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
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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EP482: 3 Surprising Ways Carriers Make Lots of Money—What Do Plan Sponsors and Clinical Organizations Really Need to Know? With Preston Alexander
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Manage episode 496247401 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.
In this episode, Stacey Richter discusses 'Three Surprising Ways Carriers Make Lots of Money' with Preston Alexander. The episode highlights how carriers leverage financial strategies—like using premium dollars as float, intracompany eliminations, and upcoding in Medicare Advantage—to enhance their profits.
The discussion emphasizes the importance for plan sponsors and policymakers to understand these tactics to better manage healthcare costs. Alexander advises collaborating with unbiased consultants who are experts in health plan design to navigate these complex financial dynamics effectively.
=== LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP482
✉️ 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/
08:29 What is float, and why is it a surprising way that carriers make money?
14:01 Summer Shorts on pharma rebates with Ann Lewandowski.
14:41 Why carriers really do denials and delays of payouts.
17:34 What are intercompany eliminations, and how do they make carriers more money?
22:21 How do carrier-owned pharmacies play into this?
23:19 How are carriers creating profit off of Medicare Advantage and Medicaid Advantage markets?
27:18 How the fee-for-service price increases affect Medicare prices.
28:12 Why aren’t large insurance carriers motivated to make costs go down?
32:42 What is a potential way forward to fix the rising cost of healthcare?
33:36 As a plan sponsor, how do you address carriers making profit on your float?
35:07 EP478 with Andreas Mang and Jon Camire.
36:34 “Our economy’s not gonna survive healthcare.”
606 episodes
Share
Fetch error
Hmmm there seems to be a problem fetching this series right now.
Last successful fetch was on September 11, 2025 12:11 (
What now? This series will be checked again in the next day. If you believe it should be working, please verify the publisher's feed link below is valid and includes actual episode links. You can contact support to request the feed be immediately fetched.
Manage episode 496247401 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.
In this episode, Stacey Richter discusses 'Three Surprising Ways Carriers Make Lots of Money' with Preston Alexander. The episode highlights how carriers leverage financial strategies—like using premium dollars as float, intracompany eliminations, and upcoding in Medicare Advantage—to enhance their profits.
The discussion emphasizes the importance for plan sponsors and policymakers to understand these tactics to better manage healthcare costs. Alexander advises collaborating with unbiased consultants who are experts in health plan design to navigate these complex financial dynamics effectively.
=== LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP482
✉️ 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/
08:29 What is float, and why is it a surprising way that carriers make money?
14:01 Summer Shorts on pharma rebates with Ann Lewandowski.
14:41 Why carriers really do denials and delays of payouts.
17:34 What are intercompany eliminations, and how do they make carriers more money?
22:21 How do carrier-owned pharmacies play into this?
23:19 How are carriers creating profit off of Medicare Advantage and Medicaid Advantage markets?
27:18 How the fee-for-service price increases affect Medicare prices.
28:12 Why aren’t large insurance carriers motivated to make costs go down?
32:42 What is a potential way forward to fix the rising cost of healthcare?
33:36 As a plan sponsor, how do you address carriers making profit on your float?
35:07 EP478 with Andreas Mang and Jon Camire.
36:34 “Our economy’s not gonna survive healthcare.”
606 episodes
All episodes
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Similar to Relentless Health Value
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 and the rotating cast of The Hustle. Plus, expert insight on business strategies including marketing, scaling, sales, and overall entrepreneurship.
…
continue reading
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
If you’re reading this, chances are you’re not an undecided voter. But if you don’t want Donald Trump to become president again, between now and November you’ll need to convince as many as you can to cast their ballot for Joe Biden. With the help of some of the smartest strategists, pollsters, and organizers in politics today, host Jon Favreau explores the minds of voters who will decide the 2024 election, and gives you everything you need to persuade the persuadables in your life. Season 4 ...
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continue reading
Global business news, with live guests and contributions from Asia and the USA.
…
continue reading
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…
continue reading
Interviews with writers, journalists, filmmakers, and podcasters about how they do their work. Hosted by Aaron Lammer, Max Linsky, and Evan Ratliff.
…
continue reading
The American healthcare system is one of the most innovative in the world. But it’s also riddled with complex challenges, such as access to affordable medications, inefficiency and administrative burdens, and communication barriers between providers. There’s clearly a better way—and at Surescripts, we have a unique sightline into what that may be. In this series, host Melanie Marcus, Chief Marketing Officer of Surescripts, sits down with today’s most inspiring and innovative leaders in healt ...
…
continue reading
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…
continue reading
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…
continue reading
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