Relentless Health Value

EP494: Six Tensions of Pharmaceutical Drug Pricing, With Sarah Emond

In Episode 494 of Relentless Health Value, host Stacey Richter engages in a detailed discussion with Sarah Emond, CEO of ICER, about the intricate dynamics of pharmaceutical drug pricing. They explore six primary tensions within the current system, including the fair valuation of drugs, the misalignment between drug prices and patient affordability, the disconnect between lifetime drug value and short-term insurance assessments, and the challenge of integrating societal and individual perceptions of value.  Emond and Richter also discuss potential solutions, emphasizing the need for value-based pricing models free from financial conflicts of interest. They highlight the critical role of payers, PBMs, and drug manufacturers in aligning pricing with value to improve patient access and reduce overall healthcare costs. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP494 🔗  Visit our sponsor Payerset   https://payerset.com ✉️  Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙  Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤  Listen on Apple Podcasts  https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤  Listen on Spotify  https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺  Subscribe to our YouTube channel   https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn   https://www.linkedin.com/company/relentless-health-value/ ✭ Threads  https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky   https://bsky.app/profile/relentleshealth.bsky.social ✭ X   https://twitter.com/relentleshealth/ 08:18 Why list prices are a lie. 10:59 How does the rebate model sometimes get in the way of paying for value? 12:50 Bonus clip with Sarah Emond. 13:14 EP491 with Elizabeth Mitchell. 13:20 EP490 and EP492 with Shane Cerone and Sam Flanders, MD. 14:37 The tension that is created between affordability and adherence. 15:03 When cost sharing makes sense in pharmaceutical drug pricing. 17:26 INBW42 with Stacey on moral hazard. 18:53 How GLP-1s are "wildly cost effective." 21:32 Why the sticker shock on cost-effective drugs is a failure in the system for paying for value. 22:38 ICER's report on GLP-1s. 26:59 EP385 with Dan Mendelson. 28:57 How employers and payers can have a value assessment approach and a health insurance system that allows access to cost-effective drugs. 29:48 How cost-effective prices are calculated. 31:55 One of the core value underpinnings for value assessment of drugs. 34:54 Why manufacturers and pharmacy benefit managers should work together more by referencing something like an ICER report. 36:55 EP426 with Nina Lathia, RPh, MSc, PhD. 38:21 "We can make different choices."

Bonus Add-on for EP494: Who Is ICER and What Is the Arms Race of Pharmaceutical Pricing That the Status Quo Has Created? With Sarah Emond

In this bonus episode of 'Relentlessly Seeking Value,' host Stacey Richter engages in a conversation with Sarah Emond, CEO of the Institute for Clinical and Economic Review (ICER). They discuss the complex 'arms race' of pharmaceutical pricing in the current healthcare system, emphasizing issues like inflated drug list prices, patient affordability, and cost-effectiveness.  They highlight ICER's role in conducting value assessments of prescription drugs to ensure fair pricing and improve affordability and access. The episode underscores the need for multi-stakeholder dialogues to deescalate financial tensions and promote value-based healthcare choices. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP494-BonusClip 🔗  Visit our sponsor Payerset:   https://payerset.com ✉️  Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙  Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤  Listen on Apple Podcasts  https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤  Listen on Spotify  https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺  Subscribe to our YouTube channel   https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn   https://www.linkedin.com/company/relentless-health-value/ ✭ Threads  https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky   https://bsky.app/profile/relentleshealth.bsky.social ✭ X   https://twitter.com/relentleshealth/ 06:51 EP293 ("Game Theory Gone Wild") with Dea Belazi, PharmD, MPH. 02:38 What is ICER? 02:54 What does the Institute for Clinical and Economic Review do? 05:14 The importance of still showing up, even when others don't understand or disagree. 09:12 Why it's important to think about population health and how our choices impact affordability for everyone.

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

In this special Thanksgiving episode of Relentless Healthcare Value, the focus is on gratitude and giving thanks to various contributors within the healthcare community. Host Stacey Richter extends her 'baskets of thank yous' to colleagues, mentors, and partners committed to transforming healthcare.  These baskets recognize those who maintain respectful dialogues despite small disagreements, those who collaborate and pay it forward within the community, and those who support the concept of a 'demand curve' in healthcare markets.  === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/INBW43 ✉️  Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙  Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤  Listen on Apple Podcasts  https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤  Listen on Spotify  https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺  Subscribe to our YouTube channel   https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn   https://www.linkedin.com/company/relentless-health-value/ ✭ Threads  https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky   https://bsky.app/profile/relentleshealth.bsky.social ✭ X   https://twitter.com/relentleshealth/ 01:25 First thank you: to those who do not succumb to healthcare narcissism. 01:36 INBW39 with Stacey. 02:51 INBW37 with Stacey. 03:00 EP399 and EP400 with Stacey. 05:40 Second thank you: to those willing to pay it forward. 05:53 EP489 with Dan Greenleaf. 08:12 EP452 with Cora Opsahl. 08:38 Third thank you: to those who aid the demand curve in healthcare. 09:14 EP490 with Shane Cerone and Sam Flanders, MD. 09:16 EP491 with Elizabeth Mitchell. 09:17 EP492 with Sam Flanders, MD, and Shane Cerone. 09:49 Why healthcare needs a demand curve. 13:34 Fourth thank you: to those who have contributed financial support to the Relentless Health Value podcast. 15:47 The final thank you: to the listeners.

