandemic. Then, Ernie is joined by Dr. Susan Bailey, president of the American Medical Association. They discuss the mission... Read More

Our special edition of Houston Matters weekdays at 3 p.m. addresses your questions and concerns about important issues affecting the community. In the first segment, host Ernie Manouse is joined by Dr. Vivian Ho with Rice University's James A. Baker III Institute to talk about the latest news surrounding COVID-19. She co-writes a blog detailing the latest updates on the pandemic. Then, Ernie is joined by Heath Racela, a TV producer (PBS' This Old House) who now produces and... Read More

Our special edition of Houston Matters weekdays at 3 p.m. addresses your questions and concerns about important issues affecting the community. In the first segment, host Ernie Manouse is joined by Dr. Vivian Ho with Rice University’s James A. Baker III Institute to talk about the latest news surrounding COVID-19. She co-writes a blog detailing the latest updates on the pandemic. Then, Ernie is joined by Dr. Peter Hotez, Dean for the National School of Tropical Medicine – Baylor... Read More

Our special edition of Houston Matters weekdays at 3 p.m. addresses your questions and concerns about important issues affecting the community. In the first segment, host Ernie Manouse is joined by Dr. Vivian Ho with Rice University's James A. Baker III Institute to talk about the latest news surrounding COVID-19. She co-writes a blog detailing the latest updates on the pandemic. Then, Ernie is joined by Fort Bend Independent School District Superintendent Dr. Charles Dupre, who discusses FBISD's plans... Read More

Our special edition of Houston Matters weekdays at 3 p.m. addresses your questions and concerns about important issues affecting the community. In the first segment, host Ernie Manouse is joined by Dr. Vivian Ho with Rice University’s James A. Baker III Institute to talk about the latest news surrounding COVID-19. She co-writes a blog detailing the latest updates on the pandemic. Then, Ernie is joined by Houston Mayor Sylvester Turner to discuss the COVID situation in Houston and the... Read More

Our special edition of Houston Matters weekdays at 3 p.m. addresses your questions and concerns about important issues affecting the community. In the first segment, host Ernie Manouse is joined by Dr. Vivian Ho with Rice University’s James A. Baker III Institute to talk about the latest news surrounding COVID-19. She co-writes a blog detailing the latest updates on the pandemic. Then, Ernie is joined by Harris County District Attorney Kim Ogg, to talk about the impact of COVID-19... Read More

Our special edition of Houston Matters weekdays at 3 p.m. addresses your questions and concerns about important issues affecting the community. In the first segment, host Ernie Manouse is joined by Dr. Vivian Ho with Rice University’s James A. Baker III Institute to talk about the latest news surrounding COVID-19. She co-writes a blog detailing the latest updates on the pandemic. Then, Ernie is joined by Dr. Melanye Price, a professor of political science at Prairie View A&M,... Read More

On Friday's Houston Matters: As Texas hospitals are seeing a spike in coronavirus cases, we learn what kind of strain that puts on area hospitals and their finances. Also this hour: Hubs, innovation nonprofits, accelerators -- those terms all refer to companies that are in the business of helping to start up other businesses. We discuss how they work -- and sometimes don't. Plus, we get some tips for small businesses struggling in the recession.... Read More

Our special edition of Houston Matters weekdays at 3 p.m. addresses your questions and concerns about important issues affecting the community. In the first segment, host Ernie Manouse is joined by Dr. Vivian Ho with Rice University’s James A. Baker III Institute to talk about the latest news surrounding COVID-19. She co-writes a blog detailing the latest updates on the pandemic. Dr. Ho is: James A. Baker III Institute Chair in Health Economics Professor of economics Professor of... Read More

Vivian Ho of Rice University and Baylor College of Medicine on struggling hospitals. Chris Rogers of Brigham Young Univ on saving Iñapari. Gaurav Khanna of Univ of Massachusetts, Dartmouth on Playstation supercomputers. Louis Boria of Brooklyn Boy Knits on men who knit. Adam Dolezal, Univ of Illinois on bees & social distancing. Chris Looney of Washington State Department of Agriculture on the murder hornet.

