EP491: Incumbent TPAs and Consultants Getting Called to Jumbo Employer Client HQ to Answer Awkward Questions, With Elizabeth Mitchell

In Episode 491, Stacey Richter interviews Elizabeth Mitchell, CEO of the Purchaser's Business Group on Health (PBGH), about the PBGH Transparency Demonstration Project.  They discuss the project's aim to provide jumbo self-insured employers with transparency in healthcare costs, quality, and safety data. Collaborating with Milliman and Embold and funded by the Peterson Center on Healthcare, PBGH's project reveals no correlation between higher prices and quality in healthcare services.  The episode highlights the impacts on TPAs, consultants, and clinical organizations, and underscores the importance of employers using this new transparency data for strategic advantage and compliance with the Consolidated Appropriations Act. Richter and Mitchell delve into the broader implications for creating high-value networks and fostering market competition based on quality and affordability. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP491 ✉️  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/   06:35 How did PBGH's transparency project start? 07:35 EP428 with Julie Selesnick. 07:37 EP408 with Chris Deacon. 07:39 Why the changes to the CAA and ERISA meant heightened risk for employers and individuals within companies. 09:09 "You can't outsource the risk." 11:10 How PBGH's transparency project demonstrated some clients being noncompliant. 12:52 Why is it irresponsible not to use the data presented if you're a self-insured employer? 15:06 How did PBGH use the transparency data and apply it effectively to improve their offerings and business? 18:37 Why TPAs should not negotiate contracts. 19:17 EP485 with Cristin Dickerson, MD. 19:22 EP486 with Stan Schwartz, MD. 19:24 EP488 with Mark Cuban and Cora Opsahl. 20:58 "There is no good price for unsafe care." 21:36 How PBGH found using the transparency data to be totally feasible. 25:03 EP483 (Part 1) with Jonathan Baran. 25:32 Why the market will evolve with this data. 28:04 EP369 with Keith Hartman, RPh. 28:06 EP370 with Erik Davis and Autumn Yongchu. 28:34 What PBGH discovered about high-value centers and centers of excellence. 28:59 EP240 with Olivia Ross. 32:26 Why incentives are another challenge. 33:49 Why this is good news for unconflicted benefits consultants. 36:04 EP487 (Part 1) with Kevin Lyons. 39:48 Why transparency is going to become the new normal. 40:22 The Innovator's Dilemma by Clayton M. Christensen. 42:14 EP436 with Elizabeth Mitchell. 44:07 EP286 with John Rodis, MD, MBA. 45:22 Why there is a great incentive to be a great clinician right now. 46:18 How this information can motivate competition in the right place. 46:52 EP490 (Part 1) with Shane Cerone and Sam Flanders, MD.

In this episode of Relentless Health Value, host Stacey Richter speaks with Shane Cerone and Dr. Sam Flanders of Kada Health about three pervasive myths in the healthcare industry. They discuss the belief in a functioning healthcare market, the necessity of high prices for hospital survival, and the notion that reducing prices means lower quality care. Highlighting the inefficiencies and lack of competition in the current system, they address the importance of transparency and competition. This episode sets the stage for a follow-up discussion focusing on tangible solutions and improvements for the healthcare system. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP490-Part1 ✉️  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/ 09:28 EP466 with Vivian Ho, PhD. 09:31 EP486 with Stan Schwartz, MD. 09:42 EP488 with Mark Cuban and Cora Opsahl. 10:08 Why we need to focus on prices in healthcare. 11:50 The first myth that holds change back: the healthcare "market." 15:04 EP286 with John Rodis, MD, MBA. 15:51 The reality behind why there is no functional market in healthcare. 17:11 Why price simplicity is so important. 19:15 EP472 with Eric Bricker, MD. 19:31 How there is pricing failure while hospitals are still facing razor-thin margins. 22:11 The second myth: Can a hospital survive on Medicare rates alone? 25:21 What is the best hospitals can achieve? 26:01 List of hospitals recognized as national leaders for care quality and affordability. 29:23 The third myth: When you lower prices, do you get lower quality? 33:11 Why a decentralized approach at improvement is the way to lower cost and raise quality.

