EP467: Connecting Sky-High ER Spend to Primary Care Access—Following the Dollar Through Carriers and Hospitals, With Stacey Richter
03/13/25 • 23 min
In this solo episode of 'Relentless Health Value,' host Stacey Richter dives into the intricate relationship between increased emergency room (ER) visits and the lack of access to effective primary care. Discussing insights from recent episodes featuring experts like Matt McQuide, Dr. Christine Hale, and others, Stacey explores how inadequate primary care leads to skyrocketing ER costs, which now account for 6% of total healthcare spending.
Key points include the systemic issues driving this trend, the incentives misalignments within hospitals and insurance carriers, and the importance of establishing trust and relationships in primary care. The episode also discusses perspectives from healthcare professionals and thought leaders on potential solutions to realign healthcare incentives and improve patient outcomes.
=== LINKS ===
🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP467
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=== CONNECT WITH THE RHV TEAM ===
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02:16 Connecting the dots between the last six shows.
05:34 EP466 with Vivian Ho, PhD.
05:53 EP463 with Betsy Seals.
05:56 EP384 with Wendell Potter.
14:38 Where does the primary care through line connect to carriers?
17:13 Health Affairs study showing ER cost increases.
19:19 Kevin O’Leary’s Health Tech Nerds newsletter.
19:40 EP407 with Vivek Garg, MD, MBA.
20:47 How are hospital board directors affecting hospital price increases and why?
21:49 Upcoming episode with Matt McQuide. Also mentioned in this episode are Matt McQuide; Christine Hale, MD, MBA; Kenny Cole, MD; Al Lewis; John Lee, MD; Rushika Fernandopulle, MD; Scott Conard, MD; Vivian Ho, PhD; Betsy Seals; Wendell Potter;
In this solo episode of 'Relentless Health Value,' host Stacey Richter dives into the intricate relationship between increased emergency room (ER) visits and the lack of access to effective primary care. Discussing insights from recent episodes featuring experts like Matt McQuide, Dr. Christine Hale, and others, Stacey explores how inadequate primary care leads to skyrocketing ER costs, which now account for 6% of total healthcare spending.
Key points include the systemic issues driving this trend, the incentives misalignments within hospitals and insurance carriers, and the importance of establishing trust and relationships in primary care. The episode also discusses perspectives from healthcare professionals and thought leaders on potential solutions to realign healthcare incentives and improve patient outcomes.
=== LINKS ===
🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP467
✉️ 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/
02:16 Connecting the dots between the last six shows.
05:34 EP466 with Vivian Ho, PhD.
05:53 EP463 with Betsy Seals.
05:56 EP384 with Wendell Potter.
14:38 Where does the primary care through line connect to carriers?
17:13 Health Affairs study showing ER cost increases.
19:19 Kevin O’Leary’s Health Tech Nerds newsletter.
19:40 EP407 with Vivek Garg, MD, MBA.
20:47 How are hospital board directors affecting hospital price increases and why?
21:49 Upcoming episode with Matt McQuide. Also mentioned in this episode are Matt McQuide; Christine Hale, MD, MBA; Kenny Cole, MD; Al Lewis; John Lee, MD; Rushika Fernandopulle, MD; Scott Conard, MD; Vivian Ho, PhD; Betsy Seals; Wendell Potter;
Previous Episode
EP466: What Is Rising Faster, Insurance Premiums or Hospital Prices? With Vivian Ho, PhD
Healthcare costs keep rising, but what’s driving those increases? In this episode, Stacey Richter speaks with Dr. Vivian Ho, a health economist at Rice University and Baylor College of Medicine, to break down the real reasons behind skyrocketing commercial insurance premiums.
- Are insurance premiums rising faster than wages—and why does it matter?
- What’s the biggest driver of premium increases? (Spoiler: It’s hospital prices.)
- Are hospital price hikes justified by rising costs—or is something else at play?
Dr. Ho shares data-backed insights on hospital consolidation, executive incentives, and how health system pricing impacts self-insured employers and plan sponsors. If you’re a healthcare executive or a jumbo employer managing benefits, this episode is a must-listen.
=== 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 Podcastshttps://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/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ X https://twitter.com/relentleshealth/
05:12 Are insurance premiums going up?05:59 What is the disparity between cost of insurance and wage increases?06:21 LinkedIn post by Byron Hugley.06:25 Article by Michael Strain.06:46 How much have insurance premiums gone up for employers versus employees?09:06 Chart showing the cost to insure populations of employees and families.10:17 What is causing hospital prices and insurance premiums to go up so exponentially?12:53 Article by (and tribute to) Uwe Reinhardt.13:49 EP450 with Marilyn Bartlett, CPA, CGMA, CMA, CFM.15:28 Are razor-thin operating margins for hospitals causing these rising hospital prices?16:56 Collaboration with Marilyn Bartlett and the NASHP Hospital Cost Tool.19:47 What is the explanation that hospitals give for justifying these profits?23:16 How do these hospital cost increases actually happen?27:06 Study by Zack Cooper, PhD.27:50 Who typically makes up a hospital board, and why do these motivations incentivize hospital price increases?30:12 EP418 with Mark Cuban and Ferrin Williams, PharmD, MBA.33:17 Why is it vital that change start at the board level?
Next Episode
EP468: Very Common Assumptions That Aren’t Actually True About Member Engagement and the Healthcare Industry, With Matt McQuide
In Episode 468, host Stacey Richter engages in a conversation with Matt McQuide, CEO of Synergy Healthcare. This episode delves into the critical assumptions surrounding member engagement within the healthcare industry.
Key points discussed include the role of employers in steering plan members, the importance of member engagement for navigating the healthcare marketplace, and Matt’s three major misconceptions about health plan membership.
Matt also presents real-life examples of how engagement significantly impacts health outcomes, emphasizing that relationships and trust are paramount. The episode concludes with practical strategies for employers to enhance engagement and manage employee health effectively.
=== LINKS ===
🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP468
✉️ 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/
You can learn more at Synergy Healthcare and by following Matt on LinkedIn.
Matt McQuide is the founder and CEO of Synergy Healthcare, a role he has held since launching the company in 2012. Under his leadership, Synergy has made significant strides in improving member health, enhancing the health insurance experience and the financial integrity of health plans.
06:28 What are Matt’s three common assumptions that employers make about member engagement?
07:08 “Health is actually hard.”
08:19 Why is it important to meet people when their need for healthcare sparks their interest in their health?
11:29 “It didn’t take much ... it just takes time.”
13:53 Why are relationships and trust more important today for employee health and member engagement?
16:04 Do people actually want optimal health?
17:44 Why is it important to meet people where they are today?
22:38 “Employers don’t want to fix healthcare.”
24:10 Why it’s important to remember that claims are real people.
24:38 Quote from Steve Schutzer, MD, about EP463 with Betsy Seals.
26:44 How do you solve the “middle way”?
Relentless Health Value - EP467: Connecting Sky-High ER Spend to Primary Care Access—Following the Dollar Through Carriers and Hospitals, With Stacey Richter
Transcript
Episode 467. This is a recurring theme show. "Connecting Sky High ER Spend to Primary Care Access, Following the Dollar Through Carriers and Hospitals".
American Healthcare Entrepreneurs and Executives You Want to Know, Talking.
Relentlessly Seeking Value. Here's my new idea for an episode. Welcome to it. I want to talk about a major theme running through the last few episodes of Relentless Health Value.
If you like this episode you’ll love
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