Our special edition of Houston Matters weekdays at 3 p.m. addresses your questions and concerns about coronavirus as a public service to our listeners. In the first segment, host Ernie Manouse is joined by Dr. Vivian Ho with Rice University’s James A. Baker III Institute to talk about our society’s response to COVID-19. She co-writes a blog detailing the latest updates on the pandemic. Dr. Ho is: James A. Baker III Institute Chair in Health Economics Professor of economics Professor... Read More

Our special edition of Houston Matters weekdays at 3 p.m. addresses your questions and concerns about coronavirus as a public service to our listeners. In the first segment, host Ernie Manouse is joined by Dr. Vivian Ho with Rice University’s James A. Baker III Institute to talk about our society’s response to COVID-19. She co-writes a blog detailing the latest updates on the pandemic. Dr. Ho is: James A. Baker III Institute Chair in Health Economics Professor of economics Professor... Read More

Our special edition of Houston Matters weekdays at 3 p.m. addresses your questions and concerns about coronavirus as a public service to our listeners. In the first half, host Ernie Manouse is joined by Dr. Vivian Ho, health economist at Rice University’s Baker Institute for Public Policy and Baylor College of Medicine. She co-writes a blog detailing the latest updates on the pandemic. Co-author and colleague Dr. Kirstin Matthews, Fellow in Science and Technology Policy, joins Dr.... Read More

Our special edition of Houston Matters weekdays at 3 p.m. addresses your questions and concerns about coronavirus as a public service to our listeners. In the first segment, host Ernie Manouse is joined by Dr. Vivian Ho with Rice University’s James A. Baker III Institute to talk about our society’s response to COVID-19. She co-writes a blog detailing the latest updates on the pandemic. Dr. Ho is: James A. Baker III Institute Chair in Health Economics Professor of economics Professor... Read More

Christine Todd, Senior Managing Director & Head of U.S. Fixed Income at Amundi Pioneer, discusses how she's playing the sell-off. Ben Holland, Political economy editor for Bloomberg, on how the bond market is saying Bernie Sanders' numbers don’t need to add up. Austin Carr, Bloomberg technology reporter, and Anand Srinivasan, Senior Semiconductor and Hardware Analyst for Bloomberg Intelligence, discuss Xerox and HP's $35 billion fight over ink cartridges. Rice University health care economist Vivian Ho, Chair in Health Economics at the Baker Institute, and Director at the Center for Health and Biosciences, discusses the economics and U.S. preparedness for the coronavirus. Hosted by Lisa Abramowicz and Paul Sweeney.

This week, we spoke to Brandon Rottinghaus, professor at Univeristy of Houston and co-host of Party Politics, a podcast on Houston Public Media, about the Democratic presidential primary in TX. Then we go deep into health care with Vivian Ho, an economics professor with the Baker Institute at Rice University. And finally we target the Texas legislature with some housecleaning, this week targeting State Representative Matt Krauss in district 93.

0:08 – Ady Barkan is a social justice activist who has built three programs at The Center for Popular Democracy: the Be A Hero and Fed Up campaigns and the Local Progress network. He was a law clerk to the Hon. Shira A. Scheindlin in the Southern District of New York and prior to that he was a Liman Fellow with Make the Road New York, where he represented low-wage workers seeking to recover unpaid wages and obtain safe and dignified working conditions. He graduated from Yale Law School and Columbia College. He lives with his wife Rachael and their two young children in Santa Barbara, California. Eyes to the Wind is a memoir and his first book. 0:22 – Vivian Ho is a journalist who has written for the San Francisco Chronicle, the Guardian, Topic and the Boston Globe. Her first book is Those Who Wander: America's Lost Street Kids. 0:55 – KPFA's Richard Wolinsky reviews Pride and Prejudice now showing at Theatreworks Palo Alto through Saturday January 4th. 1:08 – Albert Woodfox – for the hour – served more than 40 years in solitary confinement in Angola State Prison in Louisiana – the longest period of solitary confinement in US prison history. In 2014, his conviction was overturned, and in 2016 he was released. He joins us now, to talk about his experience, and his new memoir Solitary. The post ‘No one should die for lack of care' Ady Barkan on the fight for universal healthcare; Plus: Albert Woodfox on more than 40 years in solitary appeared first on KPFA.

In the conclusion to this two-part episode, crime reporter and author Vivian Ho reads the complete first chapter of Those Who Wander: America's Lost Street Kids and talks about why she expanded her coverage of two murders that grabbed San Francisco's attention in October 2015 into a book. "It just felt like a tragedy on all fronts, it was absolutely heartbreaking from the victims' perspectives — here was a young girl who was cut down as she was trying to figure out her life, as she was just starting off, and here was a man who was here to support his wife through chemo, they loved each other so much." "You look at these three suspects and you just wonder what the hell happened, how did we get here, how did we get here as a society, where did we go wrong," she said.