In Episode 489 Part 2 of 'Relentlessly Seeking Value,' Stacey Richter continues the series on 'Mission Margin' by focusing on the financial sustainability aspect with guest Dan Greenleaf, CEO of Duly, a multi-specialty group. The episode dives into the balance between maintaining mission-driven healthcare, which includes affordability, accessibility, and quality, and achieving financial margins.  Dan discusses practical strategies like reducing network leakage, negotiating effectively with payers, and leveraging technologies to lower operational costs. The conversation also highlights the significance of clinician involvement in leadership and the value of having aligned incentives across the organization.  Additionally, the episode addresses the role of capital partners in sustaining such healthcare models and ensuring they are effective and sustainable. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP489-Part2 ✉️  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/. 09:56 How does Dan achieve his mission given the realities of margin? 14:49 How Duly Health's approach and incentives differ from other health systems. 16:04 EP466 with Vivian Ho, PhD. 16:28 EP462 with Scott Conard, MD. 16:31 Summer Shorts episode with Stan Schwartz, MD. 17:27 EP460 with Rushika Fernandopulle, MD. 17:29 EP445 with Tom X. Lee, MD. 17:30 EP407 with Vivek Garg, MD, MBA. 18:50 How having physicians on the hospital board greatly improves margin and mission. 20:04 How Dan explains his approach to his capital partners. 22:23 Fee for service vs. institutional care.

In this episode of Relentless Health Value, Stacey Richter talks mission with Dan Greenleaf, CEO of Duly Health and Care. Next week we cover margin. The discussion delves into the crucial balance between mission and margin in healthcare, highlighting how focusing on mission can drive financial stability.  The interview centers around four key quadrants of Duly's mission: affordability, access, consumer experience, and quality. Greenleaf emphasizes how these elements are interconnected and essential for providing better healthcare outcomes and financial viability.  The episode is part of a series exploring the mission/margin dynamic in the healthcare industry, and sets the stage for a deeper dive into how mission-focused strategies can result in decent margins in next week's episode. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP489-Part1 ✉️  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/ 08:32 What should mission be in multispecialty? 08:54 Are mission and margin mutually exclusive? 10:47 What are the four "vectors" of Dan's mission? 11:32 Why does affordability matter? 12:11 EP466 with Vivian Ho, PhD. 12:40 EP488 with Mark Cuban and Cora Opsahl. 13:32 Who are the three payers in the marketplace? 17:31 EP388 with Merrill Goozner. 19:19 How does access play into mission? 20:28 EP464 with Al Lewis. 21:07 EP467 with Stacey. 22:56 Why price transparency is important to consumer experience. 24:16 LinkedIn post from Patrick Moore. 29:06 EP481 with Benjamin Schwartz, MD, MBA.

Stacey Richter is joined by Mark Cuban, CEO and founder of Mark Cuban Cost Plus Drugs, and Cora Opsahl, Health Fund Director of the 32BJ Health Fund, to discuss pressing issues in American healthcare.  The conversation centers on the inefficiencies and complexities created by high deductible health plans and the layers of vendors self-insured employers hire to manage healthcare claims. Mark Cuban and Cora Opsahl advocate for direct contracting and increased transparency as solutions to reduce costs and improve outcomes.  They also explore the potential of simplifying the system back to a more straightforward model where healthcare prices are transparent, and patients and providers can establish trust. This episode emphasizes the importance of leadership and a proactive approach in managing healthcare costs. If you are listening to this prior to October 9, 2025, go to the 32BJ Changing the Playbook on Hospital Prices event, where Mark Cuban will be keynoting. Cora Opsahl will also be speaking, and I will be there listening. https://32bjhealthinsights.org/2025-events/ === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP488 🔗  Healthcare Industry Acronyms and Terms https://relentlesshealthvalue.com/healthcare-acronymns ✉️  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/ 06:25 What was the original rationale behind high deductibles? 07:38 How high deductibles are creating a class of functionally uninsured people. 09:29 EP482 with Preston Alexander. 10:20 "We're using health insurance as a proxy for healthcare." —Mark 12:30 How providers are now in the debt collecting business rather than the healthcare business. 12:55 EP486 with Stan Schwartz, MD. 15:16 "We have a fundamental reasonability problem." —Cora 16:07 EP425 with Marshall Allen. 18:25 Direct contracting versus self-funded employers. 19:27 EP436 with Elizabeth Mitchell. 19:30 EP480 with Kimberly Carleson. 19:33 EP372 with Cora Opsahl. 23:53 Why the current system doesn't allow the accountability that is needed. 24:39 EP452 with Cora Opsahl. 26:34 How direct contracting gives strength back to independent practices that high deductible plans take away. 27:46 Who pays, what's the price, and where does the power lie? 31:24 EP419 with Andreas Mang. 34:45 How it comes down to power and leverage when controlling healthcare costs. 38:13 EP483 (Part 1 and Part 2) with Jonathan Baran. 38:35 Why putting together a network and just buying healthcare—not discounts—is not as difficult as it seems. 40:10 Why we need to stop talking about disruption and start talking about change. 40:56 EP453 with Claire Brockbank. 41:02 EP484 with Dave Chase. 43:07 EP485 with Cristin Dickerson, MD. 44:32 EP487 (Part 1) with Kevin Lyons. 46:34 EP466 with Vivian Ho, PhD. 47:40 Why it's the incentives that are different between American hospitals and hospitals in a single-payer program. 50:25 The main takeaways from the conversation. 51:08 Why you can't fix the problems in healthcare without transparency.  

