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Content provided by Stacey Richter. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by Stacey Richter or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://player.fm/legal.
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EP471: High-Cost Claimants in 2025 and Beyond—What Is Really Expensive Not to Know? With Christine Hale, MD, MBA
Manage episode 476235958 series 1090593
Content provided by Stacey Richter. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by Stacey Richter or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://podcastplayer.com/legal.
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 ===
🔗 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/
05:22 What is a high-cost claimant, and how is the definition changing?
07:42 Why buy-and-bill pharmaceuticals can be so costly for plan sponsors.
10:19 What are plan sponsors getting wrong about this situation?
11:28 What do you need as an employer to understand your plan data fully?
13:41 EP462 with Scott Conard, MD.
17:35 What are plan sponsors currently doing that they should not being doing?
19:54 Why starting small is important.
23:02 EP468 with Matt McQuide.
25:37 What are the steps employers should take to improve their high-cost claimant spend?
31:02 EP371 with Erik Davis and Autumn Yongchu.
33:46 EP467 with Stacey.
Recent past interviews:
Click a guest’s name for their latest RHV episode!
Nikki King, 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
583 episodes
Share
Manage episode 476235958 series 1090593
Content provided by Stacey Richter. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by Stacey Richter or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://podcastplayer.com/legal.
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 ===
🔗 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/
05:22 What is a high-cost claimant, and how is the definition changing?
07:42 Why buy-and-bill pharmaceuticals can be so costly for plan sponsors.
10:19 What are plan sponsors getting wrong about this situation?
11:28 What do you need as an employer to understand your plan data fully?
13:41 EP462 with Scott Conard, MD.
17:35 What are plan sponsors currently doing that they should not being doing?
19:54 Why starting small is important.
23:02 EP468 with Matt McQuide.
25:37 What are the steps employers should take to improve their high-cost claimant spend?
31:02 EP371 with Erik Davis and Autumn Yongchu.
33:46 EP467 with Stacey.
Recent past interviews:
Click a guest’s name for their latest RHV episode!
Nikki King, 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
583 episodes
All episodes
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Similar to Relentless Health Value
The economy and the markets are "under surveillance" as we cover the latest in finance, economics and investment. Listen to Jonathan Ferro, Lisa Abramowicz and Annmarie Hordern for the top interviews from Bloomberg Surveillance Television. And join Tom Keene and Paul Sweeney for the best conversations from Bloomberg Surveillance Radio. Watch Surveillance TV LIVE each mornings: http://bit.ly/3P7nstQ. Watch Surveillance Radio LIVE weekday mornings: http://bit.ly/3vTiACF.
…
continue reading
A top podcast for healthcare leaders, with over one million downloads, Radio Advisory is your weekly download on how to untangle the industry's most pressing challenges to help leaders like you make the best business decisions for your organization. From unpacking major trends in care delivery—like site-of-care shifts and the rise of high-cost drugs—to demystifying stakeholder dynamics, to shining a spotlight on priorities that may get overlooked, we're here to help. Our hosts and seasoned r ...
…
continue reading
A daily dose of irreverent, offbeat, and informative takes on business & tech news. Hosted by Jon Weigell, Juliet Bennett Rylah, Mark Dent, Ben Berkley, Sara Friedman, Matthew Brown, and Rob Litterst from The Hustle.
…
continue reading
America is divided, and it always has been. We're going back to the moment when that split turned into war. This is Uncivil: Gimlet Media's new history podcast, hosted by journalists Jack Hitt and Chenjerai Kumanyika. We ransack the official version of the Civil War, and take on the history you grew up with. We bring you untold stories about covert operations, corruption, resistance, mutiny, counterfeiting, antebellum drones, and so much more. And we connect these forgotten struggles to the ...
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continue reading
Bloomberg Daybreak delivers today's top stories, with context, in just 15 minutes. Get informed from Bloomberg's 3,000 journalists and analysts.
…
continue reading
Concise summaries of everything published in the latest weekly issue of the New England Journal of Medicine (NEJM). NEJM publishes new medical research findings, review articles, and editorial opinion on topics of importance to biomedical science and clinical practice.
…
continue reading
Global business and finance news and discussion from the BBC.
…
continue reading
Take a seat at the table and learn about the biggest stories in financial markets, the economy and business. Each week our editors and correspondents explore how economics influences the world we live in and share their insights across a range of topics. From inflation and recession risk to all things crypto and even the commercial success of K-pop, we have you covered. Published every Thursday. If you’re already a subscriber to The Economist, you’ll have full access to all our shows as part ...
…
continue reading
The latest business and finance news from around the world, on the BBC.
…
continue reading
Diane Rehm’s weekly podcast features newsmakers, writers, artists and thinkers on the issues she cares about most: what’s going on in Washington, ideas that inform, and the latest on living well as we live longer.
…
continue reading
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Go offline with the Player FM app!
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