Take Two: EP240: A Direct Contracted and Actually High-Value Network That Elizabeth Mitchell From PBGH Talked About, With Olivia Ross

This OG of directly contracted high-value networks or Centers of Excellence networks came up, name dropped and everything in the episode with Elizabeth Mitchell from PBGH, the Purchaser Business Group on Health, from two weeks ago. That was episode 491. So, welcome to this deep cut episode with Olivia Ross from way back, pre-pandemic times. This episode of Relentless Health Value revisits the concept of directly contracted high value networks or Centers of Excellence (ECEN) with Olivia Ross. The discussion explores the impact and potential of the ECEN network, emphasizing the importance of quality, price transparency, and multidisciplinary approaches in healthcare.  Olivia delves into the reasons why ECEN was significant in past PBGH projects and its current relevance, despite its eventual dismantling due to corporate changes. The episode highlights the benefits for employers in creating their own high-value networks and the positive outcomes from fewer unnecessary surgeries and better quality care. Additionally, it covers the rigorous process of selecting Centers of Excellence and how continuous quality improvement efforts benefit both employers and healthcare providers. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/Take2-EP240 ✉️  Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙  Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤  Listen on Apple Podcasts  https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤  Listen on Spotify  https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺  Subscribe to our YouTube channel   https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn   https://www.linkedin.com/company/relentless-health-value/ ✭ Threads  https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky   https://bsky.app/profile/relentleshealth.bsky.social ✭ X   https://twitter.com/relentleshealth/ 07:40 Prospective bundles and the cost of care. 08:22 How the largest cost savings come from the improvements in quality. 09:51 What Olivia looks for in choosing centers of excellence. 10:36 Creating market pressure and avoiding consolidation. 11:17 Creating positive disruption in the healthcare system. 12:17 How Olivia chooses the centers and providers she works with in the Purchaser Business Group on Health. 13:12 The quality metrics Purchaser Business Group on Health looks at when assessing providers and centers. 14:04 What a team assessment is, and why it's important. 15:07 How local PCPs have to factor into this health care model. 17:57 How Purchaser Business Group on Health intervenes in the patient journey to ensure that the patient and the employer are getting the best quality care for the best price. 19:39 Olivia's suggestions on how to have an intervening conversation with a patient who has already been told he or she needs surgery. 20:18 EP468 with Matt McQuide. 20:20 EP471 with Christine Hale, MD, MBA. 20:22 EP472 with Eric Bricker, MD. 25:27 "Even at a more competitive price point, there's still an upside to them getting this new business." 25:52 How choosing specific physicians is part of the COE designation process. 27:35 How COEs and their physicians are also involved in continuous quality improvement. 30:56 Employers Centers of Excellence Network collaboration with The Leapfrog Group. 32:24 How the Employers Centers of Excellence Network program is open to any employer, no matter the size. 32:54 What it takes to join the Employers Centers of Excellence Network.  

EP493: Revelations Mainstream CEOs Are Having About the Healthcare Market Right Now—Also, Some Advice, With John Quinn

In Episode 493 of Relentless Health Value, host Stacey Richter engages in an enlightening discussion with John Quinn, CEO of Wellnecity, about the current revelations and challenges employer CEOs are facing within the healthcare market. Stacey explores whether average employer C-suites are recognizing the fundamental myth that a functioning healthcare market exists.  The conversation dives into how self-insured employers are substantially the demand side of the healthcare market and why their lack of insistence on a true market exacerbates high prices. John Quinn shares insights on why C-suites and boards are now more attuned to healthcare spending, emphasizing the need for real-time, correct data and comprehensive vendor accountability.  A significant takeaway is the shift from viewing health benefits management as a one-time annual task to adopting a continuous, year-long strategic approach. Finally, the episode delves into actionable steps for employers to manage healthcare costs more effectively without compromising employee health, urging them to move beyond traditional cost-shifting tactics. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP493 🔗  Visit our Sponsor Wellnicity https://wellnecity.com/:   ✉️  Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙  Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 📺  Subscribe to our YouTube channel   https://www.youtube.com/@RelentlessHealthValue 🎤  Listen on Apple Podcasts  https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤  Listen on Spotify  https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b === CONNECT WITH THE RHV TEAM === ✭ LinkedIn   https://www.linkedin.com/company/relentless-health-value/ ✭ Threads  https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky   https://bsky.app/profile/relentleshealth.bsky.social ✭ X   https://twitter.com/relentleshealth/ 07:06 Why CEOs are looking more closely at healthcare spend. 08:06 EP397 with Paul Holmes. 08:21 How savings and health benefits are directly connected. 10:45 EP436 with Elizabeth Mitchell. 11:46 What missed earnings look like in relation to healthcare. 14:27 How costs have been shifting to employees for years, and why this doesn't work anymore. 17:36 EP475 with Peter Hayes. 18:23 What employers need to do instead of cost shift. 19:12 EP406 with Lauren Vela. 21:30 Why it's important to make health benefit changes at the speed of business, not at the speed of the benefits year. 26:17 Why is it important to put a finance function into your benefits? 27:10 EP488 with Mark Cuban and Cora Opsahl. 27:33 EP478 (Part 1) with Andreas Mang and Jon Camire. 27:35 Why daily data matters. 31:10 EP487 (Part 1) with Kevin Lyons. 31:21 Why it's important to hold vendors accountable. 31:47 Why it's important to move on from vendors who can't hold up to your scrutiny and needs. 33:46 EP472 with Eric Bricker, MD. 34:46 EP471 with Christine Hale, MD, MBA.