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The One Question to Test if a TPA Is Actually Independent, With Kimberly Carleson

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Level Funding Is Self-funding: 5 Avoidable Contract Risks, With Frank Pennachio

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Why Avoidable ER Visits Aren't the Real Cost Problem: Revisiting Our Interview With HHS Nominee Chris Klomp

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Slaying the Three-Headed Monster of Health Plan Networks, With Evan Anderson

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A Wildly Underappreciated Point: Overpaying for Infusions Means Overpaying for Stop-Loss Coverage, With Jake Velie and Keith Hartman, RPh

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How Stark Law, Stipends, and Noncompetes Drive Hospital Consolidation, With Eric Bricker, MD

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Private Equity in Primary Care: What the Data Actually Shows, With Yashaswini Singh, PhD. Episode 528.

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Mark Cuban and Cora Opsahl: The Truth About Pass-Through PBM Contracts and Generic Compliance Ratios

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PMPM vs FFS—The Perverse Incentives Plan Sponsors Sometimes Miss, With Cristin Dickerson, MD

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Beating Provider Network Pricing Games by Thinking About Buying Healthcare Like a Manufacturer Supply Chain, With John Quinn

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The Sleeping Giants of Healthcare—Why Self-insured Employers and Clinicians Keep Missing Each Other, With Suhas Gondi, MD, MBA. EP523

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How GoodRx Actually Makes Money: PBMs, Cash Prices, and Pharmacy Contracts, With Ge Bai, PhD, CPA (EP522)

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How Revenue Cycle Management (RCM) Became an Over $200 Billion Healthcare Hot Potato, With Andrew Tsang. EP521

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Cash-Pay Generic Drugs Are a Functioning Market in Healthcare—Policymakers Beware and Be Careful. EP520

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Cognitive Atrophy and Referral Incentives Breaking Primary Care, With Lisa Rosenbaum, MD (EP519)

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How Do You Explain the Difference Between an ASO Vendor and a TPA? With Claire Brockbank. Episode 518

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Prior Authorizations & Pharma Rebate Contracts — How Financial Motives Keep Generics Off Formularies (EP517)

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Cash Pay From the Pharma Manufacturer Point of View, With Ophelia Johnson (EP516)

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Self-Insured Employers: SNF Fraud or Perverse Incentives? Understaffing, Gamed STAR Ratings, and Medicare Dollars at Skilled Nursing Facilities with Michelle Cera. EP515

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Successfully Suing a Health System for Their Anticompetitive Contracts and Also Collecting Damages for Plan Sponsors and Members, With Matt Cantor. EP514

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Revisiting Cunning Anticompetitive Hospital Contracts, With Brennan Bilberry - EP513

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3 Kinds of Broker/EBC Rent-Seeking Payment Models—A Lawyer's Perspective, With Doug Aldeen. EP512

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The Perverse Incentive Trap Hidden Inside Value-Based Care — and What to Do About It. EP511

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Why Employers Pay More Because of Vertically Integrated Medicare Advantage Carriers with Betsy Seals. EP510

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The 7.7% Wake-Up Call: A Roadmap to Align Finance Teams With Non-complacent Benefit Design, With Patrick Nelli. EP509

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Why Don't More Self-insured CEOs Take Bold Action in Health Benefits Strategy? With Lee Lewis. (EP508)

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4 Core Concepts to Buy or Deliver the Highest Value Healthcare — A Review With 14 Expert Voices (EP507)

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Price Transparency Data: How Employers, Shareholders, and Clinics Use It, With Jerry DiMaso (EP506)

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The Death of the "What Is Value" Guessing Game for Clinical and Plan Decision-Makers Ready to Move On, With Ahilan Sivaganesan, MD (EP505)

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A Back-to-Basics Roadmap Through the Perverse Incentives to Advanced Primary Care, With Ryan Jacobs (EP504)

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Insights to Outwit the Hot Mess of the Non-Healthcare Market (INBW46)

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From Lazy PPO Networks to Smart Collaboration — A Roadmap for Direct-to-Employer Specialty Care. EP503

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How Some Pretty Wild Medicare Fraud Sabotages ACOs and Also Independent Practices and Could Cost Plan Sponsors Such as Self-insured Employers a Lot of Zeros Downstream, With Brian Machut. (EP502)

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Speaking of Infusions, Do You Want to Pay $135 or Do You Want to Pay $13,560 for the Exact Same Drug? With Ivana Krajcinovic, PhD. EP501

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Why the Commercial Carrier Market Never Changes — Six Reasons There Is No Market. Take 2 of EP398