In episode 487, part two, host Stacey Richter interviews Kevin Lyons, a former police detective and current Executive Director of the New Jersey State Police Benevolence Association about the application of detective skills to analyze healthcare spending.  Following a discussion on the barriers driving up healthcare costs in part one, Lyons delves into techniques such as statement analysis and facial recognition to identify deceit and uncover where healthcare dollars are going. Lyons emphasizes the need for preparation, persistent questioning, and the importance of following the money, thereby encouraging a fearless approach to advocating for transparency and better healthcare management. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP487Part2 ✉️  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/ 00:00 Introduction and Episode Overview 00:25 Recap of Part One: Barriers to Reducing Healthcare Costs 03:01 Introducing Kevin Lyons: Detective Skills in Healthcare 03:52 Detective Techniques Applied to Healthcare 06:41 Challenges and Solutions in Healthcare Transparency 12:15 Final Thoughts and Acknowledgements 13:10 Closing Remarks and Podcast Information

In Episode 487 of Relentless Health Value, host Stacey Richter speaks with Kevin Lyons, a former police detective and current executive director at the New Jersey State Police Benevolence Association. They explore, in this two part episode, the significant challenges public sector employees face in obtaining cost-effective health benefits.  The discussion highlights key issues, including the influence of industry profit motives, governmental hiring practices, and media sponsorship biases. Lyons shares insights on the rapidly escalating costs of healthcare for state workers, with specific examples from New Jersey, emphasizing the need for innovative solutions and improved legislative action. The conversation sets the stage for a subsequent episode where Lyons will delve deeper into applying detective skills to uncover financial trails and propose effective changes. Tune in next week for  part 2 when Kevin talks about how he pulls out his notebook and uses what he learned as a detective to, first of all, figure out everything probably that we just talked about in this part one. But also, you can't solve for something unless you do what most investigators do, which is follow the money. === LINKS === 🔗  Show Notes with all mentioned links:   https://relentlesshealthvalue.com/episodes ✉️  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/   00:00 Introduction to Episode 487 00:33 Viral Video and Metaphor for Healthcare 04:48 Healthcare Costs and Union Challenges 07:32   Interview with Kevin Lyons Begins 08:17 Why is it important to "dig in" right now on health benefit cost increases? 08:39 Barriers to Affordable Healthcare 10:16 The first barrier to better health benefits: profit defending profit. 10:54 Profit Defense and Political Influence 16:38 Why "throw money at the problem" isn't a real solution. 18:31 The second barrier: why a lack of employed experts costs more money. 18:59 Government Inefficiencies and Conflicts of Interest 25:58 The third barrier: media sponsorship from incumbents prevents change. 26:19 Media Influence and Public Perception 28:55 EP483 (Part 1 and Part 2) with Jonathan Baran. 30:23 Conclusion and Teaser for Part Two  