San Francisco's street kids are highly visible and poorly understood. No one has a firm grasp on how many of them live on our streets, as a good number are transient and belong to the community of “Travelers” who congregate in Haight-Ashbury. Few residents view them as violent or a threat, however, which is why a 2015 crime spree committed by three young vagabonds in Golden Gate Park captured San Francisco's attention. In this episode, crime reporter Vivian Ho discusses the case, which forms the basis for her book, Those Who Wander: America's Lost Street Kids.

Healthcare is a hot topic in the ongoing race for the Democratic Presidential nomination.  It is likely to be so in the 2020 general election.    Several major candidates – notably Senators Elizabeth Warren and Bernie Sanders – have proposed a universal government-financed program called “Medicare for All.”  What is Medicare for All?   What is it designed to do?   How much will it cost?   And are there other, less sweeping suggestions to reform our health-care finance system? This episode’s guest is Dr. Vivian Ho, Director of the Center for Health and Biosciences here at the Baker Institute.  Vivian is an expert on the US healthcare system in all its bewildering complexity.  Note:   This episode was recorded before Senator Warren released her Medicare-for-All plan. 

The double murder of Audrey Carey and Steve Carter captivated the Bay Area back in 2015 after it was found that the crimes had been carried out by a trio of transient youth.   For many around the Bay, it was a catalyzing moment that pushed the problems of homelessness and youth dislocation out of the realm of “social problem to be addressed,” and instead into the realm of “clear and present danger to be protected against.” But is there something more to be learned from the stories of the three young people responsible for these crimes? And if we did manage to learn those lessons, could we do a better job supporting other young people walking a similar path? That’s the set of questions raised by former San Francisco Chronicle crime and criminal justice reporter Vivian Ho in her new book, “Those Who Wander: America’s Lost Street Kids.” She joins this edition of KCBS In Depth to discuss.  Host: KCBS Radio reporter Keith Menconi 

Nationwide, hospital consolidation remains a powerful trend shaping healthcare delivery to millions of Americans.   So does hospital acquisition of physician practices and physician organizations.  Theoretically, such mergers and acquisitions could make sense by creating economies of scale and complementarities in patient services.   But there is also evidence that such mergers do little to restrain prices or improve patient outcomes. Our guest this episode is Marah Short, associate director of the Center for Health and Biosciences at the Baker Institute.   She has recently published a paper, coauthored by Dr. Vivian Ho, Director of the Center, on today’s subject. 

New data shows health costs increase when Texas physicians consolidate into hospital systems. Why do providers enter these types of relationships and how can we help them stay independent? Dr. McCoy discusses the changing healthcare landscape and strategies to keep costs down with a panel of experts. This edition features Dr. Vivian Ho, a health economist at Rice University's Baker Institute, Lee Spangler, JD, BCBSTX Vice President of Texas Government Relations, and co-host Ross Blackstone, BCBSTX Director of Strategic Influence. You can view this discussion in video format on YouTube. Blue Promise is an online video blog and podcast that aims to address complicated health issues with candid conversations from subject matter experts. New editions are published regularly and are hosted by Dr. Dan McCoy, President of Blue Cross and Blue Shield of Texas.

Using the emergency room in non-emergency situations drives up health care costs for all Texans. In this edition of Blue Promise, we talk the root causes of these high costs and what individuals can do to protect themselves. Dr. Vivian Ho, a health economist at Rice University's Baker Institute, Dr. Paul Hain, BCBSTX North Texas Market President, and co-host Ross Blackstone, BCBSTX Director of Strategic Influence, join Dr. McCoy for this discussion. You can listen to the complete discussion in podcast form on Apple Podcasts (https://apple.co/2KyH87U) and SoundCloud (https://bit.ly/2jncyl6). Blue Promise is an online video blog and podcast that aims to address complicated health issues with candid conversations from subject matter experts. New editions are published regularly and are hosted by Dr. Dan McCoy, President of Blue Cross and Blue Shield of Texas.