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EP500: This Is Episode 500, and It's All About You, Tribe

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Self-insured Employers and Other Plan Sponsors Are Paying Millions for MSK (Musculoskeletal) Injuries That Would Have Healed Themselves, With Jay Kimmel, MD. EP499

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The Payment Integrity Arms Race—RCM (Revenue Cycle Management) and Plan Sponsors, With Mark Noel (EP498)

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The "Just Spend Everything You're Given" Trap—Lessons in True Provider Fiscal Discipline, With Gary Campbell

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What You Don't Know About Healthcare Transactions and Clearinghouses Could Cost You, With Zack Kanter

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Plan Sponsors Spend About $1.20 to Buy $1 of Healthcare, and Clinical Organizations Receive 80¢ for Every $1.20 Spent, With Mark Newman

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2025 Year-End Themes, Part 2: The Two Things That Have to Change for Any of the Rest of It to Work

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INBW44: The Relentless Health Value Themes That We Covered Throughout 2025—A Recap, Part 1

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Encore! EP450: When Your Health Plan Is $9 Million in the Hole, Who Are You Going to Call? A CPA. And Tell Them to Bring Their Spreadsheets, With Marilyn Bartlett, CPA, CMA, CFM, CGMA

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The Measurement Trap: Why We Track Healthcare Costs and Outcomes Exactly Backwards with Dr. Mick Connors. EP495

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Six Tensions of Pharmaceutical Drug Pricing, With Sarah Emond of ICER. EP494

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Bonus Add-on for EP494: ICER and the Pharma Pricing Arms Race, With Sarah Emond

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INBW43: Five Baskets of Thank Yous to Hand Out, Along With a Plug for Big Demand Curve Energy

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Direct Contracts and the ECEN High-Value Network Model, Take Two EP240: With Olivia Ross

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What Employer CEOs Are Figuring Out About Healthcare Costs Right Now, With John Quinn. EP493

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How to Run a High-Quality Hospital at 143% of Medicare, With Dr. Sam Flanders and Shane Cerone

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The PBGH Transparency Demonstration Project and What It Means for TPAs, Consultants, and Employers

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3 Problematic Hospital Myths: There Is No Healthcare Market, With Shane Cerone and Dr. Sam Flanders. EP490

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How Margin and Mission Work Together at a Multispecialty Group, With Dan Greenleaf of Duly. EP489 Part 2

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How Mission Becomes a Path to Margin at a Multispecialty Group, With Dan Greenleaf of Duly. EP489 Part 1

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Mark Cuban and Cora Opsahl on Trust, Simplicity, High Deductibles, and Direct Contracting. EP488

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Detective Skills for Following the Healthcare Dollar, Part 2 With Kevin Lyons of the NJ State PBA. EP487 Part 2

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A Former Police Detective Investigates the 3 Big Barriers to the Public Sector Getting Better Affordable Health Benefits, With Kevin Lyons. EP487 Part 1

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How to Operationalize Direct Contracting and Bundled Payments, With Dr. Stan Schwartz of ZERO.health. EP486

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Why Imaging Is 6-11% of Plan Spend and How Direct Contracting Fixes It, With Dr. Cristin Dickerson. EP485

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TPA and Health Plan Inertia: What Self-Insured Employers Need to Know, With Elizabeth Mitchell

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3 Burning Questions Every Self-Insured Employer Should Be Asking Right Now, With Dave Chase. EP484

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Reversing the Healthcare Cost Flywheel: From Discounts to Better Member Health, With Jonathan Baran. EP483 Part 2

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How the Healthcare Cost Flywheel Works — and Why It Keeps Spinning, With Jonathan Baran. EP483 Part 1

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Bonus Add-on: Honoring Those in Healthcare Who Are Trying Every Day to Do the Right Thing, With Jonathan Baran

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How Margin Shoves Mission Off the Bus: A Primary Care Case Study, With Dr. Stan Schwartz

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3 Surprising Ways Carriers Make Lots of Money, With Preston Alexander of The Healthcare Breakdown. EP482

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Take Two: EP445: What Does It Take for an Indie Primary Care Practice to Survive Right Now? With Tom X. Lee, MD

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Bonus Clip: Dr. Tom Lee Talks About Why Retail Clinics Are Not Doing So Well, in His Opinion

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EP481: Seriously, IRL, What Does "No Margin, No Mission" Even Mean? With Benjamin Schwartz, MD, MBA

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Take Two: EP438: Is It Mission and/or Margin? With John Lee, MD

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Payment Integrity Meets Health System Boasts, Such as Our Rates Are 2x Medicare, With Kimberly Carleson. EP480

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The Rebate Wall: Why Chasing Pharma Rebates Can Block Better Patient Care with Ann Lewandowski - Summer Short

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What Could Go Wrong Covering High-Cost Claimants With Stop-Loss Reinsurance? EP479.