In this episode of Relentless Health Value, host Stacey Richter sits down with Dr. Stan Schwartz, co-founder of ZERO.health, to explore the practical realities and benefits of direct contracting in healthcare.  Dr. Schwartz shares his journey from traditional healthcare to pioneering bundled payments and direct contracts, offering actionable insights for employers, providers, and anyone interested in making healthcare more affordable and predictable. The conversation covers the challenges of claims, cost variability, operationalizing direct contracts, and the impact on both patients and providers. Discover how employers and providers can use bundled payments to cut costs, simplify administration, and deliver $0 out-of-pocket care for patients. It was an honor to get Dr. Schwartz on the pod, and we are doubly thankful because he stepped up and offered to help support Relentless Health Value financially as well as spending his time with me and you. So, thanks to everyone over at ZERO.health for being part of the kind of folks who support shows like this one. Dr. Stan Schwartz is co-founder over at ZERO.health. ZERO gets members access to high-quality providers for $0 out of pocket, leveraging bundled payments and direct contracting. This episode, as I just said, is sponsored by ZERO.health, with an assist from Aventria Health Group. === LINKS === 🔗  Show Notes with all mentioned links:   https://relentlesshealthvalue.com/episodes 🔗 Zero.Health https://zero.health.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/ 07:59 How did ZERO.health start? 10:38 EP480 with Kimberly Carleson. 11:04 Why does the emotional energy behind understanding how the problem of healthcare affects individuals matter in changing healthcare? 12:45 "If you can schedule it, you can put a price on it." 15:32 EP420 with Ge Bai, PhD, CPA. 16:38 EP436 with Elizabeth Mitchell. 18:21 How do employers ensure that patients and clinicians are coordinated and on board with direct contracting within their health plans? 20:26 EP475 with Peter Hayes. 22:52 Why is it important that this direct contracting system isn't mandatory for health plan members? 24:50 How does direct contracting affect excessive utilization? 26:41 EP477 (Through Line Show) with Stacey. 27:29 Why is it important that your plan benefits benefit health? 29:39 Why is it important to educate not only members but also providers who agree to participate in the program? 31:06 "It's all about simplicity." 33:11 How do you ensure plan members use the service after it is installed? Recent past interviews: Click a guest's name for their latest RHV episode! Dr Cristin Dickerson, Elizabeth Mitchell (Take Two: EP436), Dave Chase, Jonathan Baran (Part 2), Jonathan Baran (Part 1), Jonathan Baran (Bonus Episode), Dr Stan Schwartz (Summer Shorts), Preston Alexander, Dr Tom X Lee (Take Two: EP445), Dr Tom X Lee (Bonus Episode), Dr Benjamin Schwartz, Dr John Lee (Take Two: EP438)

In episode 485, Stacey Richter interviews Dr. Cristin Dickerson on the topic of direct contracting for imaging services. They discuss the high costs of imaging, which can account for 6-11% of a plan sponsor's healthcare spend. The episode covers the potential for significant cost savings and improved patient access through direct contracting, bypassing traditional TPAs that may have conflicts of interest or contractual constraints.  Dr. Dickerson, who is the founding partner of Green Imaging, explains how her organization has successfully implemented direct contracting, providing affordable and high-quality imaging services nationwide. They also address common barriers such as complexity in coding and payment processes, the reluctance of TPAs, and the habitual referral to 'down the hall' services. The conversation highlights the importance of price transparency, patient education, and how Green Imaging supports plan sponsors in navigating these challenges. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP486 ✉️  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/ 00:00 Introduction and Episode Overview 00:31 The Case for Direct Contracting in Imaging 01:43 Real-World Examples and Challenges 04:47 The Importance of Data and Transparency 08:49 Interview with Dr. Kristen Dickerson 12:39 Barriers to Direct Contracting 24:05 Overcoming Barriers and Final Thoughts 33:22 Conclusion and Contact Information

Exploring TPA and Health Plan Inertia with Elizabeth Mitchell: What Plan Sponsors Need to Know. In this Take 2 of episode 436 of Relentless Health Value, host Stacey Richter speaks with Elizabeth Mitchell, President and CEO of the Purchaser Business Group on Health, about the challenges third-party administrators (TPAs) face, the issues around hidden fees, and the problems with health plan inertia.  They discuss how self-insured employers can find reliable TPA partners, the impact of anti-competitive contracts, and the importance of transparency in healthcare procurement. Mitchell emphasizes the need for direct contracting between employers and providers to reduce costs and improve quality.  The episode covers the implications of the Consolidated Appropriations Act, the role of brokers, and how employers can achieve better value for their healthcare spend. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP436-Take2 ✉️  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/ 08:06 What is the overarching context for health plans in healthcare purchasing? 11:31 Why is it important to reestablish a connection between the people paying for care and people providing care? 13:47 What are the needs of a self-insured employer when managing employee benefits? 19:00 Is it doable for employers to set their own contracts? 21:24 Is transparency presumed? 22:39 Will the new transparency upon us actually expose wasted expense? 24:23 EP408 with Chris Deacon. 25:58 "This is not about individual bad actors. … The systems … that is not aligned." 27:39 Are there providers who want to work directly with employers? 30:53 Why is it important that incentives need to be aligned? 32:42 EP427 with Rik Renard. 33:51 What's missing from the conversation on changing health plans?