Reporter Vivian Ho  has worked for the San Francisco Chronicle since 2011, covering criminal justice and breaking news. She reported on the Mario Woods shooting, the San Francisco Police Department, wild fires, and she’s just published an incredible investigative piece called "A Life on the Line." She's seen a lot of San Francisco, from the incredibly serious and life-and-death moments to the more quirky and offbeat happenings around town. In today's episode, Vivian tells is about the one BART story that she didn't expect to be known for.  You can also hear Vivian's San Francisco Diaries story here. If you have your own story that happened on or off the bus, our inbox is wide open for your pitches at muni.diaries.sf@gmail.com. 

You may know storyteller Vivian Ho as the criminal justice reporter at the San Francisco Chronicle since 2011. She's reported on the Mario Woods shooting, the San Francisco Police Department, wildfires, and she’s just published an incredible investigative piece called "A Life on the Line." In this episode, Vivian shares a personal story about the challenges of adulthood in San Francisco, and how a pair of pigeons helped her realize the importance of a new love in her life. You can find her on Twitter @VivianHo.  Got your own story about finding yourself in this foggy city? Share your story with us by emailing us at muni.diaries.sf@gmail.com. Follow us on Facebook at Facebook.com/sanfranciscodiaries.

Since its enactment in 2010, Republicans have sought to repeal and replace the Affordable Care Act (ACA). Under Obamacare, millions of Americans have acquired health insurance, but the program has remained controversial. Despite majorities in the House and Senate, Republican efforts to overturn Obamacare have stalled. In this podcast, Vivian Ho, director of the Baker Institute’s Center for Health and Biosciences, discusses the challenges surrounding the ACA and congressional efforts to change the act.

Every American needs it. Every American uses it. And yet, our nation remains undecided on whether health care is a right or a privilege. We'll start this week's Flyover on that topic. Our guests were Iowa Public Radio reporter and host Clay Masters; Vivian Ho, director of Rice University's Center for Health and Biosciences; and Sally Pipes, president, CEO and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute.

"If you've got an elevated fever or a stomach bug, be very careful to look at the signage on the place that you're about to walk into." Hear more insight on what consumers and policy makers should know about Freestanding Emergency rooms from Dr. Vivian Ho at Rice University's Baker Institute for Public Policy. Blue Promise is an online video blog that aims to address complicated health issues with candid conversations from subject matter experts. New editions are published regularly and are hosted by Dr. Dan McCoy, President of Blue Cross and Blue Shield of Texas.

There are many confusing reasons why health care costs keep going up. That's why we're partnering with Texas' leading researchers to help us find some answers. In this edition of Blue Promise, Dr. McCoy talks about the value of research with Dr. Vivian Ho at Rice University's Baker Institute for Public Policy. Blue Promise is an online video blog that aims to address complicated health issues with candid conversations from subject matter experts. New editions are published regularly and are hosted by Dr. Dan McCoy, President of Blue Cross and Blue Shield of Texas.

While the rising cost of health care can be concerning for many of us, it has sparked interest from investors. Why? They see profit to be made. In this edition of Blue Promise, Dr. McCoy hears how venture capitalists targeted Texas' Freestanding Emergency Rooms from Dr. Vivian Ho at Rice University's Baker Institute for Public Policy. Blue Promise is an online video blog that aims to address complicated health issues with candid conversations from subject matter experts. New editions are published regularly and are hosted by Dr. Dan McCoy, President of Blue Cross and Blue Shield of Texas. If you are interested in watching the Blue Promise videos, click the link below for a list of programs. www.youtube.com/playlist?list=PL9…dyKd7TaJy-dM0iX7T

Visits to Freestanding Emergency Rooms in Texas went up 236% from 2012-2015 and many of those patients could have paid ten times less by visiting an Urgent Care Clinic. These are some of the findings in a first-of-its-kind academic journal published by several Texas universities. In this Blue Promise, Dr. McCoy discusses the consumer impact with the study’s author, Dr. Vivian Ho, Director of the Center for Health and Bioscience at the Baker Institute for Public Policy with Rice University. Blue Promise is an online video blog that aims to address complicated health issues with candid conversations from subject matter experts. New editions are published regularly and are hosted by Dr. Dan McCoy, President of Blue Cross and Blue Shield of Texas. If you are interested in watching the Blue Promise videos, click the link below for a list of programs. www.youtube.com/playlist?list=PL9…dyKd7TaJy-dM0iX7T

Guest: Vivian Ho, MD Host: Matthew J. Sorrentino, MD, FACC, FASH Dr. Vivian Ho discusses regulations related to the Certificate of Need and its implications. Dr. Ho also reviews findings from a recent study published in Healthcare, Finance, and Economics.