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Take Two: EP433: The Mystery of the Weekly Claims Wire, With Justin Leader

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EP478: Stop-Loss Coverage, Part 1: How It Goes Right, and How It Can Go Horribly Wrong, With Andreas Mang and Jon Camire

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Through Line Show: What the Tribe Thinks You Need to Know About Trust or It's Gonna Be a Problem. Also, Why You Are Smart, With Stacey Richter

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How to Earn Trust in Healthcare: Four Principles That Actually Work. Bonus Add-on to EP477 with Charles Green

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Talking Whistleblowing and the Pharma Rebates Whistleblower Case With an Actual Whistleblower, With Ann Lewandowski. EP476

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Is This a Moment or a Movement? Three Forces Reshaping Healthcare With Peter Hayes. EP475

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Private Equity in Healthcare—The Big Data Points You Really Need to Know, All Together in One Episode, With Yashaswini Singh, PhD. EP474

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How Trusted Primary Care Relationships Keep Patients Out of the ER — and Lower Plan Costs. EP473

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How Hospitals Engineer $800,000 Claims and What Plan Sponsors Can Do About It. EP472

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EP471: High-Cost Claimants in 2025 and Beyond—What Is Really Expensive Not to Know? With Christine Hale, MD, MBA

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EP470: Continuing the ER and Primary Care Through Line Over to Rural Hospitals and Healthcare, With Nikki King, DHA

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EP469 (Part 2): The Impact on Plan Sponsors of Medicare Site-Neutral Payments and HSA Reforms, With James Gelfand, JD

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EP469 (Part 1): The Impact on Plan Sponsors of Medicaid Cuts, With James Gelfand, JD

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EP468: Very Common Assumptions That Aren't Actually True About Member Engagement and the Healthcare Industry, With Matt McQuide

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EP467: Connecting Sky-High ER Spend to Primary Care Access—Following the Dollar Through Carriers and Hospitals, With Stacey Richter

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EP466: What Is Rising Faster, Insurance Premiums or Hospital Prices? With Vivian Ho, PhD

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EP465: The Not Super Effective Contracting Industry Norm, Where Jumbo Plans and Others Wind Up Paying $10,000 for $50 Drugs, With Chris Crawford

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EP464: ER Visits Now 6% of Total Plan Spend. Is It Upcoding or What? With Al Lewis

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EP463: Medicare Advantage Policies—Which Will Stay and Which Will Go Now? With Betsy Seals

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Encore! EP384: How Shareholders Impact Carrier Behavior, Exactly and Specifically, With Wendell Potter

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EP462: Managing Populations of Whole, Actual People Who Are Not the Sum of a Bunch of Different Body Parts, With Scott Conard, MD

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INBW42: A Philosophical Rabbit Hole of Considerations for Plan Sponsors and Others

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EP461: Pick Only One, Plan Sponsors: Do You Want to Control GLP-1 Volume or Control GLP-1 Unit Cost? With Chris Crawford

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How Disruptors Can Scale to 99% of Americans: A Theory of Change for Healthcare with Rushika Fernandopulle, MD. EP460

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EP459: Cost Containment by Co-Pay Maximizer or Co-Pay Accumulator: Points to Ponder, With Bill Sarraille

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INBW41: End-of-Year Wrap-Up and My Personal Charter Encore: Where the Rubber Hits the Road

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Podcast Details

Information

Listen Show PodCast

The One Question to Test if a TPA Is Actually Independent, With Kimberly Carleson

Playlist

Level Funding Is Self-funding: 5 Avoidable Contract Risks, With Frank Pennachio

Playlist

Why Avoidable ER Visits Aren't the Real Cost Problem: Revisiting Our Interview With HHS Nominee Chris Klomp

Playlist

Slaying the Three-Headed Monster of Health Plan Networks, With Evan Anderson

Playlist

A Wildly Underappreciated Point: Overpaying for Infusions Means Overpaying for Stop-Loss Coverage, With Jake Velie and Keith Hartman, RPh

Playlist

How Stark Law, Stipends, and Noncompetes Drive Hospital Consolidation, With Eric Bricker, MD

Playlist

Private Equity in Primary Care: What the Data Actually Shows, With Yashaswini Singh, PhD. Episode 528.

Playlist

Mark Cuban and Cora Opsahl: The Truth About Pass-Through PBM Contracts and Generic Compliance Ratios

Playlist

PMPM vs FFS—The Perverse Incentives Plan Sponsors Sometimes Miss, With Cristin Dickerson, MD

Playlist

Beating Provider Network Pricing Games by Thinking About Buying Healthcare Like a Manufacturer Supply Chain, With John Quinn

Playlist

The Sleeping Giants of Healthcare—Why Self-insured Employers and Clinicians Keep Missing Each Other, With Suhas Gondi, MD, MBA. EP523

Playlist

How GoodRx Actually Makes Money: PBMs, Cash Prices, and Pharmacy Contracts, With Ge Bai, PhD, CPA (EP522)

Playlist

How Revenue Cycle Management (RCM) Became an Over $200 Billion Healthcare Hot Potato, With Andrew Tsang. EP521

Playlist

Cash-Pay Generic Drugs Are a Functioning Market in Healthcare—Policymakers Beware and Be Careful. EP520

Playlist

Cognitive Atrophy and Referral Incentives Breaking Primary Care, With Lisa Rosenbaum, MD (EP519)

Playlist

How Do You Explain the Difference Between an ASO Vendor and a TPA? With Claire Brockbank. Episode 518

Playlist

Prior Authorizations & Pharma Rebate Contracts — How Financial Motives Keep Generics Off Formularies (EP517)

Playlist

Cash Pay From the Pharma Manufacturer Point of View, With Ophelia Johnson (EP516)

Playlist

Self-Insured Employers: SNF Fraud or Perverse Incentives? Understaffing, Gamed STAR Ratings, and Medicare Dollars at Skilled Nursing Facilities with Michelle Cera. EP515

Playlist

Successfully Suing a Health System for Their Anticompetitive Contracts and Also Collecting Damages for Plan Sponsors and Members, With Matt Cantor. EP514

Playlist

Revisiting Cunning Anticompetitive Hospital Contracts, With Brennan Bilberry - EP513

Playlist

3 Kinds of Broker/EBC Rent-Seeking Payment Models—A Lawyer's Perspective, With Doug Aldeen. EP512

Playlist

The Perverse Incentive Trap Hidden Inside Value-Based Care — and What to Do About It. EP511

Playlist

Why Employers Pay More Because of Vertically Integrated Medicare Advantage Carriers with Betsy Seals. EP510

Playlist

The 7.7% Wake-Up Call: A Roadmap to Align Finance Teams With Non-complacent Benefit Design, With Patrick Nelli. EP509

Playlist

Why Don't More Self-insured CEOs Take Bold Action in Health Benefits Strategy? With Lee Lewis. (EP508)

Playlist

4 Core Concepts to Buy or Deliver the Highest Value Healthcare — A Review With 14 Expert Voices (EP507)

Playlist

Price Transparency Data: How Employers, Shareholders, and Clinics Use It, With Jerry DiMaso (EP506)

Playlist

The Death of the "What Is Value" Guessing Game for Clinical and Plan Decision-Makers Ready to Move On, With Ahilan Sivaganesan, MD (EP505)

Playlist

A Back-to-Basics Roadmap Through the Perverse Incentives to Advanced Primary Care, With Ryan Jacobs (EP504)

Playlist

Insights to Outwit the Hot Mess of the Non-Healthcare Market (INBW46)

Playlist

From Lazy PPO Networks to Smart Collaboration — A Roadmap for Direct-to-Employer Specialty Care. EP503

Playlist

How Some Pretty Wild Medicare Fraud Sabotages ACOs and Also Independent Practices and Could Cost Plan Sponsors Such as Self-insured Employers a Lot of Zeros Downstream, With Brian Machut. (EP502)

Playlist

Speaking of Infusions, Do You Want to Pay $135 or Do You Want to Pay $13,560 for the Exact Same Drug? With Ivana Krajcinovic, PhD. EP501

Playlist

Why the Commercial Carrier Market Never Changes — Six Reasons There Is No Market. Take 2 of EP398

Playlist

EP500: This Is Episode 500, and It's All About You, Tribe

Playlist

Self-insured Employers and Other Plan Sponsors Are Paying Millions for MSK (Musculoskeletal) Injuries That Would Have Healed Themselves, With Jay Kimmel, MD. EP499

Playlist

The Payment Integrity Arms Race—RCM (Revenue Cycle Management) and Plan Sponsors, With Mark Noel (EP498)

Playlist

The "Just Spend Everything You're Given" Trap—Lessons in True Provider Fiscal Discipline, With Gary Campbell